|
HC SPEECH FLUENCY EVAL
|
Facility
|
OP
|
$354.68
|
|
|
Service Code
|
CPT 92521
|
| Hospital Charge Code |
44400012
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$86.82 |
| Max. Negotiated Rate |
$319.21 |
| Rate for Payer: Aetna Commercial |
$301.48
|
| Rate for Payer: Aetna Medicare |
$177.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.54
|
| Rate for Payer: BCBS Complete |
$141.87
|
| Rate for Payer: BCBS Trust/PPO |
$183.58
|
| Rate for Payer: BCN Commercial |
$183.58
|
| Rate for Payer: Cash Price |
$283.74
|
| Rate for Payer: Cash Price |
$283.74
|
| Rate for Payer: Cash Price |
$283.74
|
| Rate for Payer: Cofinity Advantage |
$248.28
|
| Rate for Payer: Cofinity Commercial |
$305.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.74
|
| Rate for Payer: Healthscope Commercial |
$319.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$283.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.48
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.01
|
| Rate for Payer: PHP Commercial |
$301.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$108.53
|
| Rate for Payer: Priority Health SBD |
$223.45
|
| Rate for Payer: Priority Health Tiered Network |
$86.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.54
|
| Rate for Payer: UHC Core |
$184.79
|
| Rate for Payer: UHC Exchange |
$139.39
|
|
|
HC SPEECH FLUENCY EVAL
|
Facility
|
IP
|
$354.68
|
|
|
Service Code
|
CPT 92521
|
| Hospital Charge Code |
44400012
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$223.45 |
| Max. Negotiated Rate |
$319.21 |
| Rate for Payer: Aetna Commercial |
$301.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.54
|
| Rate for Payer: Cash Price |
$283.74
|
| Rate for Payer: Cofinity Advantage |
$248.28
|
| Rate for Payer: Cofinity Commercial |
$305.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.74
|
| Rate for Payer: Healthscope Commercial |
$319.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.01
|
| Rate for Payer: PHP Commercial |
$301.48
|
| Rate for Payer: Priority Health SBD |
$223.45
|
|
|
HC SPEECH/LANGUAGE/HEARING THERAPY
|
Facility
|
OP
|
$223.98
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
44000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$201.58 |
| Rate for Payer: Aetna Commercial |
$190.38
|
| Rate for Payer: Aetna Medicare |
$111.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.59
|
| Rate for Payer: BCBS Complete |
$89.59
|
| Rate for Payer: BCBS Trust/PPO |
$105.42
|
| Rate for Payer: BCN Commercial |
$105.42
|
| Rate for Payer: Cash Price |
$179.18
|
| Rate for Payer: Cash Price |
$179.18
|
| Rate for Payer: Cash Price |
$179.18
|
| Rate for Payer: Cofinity Advantage |
$156.79
|
| Rate for Payer: Cofinity Commercial |
$192.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.18
|
| Rate for Payer: Healthscope Commercial |
$201.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.38
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.99
|
| Rate for Payer: PHP Commercial |
$190.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$83.00
|
| Rate for Payer: Priority Health SBD |
$141.11
|
| Rate for Payer: Priority Health Tiered Network |
$66.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.59
|
| Rate for Payer: UHC Core |
$116.69
|
| Rate for Payer: UHC Exchange |
$88.02
|
|
|
HC SPEECH/LANGUAGE/HEARING THERAPY
|
Facility
|
IP
|
$223.98
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
44000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$141.11 |
| Max. Negotiated Rate |
$201.58 |
| Rate for Payer: Aetna Commercial |
$190.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.59
|
| Rate for Payer: Cash Price |
$179.18
|
| Rate for Payer: Cofinity Advantage |
$156.79
|
| Rate for Payer: Cofinity Commercial |
$192.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.18
|
| Rate for Payer: Healthscope Commercial |
$201.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.99
|
| Rate for Payer: PHP Commercial |
$190.38
|
| Rate for Payer: Priority Health SBD |
$141.11
|
|
|
HC SPEECH SOUND PRODUCTION EVAL
|
Facility
|
OP
|
$311.47
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
44400010
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$264.75
|
| Rate for Payer: Aetna Medicare |
$155.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.46
|
| Rate for Payer: BCBS Complete |
$124.59
|
| Rate for Payer: BCBS Trust/PPO |
$152.68
|
| Rate for Payer: BCN Commercial |
$152.68
|
| Rate for Payer: Cash Price |
$249.18
|
| Rate for Payer: Cash Price |
$249.18
|
| Rate for Payer: Cash Price |
$249.18
|
| Rate for Payer: Cofinity Advantage |
$218.03
|
| Rate for Payer: Cofinity Commercial |
$267.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.18
|
| Rate for Payer: Healthscope Commercial |
$280.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.75
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.60
|
| Rate for Payer: PHP Commercial |
$264.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$88.12
|
| Rate for Payer: Priority Health SBD |
$196.23
|
| Rate for Payer: Priority Health Tiered Network |
$70.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.46
|
| Rate for Payer: UHC Core |
$162.28
|
| Rate for Payer: UHC Exchange |
$122.41
|
|
|
HC SPEECH SOUND PRODUCTION EVAL
|
Facility
|
IP
|
$311.47
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
44400010
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$196.23 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$264.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.46
|
| Rate for Payer: Cash Price |
$249.18
|
| Rate for Payer: Cofinity Advantage |
$218.03
|
| Rate for Payer: Cofinity Commercial |
$267.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.18
|
| Rate for Payer: Healthscope Commercial |
$280.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.60
|
| Rate for Payer: PHP Commercial |
$264.75
|
| Rate for Payer: Priority Health SBD |
$196.23
|
|
|
HC SPEECH THRESHOLD AUDIOMETRY
|
Facility
|
IP
|
$51.12
|
|
|
Service Code
|
CPT 92555
|
| Hospital Charge Code |
47100011
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$32.21 |
| Max. Negotiated Rate |
$46.01 |
| Rate for Payer: Aetna Commercial |
$43.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.23
|
| Rate for Payer: Cash Price |
$40.90
|
| Rate for Payer: Cofinity Advantage |
$35.78
|
| Rate for Payer: Cofinity Commercial |
$43.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.90
|
| Rate for Payer: Healthscope Commercial |
$46.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.34
|
| Rate for Payer: PHP Commercial |
$43.45
|
| Rate for Payer: Priority Health SBD |
$32.21
|
|
|
HC SPEECH THRESHOLD AUDIOMETRY
|
Facility
|
OP
|
$51.12
|
|
|
Service Code
|
CPT 92555
|
| Hospital Charge Code |
47100011
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$43.45
|
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$133.23
|
| Rate for Payer: BCN Commercial |
$133.23
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$40.90
|
| Rate for Payer: Cash Price |
$40.90
|
| Rate for Payer: Cofinity Advantage |
$35.78
|
| Rate for Payer: Cofinity Commercial |
$43.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$46.01
|
| Rate for Payer: Mclaren Medicaid |
$30.74
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.45
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.34
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$43.45
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health SBD |
$32.21
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.23
|
| Rate for Payer: UHC Core |
$26.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$20.09
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC SPEECH VIDEO FLUORO EVAL
|
Facility
|
OP
|
$404.95
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
44000004
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$364.45 |
| Rate for Payer: Aetna Commercial |
$344.21
|
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.22
|
| Rate for Payer: BCBS Complete |
$161.98
|
| Rate for Payer: BCBS Trust/PPO |
$124.97
|
| Rate for Payer: BCN Commercial |
$124.97
|
| Rate for Payer: Cash Price |
$323.96
|
| Rate for Payer: Cash Price |
$323.96
|
| Rate for Payer: Cash Price |
$323.96
|
| Rate for Payer: Cofinity Advantage |
$283.46
|
| Rate for Payer: Cofinity Commercial |
$348.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.96
|
| Rate for Payer: Healthscope Commercial |
$364.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.21
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.71
|
| Rate for Payer: PHP Commercial |
$344.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$115.00
|
| Rate for Payer: Priority Health SBD |
$255.12
|
| Rate for Payer: Priority Health Tiered Network |
$92.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.22
|
| Rate for Payer: UHC Core |
$210.98
|
| Rate for Payer: UHC Exchange |
$159.15
|
|
|
HC SPEECH VIDEO FLUORO EVAL
|
Facility
|
IP
|
$404.95
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
44000004
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$255.12 |
| Max. Negotiated Rate |
$364.45 |
| Rate for Payer: Aetna Commercial |
$344.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.22
|
| Rate for Payer: Cash Price |
$323.96
|
| Rate for Payer: Cofinity Advantage |
$283.46
|
| Rate for Payer: Cofinity Commercial |
$348.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.96
|
| Rate for Payer: Healthscope Commercial |
$364.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.71
|
| Rate for Payer: PHP Commercial |
$344.21
|
| Rate for Payer: Priority Health SBD |
$255.12
|
|
|
HC SPEECH VOICE EVALUATION
|
Facility
|
OP
|
$318.60
|
|
|
Service Code
|
CPT 92524
|
| Hospital Charge Code |
44400011
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$73.49 |
| Max. Negotiated Rate |
$286.74 |
| Rate for Payer: Aetna Commercial |
$270.81
|
| Rate for Payer: Aetna Medicare |
$159.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.09
|
| Rate for Payer: BCBS Complete |
$127.44
|
| Rate for Payer: BCBS Trust/PPO |
$149.96
|
| Rate for Payer: BCN Commercial |
$149.96
|
| Rate for Payer: Cash Price |
$254.88
|
| Rate for Payer: Cash Price |
$254.88
|
| Rate for Payer: Cash Price |
$254.88
|
| Rate for Payer: Cofinity Advantage |
$223.02
|
| Rate for Payer: Cofinity Commercial |
$274.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.88
|
| Rate for Payer: Healthscope Commercial |
$286.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.81
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.95
|
| Rate for Payer: PHP Commercial |
$270.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$91.86
|
| Rate for Payer: Priority Health SBD |
$200.72
|
| Rate for Payer: Priority Health Tiered Network |
$73.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.09
|
| Rate for Payer: UHC Core |
$165.99
|
| Rate for Payer: UHC Exchange |
$125.21
|
|
|
HC SPEECH VOICE EVALUATION
|
Facility
|
IP
|
$318.60
|
|
|
Service Code
|
CPT 92524
|
| Hospital Charge Code |
44400011
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$200.72 |
| Max. Negotiated Rate |
$286.74 |
| Rate for Payer: Aetna Commercial |
$270.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.09
|
| Rate for Payer: Cash Price |
$254.88
|
| Rate for Payer: Cofinity Advantage |
$223.02
|
| Rate for Payer: Cofinity Commercial |
$274.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.88
|
| Rate for Payer: Healthscope Commercial |
$286.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.95
|
| Rate for Payer: PHP Commercial |
$270.81
|
| Rate for Payer: Priority Health SBD |
$200.72
|
|
|
HC SPIKE BLOOD ACCESS
|
Facility
|
OP
|
$16.39
|
|
| Hospital Charge Code |
27000669
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$14.75 |
| Rate for Payer: Aetna Commercial |
$13.93
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.65
|
| Rate for Payer: BCBS Complete |
$6.56
|
| Rate for Payer: Cash Price |
$13.11
|
| Rate for Payer: Cofinity Advantage |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$14.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.11
|
| Rate for Payer: Healthscope Commercial |
$14.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.29
|
| Rate for Payer: PHP Commercial |
$13.93
|
| Rate for Payer: Priority Health SBD |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.65
|
| Rate for Payer: UHC Core |
$8.54
|
| Rate for Payer: UHC Exchange |
$6.44
|
|
|
HC SPIKE BLOOD ACCESS
|
Facility
|
IP
|
$16.39
|
|
| Hospital Charge Code |
27000669
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$14.75 |
| Rate for Payer: Aetna Commercial |
$13.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.65
|
| Rate for Payer: Cash Price |
$13.11
|
| Rate for Payer: Cofinity Advantage |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$14.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.11
|
| Rate for Payer: Healthscope Commercial |
$14.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.29
|
| Rate for Payer: PHP Commercial |
$13.93
|
| Rate for Payer: Priority Health SBD |
$10.33
|
|
|
HC SPINAL/EPI ADDL 15 MIN
|
Facility
|
IP
|
$162.90
|
|
| Hospital Charge Code |
37000013
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$102.63 |
| Max. Negotiated Rate |
$146.61 |
| Rate for Payer: Aetna Commercial |
$138.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.89
|
| Rate for Payer: Cash Price |
$130.32
|
| Rate for Payer: Cofinity Advantage |
$114.03
|
| Rate for Payer: Cofinity Commercial |
$140.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.32
|
| Rate for Payer: Healthscope Commercial |
$146.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.17
|
| Rate for Payer: PHP Commercial |
$138.47
|
| Rate for Payer: Priority Health SBD |
$102.63
|
|
|
HC SPINAL/EPI ADDL 15 MIN
|
Facility
|
OP
|
$162.90
|
|
| Hospital Charge Code |
37000013
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$64.02 |
| Max. Negotiated Rate |
$146.61 |
| Rate for Payer: Aetna Commercial |
$138.47
|
| Rate for Payer: Aetna Medicare |
$81.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.89
|
| Rate for Payer: BCBS Complete |
$65.16
|
| Rate for Payer: Cash Price |
$130.32
|
| Rate for Payer: Cofinity Advantage |
$114.03
|
| Rate for Payer: Cofinity Commercial |
$140.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.32
|
| Rate for Payer: Healthscope Commercial |
$146.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.17
|
| Rate for Payer: PHP Commercial |
$138.47
|
| Rate for Payer: Priority Health SBD |
$102.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.89
|
| Rate for Payer: UHC Core |
$84.87
|
| Rate for Payer: UHC Exchange |
$64.02
|
|
|
HC SPINAL/EPI INIT 30 MIN
|
Facility
|
IP
|
$445.46
|
|
| Hospital Charge Code |
37000014
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$280.64 |
| Max. Negotiated Rate |
$400.91 |
| Rate for Payer: Aetna Commercial |
$378.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.55
|
| Rate for Payer: Cash Price |
$356.37
|
| Rate for Payer: Cofinity Advantage |
$311.82
|
| Rate for Payer: Cofinity Commercial |
$383.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.37
|
| Rate for Payer: Healthscope Commercial |
$400.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.10
|
| Rate for Payer: PHP Commercial |
$378.64
|
| Rate for Payer: Priority Health SBD |
$280.64
|
|
|
HC SPINAL/EPI INIT 30 MIN
|
Facility
|
OP
|
$445.46
|
|
| Hospital Charge Code |
37000014
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$175.07 |
| Max. Negotiated Rate |
$400.91 |
| Rate for Payer: Aetna Commercial |
$378.64
|
| Rate for Payer: Aetna Medicare |
$222.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.55
|
| Rate for Payer: BCBS Complete |
$178.18
|
| Rate for Payer: Cash Price |
$356.37
|
| Rate for Payer: Cofinity Advantage |
$311.82
|
| Rate for Payer: Cofinity Commercial |
$383.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.37
|
| Rate for Payer: Healthscope Commercial |
$400.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$356.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.10
|
| Rate for Payer: PHP Commercial |
$378.64
|
| Rate for Payer: Priority Health SBD |
$280.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.55
|
| Rate for Payer: UHC Core |
$232.08
|
| Rate for Payer: UHC Exchange |
$175.07
|
|
|
HC SPINE JACK
|
Facility
|
OP
|
$14,401.38
|
|
|
Service Code
|
CPT C1062
|
| Hospital Charge Code |
27800148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,659.74 |
| Max. Negotiated Rate |
$12,961.24 |
| Rate for Payer: Aetna Commercial |
$12,241.17
|
| Rate for Payer: Aetna Medicare |
$7,200.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,360.90
|
| Rate for Payer: BCBS Complete |
$5,760.55
|
| Rate for Payer: Cash Price |
$11,521.10
|
| Rate for Payer: Cofinity Advantage |
$10,080.97
|
| Rate for Payer: Cofinity Commercial |
$12,385.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,521.10
|
| Rate for Payer: Healthscope Commercial |
$12,961.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,521.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,241.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,801.03
|
| Rate for Payer: PHP Commercial |
$12,241.17
|
| Rate for Payer: Priority Health SBD |
$9,072.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,360.90
|
| Rate for Payer: UHC Core |
$7,503.12
|
| Rate for Payer: UHC Exchange |
$5,659.74
|
|
|
HC SPINE JACK
|
Facility
|
IP
|
$14,401.38
|
|
|
Service Code
|
CPT C1062
|
| Hospital Charge Code |
27800148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,072.87 |
| Max. Negotiated Rate |
$12,961.24 |
| Rate for Payer: Aetna Commercial |
$12,241.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,360.90
|
| Rate for Payer: Cash Price |
$11,521.10
|
| Rate for Payer: Cofinity Advantage |
$10,080.97
|
| Rate for Payer: Cofinity Commercial |
$12,385.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,521.10
|
| Rate for Payer: Healthscope Commercial |
$12,961.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,241.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,801.03
|
| Rate for Payer: PHP Commercial |
$12,241.17
|
| Rate for Payer: Priority Health SBD |
$9,072.87
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 1 VIEW
|
Facility
|
OP
|
$153.55
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
32000317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$280.42 |
| Rate for Payer: Aetna Commercial |
$130.52
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$69.66
|
| Rate for Payer: BCN Commercial |
$69.66
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$122.84
|
| Rate for Payer: Cash Price |
$122.84
|
| Rate for Payer: Cofinity Advantage |
$107.48
|
| Rate for Payer: Cofinity Commercial |
$132.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$138.19
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.52
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.16
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$130.52
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$96.74
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.81
|
| Rate for Payer: UHC Core |
$80.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$60.35
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 1 VIEW
|
Facility
|
IP
|
$153.55
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
32000317
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.74 |
| Max. Negotiated Rate |
$138.19 |
| Rate for Payer: Aetna Commercial |
$130.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.81
|
| Rate for Payer: Cash Price |
$122.84
|
| Rate for Payer: Cofinity Advantage |
$107.48
|
| Rate for Payer: Cofinity Commercial |
$132.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.84
|
| Rate for Payer: Healthscope Commercial |
$138.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.16
|
| Rate for Payer: PHP Commercial |
$130.52
|
| Rate for Payer: Priority Health SBD |
$96.74
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 2 OR 3 VIEW
|
Facility
|
OP
|
$368.55
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
32000306
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$336.87 |
| Rate for Payer: Aetna Commercial |
$313.27
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$125.68
|
| Rate for Payer: BCN Commercial |
$125.68
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$294.84
|
| Rate for Payer: Cash Price |
$294.84
|
| Rate for Payer: Cofinity Advantage |
$257.99
|
| Rate for Payer: Cofinity Commercial |
$316.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$331.69
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.27
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.41
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$313.27
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$232.19
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.56
|
| Rate for Payer: UHC Core |
$192.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$144.84
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 2 OR 3 VIEW
|
Facility
|
IP
|
$368.55
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
32000306
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$232.19 |
| Max. Negotiated Rate |
$331.69 |
| Rate for Payer: Aetna Commercial |
$313.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.56
|
| Rate for Payer: Cash Price |
$294.84
|
| Rate for Payer: Cofinity Advantage |
$257.99
|
| Rate for Payer: Cofinity Commercial |
$316.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.84
|
| Rate for Payer: Healthscope Commercial |
$331.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.41
|
| Rate for Payer: PHP Commercial |
$313.27
|
| Rate for Payer: Priority Health SBD |
$232.19
|
|
|
HC SPINE THORACIC AND LUMBAR INC SKULL CERVICAL AND SACRAL 4 OR 5 VIEW
|
Facility
|
IP
|
$491.40
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
32000307
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$309.58 |
| Max. Negotiated Rate |
$442.26 |
| Rate for Payer: Aetna Commercial |
$417.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.41
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cofinity Advantage |
$343.98
|
| Rate for Payer: Cofinity Commercial |
$422.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.12
|
| Rate for Payer: Healthscope Commercial |
$442.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.55
|
| Rate for Payer: PHP Commercial |
$417.69
|
| Rate for Payer: Priority Health SBD |
$309.58
|
|
