|
HC ATS NON OPEN HEART
|
Facility
|
IP
|
$2,250.45
|
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,462.79 |
| Max. Negotiated Rate |
$2,250.45 |
| Rate for Payer: Aetna Commercial |
$2,025.40
|
| Rate for Payer: ASR ASR |
$2,182.94
|
| Rate for Payer: ASR Commercial |
$2,182.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,833.89
|
| Rate for Payer: BCN Commercial |
$1,744.77
|
| Rate for Payer: Cash Price |
$1,800.36
|
| Rate for Payer: Cofinity Commercial |
$2,115.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,800.36
|
| Rate for Payer: Healthscope Commercial |
$2,250.45
|
| Rate for Payer: Healthscope Whirlpool |
$2,182.94
|
| Rate for Payer: Mclaren Commercial |
$2,025.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,912.88
|
| Rate for Payer: Nomi Health Commercial |
$1,845.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,462.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,980.40
|
|
|
HC ATS STAND BY HR
|
Facility
|
OP
|
$1,537.13
|
|
| Hospital Charge Code |
27000089
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$614.85 |
| Max. Negotiated Rate |
$1,537.13 |
| Rate for Payer: Aetna Commercial |
$1,383.42
|
| Rate for Payer: Aetna Medicare |
$768.57
|
| Rate for Payer: ASR ASR |
$1,491.02
|
| Rate for Payer: ASR Commercial |
$1,491.02
|
| Rate for Payer: BCBS Complete |
$614.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,258.76
|
| Rate for Payer: BCN Commercial |
$1,191.74
|
| Rate for Payer: Cash Price |
$1,229.70
|
| Rate for Payer: Cofinity Commercial |
$1,444.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.70
|
| Rate for Payer: Healthscope Commercial |
$1,537.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,491.02
|
| Rate for Payer: Mclaren Commercial |
$1,383.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,306.56
|
| Rate for Payer: Nomi Health Commercial |
$1,260.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$999.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,346.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,077.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,352.67
|
|
|
HC ATS STAND BY HR
|
Facility
|
IP
|
$1,537.13
|
|
| Hospital Charge Code |
27000089
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$999.13 |
| Max. Negotiated Rate |
$1,537.13 |
| Rate for Payer: Aetna Commercial |
$1,383.42
|
| Rate for Payer: ASR ASR |
$1,491.02
|
| Rate for Payer: ASR Commercial |
$1,491.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,252.61
|
| Rate for Payer: BCN Commercial |
$1,191.74
|
| Rate for Payer: Cash Price |
$1,229.70
|
| Rate for Payer: Cofinity Commercial |
$1,444.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.70
|
| Rate for Payer: Healthscope Commercial |
$1,537.13
|
| Rate for Payer: Healthscope Whirlpool |
$1,491.02
|
| Rate for Payer: Mclaren Commercial |
$1,383.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,306.56
|
| Rate for Payer: Nomi Health Commercial |
$1,260.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$999.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,352.67
|
|
|
HC ATYPICAL PNEUMO EVAL C PNEUM
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200240
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: ASR ASR |
$15.14
|
| Rate for Payer: ASR Commercial |
$15.14
|
| Rate for Payer: BCBS Trust/PPO |
$12.72
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$15.61
|
| Rate for Payer: Healthscope Whirlpool |
$15.14
|
| Rate for Payer: Mclaren Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
|
|
HC ATYPICAL PNEUMO EVAL C PNEUM
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200240
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$18.32 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: Aetna Medicare |
$11.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.78
|
| Rate for Payer: ASR ASR |
$15.14
|
| Rate for Payer: ASR Commercial |
$15.14
|
| Rate for Payer: BCBS Complete |
$6.65
|
| Rate for Payer: BCBS MAPPO |
$11.82
|
| Rate for Payer: BCBS Trust/PPO |
$12.78
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: BCN Medicare Advantage |
$11.82
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.82
|
| Rate for Payer: Healthscope Commercial |
$15.61
|
| Rate for Payer: Healthscope Whirlpool |
$15.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.82
|
| Rate for Payer: Mclaren Commercial |
$14.05
|
| Rate for Payer: Mclaren Medicaid |
$6.34
|
| Rate for Payer: Mclaren Medicare |
$11.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.41
|
| Rate for Payer: Meridian Medicaid |
$6.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: PACE Medicare |
$11.23
|
| Rate for Payer: PACE SWMI |
$11.82
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: PHP Medicaid |
$6.34
|
| Rate for Payer: PHP Medicare Advantage |
$11.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.68
|
| Rate for Payer: Priority Health Medicare |
$11.82
|
| Rate for Payer: Priority Health Narrow Network |
$10.94
|
| Rate for Payer: Railroad Medicare Medicare |
$11.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.82
|
| Rate for Payer: UHC Exchange |
$18.32
|
| Rate for Payer: UHC Medicare Advantage |
$11.82
|
| Rate for Payer: UHCCP DNSP |
$11.82
|
| Rate for Payer: UHCCP Medicaid |
$6.34
|
| Rate for Payer: VA VA |
$11.82
|
|
|
HC ATYPICAL PNEUMO EVAL C PNEUM IGM
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
30200243
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: ASR ASR |
$15.14
|
| Rate for Payer: ASR Commercial |
$15.14
|
| Rate for Payer: BCBS Trust/PPO |
$12.72
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$15.61
|
| Rate for Payer: Healthscope Whirlpool |
$15.14
|
| Rate for Payer: Mclaren Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
|
|
HC ATYPICAL PNEUMO EVAL C PNEUM IGM
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
30200243
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: Aetna Medicare |
$12.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.85
|
| Rate for Payer: ASR ASR |
$15.14
|
| Rate for Payer: ASR Commercial |
$15.14
|
| Rate for Payer: BCBS Complete |
$7.14
|
| Rate for Payer: BCBS MAPPO |
$12.68
|
| Rate for Payer: BCBS Trust/PPO |
$12.78
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: BCN Medicare Advantage |
$12.68
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.68
|
| Rate for Payer: Healthscope Commercial |
$15.61
|
| Rate for Payer: Healthscope Whirlpool |
$15.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.68
|
| Rate for Payer: Mclaren Commercial |
$14.05
|
| Rate for Payer: Mclaren Medicaid |
$6.80
|
| Rate for Payer: Mclaren Medicare |
$12.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.31
|
| Rate for Payer: Meridian Medicaid |
$7.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: PACE Medicare |
$12.05
|
| Rate for Payer: PACE SWMI |
$12.68
|
| Rate for Payer: PHP Commercial |
$13.95
|
| Rate for Payer: PHP Medicaid |
$6.80
|
| Rate for Payer: PHP Medicare Advantage |
$12.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.68
|
| Rate for Payer: Priority Health Medicare |
$12.68
|
| Rate for Payer: Priority Health Narrow Network |
$10.94
|
| Rate for Payer: Railroad Medicare Medicare |
$12.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.68
|
| Rate for Payer: UHC Exchange |
$19.65
|
| Rate for Payer: UHC Medicare Advantage |
$12.68
|
| Rate for Payer: UHCCP DNSP |
$12.68
|
| Rate for Payer: UHCCP Medicaid |
$6.80
|
| Rate for Payer: VA VA |
$12.68
|
|
|
HC ATYPICAL PNEUMO EVAL L PNEUM
|
Facility
|
OP
|
$21.85
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
30200302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$23.71 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Medicare |
$15.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: ASR ASR |
$21.19
|
| Rate for Payer: ASR Commercial |
$21.19
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$17.89
|
| Rate for Payer: BCN Commercial |
$16.94
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$20.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$21.85
|
| Rate for Payer: Healthscope Whirlpool |
$21.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.30
|
| Rate for Payer: Mclaren Commercial |
$19.66
|
| Rate for Payer: Mclaren Medicaid |
$8.20
|
| Rate for Payer: Mclaren Medicare |
$15.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.07
|
| Rate for Payer: Meridian Medicaid |
$8.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: Nomi Health Commercial |
$17.92
|
| Rate for Payer: PACE Medicare |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$16.83
|
| Rate for Payer: PHP Medicaid |
$8.20
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.14
|
| Rate for Payer: Priority Health Medicare |
$15.30
|
| Rate for Payer: Priority Health Narrow Network |
$15.32
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.30
|
| Rate for Payer: UHC Exchange |
$23.71
|
| Rate for Payer: UHC Medicare Advantage |
$15.30
|
| Rate for Payer: UHCCP DNSP |
$15.30
|
| Rate for Payer: UHCCP Medicaid |
$8.20
|
| Rate for Payer: VA VA |
$15.30
|
|
|
HC ATYPICAL PNEUMO EVAL L PNEUM
|
Facility
|
IP
|
$21.85
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
30200302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: ASR ASR |
$21.19
|
| Rate for Payer: ASR Commercial |
$21.19
|
| Rate for Payer: BCBS Trust/PPO |
$17.81
|
| Rate for Payer: BCN Commercial |
$16.94
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$20.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$21.85
|
| Rate for Payer: Healthscope Whirlpool |
$21.19
|
| Rate for Payer: Mclaren Commercial |
$19.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: Nomi Health Commercial |
$17.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.23
|
|
|
HC ATYPICAL PNEUMO EVAL M PNEUM
|
Facility
|
OP
|
$14.57
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$20.52 |
| Rate for Payer: Aetna Commercial |
$13.11
|
| Rate for Payer: Aetna Medicare |
$13.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.55
|
| Rate for Payer: ASR ASR |
$14.13
|
| Rate for Payer: ASR Commercial |
$14.13
|
| Rate for Payer: BCBS Complete |
$7.45
|
| Rate for Payer: BCBS MAPPO |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$11.93
|
| Rate for Payer: BCN Commercial |
$11.30
|
| Rate for Payer: BCN Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$13.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.24
|
| Rate for Payer: Healthscope Commercial |
$14.57
|
| Rate for Payer: Healthscope Whirlpool |
$14.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.24
|
| Rate for Payer: Mclaren Commercial |
$13.11
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| Rate for Payer: Mclaren Medicare |
$13.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.90
|
| Rate for Payer: Meridian Medicaid |
$7.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: PACE Medicare |
$12.58
|
| Rate for Payer: PACE SWMI |
$13.24
|
| Rate for Payer: PHP Commercial |
$14.56
|
| Rate for Payer: PHP Medicaid |
$7.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.77
|
| Rate for Payer: Priority Health Medicare |
$13.24
|
| Rate for Payer: Priority Health Narrow Network |
$10.21
|
| Rate for Payer: Railroad Medicare Medicare |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.24
|
| Rate for Payer: UHC Exchange |
$20.52
|
| Rate for Payer: UHC Medicare Advantage |
$13.24
|
| Rate for Payer: UHCCP DNSP |
$13.24
|
| Rate for Payer: UHCCP Medicaid |
$7.10
|
| Rate for Payer: VA VA |
$13.24
|
|
|
HC ATYPICAL PNEUMO EVAL M PNEUM
|
Facility
|
IP
|
$14.57
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$14.57 |
| Rate for Payer: Aetna Commercial |
$13.11
|
| Rate for Payer: ASR ASR |
$14.13
|
| Rate for Payer: ASR Commercial |
$14.13
|
| Rate for Payer: BCBS Trust/PPO |
$11.87
|
| Rate for Payer: BCN Commercial |
$11.30
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$13.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$14.57
|
| Rate for Payer: Healthscope Whirlpool |
$14.13
|
| Rate for Payer: Mclaren Commercial |
$13.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.82
|
|
|
HC ATYPICAL PNEUMO EVALUATION
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200241
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: ASR ASR |
$15.14
|
| Rate for Payer: ASR Commercial |
$15.14
|
| Rate for Payer: BCBS Trust/PPO |
$12.72
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$15.61
|
| Rate for Payer: Healthscope Whirlpool |
$15.14
|
| Rate for Payer: Mclaren Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
|
|
HC ATYPICAL PNEUMO EVALUATION
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200241
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$18.32 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: Aetna Medicare |
$11.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.78
|
| Rate for Payer: ASR ASR |
$15.14
|
| Rate for Payer: ASR Commercial |
$15.14
|
| Rate for Payer: BCBS Complete |
$6.65
|
| Rate for Payer: BCBS MAPPO |
$11.82
|
| Rate for Payer: BCBS Trust/PPO |
$12.78
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: BCN Medicare Advantage |
$11.82
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.82
|
| Rate for Payer: Healthscope Commercial |
$15.61
|
| Rate for Payer: Healthscope Whirlpool |
$15.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.82
|
| Rate for Payer: Mclaren Commercial |
$14.05
|
| Rate for Payer: Mclaren Medicaid |
$6.34
|
| Rate for Payer: Mclaren Medicare |
$11.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.41
|
| Rate for Payer: Meridian Medicaid |
$6.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: PACE Medicare |
$11.23
|
| Rate for Payer: PACE SWMI |
$11.82
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: PHP Medicaid |
$6.34
|
| Rate for Payer: PHP Medicare Advantage |
$11.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.68
|
| Rate for Payer: Priority Health Medicare |
$11.82
|
| Rate for Payer: Priority Health Narrow Network |
$10.94
|
| Rate for Payer: Railroad Medicare Medicare |
$11.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.82
|
| Rate for Payer: UHC Exchange |
$18.32
|
| Rate for Payer: UHC Medicare Advantage |
$11.82
|
| Rate for Payer: UHCCP DNSP |
$11.82
|
| Rate for Payer: UHCCP Medicaid |
$6.34
|
| Rate for Payer: VA VA |
$11.82
|
|
|
HC AUDIOMETRY AIR AND BONE
|
Facility
|
OP
|
$212.17
|
|
|
Service Code
|
CPT 92553
|
| Hospital Charge Code |
47100010
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$236.51 |
| Rate for Payer: Aetna Commercial |
$190.95
|
| Rate for Payer: Aetna Medicare |
$152.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: ASR ASR |
$205.80
|
| Rate for Payer: ASR Commercial |
$205.80
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCBS Trust/PPO |
$173.75
|
| Rate for Payer: BCN Commercial |
$164.50
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cofinity Commercial |
$199.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$212.17
|
| Rate for Payer: Healthscope Whirlpool |
$205.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$152.59
|
| Rate for Payer: Mclaren Commercial |
$190.95
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: Nomi Health Commercial |
$173.98
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$167.85
|
| Rate for Payer: PHP Medicaid |
$81.79
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.90
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health Narrow Network |
$148.73
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$236.51
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP DNSP |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$81.79
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC AUDIOMETRY AIR AND BONE
|
Facility
|
IP
|
$212.17
|
|
|
Service Code
|
CPT 92553
|
| Hospital Charge Code |
47100010
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$137.91 |
| Max. Negotiated Rate |
$212.17 |
| Rate for Payer: Aetna Commercial |
$190.95
|
| Rate for Payer: ASR ASR |
$205.80
|
| Rate for Payer: ASR Commercial |
$205.80
|
| Rate for Payer: BCBS Trust/PPO |
$172.90
|
| Rate for Payer: BCN Commercial |
$164.50
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cofinity Commercial |
$199.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.74
|
| Rate for Payer: Healthscope Commercial |
$212.17
|
| Rate for Payer: Healthscope Whirlpool |
$205.80
|
| Rate for Payer: Mclaren Commercial |
$190.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: Nomi Health Commercial |
$173.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.71
|
|
|
HC AUDITORY EVOKED POTENTIAL SCREENING
|
Facility
|
IP
|
$256.13
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
47100015
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$166.48 |
| Max. Negotiated Rate |
$256.13 |
| Rate for Payer: Aetna Commercial |
$230.52
|
| Rate for Payer: ASR ASR |
$248.45
|
| Rate for Payer: ASR Commercial |
$248.45
|
| Rate for Payer: BCBS Trust/PPO |
$208.72
|
| Rate for Payer: BCN Commercial |
$198.58
|
| Rate for Payer: Cash Price |
$204.90
|
| Rate for Payer: Cofinity Commercial |
$240.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.90
|
| Rate for Payer: Healthscope Commercial |
$256.13
|
| Rate for Payer: Healthscope Whirlpool |
$248.45
|
| Rate for Payer: Mclaren Commercial |
$230.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.71
|
| Rate for Payer: Nomi Health Commercial |
$210.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.39
|
|
|
HC AUDITORY EVOKED POTENTIAL SCREENING
|
Facility
|
OP
|
$256.13
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
47100015
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$102.45 |
| Max. Negotiated Rate |
$256.13 |
| Rate for Payer: Aetna Commercial |
$230.52
|
| Rate for Payer: Aetna Medicare |
$128.06
|
| Rate for Payer: ASR ASR |
$248.45
|
| Rate for Payer: ASR Commercial |
$248.45
|
| Rate for Payer: BCBS Complete |
$102.45
|
| Rate for Payer: BCBS Trust/PPO |
$209.74
|
| Rate for Payer: BCN Commercial |
$198.58
|
| Rate for Payer: Cash Price |
$204.90
|
| Rate for Payer: Cofinity Commercial |
$240.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.90
|
| Rate for Payer: Healthscope Commercial |
$256.13
|
| Rate for Payer: Healthscope Whirlpool |
$248.45
|
| Rate for Payer: Mclaren Commercial |
$230.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.71
|
| Rate for Payer: Nomi Health Commercial |
$210.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.42
|
| Rate for Payer: Priority Health Narrow Network |
$179.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.39
|
|
|
HC AUDITORY EVOK POT NEURODIAGNOSTIC W I&R
|
Facility
|
IP
|
$687.84
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
47000001
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$447.10 |
| Max. Negotiated Rate |
$687.84 |
| Rate for Payer: Aetna Commercial |
$619.06
|
| Rate for Payer: ASR ASR |
$667.20
|
| Rate for Payer: ASR Commercial |
$667.20
|
| Rate for Payer: BCBS Trust/PPO |
$560.52
|
| Rate for Payer: BCN Commercial |
$533.28
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cofinity Commercial |
$646.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.27
|
| Rate for Payer: Healthscope Commercial |
$687.84
|
| Rate for Payer: Healthscope Whirlpool |
$667.20
|
| Rate for Payer: Mclaren Commercial |
$619.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: Nomi Health Commercial |
$564.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$605.30
|
|
|
HC AUDITORY EVOK POT NEURODIAGNOSTIC W I&R
|
Facility
|
OP
|
$687.84
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
47000001
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$687.84 |
| Rate for Payer: Aetna Commercial |
$619.06
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$667.20
|
| Rate for Payer: ASR Commercial |
$667.20
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$563.27
|
| Rate for Payer: BCN Commercial |
$533.28
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cofinity Commercial |
$646.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$687.84
|
| Rate for Payer: Healthscope Whirlpool |
$667.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$619.06
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: Nomi Health Commercial |
$564.03
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$602.69
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$482.18
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$605.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC AUDITORY EVOK POT THRESHOLD MULTI FREQ
|
Facility
|
IP
|
$687.84
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$447.10 |
| Max. Negotiated Rate |
$687.84 |
| Rate for Payer: Aetna Commercial |
$619.06
|
| Rate for Payer: ASR ASR |
$667.20
|
| Rate for Payer: ASR Commercial |
$667.20
|
| Rate for Payer: BCBS Trust/PPO |
$560.52
|
| Rate for Payer: BCN Commercial |
$533.28
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cofinity Commercial |
$646.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.27
|
| Rate for Payer: Healthscope Commercial |
$687.84
|
| Rate for Payer: Healthscope Whirlpool |
$667.20
|
| Rate for Payer: Mclaren Commercial |
$619.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: Nomi Health Commercial |
$564.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$605.30
|
|
|
HC AUDITORY EVOK POT THRESHOLD MULTI FREQ
|
Facility
|
OP
|
$687.84
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$687.84 |
| Rate for Payer: Aetna Commercial |
$619.06
|
| Rate for Payer: Aetna Medicare |
$303.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: ASR ASR |
$667.20
|
| Rate for Payer: ASR Commercial |
$667.20
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$563.27
|
| Rate for Payer: BCN Commercial |
$533.28
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cofinity Commercial |
$646.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$687.84
|
| Rate for Payer: Healthscope Whirlpool |
$667.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$619.06
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: Nomi Health Commercial |
$564.03
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$334.07
|
| Rate for Payer: PHP Medicaid |
$162.78
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$602.69
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$482.18
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$605.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP DNSP |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC AUDITORY FUNCTION 60 MIN
|
Facility
|
OP
|
$168.30
|
|
|
Service Code
|
CPT 92620
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$236.51 |
| Rate for Payer: Aetna Commercial |
$151.47
|
| Rate for Payer: Aetna Medicare |
$152.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: ASR ASR |
$163.25
|
| Rate for Payer: ASR Commercial |
$163.25
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCBS Trust/PPO |
$137.82
|
| Rate for Payer: BCN Commercial |
$130.48
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cofinity Commercial |
$158.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$168.30
|
| Rate for Payer: Healthscope Whirlpool |
$163.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$152.59
|
| Rate for Payer: Mclaren Commercial |
$151.47
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.06
|
| Rate for Payer: Nomi Health Commercial |
$138.01
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$167.85
|
| Rate for Payer: PHP Medicaid |
$81.79
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.46
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health Narrow Network |
$117.98
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$236.51
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP DNSP |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$81.79
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC AUDITORY FUNCTION 60 MIN
|
Facility
|
IP
|
$168.30
|
|
|
Service Code
|
CPT 92620
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$109.39 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Aetna Commercial |
$151.47
|
| Rate for Payer: ASR ASR |
$163.25
|
| Rate for Payer: ASR Commercial |
$163.25
|
| Rate for Payer: BCBS Trust/PPO |
$137.15
|
| Rate for Payer: BCN Commercial |
$130.48
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cofinity Commercial |
$158.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.64
|
| Rate for Payer: Healthscope Commercial |
$168.30
|
| Rate for Payer: Healthscope Whirlpool |
$163.25
|
| Rate for Payer: Mclaren Commercial |
$151.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.06
|
| Rate for Payer: Nomi Health Commercial |
$138.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.10
|
|
|
HC AUD SCREEN PURE TONE AIR ONLY
|
Facility
|
OP
|
$59.97
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
47100003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$23.99 |
| Max. Negotiated Rate |
$59.97 |
| Rate for Payer: Aetna Commercial |
$53.97
|
| Rate for Payer: Aetna Medicare |
$29.98
|
| Rate for Payer: ASR ASR |
$58.17
|
| Rate for Payer: ASR Commercial |
$58.17
|
| Rate for Payer: BCBS Complete |
$23.99
|
| Rate for Payer: BCBS Trust/PPO |
$49.11
|
| Rate for Payer: BCN Commercial |
$46.49
|
| Rate for Payer: Cash Price |
$47.98
|
| Rate for Payer: Cofinity Commercial |
$56.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.98
|
| Rate for Payer: Healthscope Commercial |
$59.97
|
| Rate for Payer: Healthscope Whirlpool |
$58.17
|
| Rate for Payer: Mclaren Commercial |
$53.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.97
|
| Rate for Payer: Nomi Health Commercial |
$49.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.55
|
| Rate for Payer: Priority Health Narrow Network |
$42.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.77
|
|
|
HC AUD SCREEN PURE TONE AIR ONLY
|
Facility
|
IP
|
$59.97
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
47100003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$38.98 |
| Max. Negotiated Rate |
$59.97 |
| Rate for Payer: Aetna Commercial |
$53.97
|
| Rate for Payer: ASR ASR |
$58.17
|
| Rate for Payer: ASR Commercial |
$58.17
|
| Rate for Payer: BCBS Trust/PPO |
$48.87
|
| Rate for Payer: BCN Commercial |
$46.49
|
| Rate for Payer: Cash Price |
$47.98
|
| Rate for Payer: Cofinity Commercial |
$56.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.98
|
| Rate for Payer: Healthscope Commercial |
$59.97
|
| Rate for Payer: Healthscope Whirlpool |
$58.17
|
| Rate for Payer: Mclaren Commercial |
$53.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.97
|
| Rate for Payer: Nomi Health Commercial |
$49.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.77
|
|
