|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
OP
|
$1,546.41
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$618.56 |
| Max. Negotiated Rate |
$3,424.81 |
| Rate for Payer: Aetna Commercial |
$1,314.45
|
| Rate for Payer: Aetna Medicare |
$773.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,005.17
|
| Rate for Payer: BCBS Complete |
$618.56
|
| Rate for Payer: BCBS Trust/PPO |
$3,424.81
|
| Rate for Payer: BCN Commercial |
$3,424.81
|
| Rate for Payer: Cash Price |
$1,237.13
|
| Rate for Payer: Cash Price |
$1,237.13
|
| Rate for Payer: Cofinity Commercial |
$1,329.91
|
| Rate for Payer: Cofinity Commercial |
$1,082.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,082.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,237.13
|
| Rate for Payer: Healthscope Commercial |
$1,391.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,314.45
|
| Rate for Payer: PHP Commercial |
$1,314.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,225.66
|
| Rate for Payer: Priority Health Narrow Network |
$980.53
|
| Rate for Payer: Priority Health SBD |
$974.24
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
OP
|
$300.99
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$362.04 |
| Rate for Payer: Aetna Commercial |
$255.84
|
| Rate for Payer: Aetna Medicare |
$125.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.85
|
| Rate for Payer: BCBS Complete |
$67.92
|
| Rate for Payer: BCBS MAPPO |
$120.68
|
| Rate for Payer: BCBS Trust/PPO |
$342.68
|
| Rate for Payer: BCN Commercial |
$342.68
|
| Rate for Payer: BCN Medicare Advantage |
$120.68
|
| Rate for Payer: Cash Price |
$240.79
|
| Rate for Payer: Cash Price |
$240.79
|
| Rate for Payer: Cofinity Commercial |
$258.85
|
| Rate for Payer: Cofinity Commercial |
$210.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.68
|
| Rate for Payer: Healthscope Commercial |
$270.89
|
| Rate for Payer: Mclaren Medicaid |
$64.68
|
| Rate for Payer: Mclaren Medicare |
$120.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.71
|
| Rate for Payer: Meridian Medicaid |
$67.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.84
|
| Rate for Payer: Nomi Health Commercial |
$362.04
|
| Rate for Payer: PACE Medicare |
$114.65
|
| Rate for Payer: PACE SWMI |
$120.68
|
| Rate for Payer: PHP Commercial |
$255.84
|
| Rate for Payer: PHP Medicare Advantage |
$120.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$349.15
|
| Rate for Payer: Priority Health Medicare |
$120.68
|
| Rate for Payer: Priority Health Narrow Network |
$279.32
|
| Rate for Payer: Priority Health SBD |
$189.62
|
| Rate for Payer: Railroad Medicare Medicare |
$120.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.68
|
| Rate for Payer: UHC Medicare Advantage |
$120.68
|
| Rate for Payer: UHCCP Medicaid |
$67.94
|
| Rate for Payer: VA VA |
$120.68
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
IP
|
$300.99
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.62 |
| Max. Negotiated Rate |
$270.89 |
| Rate for Payer: Aetna Commercial |
$255.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.64
|
| Rate for Payer: Cash Price |
$240.79
|
| Rate for Payer: Cofinity Commercial |
$210.69
|
| Rate for Payer: Cofinity Commercial |
$258.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.79
|
| Rate for Payer: Healthscope Commercial |
$270.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.84
|
| Rate for Payer: PHP Commercial |
$255.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.64
|
| Rate for Payer: Priority Health SBD |
$189.62
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$92.19
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$78.36
|
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.92
|
| 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 |
$54.99
|
| Rate for Payer: BCN Commercial |
$54.99
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cofinity Commercial |
$64.53
|
| Rate for Payer: Cofinity Commercial |
$79.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$82.97
|
| 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 |
$78.36
|
| 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 |
$78.36
|
| 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 |
$59.92
|
| 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 |
$58.08
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.30
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$71.10
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$92.19
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.08 |
| Max. Negotiated Rate |
$82.97 |
| Rate for Payer: Aetna Commercial |
$78.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.92
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cofinity Commercial |
$64.53
|
| Rate for Payer: Cofinity Commercial |
$79.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.75
|
| Rate for Payer: Healthscope Commercial |
$82.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.36
|
| Rate for Payer: PHP Commercial |
$78.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.92
|
| Rate for Payer: Priority Health SBD |
$58.08
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
OP
|
$261.73
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$81.39 |
| Max. Negotiated Rate |
$235.56 |
| Rate for Payer: Aetna Commercial |
$222.47
|
| Rate for Payer: Aetna Medicare |
$130.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.12
|
| Rate for Payer: BCBS Complete |
$104.69
|
| Rate for Payer: BCBS Trust/PPO |
$117.99
|
| Rate for Payer: BCN Commercial |
$117.99
|
| Rate for Payer: Cash Price |
$209.38
|
| Rate for Payer: Cash Price |
$209.38
|
| Rate for Payer: Cash Price |
$209.38
|
| Rate for Payer: Cofinity Commercial |
$183.21
|
| Rate for Payer: Cofinity Commercial |
$225.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.38
|
| Rate for Payer: Healthscope Commercial |
$235.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.47
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$222.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.74
|
| Rate for Payer: Priority Health Narrow Network |
$81.39
|
| Rate for Payer: Priority Health SBD |
$164.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.77
|
| Rate for Payer: UHC Exchange |
$193.68
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
IP
|
$261.73
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$164.89 |
| Max. Negotiated Rate |
$235.56 |
| Rate for Payer: Aetna Commercial |
$222.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.12
|
| Rate for Payer: Cash Price |
$209.38
|
| Rate for Payer: Cofinity Commercial |
$183.21
|
| Rate for Payer: Cofinity Commercial |
$225.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.38
|
| Rate for Payer: Healthscope Commercial |
$235.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.47
|
| Rate for Payer: PHP Commercial |
$222.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.12
|
| Rate for Payer: Priority Health SBD |
$164.89
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
47100017
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$77.06 |
| Max. Negotiated Rate |
$481.80 |
| Rate for Payer: Aetna Commercial |
$372.30
|
| Rate for Payer: Aetna Medicare |
$159.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.70
|
| 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 |
$105.70
|
| Rate for Payer: BCN Commercial |
$105.70
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cofinity Commercial |
$376.68
|
| Rate for Payer: Cofinity Commercial |
$306.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$306.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$394.20
|
| 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 |
$372.30
|
| 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 |
$372.30
|
| 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 |
$284.70
|
| 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 |
$275.94
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$324.12
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$86.31
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
47100017
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$275.94 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Aetna Commercial |
$372.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.70
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cofinity Commercial |
$306.60
|
| Rate for Payer: Cofinity Commercial |
$376.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$306.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.40
|
| Rate for Payer: Healthscope Commercial |
$394.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.30
|
| Rate for Payer: PHP Commercial |
$372.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.70
|
| Rate for Payer: Priority Health SBD |
$275.94
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
47100018
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$18.22 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS Trust/PPO |
$24.99
|
| Rate for Payer: BCN Commercial |
$24.99
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health SBD |
$47.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.22
|
| Rate for Payer: UHC Exchange |
$55.50
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
47100018
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health SBD |
$47.25
|
|
|
HC EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Facility
|
OP
|
$39.78
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$33.81
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.86
|
| Rate for Payer: BCBS Complete |
$15.91
|
| Rate for Payer: Cash Price |
$31.82
|
| Rate for Payer: Cash Price |
$31.82
|
| Rate for Payer: Cofinity Commercial |
$34.21
|
| Rate for Payer: Cofinity Commercial |
$27.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$35.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.81
|
| Rate for Payer: PHP Commercial |
$33.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.86
|
| Rate for Payer: Priority Health SBD |
$25.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.26
|
| Rate for Payer: UHC Exchange |
$29.44
|
|
|
HC EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Facility
|
IP
|
$39.78
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$25.06 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$33.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.86
|
| Rate for Payer: Cash Price |
$31.82
|
| Rate for Payer: Cofinity Commercial |
$27.85
|
| Rate for Payer: Cofinity Commercial |
$34.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$35.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.81
|
| Rate for Payer: PHP Commercial |
$33.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.86
|
| Rate for Payer: Priority Health SBD |
$25.06
|
|
|
HC EVAL ORAL SPEECH ADDL 30 MIN
|
Facility
|
IP
|
$116.69
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
44400015
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$73.51 |
| Max. Negotiated Rate |
$105.02 |
| Rate for Payer: Aetna Commercial |
$99.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.85
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cofinity Commercial |
$100.35
|
| Rate for Payer: Cofinity Commercial |
$81.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.35
|
| Rate for Payer: Healthscope Commercial |
$105.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.19
|
| Rate for Payer: PHP Commercial |
$99.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.85
|
| Rate for Payer: Priority Health SBD |
$73.51
|
|
|
HC EVAL ORAL SPEECH ADDL 30 MIN
|
Facility
|
OP
|
$116.69
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
44400015
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$99.19
|
| Rate for Payer: Aetna Medicare |
$58.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.85
|
| Rate for Payer: BCBS Complete |
$46.68
|
| Rate for Payer: BCBS Trust/PPO |
$59.81
|
| Rate for Payer: BCN Commercial |
$59.81
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cofinity Commercial |
$100.35
|
| Rate for Payer: Cofinity Commercial |
$81.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.35
|
| Rate for Payer: Healthscope Commercial |
$105.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.19
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$99.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.00
|
| Rate for Payer: Priority Health Narrow Network |
$31.20
|
| Rate for Payer: Priority Health SBD |
$73.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.34
|
| Rate for Payer: UHC Exchange |
$86.35
|
|
|
HC EVAL ORAL SPEECH DEVICE
|
Facility
|
IP
|
$302.96
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
44400014
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$190.86 |
| Max. Negotiated Rate |
$272.66 |
| Rate for Payer: Aetna Commercial |
$257.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.92
|
| Rate for Payer: Cash Price |
$242.37
|
| Rate for Payer: Cofinity Commercial |
$212.07
|
| Rate for Payer: Cofinity Commercial |
$260.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.37
|
| Rate for Payer: Healthscope Commercial |
$272.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.52
|
| Rate for Payer: PHP Commercial |
$257.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.92
|
| Rate for Payer: Priority Health SBD |
$190.86
|
|
|
HC EVAL ORAL SPEECH DEVICE
|
Facility
|
OP
|
$302.96
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
44400014
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$121.18 |
| Max. Negotiated Rate |
$272.66 |
| Rate for Payer: Aetna Commercial |
$257.52
|
| Rate for Payer: Aetna Medicare |
$151.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.92
|
| Rate for Payer: BCBS Complete |
$121.18
|
| Rate for Payer: BCBS Trust/PPO |
$152.40
|
| Rate for Payer: BCN Commercial |
$152.40
|
| Rate for Payer: Cash Price |
$242.37
|
| Rate for Payer: Cash Price |
$242.37
|
| Rate for Payer: Cash Price |
$242.37
|
| Rate for Payer: Cofinity Commercial |
$212.07
|
| Rate for Payer: Cofinity Commercial |
$260.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.37
|
| Rate for Payer: Healthscope Commercial |
$272.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.52
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$257.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$203.00
|
| Rate for Payer: Priority Health Narrow Network |
$162.40
|
| Rate for Payer: Priority Health SBD |
$190.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.47
|
| Rate for Payer: UHC Exchange |
$224.19
|
|
|
HC EVENT MONITOR
|
Facility
|
IP
|
$510.24
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
48000003
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$321.45 |
| Max. Negotiated Rate |
$459.22 |
| Rate for Payer: Aetna Commercial |
$433.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.66
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cofinity Commercial |
$357.17
|
| Rate for Payer: Cofinity Commercial |
$438.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Healthscope Commercial |
$459.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: PHP Commercial |
$433.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: Priority Health SBD |
$321.45
|
|
|
HC EVENT MONITOR
|
Facility
|
OP
|
$510.24
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
48000003
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$8.29 |
| Max. Negotiated Rate |
$459.22 |
| Rate for Payer: Aetna Commercial |
$433.70
|
| Rate for Payer: Aetna Medicare |
$38.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.68
|
| Rate for Payer: BCBS Complete |
$20.56
|
| Rate for Payer: BCBS MAPPO |
$36.54
|
| Rate for Payer: BCBS Trust/PPO |
$35.43
|
| Rate for Payer: BCN Commercial |
$35.43
|
| Rate for Payer: BCN Medicare Advantage |
$36.54
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cofinity Commercial |
$438.81
|
| Rate for Payer: Cofinity Commercial |
$357.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.54
|
| Rate for Payer: Healthscope Commercial |
$459.22
|
| Rate for Payer: Mclaren Medicaid |
$19.59
|
| Rate for Payer: Mclaren Medicare |
$36.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.37
|
| Rate for Payer: Meridian Medicaid |
$20.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: Nomi Health Commercial |
$109.62
|
| Rate for Payer: PACE Medicare |
$34.71
|
| Rate for Payer: PACE SWMI |
$36.54
|
| Rate for Payer: PHP Commercial |
$433.70
|
| Rate for Payer: PHP Medicare Advantage |
$36.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.83
|
| Rate for Payer: Priority Health Medicare |
$36.54
|
| Rate for Payer: Priority Health Narrow Network |
$91.86
|
| Rate for Payer: Priority Health SBD |
$321.45
|
| Rate for Payer: Railroad Medicare Medicare |
$36.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.54
|
| Rate for Payer: UHC Exchange |
$377.58
|
| Rate for Payer: UHC Medicare Advantage |
$36.54
|
| Rate for Payer: UHCCP Medicaid |
$20.57
|
| Rate for Payer: VA VA |
$36.54
|
|
|
HC EVEROLIMUS
|
Facility
|
OP
|
$69.71
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
30100626
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$62.74 |
| Rate for Payer: Aetna Commercial |
$59.25
|
| Rate for Payer: Aetna Medicare |
$14.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.16
|
| Rate for Payer: BCBS Complete |
$7.73
|
| Rate for Payer: BCBS MAPPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$12.16
|
| Rate for Payer: BCN Commercial |
$12.16
|
| Rate for Payer: BCN Medicare Advantage |
$13.73
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cofinity Commercial |
$59.95
|
| Rate for Payer: Cofinity Commercial |
$48.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.73
|
| Rate for Payer: Healthscope Commercial |
$62.74
|
| Rate for Payer: Mclaren Medicaid |
$7.36
|
| Rate for Payer: Mclaren Medicare |
$13.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.42
|
| Rate for Payer: Meridian Medicaid |
$7.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.25
|
| Rate for Payer: Nomi Health Commercial |
$20.60
|
| Rate for Payer: PACE Medicare |
$13.04
|
| Rate for Payer: PACE SWMI |
$13.73
|
| Rate for Payer: PHP Commercial |
$59.25
|
| Rate for Payer: PHP Medicare Advantage |
$13.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.13
|
| Rate for Payer: Priority Health Medicare |
$13.73
|
| Rate for Payer: Priority Health Narrow Network |
$11.30
|
| Rate for Payer: Priority Health SBD |
$43.92
|
| Rate for Payer: Railroad Medicare Medicare |
$13.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.73
|
| Rate for Payer: UHC Medicare Advantage |
$13.73
|
| Rate for Payer: UHCCP Medicaid |
$7.73
|
| Rate for Payer: VA VA |
$13.73
|
|
|
HC EVEROLIMUS
|
Facility
|
IP
|
$69.71
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
30100626
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$62.74 |
| Rate for Payer: Aetna Commercial |
$59.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.31
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cofinity Commercial |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$59.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.77
|
| Rate for Payer: Healthscope Commercial |
$62.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.25
|
| Rate for Payer: PHP Commercial |
$59.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.31
|
| Rate for Payer: Priority Health SBD |
$43.92
|
|
|
HC EVOKED AUDITORY TEST COMPLETE
|
Facility
|
OP
|
$286.62
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
76100506
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$22.15 |
| Max. Negotiated Rate |
$958.92 |
| Rate for Payer: Aetna Commercial |
$243.63
|
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.30
|
| 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 |
$22.15
|
| Rate for Payer: BCN Commercial |
$22.15
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cofinity Commercial |
$200.63
|
| Rate for Payer: Cofinity Commercial |
$246.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$257.96
|
| 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 |
$243.63
|
| 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 |
$243.63
|
| 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 |
$186.30
|
| 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 |
$180.57
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$212.10
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$171.77
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC EVOKED AUDITORY TEST COMPLETE
|
Facility
|
IP
|
$286.62
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
76100506
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$180.57 |
| Max. Negotiated Rate |
$257.96 |
| Rate for Payer: Aetna Commercial |
$243.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.30
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cofinity Commercial |
$200.63
|
| Rate for Payer: Cofinity Commercial |
$246.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.30
|
| Rate for Payer: Healthscope Commercial |
$257.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.63
|
| Rate for Payer: PHP Commercial |
$243.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.30
|
| Rate for Payer: Priority Health SBD |
$180.57
|
|
|
HC EVOKED AUDITORY TEST LIMITED
|
Facility
|
OP
|
$286.62
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
76100507
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$958.92 |
| Rate for Payer: Aetna Commercial |
$243.63
|
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.30
|
| 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 |
$16.25
|
| Rate for Payer: BCN Commercial |
$16.25
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cofinity Commercial |
$246.49
|
| Rate for Payer: Cofinity Commercial |
$200.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$257.96
|
| 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 |
$243.63
|
| 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 |
$243.63
|
| 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 |
$186.30
|
| 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 |
$180.57
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$212.10
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$171.77
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC EVOKED AUDITORY TEST LIMITED
|
Facility
|
IP
|
$286.62
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
76100507
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$180.57 |
| Max. Negotiated Rate |
$257.96 |
| Rate for Payer: Aetna Commercial |
$243.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.30
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cofinity Commercial |
$200.63
|
| Rate for Payer: Cofinity Commercial |
$246.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.30
|
| Rate for Payer: Healthscope Commercial |
$257.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.63
|
| Rate for Payer: PHP Commercial |
$243.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.30
|
| Rate for Payer: Priority Health SBD |
$180.57
|
|
