|
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 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 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 |
$163.53 |
| Max. Negotiated Rate |
$687.84 |
| Rate for Payer: Aetna Commercial |
$619.06
|
| Rate for Payer: Aetna Medicare |
$305.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: ASR ASR |
$667.20
|
| Rate for Payer: ASR Commercial |
$667.20
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$563.27
|
| Rate for Payer: BCN Commercial |
$533.28
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| 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 |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$687.84
|
| Rate for Payer: Healthscope Whirlpool |
$667.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$619.06
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: Nomi Health Commercial |
$564.03
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$335.61
|
| Rate for Payer: PHP Medicaid |
$163.53
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$602.69
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$482.18
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$605.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$472.90
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP DNSP |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: VA VA |
$305.10
|
|
|
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 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 |
$163.53 |
| Max. Negotiated Rate |
$687.84 |
| Rate for Payer: Aetna Commercial |
$619.06
|
| Rate for Payer: Aetna Medicare |
$305.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: ASR ASR |
$667.20
|
| Rate for Payer: ASR Commercial |
$667.20
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$563.27
|
| Rate for Payer: BCN Commercial |
$533.28
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| 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 |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$687.84
|
| Rate for Payer: Healthscope Whirlpool |
$667.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$619.06
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: Nomi Health Commercial |
$564.03
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$335.61
|
| Rate for Payer: PHP Medicaid |
$163.53
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$602.69
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$482.18
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$605.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$472.90
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP DNSP |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC AUDITORY FUNCTION 60 MIN
|
Facility
|
OP
|
$168.30
|
|
|
Service Code
|
CPT 92620
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$237.62 |
| Rate for Payer: Aetna Commercial |
$151.47
|
| Rate for Payer: Aetna Medicare |
$153.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: ASR ASR |
$163.25
|
| Rate for Payer: ASR Commercial |
$163.25
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$137.82
|
| Rate for Payer: BCN Commercial |
$130.48
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| 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 |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$168.30
|
| Rate for Payer: Healthscope Whirlpool |
$163.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.30
|
| Rate for Payer: Mclaren Commercial |
$151.47
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.06
|
| Rate for Payer: Nomi Health Commercial |
$138.01
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$168.63
|
| Rate for Payer: PHP Medicaid |
$82.17
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.46
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$117.98
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$237.62
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP DNSP |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$82.17
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC AUDITORY FUNCTION 60 MIN
|
Facility
|
IP
|
$168.30
|
|
|
Service Code
|
CPT 92620
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$109.40 |
| 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 |
$109.40
|
| 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
|
|
|
HC AUD VERTICAL ELECTRODE USE
|
Facility
|
IP
|
$55.11
|
|
|
Service Code
|
CPT 92547
|
| Hospital Charge Code |
47100004
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$55.11 |
| Rate for Payer: Aetna Commercial |
$49.60
|
| Rate for Payer: ASR ASR |
$53.46
|
| Rate for Payer: ASR Commercial |
$53.46
|
| Rate for Payer: BCBS Trust/PPO |
$44.91
|
| Rate for Payer: BCN Commercial |
$42.73
|
| Rate for Payer: Cash Price |
$44.09
|
| Rate for Payer: Cofinity Commercial |
$51.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.09
|
| Rate for Payer: Healthscope Commercial |
$55.11
|
| Rate for Payer: Healthscope Whirlpool |
$53.46
|
| Rate for Payer: Mclaren Commercial |
$49.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.84
|
| Rate for Payer: Nomi Health Commercial |
$45.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.50
|
|
|
HC AUD VERTICAL ELECTRODE USE
|
Facility
|
OP
|
$55.11
|
|
|
Service Code
|
CPT 92547
|
| Hospital Charge Code |
47100004
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$55.11 |
| Rate for Payer: Aetna Commercial |
$49.60
|
| Rate for Payer: Aetna Medicare |
$27.56
|
| Rate for Payer: ASR ASR |
$53.46
|
| Rate for Payer: ASR Commercial |
$53.46
|
| Rate for Payer: BCBS Complete |
$22.04
|
| Rate for Payer: BCBS Trust/PPO |
$45.13
|
| Rate for Payer: BCN Commercial |
$42.73
|
| Rate for Payer: Cash Price |
$44.09
|
| Rate for Payer: Cofinity Commercial |
$51.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.09
|
| Rate for Payer: Healthscope Commercial |
$55.11
|
| Rate for Payer: Healthscope Whirlpool |
$53.46
|
| Rate for Payer: Mclaren Commercial |
$49.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.84
|
| Rate for Payer: Nomi Health Commercial |
$45.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.29
|
| Rate for Payer: Priority Health Narrow Network |
$38.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.50
|
|
|
HC AUD VESTIBULAR EVAL BASIC
|
Facility
|
OP
|
$463.45
|
|
|
Service Code
|
CPT 92540
|
| Hospital Charge Code |
47100005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$463.45 |
| Rate for Payer: Aetna Commercial |
$417.10
|
| Rate for Payer: Aetna Medicare |
$153.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: ASR ASR |
$449.55
|
| Rate for Payer: ASR Commercial |
$449.55
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$379.52
|
| Rate for Payer: BCN Commercial |
$359.31
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cofinity Commercial |
$435.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$463.45
|
| Rate for Payer: Healthscope Whirlpool |
$449.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.30
|
| Rate for Payer: Mclaren Commercial |
$417.10
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.93
|
| Rate for Payer: Nomi Health Commercial |
$380.03
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$168.63
|
| Rate for Payer: PHP Medicaid |
$82.17
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$406.07
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$324.88
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$407.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$237.62
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP DNSP |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$82.17
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC AUD VESTIBULAR EVAL BASIC
|
Facility
|
IP
|
$463.45
|
|
|
Service Code
|
CPT 92540
|
| Hospital Charge Code |
47100005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$301.24 |
| Max. Negotiated Rate |
$463.45 |
| Rate for Payer: Aetna Commercial |
$417.10
|
| Rate for Payer: ASR ASR |
$449.55
|
| Rate for Payer: ASR Commercial |
$449.55
|
| Rate for Payer: BCBS Trust/PPO |
$377.67
|
| Rate for Payer: BCN Commercial |
$359.31
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cofinity Commercial |
$435.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.76
|
| Rate for Payer: Healthscope Commercial |
$463.45
|
| Rate for Payer: Healthscope Whirlpool |
$449.55
|
| Rate for Payer: Mclaren Commercial |
$417.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.93
|
| Rate for Payer: Nomi Health Commercial |
$380.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$407.84
|
|
|
HC AUTOLOGOUS UNIT
|
Facility
|
OP
|
$825.28
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
39000040
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$75.79 |
| Max. Negotiated Rate |
$825.28 |
| Rate for Payer: Aetna Commercial |
$742.75
|
| Rate for Payer: Aetna Medicare |
$141.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$176.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$176.75
|
| Rate for Payer: ASR ASR |
$800.52
|
| Rate for Payer: ASR Commercial |
$800.52
|
| Rate for Payer: BCBS Complete |
$79.58
|
| Rate for Payer: BCBS MAPPO |
$141.40
|
| Rate for Payer: BCBS Trust/PPO |
$675.82
|
| Rate for Payer: BCN Commercial |
$639.84
|
| Rate for Payer: BCN Medicare Advantage |
$141.40
|
| Rate for Payer: Cash Price |
$660.22
|
| Rate for Payer: Cash Price |
$660.22
|
| Rate for Payer: Cofinity Commercial |
$775.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.40
|
| Rate for Payer: Healthscope Commercial |
$825.28
|
| Rate for Payer: Healthscope Whirlpool |
$800.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$141.40
|
| Rate for Payer: Mclaren Commercial |
$742.75
|
| Rate for Payer: Mclaren Medicaid |
$75.79
|
| Rate for Payer: Mclaren Medicare |
$141.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.47
|
| Rate for Payer: Meridian Medicaid |
$79.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.49
|
| Rate for Payer: Nomi Health Commercial |
$676.73
|
| Rate for Payer: PACE Medicare |
$134.33
|
| Rate for Payer: PACE SWMI |
$141.40
|
| Rate for Payer: PHP Commercial |
$155.54
|
| Rate for Payer: PHP Medicaid |
$75.79
|
| Rate for Payer: PHP Medicare Advantage |
$141.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$723.11
|
| Rate for Payer: Priority Health Medicare |
$141.40
|
| Rate for Payer: Priority Health Narrow Network |
$578.52
|
| Rate for Payer: Railroad Medicare Medicare |
$141.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$726.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.40
|
| Rate for Payer: UHC Exchange |
$219.17
|
| Rate for Payer: UHC Medicare Advantage |
$141.40
|
| Rate for Payer: UHCCP DNSP |
$141.40
|
| Rate for Payer: UHCCP Medicaid |
$75.79
|
| Rate for Payer: VA VA |
$141.40
|
|
|
HC AUTOLOGOUS UNIT
|
Facility
|
IP
|
$825.28
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
39000040
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$536.43 |
| Max. Negotiated Rate |
$825.28 |
| Rate for Payer: Aetna Commercial |
$742.75
|
| Rate for Payer: ASR ASR |
$800.52
|
| Rate for Payer: ASR Commercial |
$800.52
|
| Rate for Payer: BCBS Trust/PPO |
$672.52
|
| Rate for Payer: BCN Commercial |
$639.84
|
| Rate for Payer: Cash Price |
$660.22
|
| Rate for Payer: Cofinity Commercial |
$775.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.22
|
| Rate for Payer: Healthscope Commercial |
$825.28
|
| Rate for Payer: Healthscope Whirlpool |
$800.52
|
| Rate for Payer: Mclaren Commercial |
$742.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.49
|
| Rate for Payer: Nomi Health Commercial |
$676.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$726.25
|
|
|
HC AUTONOMIC FUNC ADRENERGIC
|
Facility
|
IP
|
$181.53
|
|
|
Service Code
|
CPT 95922
|
| Hospital Charge Code |
92000007
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$181.53 |
| Rate for Payer: Aetna Commercial |
$163.38
|
| Rate for Payer: ASR ASR |
$176.08
|
| Rate for Payer: ASR Commercial |
$176.08
|
| Rate for Payer: BCBS Trust/PPO |
$147.93
|
| Rate for Payer: BCN Commercial |
$140.74
|
| Rate for Payer: Cash Price |
$145.22
|
| Rate for Payer: Cofinity Commercial |
$170.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.22
|
| Rate for Payer: Healthscope Commercial |
$181.53
|
| Rate for Payer: Healthscope Whirlpool |
$176.08
|
| Rate for Payer: Mclaren Commercial |
$163.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.30
|
| Rate for Payer: Nomi Health Commercial |
$148.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.75
|
|
|
HC AUTONOMIC FUNC ADRENERGIC
|
Facility
|
OP
|
$181.53
|
|
|
Service Code
|
CPT 95922
|
| Hospital Charge Code |
92000007
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$195.75 |
| Rate for Payer: Aetna Commercial |
$163.38
|
| Rate for Payer: Aetna Medicare |
$126.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: ASR ASR |
$176.08
|
| Rate for Payer: ASR Commercial |
$176.08
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$148.65
|
| Rate for Payer: BCN Commercial |
$140.74
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$145.22
|
| Rate for Payer: Cash Price |
$145.22
|
| Rate for Payer: Cofinity Commercial |
$170.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$181.53
|
| Rate for Payer: Healthscope Whirlpool |
$176.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$126.29
|
| Rate for Payer: Mclaren Commercial |
$163.38
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.30
|
| Rate for Payer: Nomi Health Commercial |
$148.85
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$138.92
|
| Rate for Payer: PHP Medicaid |
$67.69
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.06
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$127.25
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$195.75
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP DNSP |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC AUTONOMIC FUNC CARDIO INNERVAT
|
Facility
|
OP
|
$363.05
|
|
|
Service Code
|
CPT 95921
|
| Hospital Charge Code |
92000006
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$363.05 |
| Rate for Payer: Aetna Commercial |
$326.74
|
| Rate for Payer: Aetna Medicare |
$153.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: ASR ASR |
$352.16
|
| Rate for Payer: ASR Commercial |
$352.16
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$297.30
|
| Rate for Payer: BCN Commercial |
$281.47
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$290.44
|
| Rate for Payer: Cash Price |
$290.44
|
| Rate for Payer: Cofinity Commercial |
$341.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$363.05
|
| Rate for Payer: Healthscope Whirlpool |
$352.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$153.30
|
| Rate for Payer: Mclaren Commercial |
$326.74
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.59
|
| Rate for Payer: Nomi Health Commercial |
$297.70
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$168.63
|
| Rate for Payer: PHP Medicaid |
$82.17
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.10
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$254.50
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$237.62
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP DNSP |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$82.17
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC AUTONOMIC FUNC CARDIO INNERVAT
|
Facility
|
IP
|
$363.05
|
|
|
Service Code
|
CPT 95921
|
| Hospital Charge Code |
92000006
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$235.98 |
| Max. Negotiated Rate |
$363.05 |
| Rate for Payer: Aetna Commercial |
$326.74
|
| Rate for Payer: ASR ASR |
$352.16
|
| Rate for Payer: ASR Commercial |
$352.16
|
| Rate for Payer: BCBS Trust/PPO |
$295.85
|
| Rate for Payer: BCN Commercial |
$281.47
|
| Rate for Payer: Cash Price |
$290.44
|
| Rate for Payer: Cofinity Commercial |
$341.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.44
|
| Rate for Payer: Healthscope Commercial |
$363.05
|
| Rate for Payer: Healthscope Whirlpool |
$352.16
|
| Rate for Payer: Mclaren Commercial |
$326.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.59
|
| Rate for Payer: Nomi Health Commercial |
$297.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.48
|
|
|
HC AUTONOMIC FUNC QSART
|
Facility
|
OP
|
$363.05
|
|
|
Service Code
|
CPT 95923
|
| Hospital Charge Code |
92000008
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$363.05 |
| Rate for Payer: Aetna Commercial |
$326.74
|
| Rate for Payer: Aetna Medicare |
$126.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: ASR ASR |
$352.16
|
| Rate for Payer: ASR Commercial |
$352.16
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$297.30
|
| Rate for Payer: BCN Commercial |
$281.47
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$290.44
|
| Rate for Payer: Cash Price |
$290.44
|
| Rate for Payer: Cofinity Commercial |
$341.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$363.05
|
| Rate for Payer: Healthscope Whirlpool |
$352.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$126.29
|
| Rate for Payer: Mclaren Commercial |
$326.74
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.59
|
| Rate for Payer: Nomi Health Commercial |
$297.70
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$138.92
|
| Rate for Payer: PHP Medicaid |
$67.69
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.10
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$254.50
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$195.75
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP DNSP |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC AUTONOMIC FUNC QSART
|
Facility
|
IP
|
$363.05
|
|
|
Service Code
|
CPT 95923
|
| Hospital Charge Code |
92000008
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$235.98 |
| Max. Negotiated Rate |
$363.05 |
| Rate for Payer: Aetna Commercial |
$326.74
|
| Rate for Payer: ASR ASR |
$352.16
|
| Rate for Payer: ASR Commercial |
$352.16
|
| Rate for Payer: BCBS Trust/PPO |
$295.85
|
| Rate for Payer: BCN Commercial |
$281.47
|
| Rate for Payer: Cash Price |
$290.44
|
| Rate for Payer: Cofinity Commercial |
$341.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.44
|
| Rate for Payer: Healthscope Commercial |
$363.05
|
| Rate for Payer: Healthscope Whirlpool |
$352.16
|
| Rate for Payer: Mclaren Commercial |
$326.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.59
|
| Rate for Payer: Nomi Health Commercial |
$297.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.48
|
|
|
HC AUTONOMIC W/O QSART
|
Facility
|
OP
|
$518.64
|
|
|
Service Code
|
CPT 95924
|
| Hospital Charge Code |
92000012
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$73.12 |
| Max. Negotiated Rate |
$518.64 |
| Rate for Payer: Aetna Commercial |
$466.78
|
| Rate for Payer: Aetna Medicare |
$305.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: ASR ASR |
$503.08
|
| Rate for Payer: ASR Commercial |
$503.08
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$424.71
|
| Rate for Payer: BCN Commercial |
$402.10
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$414.91
|
| Rate for Payer: Cash Price |
$414.91
|
| Rate for Payer: Cofinity Commercial |
$487.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$518.64
|
| Rate for Payer: Healthscope Whirlpool |
$503.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$466.78
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.84
|
| Rate for Payer: Nomi Health Commercial |
$425.28
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$335.61
|
| Rate for Payer: PHP Medicaid |
$163.53
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.40
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$73.12
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$456.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$472.90
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP DNSP |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC AUTONOMIC W/O QSART
|
Facility
|
IP
|
$518.64
|
|
|
Service Code
|
CPT 95924
|
| Hospital Charge Code |
92000012
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$337.12 |
| Max. Negotiated Rate |
$518.64 |
| Rate for Payer: Aetna Commercial |
$466.78
|
| Rate for Payer: ASR ASR |
$503.08
|
| Rate for Payer: ASR Commercial |
$503.08
|
| Rate for Payer: BCBS Trust/PPO |
$422.64
|
| Rate for Payer: BCN Commercial |
$402.10
|
| Rate for Payer: Cash Price |
$414.91
|
| Rate for Payer: Cofinity Commercial |
$487.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.91
|
| Rate for Payer: Healthscope Commercial |
$518.64
|
| Rate for Payer: Healthscope Whirlpool |
$503.08
|
| Rate for Payer: Mclaren Commercial |
$466.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.84
|
| Rate for Payer: Nomi Health Commercial |
$425.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$456.40
|
|
|
HC AVULSION OF NAIL PLATE
|
Facility
|
OP
|
$319.94
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
76100045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$319.94 |
| Rate for Payer: Aetna Commercial |
$287.95
|
| Rate for Payer: Aetna Medicare |
$194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: ASR ASR |
$310.34
|
| Rate for Payer: ASR Commercial |
$310.34
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$262.00
|
| Rate for Payer: BCN Commercial |
$248.05
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$255.95
|
| Rate for Payer: Cash Price |
$255.95
|
| Rate for Payer: Cofinity Commercial |
$300.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$319.94
|
| Rate for Payer: Healthscope Whirlpool |
$310.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$194.68
|
| Rate for Payer: Mclaren Commercial |
$287.95
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.95
|
| Rate for Payer: Nomi Health Commercial |
$262.35
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$214.15
|
| Rate for Payer: PHP Medicaid |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.84
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$141.47
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$281.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP DNSP |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
