|
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 |
$54.65 |
| 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: BCBS Trust/PPO |
$54.65
|
| Rate for Payer: BCN Commercial |
$54.65
|
| Rate for Payer: Cash Price |
$47.98
|
| Rate for Payer: Cash Price |
$47.98
|
| Rate for Payer: Cofinity Commercial |
$51.57
|
| Rate for Payer: Cofinity Commercial |
$41.98
|
| 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 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
|
OP
|
$55.11
|
|
|
Service Code
|
CPT 92547
|
| Hospital Charge Code |
47100004
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$49.60 |
| Rate for Payer: Aetna Commercial |
$46.84
|
| Rate for Payer: Aetna Medicare |
$27.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.82
|
| Rate for Payer: BCBS Complete |
$22.04
|
| Rate for Payer: BCBS Trust/PPO |
$47.24
|
| Rate for Payer: BCN Commercial |
$47.24
|
| Rate for Payer: Cash Price |
$44.09
|
| 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 All Payor (Choice/PPO) |
$10.50
|
| Rate for Payer: UHC Exchange |
$40.78
|
|
|
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 VESTIBULAR EVAL BASIC
|
Facility
|
OP
|
$463.45
|
|
|
Service Code
|
CPT 92540
|
| Hospital Charge Code |
47100005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$481.80 |
| Rate for Payer: Aetna Commercial |
$393.93
|
| Rate for Payer: Aetna Medicare |
$159.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$137.32
|
| Rate for Payer: BCN Commercial |
$137.32
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cofinity Commercial |
$398.57
|
| Rate for Payer: Cofinity Commercial |
$324.42
|
| 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 |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$417.10
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.93
|
| Rate for Payer: Nomi Health Commercial |
$459.90
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$393.93
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.80
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$385.44
|
| Rate for Payer: Priority Health SBD |
$291.97
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$342.95
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$86.31
|
| Rate for Payer: VA VA |
$153.30
|
|
|
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 |
$417.10 |
| 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 |
$398.57
|
| Rate for Payer: Cofinity Commercial |
$324.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.76
|
| Rate for Payer: Healthscope Commercial |
$417.10
|
| 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 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 AUTOLOGOUS UNIT
|
Facility
|
OP
|
$825.28
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
39000040
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$75.79 |
| Max. Negotiated Rate |
$742.75 |
| Rate for Payer: Aetna Commercial |
$701.49
|
| Rate for Payer: Aetna Medicare |
$147.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$176.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$176.75
|
| Rate for Payer: BCBS Complete |
$79.58
|
| Rate for Payer: BCBS MAPPO |
$141.40
|
| Rate for Payer: BCBS Trust/PPO |
$378.47
|
| Rate for Payer: BCN Commercial |
$378.47
|
| Rate for Payer: BCN Medicare Advantage |
$141.40
|
| 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 |
$141.40
|
| Rate for Payer: Healthscope Commercial |
$742.75
|
| Rate for Payer: Mclaren Medicaid |
$75.79
|
| Rate for Payer: Mclaren Medicare |
$141.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.47
|
| Rate for Payer: Meridian Medicaid |
$79.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.49
|
| Rate for Payer: Nomi Health Commercial |
$424.20
|
| Rate for Payer: PACE Medicare |
$134.33
|
| Rate for Payer: PACE SWMI |
$141.40
|
| Rate for Payer: PHP Commercial |
$701.49
|
| Rate for Payer: PHP Medicare Advantage |
$141.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$444.42
|
| Rate for Payer: Priority Health Medicare |
$141.40
|
| Rate for Payer: Priority Health Narrow Network |
$355.54
|
| Rate for Payer: Priority Health SBD |
$519.93
|
| Rate for Payer: Railroad Medicare Medicare |
$141.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$398.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.40
|
| Rate for Payer: UHC Exchange |
$610.71
|
| Rate for Payer: UHC Medicare Advantage |
$141.40
|
| Rate for Payer: UHCCP Medicaid |
$79.61
|
| Rate for Payer: VA VA |
$141.40
|
|
|
HC AUTONOMIC FUNC ADRENERGIC
|
Facility
|
OP
|
$181.53
|
|
|
Service Code
|
CPT 95922
|
| Hospital Charge Code |
92000007
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$396.95 |
| Rate for Payer: Aetna Commercial |
$154.30
|
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$220.03
|
| Rate for Payer: BCN Commercial |
$220.03
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| 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 |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$163.38
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.30
|
| Rate for Payer: Nomi Health Commercial |
$378.87
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$154.30
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Priority Health SBD |
$114.36
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$134.33
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$71.10
|
| Rate for Payer: VA VA |
$126.29
|
|
|
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 CARDIO INNERVAT
|
Facility
|
OP
|
$363.05
|
|
|
Service Code
|
CPT 95921
|
| Hospital Charge Code |
92000006
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$481.80 |
| Rate for Payer: Aetna Commercial |
$308.59
|
| Rate for Payer: Aetna Medicare |
$159.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$196.40
|
| Rate for Payer: BCN Commercial |
$196.40
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| 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 |
$254.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$326.74
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.59
|
| Rate for Payer: Nomi Health Commercial |
$459.90
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$308.59
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.80
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$385.44
|
| Rate for Payer: Priority Health SBD |
$228.72
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$268.66
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$86.31
|
| Rate for Payer: VA VA |
$153.30
|
|
|
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 |
$326.74 |
| 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 |
$254.14
|
| Rate for Payer: Cofinity Commercial |
$312.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.44
|
| Rate for Payer: Healthscope Commercial |
$326.74
|
| 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
|
IP
|
$363.05
|
|
|
Service Code
|
CPT 95923
|
| Hospital Charge Code |
92000008
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$228.72 |
| Max. Negotiated Rate |
$326.74 |
| 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 |
$254.14
|
| Rate for Payer: Cofinity Commercial |
$312.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.44
|
| Rate for Payer: Healthscope Commercial |
$326.74
|
| 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 |
$67.69 |
| Max. Negotiated Rate |
$396.95 |
| Rate for Payer: Aetna Commercial |
$308.59
|
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$347.01
|
| Rate for Payer: BCN Commercial |
$347.01
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| 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 |
$254.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$326.74
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.59
|
| Rate for Payer: Nomi Health Commercial |
$378.87
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$308.59
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Priority Health SBD |
$228.72
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$268.66
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$71.10
|
| Rate for Payer: VA VA |
$126.29
|
|
|
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
|
|
|
HC AUTONOMIC W/O QSART
|
Facility
|
OP
|
$518.64
|
|
|
Service Code
|
CPT 95924
|
| Hospital Charge Code |
92000012
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$155.23 |
| Max. Negotiated Rate |
$958.92 |
| Rate for Payer: Aetna Commercial |
$440.84
|
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$292.36
|
| Rate for Payer: BCN Commercial |
$292.36
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| 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 |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$466.78
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.84
|
| Rate for Payer: Nomi Health Commercial |
$915.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$440.84
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.92
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$767.14
|
| Rate for Payer: Priority Health SBD |
$326.74
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$383.79
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$171.77
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC AVULSION OF NAIL PLATE
|
Facility
|
OP
|
$319.94
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
76100045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.72 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$271.95
|
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$99.66
|
| Rate for Payer: BCN Commercial |
$99.66
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$255.95
|
| Rate for Payer: Cash Price |
$255.95
|
| Rate for Payer: Cash Price |
$255.95
|
| Rate for Payer: Cofinity Commercial |
$223.96
|
| Rate for Payer: Cofinity Commercial |
$275.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$223.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$287.95
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.95
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$271.95
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Priority Health SBD |
$201.56
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.72
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$109.60
|
| Rate for Payer: VA VA |
$194.68
|
|
|
HC AVULSION OF NAIL PLATE
|
Facility
|
IP
|
$319.94
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
76100045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.56 |
| Max. Negotiated Rate |
$287.95 |
| Rate for Payer: Aetna Commercial |
$271.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.96
|
| Rate for Payer: Cash Price |
$255.95
|
| Rate for Payer: Cofinity Commercial |
$223.96
|
| Rate for Payer: Cofinity Commercial |
$275.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$223.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.95
|
| Rate for Payer: Healthscope Commercial |
$287.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.95
|
| Rate for Payer: PHP Commercial |
$271.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.96
|
| Rate for Payer: Priority Health SBD |
$201.56
|
|
|
HC BACITRACIN 1 OZ
|
Facility
|
IP
|
$8.13
|
|
| Hospital Charge Code |
27100006
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Aetna Commercial |
$6.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.28
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cofinity Commercial |
$5.69
|
| Rate for Payer: Cofinity Commercial |
$6.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$7.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.91
|
| Rate for Payer: PHP Commercial |
$6.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.28
|
| Rate for Payer: Priority Health SBD |
$5.12
|
|
|
HC BACITRACIN 1 OZ
|
Facility
|
OP
|
$8.13
|
|
| Hospital Charge Code |
27100006
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Aetna Commercial |
$6.91
|
| Rate for Payer: Aetna Medicare |
$4.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.28
|
| Rate for Payer: BCBS Complete |
$3.25
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cofinity Commercial |
$5.69
|
| Rate for Payer: Cofinity Commercial |
$6.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$7.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.91
|
| Rate for Payer: PHP Commercial |
$6.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.28
|
| Rate for Payer: Priority Health SBD |
$5.12
|
|
|
HC BACITRACIN 4 OZ
|
Facility
|
IP
|
$30.98
|
|
| Hospital Charge Code |
27100007
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$27.88 |
| Rate for Payer: Aetna Commercial |
$26.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.14
|
| Rate for Payer: Cash Price |
$24.78
|
| Rate for Payer: Cofinity Commercial |
$21.69
|
| Rate for Payer: Cofinity Commercial |
$26.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.78
|
| Rate for Payer: Healthscope Commercial |
$27.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.33
|
| Rate for Payer: PHP Commercial |
$26.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.14
|
| Rate for Payer: Priority Health SBD |
$19.52
|
|
|
HC BACITRACIN 4 OZ
|
Facility
|
OP
|
$30.98
|
|
| Hospital Charge Code |
27100007
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$27.88 |
| Rate for Payer: Aetna Commercial |
$26.33
|
| Rate for Payer: Aetna Medicare |
$15.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.14
|
| Rate for Payer: BCBS Complete |
$12.39
|
| Rate for Payer: Cash Price |
$24.78
|
| Rate for Payer: Cofinity Commercial |
$21.69
|
| Rate for Payer: Cofinity Commercial |
$26.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.78
|
| Rate for Payer: Healthscope Commercial |
$27.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.33
|
| Rate for Payer: PHP Commercial |
$26.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.14
|
| Rate for Payer: Priority Health SBD |
$19.52
|
|
|
HC BACK SCREEN
|
Facility
|
OP
|
$52.02
|
|
| Hospital Charge Code |
42000047
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: UHC Core |
$38.49
|
| Rate for Payer: UHC Exchange |
$38.49
|
|
|
HC BACK SCREEN
|
Facility
|
IP
|
$52.02
|
|
| Hospital Charge Code |
42000047
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC BACK SCREEN, VBISD
|
Facility
|
OP
|
$68.34
|
|
| Hospital Charge Code |
43000014
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$27.34 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$58.09
|
| Rate for Payer: Aetna Medicare |
$34.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.42
|
| Rate for Payer: BCBS Complete |
$27.34
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$58.77
|
| Rate for Payer: Cofinity Commercial |
$47.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Healthscope Commercial |
$61.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.09
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$58.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.42
|
| Rate for Payer: Priority Health SBD |
$43.05
|
| Rate for Payer: UHC Core |
$50.57
|
| Rate for Payer: UHC Exchange |
$50.57
|
|
