|
HC SPEC PHYSICS CONSULT
|
Facility
|
OP
|
$545.70
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
33300017
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$491.13 |
| Rate for Payer: Aetna Commercial |
$463.84
|
| Rate for Payer: Aetna Commercial |
$702.10
|
| Rate for Payer: Aetna Medicare |
$125.56
|
| Rate for Payer: Aetna Medicare |
$125.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.91
|
| Rate for Payer: BCBS Complete |
$69.35
|
| Rate for Payer: BCBS Complete |
$69.35
|
| Rate for Payer: BCBS MAPPO |
$120.73
|
| Rate for Payer: BCBS MAPPO |
$120.73
|
| Rate for Payer: BCBS Trust/PPO |
$228.91
|
| Rate for Payer: BCBS Trust/PPO |
$228.91
|
| Rate for Payer: BCN Medicare Advantage |
$120.73
|
| Rate for Payer: BCN Medicare Advantage |
$120.73
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cash Price |
$436.56
|
| Rate for Payer: Cash Price |
$436.56
|
| Rate for Payer: Cofinity Commercial |
$381.99
|
| Rate for Payer: Cofinity Commercial |
$578.20
|
| Rate for Payer: Cofinity Commercial |
$469.30
|
| Rate for Payer: Cofinity Commercial |
$710.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.73
|
| Rate for Payer: Healthscope Commercial |
$491.13
|
| Rate for Payer: Healthscope Commercial |
$743.40
|
| Rate for Payer: Mclaren Medicaid |
$66.04
|
| Rate for Payer: Mclaren Medicaid |
$66.04
|
| Rate for Payer: Mclaren Medicare |
$120.73
|
| Rate for Payer: Mclaren Medicare |
$120.73
|
| Rate for Payer: Meridian Medicaid |
$69.35
|
| Rate for Payer: Meridian Medicaid |
$69.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$702.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$463.84
|
| Rate for Payer: PACE Medicare |
$114.69
|
| Rate for Payer: PACE Medicare |
$114.69
|
| Rate for Payer: PACE SWMI |
$120.73
|
| Rate for Payer: PACE SWMI |
$120.73
|
| Rate for Payer: PHP Commercial |
$463.84
|
| Rate for Payer: PHP Commercial |
$702.10
|
| Rate for Payer: PHP Medicare Advantage |
$120.73
|
| Rate for Payer: PHP Medicare Advantage |
$120.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.99
|
| Rate for Payer: Priority Health Medicare |
$120.73
|
| Rate for Payer: Priority Health Medicare |
$120.73
|
| Rate for Payer: Priority Health SBD |
$343.79
|
| Rate for Payer: Priority Health SBD |
$520.38
|
| Rate for Payer: Railroad Medicare Medicare |
$120.73
|
| Rate for Payer: Railroad Medicare Medicare |
$120.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.73
|
| Rate for Payer: UHC Exchange |
$142.11
|
| Rate for Payer: UHC Exchange |
$142.11
|
| Rate for Payer: UHC Medicare Advantage |
$124.35
|
| Rate for Payer: UHC Medicare Advantage |
$124.35
|
| Rate for Payer: VA VA |
$120.73
|
| Rate for Payer: VA VA |
$120.73
|
|
|
HC SPECTRAL DOPPLER
|
Facility
|
OP
|
$483.91
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
48000006
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$49.77 |
| Max. Negotiated Rate |
$435.52 |
| Rate for Payer: Aetna Commercial |
$411.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.54
|
| Rate for Payer: BCBS Complete |
$193.56
|
| Rate for Payer: BCBS Trust/PPO |
$151.97
|
| Rate for Payer: Cash Price |
$387.13
|
| Rate for Payer: Cash Price |
$387.13
|
| Rate for Payer: Cofinity Commercial |
$416.16
|
| Rate for Payer: Cofinity Commercial |
$338.74
|
| Rate for Payer: Healthscope Commercial |
$435.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$411.32
|
| Rate for Payer: PHP Commercial |
$411.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.74
|
| Rate for Payer: Priority Health SBD |
$304.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.75
|
| Rate for Payer: UHC Exchange |
$49.77
|
|
|
HC SPECTRAL DOPPLER
|
Facility
|
IP
|
$483.91
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
48000006
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$304.86 |
| Max. Negotiated Rate |
$435.52 |
| Rate for Payer: Aetna Commercial |
$411.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.54
|
| Rate for Payer: Cash Price |
$387.13
|
| Rate for Payer: Cofinity Commercial |
$416.16
|
| Rate for Payer: Cofinity Commercial |
$338.74
|
| Rate for Payer: Healthscope Commercial |
$435.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$411.32
|
| Rate for Payer: PHP Commercial |
$411.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.74
|
| Rate for Payer: Priority Health SBD |
$304.86
|
|
|
HC SPEC TX PROCEDURE
|
Facility
|
OP
|
$1,556.52
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
33300026
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$1,400.87 |
| Rate for Payer: Aetna Commercial |
$1,323.04
|
| Rate for Payer: Aetna Commercial |
$1,987.30
|
| Rate for Payer: Aetna Medicare |
$544.74
|
| Rate for Payer: Aetna Medicare |
$544.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,011.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,519.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.74
|
| Rate for Payer: BCBS Complete |
$300.86
|
| Rate for Payer: BCBS Complete |
$300.86
|
| Rate for Payer: BCBS MAPPO |
$523.79
|
| Rate for Payer: BCBS MAPPO |
$523.79
|
| Rate for Payer: BCBS Trust/PPO |
$53.51
|
| Rate for Payer: BCBS Trust/PPO |
$53.51
|
| Rate for Payer: BCN Medicare Advantage |
$523.79
|
| Rate for Payer: BCN Medicare Advantage |
$523.79
|
| Rate for Payer: Cash Price |
$1,870.40
|
| Rate for Payer: Cash Price |
$1,245.22
|
| Rate for Payer: Cash Price |
$1,245.22
|
| Rate for Payer: Cash Price |
$1,870.40
|
| Rate for Payer: Cofinity Commercial |
$1,338.61
|
| Rate for Payer: Cofinity Commercial |
$2,010.68
|
| Rate for Payer: Cofinity Commercial |
$1,636.60
|
| Rate for Payer: Cofinity Commercial |
$1,089.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.79
|
| Rate for Payer: Healthscope Commercial |
$2,104.20
|
| Rate for Payer: Healthscope Commercial |
$1,400.87
|
| Rate for Payer: Mclaren Medicaid |
$286.51
|
| Rate for Payer: Mclaren Medicaid |
$286.51
|
| Rate for Payer: Mclaren Medicare |
$523.79
|
| Rate for Payer: Mclaren Medicare |
$523.79
|
| Rate for Payer: Meridian Medicaid |
$300.86
|
| Rate for Payer: Meridian Medicaid |
$300.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$602.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$602.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,323.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,987.30
|
| Rate for Payer: PACE Medicare |
$497.60
|
| Rate for Payer: PACE Medicare |
$497.60
|
| Rate for Payer: PACE SWMI |
$523.79
|
| Rate for Payer: PACE SWMI |
$523.79
|
| Rate for Payer: PHP Commercial |
$1,987.30
|
| Rate for Payer: PHP Commercial |
$1,323.04
|
| Rate for Payer: PHP Medicare Advantage |
$523.79
|
| Rate for Payer: PHP Medicare Advantage |
$523.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,089.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,636.60
|
| Rate for Payer: Priority Health Medicare |
$523.79
|
| Rate for Payer: Priority Health Medicare |
$523.79
|
| Rate for Payer: Priority Health SBD |
$980.61
|
| Rate for Payer: Priority Health SBD |
$1,472.94
|
| Rate for Payer: Railroad Medicare Medicare |
$523.79
|
| Rate for Payer: Railroad Medicare Medicare |
$523.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$523.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$523.79
|
| Rate for Payer: UHC Exchange |
$139.49
|
| Rate for Payer: UHC Exchange |
$139.49
|
| Rate for Payer: UHC Medicare Advantage |
$539.50
|
| Rate for Payer: UHC Medicare Advantage |
$539.50
|
| Rate for Payer: VA VA |
$523.79
|
| Rate for Payer: VA VA |
$523.79
|
|
|
HC SPEC TX PROCEDURE
|
Facility
|
IP
|
$1,556.52
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
33300026
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$980.61 |
| Max. Negotiated Rate |
$1,400.87 |
| Rate for Payer: Aetna Commercial |
$1,323.04
|
| Rate for Payer: Aetna Commercial |
$1,987.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,011.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,519.70
|
| Rate for Payer: Cash Price |
$1,245.22
|
| Rate for Payer: Cash Price |
$1,870.40
|
| Rate for Payer: Cofinity Commercial |
$1,636.60
|
| Rate for Payer: Cofinity Commercial |
$1,089.56
|
| Rate for Payer: Cofinity Commercial |
$1,338.61
|
| Rate for Payer: Cofinity Commercial |
$2,010.68
|
| Rate for Payer: Healthscope Commercial |
$1,400.87
|
| Rate for Payer: Healthscope Commercial |
$2,104.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,987.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,323.04
|
| Rate for Payer: PHP Commercial |
$1,987.30
|
| Rate for Payer: PHP Commercial |
$1,323.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,089.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,636.60
|
| Rate for Payer: Priority Health SBD |
$980.61
|
| Rate for Payer: Priority Health SBD |
$1,472.94
|
|
|
HC SPEECH AUDIOMETRY COMPLETE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 92556
|
| Hospital Charge Code |
76100502
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$193.43 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.04
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCBS Trust/PPO |
$193.43
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$45.50
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Mclaren Medicaid |
$29.77
|
| Rate for Payer: Mclaren Medicare |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$31.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.33
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health Narrow Network |
$138.66
|
| Rate for Payer: Priority Health SBD |
$40.95
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$44.20
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
|
HC SPEECH AUDIOMETRY COMPLETE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 92556
|
| Hospital Charge Code |
76100502
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$45.50
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health SBD |
$40.95
|
|
|
HC SPEECH EVAL
|
Facility
|
OP
|
$575.48
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
44400009
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$223.97 |
| Max. Negotiated Rate |
$517.93 |
| Rate for Payer: Aetna Commercial |
$489.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.06
|
| Rate for Payer: BCBS Complete |
$230.19
|
| Rate for Payer: BCBS Trust/PPO |
$227.11
|
| Rate for Payer: Cash Price |
$460.38
|
| Rate for Payer: Cash Price |
$460.38
|
| Rate for Payer: Cofinity Commercial |
$494.91
|
| Rate for Payer: Cofinity Commercial |
$402.84
|
| Rate for Payer: Healthscope Commercial |
$517.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$489.16
|
| Rate for Payer: PHP Commercial |
$489.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$402.84
|
| Rate for Payer: Priority Health SBD |
$362.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.37
|
| Rate for Payer: UHC Exchange |
$223.97
|
|
|
HC SPEECH EVAL
|
Facility
|
IP
|
$575.48
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
44400009
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$362.55 |
| Max. Negotiated Rate |
$517.93 |
| Rate for Payer: Aetna Commercial |
$489.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.06
|
| Rate for Payer: Cash Price |
$460.38
|
| Rate for Payer: Cofinity Commercial |
$402.84
|
| Rate for Payer: Cofinity Commercial |
$494.91
|
| Rate for Payer: Healthscope Commercial |
$517.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$489.16
|
| Rate for Payer: PHP Commercial |
$489.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$402.84
|
| Rate for Payer: Priority Health SBD |
$362.55
|
|
|
HC SPEECH FLUENCY EVAL
|
Facility
|
IP
|
$289.77
|
|
|
Service Code
|
CPT 92521
|
| Hospital Charge Code |
44400012
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$182.56 |
| Max. Negotiated Rate |
$260.79 |
| Rate for Payer: Aetna Commercial |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.35
|
| Rate for Payer: Cash Price |
$231.82
|
| Rate for Payer: Cofinity Commercial |
$202.84
|
| Rate for Payer: Cofinity Commercial |
$249.20
|
| Rate for Payer: Healthscope Commercial |
$260.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.30
|
| Rate for Payer: PHP Commercial |
$246.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.84
|
| Rate for Payer: Priority Health SBD |
$182.56
|
|
|
HC SPEECH FLUENCY EVAL
|
Facility
|
OP
|
$289.77
|
|
|
Service Code
|
CPT 92521
|
| Hospital Charge Code |
44400012
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$115.91 |
| Max. Negotiated Rate |
$260.79 |
| Rate for Payer: Aetna Commercial |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.35
|
| Rate for Payer: BCBS Complete |
$115.91
|
| Rate for Payer: BCBS Trust/PPO |
$132.45
|
| Rate for Payer: Cash Price |
$231.82
|
| Rate for Payer: Cash Price |
$231.82
|
| Rate for Payer: Cofinity Commercial |
$249.20
|
| Rate for Payer: Cofinity Commercial |
$202.84
|
| Rate for Payer: Healthscope Commercial |
$260.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.30
|
| Rate for Payer: PHP Commercial |
$246.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.84
|
| Rate for Payer: Priority Health SBD |
$182.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.72
|
| Rate for Payer: UHC Exchange |
$130.65
|
|
|
HC SPEECH/LANGUAGE/HEARING THERAPY
|
Facility
|
IP
|
$212.16
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
44000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$133.66 |
| Max. Negotiated Rate |
$190.94 |
| Rate for Payer: Aetna Commercial |
$180.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.90
|
| Rate for Payer: Cash Price |
$169.73
|
| Rate for Payer: Cofinity Commercial |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$182.46
|
| Rate for Payer: Healthscope Commercial |
$190.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.34
|
| Rate for Payer: PHP Commercial |
$180.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.51
|
| Rate for Payer: Priority Health SBD |
$133.66
|
|
|
HC SPEECH/LANGUAGE/HEARING THERAPY
|
Facility
|
OP
|
$212.16
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
44000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$190.94 |
| Rate for Payer: Aetna Commercial |
$180.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.90
|
| Rate for Payer: BCBS Complete |
$84.86
|
| Rate for Payer: BCBS Trust/PPO |
$76.26
|
| Rate for Payer: Cash Price |
$169.73
|
| Rate for Payer: Cash Price |
$169.73
|
| Rate for Payer: Cofinity Commercial |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$182.46
|
| Rate for Payer: Healthscope Commercial |
$190.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.34
|
| Rate for Payer: PHP Commercial |
$180.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.51
|
| Rate for Payer: Priority Health SBD |
$133.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.48
|
| Rate for Payer: UHC Exchange |
$74.98
|
|
|
HC SPEECH SOUND PRODUCTION EVAL
|
Facility
|
IP
|
$254.47
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
44400010
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$160.32 |
| Max. Negotiated Rate |
$229.02 |
| Rate for Payer: Aetna Commercial |
$216.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.41
|
| Rate for Payer: Cash Price |
$203.58
|
| Rate for Payer: Cofinity Commercial |
$178.13
|
| Rate for Payer: Cofinity Commercial |
$218.84
|
| Rate for Payer: Healthscope Commercial |
$229.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.30
|
| Rate for Payer: PHP Commercial |
$216.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.13
|
| Rate for Payer: Priority Health SBD |
$160.32
|
|
|
HC SPEECH SOUND PRODUCTION EVAL
|
Facility
|
OP
|
$254.47
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
44400010
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$229.02 |
| Rate for Payer: Aetna Commercial |
$216.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.41
|
| Rate for Payer: BCBS Complete |
$101.79
|
| Rate for Payer: BCBS Trust/PPO |
$110.71
|
| Rate for Payer: Cash Price |
$203.58
|
| Rate for Payer: Cash Price |
$203.58
|
| Rate for Payer: Cofinity Commercial |
$178.13
|
| Rate for Payer: Cofinity Commercial |
$218.84
|
| Rate for Payer: Healthscope Commercial |
$229.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.30
|
| Rate for Payer: PHP Commercial |
$216.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.13
|
| Rate for Payer: Priority Health SBD |
$160.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.31
|
| Rate for Payer: UHC Exchange |
$109.37
|
|
|
HC SPEECH THRESHOLD AUDIOMETRY
|
Facility
|
IP
|
$49.14
|
|
|
Service Code
|
CPT 92555
|
| Hospital Charge Code |
47100011
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$30.96 |
| Max. Negotiated Rate |
$44.23 |
| Rate for Payer: Aetna Commercial |
$41.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.94
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$42.26
|
| Rate for Payer: Healthscope Commercial |
$44.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.77
|
| Rate for Payer: PHP Commercial |
$41.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.40
|
| Rate for Payer: Priority Health SBD |
$30.96
|
|
|
HC SPEECH THRESHOLD AUDIOMETRY
|
Facility
|
OP
|
$49.14
|
|
|
Service Code
|
CPT 92555
|
| Hospital Charge Code |
47100011
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$124.33 |
| Rate for Payer: Aetna Commercial |
$41.77
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.04
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCBS Trust/PPO |
$124.33
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$42.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Healthscope Commercial |
$44.23
|
| Rate for Payer: Mclaren Medicaid |
$29.77
|
| Rate for Payer: Mclaren Medicare |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$31.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.77
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Commercial |
$41.77
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.83
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health Narrow Network |
$81.46
|
| Rate for Payer: Priority Health SBD |
$30.96
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$28.49
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
|
HC SPEECH VIDEO FLUORO EVAL
|
Facility
|
IP
|
$389.23
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
44000004
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$245.21 |
| Max. Negotiated Rate |
$350.31 |
| Rate for Payer: Aetna Commercial |
$330.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.00
|
| Rate for Payer: Cash Price |
$311.38
|
| Rate for Payer: Cofinity Commercial |
$272.46
|
| Rate for Payer: Cofinity Commercial |
$334.74
|
| Rate for Payer: Healthscope Commercial |
$350.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.85
|
| Rate for Payer: PHP Commercial |
$330.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.46
|
| Rate for Payer: Priority Health SBD |
$245.21
|
|
|
HC SPEECH VIDEO FLUORO EVAL
|
Facility
|
OP
|
$389.23
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
44000004
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$90.37 |
| Max. Negotiated Rate |
$350.31 |
| Rate for Payer: Aetna Commercial |
$330.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.00
|
| Rate for Payer: BCBS Complete |
$155.69
|
| Rate for Payer: BCBS Trust/PPO |
$150.59
|
| Rate for Payer: Cash Price |
$311.38
|
| Rate for Payer: Cash Price |
$311.38
|
| Rate for Payer: Cofinity Commercial |
$334.74
|
| Rate for Payer: Cofinity Commercial |
$272.46
|
| Rate for Payer: Healthscope Commercial |
$350.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.85
|
| Rate for Payer: PHP Commercial |
$330.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.46
|
| Rate for Payer: Priority Health SBD |
$245.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.41
|
| Rate for Payer: UHC Exchange |
$90.37
|
|
|
HC SPEECH VOICE EVALUATION
|
Facility
|
OP
|
$280.23
|
|
|
Service Code
|
CPT 92524
|
| Hospital Charge Code |
44400011
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$107.73 |
| Max. Negotiated Rate |
$252.21 |
| Rate for Payer: Aetna Commercial |
$238.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.15
|
| Rate for Payer: BCBS Complete |
$112.09
|
| Rate for Payer: BCBS Trust/PPO |
$109.37
|
| Rate for Payer: Cash Price |
$224.18
|
| Rate for Payer: Cash Price |
$224.18
|
| Rate for Payer: Cofinity Commercial |
$196.16
|
| Rate for Payer: Cofinity Commercial |
$241.00
|
| Rate for Payer: Healthscope Commercial |
$252.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.20
|
| Rate for Payer: PHP Commercial |
$238.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.16
|
| Rate for Payer: Priority Health SBD |
$176.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.50
|
| Rate for Payer: UHC Exchange |
$107.73
|
|
|
HC SPEECH VOICE EVALUATION
|
Facility
|
IP
|
$280.23
|
|
|
Service Code
|
CPT 92524
|
| Hospital Charge Code |
44400011
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$176.54 |
| Max. Negotiated Rate |
$252.21 |
| Rate for Payer: Aetna Commercial |
$238.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.15
|
| Rate for Payer: Cash Price |
$224.18
|
| Rate for Payer: Cofinity Commercial |
$196.16
|
| Rate for Payer: Cofinity Commercial |
$241.00
|
| Rate for Payer: Healthscope Commercial |
$252.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.20
|
| Rate for Payer: PHP Commercial |
$238.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.16
|
| Rate for Payer: Priority Health SBD |
$176.54
|
|
|
HC SPIKE BLOOD ACCESS
|
Facility
|
OP
|
$15.75
|
|
| Hospital Charge Code |
27000669
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$14.18 |
| Rate for Payer: Aetna Commercial |
$13.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.24
|
| Rate for Payer: BCBS Complete |
$6.30
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cofinity Commercial |
$11.02
|
| Rate for Payer: Cofinity Commercial |
$13.54
|
| Rate for Payer: Healthscope Commercial |
$14.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.39
|
| Rate for Payer: PHP Commercial |
$13.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.02
|
| Rate for Payer: Priority Health SBD |
$9.92
|
|
|
HC SPIKE BLOOD ACCESS
|
Facility
|
IP
|
$15.75
|
|
| Hospital Charge Code |
27000669
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$14.18 |
| Rate for Payer: Aetna Commercial |
$13.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.24
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cofinity Commercial |
$11.02
|
| Rate for Payer: Cofinity Commercial |
$13.54
|
| Rate for Payer: Healthscope Commercial |
$14.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.39
|
| Rate for Payer: PHP Commercial |
$13.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.02
|
| Rate for Payer: Priority Health SBD |
$9.92
|
|
|
HC SPINAL/EPI ADDL 15 MIN
|
Facility
|
IP
|
$156.58
|
|
| Hospital Charge Code |
37000013
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$98.65 |
| Max. Negotiated Rate |
$140.92 |
| Rate for Payer: Aetna Commercial |
$133.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.78
|
| Rate for Payer: Cash Price |
$125.26
|
| Rate for Payer: Cofinity Commercial |
$109.61
|
| Rate for Payer: Cofinity Commercial |
$134.66
|
| Rate for Payer: Healthscope Commercial |
$140.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.09
|
| Rate for Payer: PHP Commercial |
$133.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.61
|
| Rate for Payer: Priority Health SBD |
$98.65
|
|
|
HC SPINAL/EPI ADDL 15 MIN
|
Facility
|
OP
|
$156.58
|
|
| Hospital Charge Code |
37000013
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$62.63 |
| Max. Negotiated Rate |
$140.92 |
| Rate for Payer: Aetna Commercial |
$133.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.78
|
| Rate for Payer: BCBS Complete |
$62.63
|
| Rate for Payer: Cash Price |
$125.26
|
| Rate for Payer: Cofinity Commercial |
$109.61
|
| Rate for Payer: Cofinity Commercial |
$134.66
|
| Rate for Payer: Healthscope Commercial |
$140.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.09
|
| Rate for Payer: PHP Commercial |
$133.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.61
|
| Rate for Payer: Priority Health SBD |
$98.65
|
|
