|
HC ETHYL GLUCURONIDE SCREEN W/REFLEX, URINE
|
Facility
|
IP
|
$125.90
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.13 |
| Max. Negotiated Rate |
$125.90 |
| Rate for Payer: Aetna Commercial |
$113.31
|
| Rate for Payer: ASR ASR |
$122.12
|
| Rate for Payer: BCBS Trust/PPO |
$97.61
|
| Rate for Payer: BCN Commercial |
$97.61
|
| Rate for Payer: Cash Price |
$100.72
|
| Rate for Payer: Cofinity Commercial |
$118.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.72
|
| Rate for Payer: Healthscope Commercial |
$125.90
|
| Rate for Payer: Healthscope Whirlpool |
$122.12
|
| Rate for Payer: Mclaren Commercial |
$113.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.79
|
|
|
HC ETHYL GLUCURONIDE SCREEN W/REFLEX, URINE
|
Facility
|
OP
|
$125.90
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$125.90 |
| Rate for Payer: Aetna Commercial |
$113.31
|
| Rate for Payer: Aetna Medicare |
$62.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: ASR ASR |
$122.12
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$97.61
|
| Rate for Payer: BCN Commercial |
$97.61
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$100.72
|
| Rate for Payer: Cash Price |
$100.72
|
| Rate for Payer: Cofinity Commercial |
$118.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$125.90
|
| Rate for Payer: Healthscope Whirlpool |
$122.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.14
|
| Rate for Payer: Mclaren Commercial |
$113.31
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.02
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: PHP Medicaid |
$33.99
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.57
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$89.39
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.79
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
OP
|
$1,516.09
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$606.44 |
| Max. Negotiated Rate |
$1,516.09 |
| Rate for Payer: Aetna Commercial |
$1,364.48
|
| Rate for Payer: ASR ASR |
$1,470.61
|
| Rate for Payer: BCBS Complete |
$606.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,175.42
|
| Rate for Payer: BCN Commercial |
$1,175.42
|
| Rate for Payer: Cash Price |
$1,212.87
|
| Rate for Payer: Cofinity Commercial |
$1,425.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,212.87
|
| Rate for Payer: Healthscope Commercial |
$1,516.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,470.61
|
| Rate for Payer: Mclaren Commercial |
$1,364.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,288.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,061.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,379.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,076.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,334.16
|
|
|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
IP
|
$1,516.09
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,061.26 |
| Max. Negotiated Rate |
$1,516.09 |
| Rate for Payer: Aetna Commercial |
$1,364.48
|
| Rate for Payer: ASR ASR |
$1,470.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,175.42
|
| Rate for Payer: BCN Commercial |
$1,175.42
|
| Rate for Payer: Cash Price |
$1,212.87
|
| Rate for Payer: Cofinity Commercial |
$1,425.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,212.87
|
| Rate for Payer: Healthscope Commercial |
$1,516.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,470.61
|
| Rate for Payer: Mclaren Commercial |
$1,364.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,288.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,061.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,334.16
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
IP
|
$295.09
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$206.56 |
| Max. Negotiated Rate |
$295.09 |
| Rate for Payer: Aetna Commercial |
$265.58
|
| Rate for Payer: ASR ASR |
$286.24
|
| Rate for Payer: BCBS Trust/PPO |
$228.78
|
| Rate for Payer: BCN Commercial |
$228.78
|
| Rate for Payer: Cash Price |
$236.07
|
| Rate for Payer: Cofinity Commercial |
$277.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.07
|
| Rate for Payer: Healthscope Commercial |
$295.09
|
| Rate for Payer: Healthscope Whirlpool |
$286.24
|
| Rate for Payer: Mclaren Commercial |
$265.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.68
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
OP
|
$295.09
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.63 |
| Max. Negotiated Rate |
$295.09 |
| Rate for Payer: Aetna Commercial |
$265.58
|
| Rate for Payer: Aetna Medicare |
$127.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.12
|
| Rate for Payer: ASR ASR |
$286.24
|
| Rate for Payer: BCBS Complete |
$73.12
|
| Rate for Payer: BCBS MAPPO |
$127.30
|
| Rate for Payer: BCBS Trust/PPO |
$228.78
|
| Rate for Payer: BCN Commercial |
$228.78
|
| Rate for Payer: BCN Medicare Advantage |
$127.30
|
| Rate for Payer: Cash Price |
$236.07
|
| Rate for Payer: Cash Price |
$236.07
|
| Rate for Payer: Cofinity Commercial |
$277.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.30
|
| Rate for Payer: Healthscope Commercial |
$295.09
|
| Rate for Payer: Healthscope Whirlpool |
$286.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$127.30
|
| Rate for Payer: Mclaren Commercial |
$265.58
|
| Rate for Payer: Mclaren Medicaid |
$69.63
|
| Rate for Payer: Mclaren Medicare |
$127.30
|
| Rate for Payer: Meridian Medicaid |
$73.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$133.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.83
|
| Rate for Payer: PACE Medicare |
$120.94
|
| Rate for Payer: PACE SWMI |
$127.30
|
| Rate for Payer: PHP Commercial |
$140.03
|
| Rate for Payer: PHP Medicaid |
$69.63
|
| Rate for Payer: PHP Medicare Advantage |
$127.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.53
|
| Rate for Payer: Priority Health Medicare |
$127.30
|
| Rate for Payer: Priority Health Narrow Network |
$209.51
|
| Rate for Payer: Railroad Medicare Medicare |
$127.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.68
|
| Rate for Payer: UHC Medicare Advantage |
$131.12
|
| Rate for Payer: VA VA |
$127.30
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$90.38
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.27 |
| Max. Negotiated Rate |
$90.38 |
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: ASR ASR |
$87.67
|
| Rate for Payer: BCBS Trust/PPO |
$70.07
|
| Rate for Payer: BCN Commercial |
$70.07
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cofinity Commercial |
$84.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.30
|
| Rate for Payer: Healthscope Commercial |
$90.38
|
| Rate for Payer: Healthscope Whirlpool |
$87.67
|
| Rate for Payer: Mclaren Commercial |
$81.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.53
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$90.38
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$141.94 |
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: Aetna Medicare |
$113.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: ASR ASR |
$87.67
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$70.07
|
| Rate for Payer: BCN Commercial |
$70.07
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cofinity Commercial |
$84.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Healthscope Commercial |
$90.38
|
| Rate for Payer: Healthscope Whirlpool |
$87.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$113.55
|
| Rate for Payer: Mclaren Commercial |
$81.34
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.82
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: PHP Medicaid |
$62.11
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.23
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$93.78
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.53
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
OP
|
$256.60
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$102.64 |
| Max. Negotiated Rate |
$256.60 |
| Rate for Payer: Aetna Commercial |
$230.94
|
| Rate for Payer: ASR ASR |
$248.90
|
| Rate for Payer: BCBS Complete |
$102.64
|
| Rate for Payer: BCBS Trust/PPO |
$198.94
|
| Rate for Payer: BCN Commercial |
$198.94
|
| Rate for Payer: Cash Price |
$205.28
|
| Rate for Payer: Cash Price |
$205.28
|
| Rate for Payer: Cofinity Commercial |
$241.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.28
|
| Rate for Payer: Healthscope Commercial |
$256.60
|
| Rate for Payer: Healthscope Whirlpool |
$248.90
|
| Rate for Payer: Mclaren Commercial |
$230.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$218.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.34
|
| Rate for Payer: Priority Health Narrow Network |
$198.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.81
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
IP
|
$256.60
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$179.62 |
| Max. Negotiated Rate |
$256.60 |
| Rate for Payer: Aetna Commercial |
$230.94
|
| Rate for Payer: ASR ASR |
$248.90
|
| Rate for Payer: BCBS Trust/PPO |
$198.94
|
| Rate for Payer: BCN Commercial |
$198.94
|
| Rate for Payer: Cash Price |
$205.28
|
| Rate for Payer: Cofinity Commercial |
$241.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.28
|
| Rate for Payer: Healthscope Commercial |
$256.60
|
| Rate for Payer: Healthscope Whirlpool |
$248.90
|
| Rate for Payer: Mclaren Commercial |
$230.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$218.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.81
|
|
|
HC EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna Commercial |
$35.10
|
| Rate for Payer: ASR ASR |
$37.83
|
| Rate for Payer: BCBS Trust/PPO |
$30.24
|
| Rate for Payer: BCN Commercial |
$30.24
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$36.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.20
|
| Rate for Payer: Healthscope Commercial |
$39.00
|
| Rate for Payer: Healthscope Whirlpool |
$37.83
|
| Rate for Payer: Mclaren Commercial |
$35.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.32
|
|
|
HC EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna Commercial |
$35.10
|
| Rate for Payer: ASR ASR |
$37.83
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Trust/PPO |
$30.24
|
| Rate for Payer: BCN Commercial |
$30.24
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$36.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.20
|
| Rate for Payer: Healthscope Commercial |
$39.00
|
| Rate for Payer: Healthscope Whirlpool |
$37.83
|
| Rate for Payer: Mclaren Commercial |
$35.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.49
|
| Rate for Payer: Priority Health Narrow Network |
$27.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.32
|
|
|
HC EVAL ORAL SPEECH ADDL 30 MIN
|
Facility
|
IP
|
$114.40
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
44400015
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$114.40 |
| Rate for Payer: Aetna Commercial |
$102.96
|
| Rate for Payer: ASR ASR |
$110.97
|
| Rate for Payer: BCBS Trust/PPO |
$88.69
|
| Rate for Payer: BCN Commercial |
$88.69
|
| Rate for Payer: Cash Price |
$91.52
|
| Rate for Payer: Cofinity Commercial |
$107.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.52
|
| Rate for Payer: Healthscope Commercial |
$114.40
|
| Rate for Payer: Healthscope Whirlpool |
$110.97
|
| Rate for Payer: Mclaren Commercial |
$102.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.67
|
|
|
HC EVAL ORAL SPEECH ADDL 30 MIN
|
Facility
|
OP
|
$114.40
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
44400015
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$114.40 |
| Rate for Payer: Aetna Commercial |
$102.96
|
| Rate for Payer: ASR ASR |
$110.97
|
| Rate for Payer: BCBS Complete |
$45.76
|
| Rate for Payer: BCBS Trust/PPO |
$88.69
|
| Rate for Payer: BCN Commercial |
$88.69
|
| Rate for Payer: Cash Price |
$91.52
|
| Rate for Payer: Cofinity Commercial |
$107.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.52
|
| Rate for Payer: Healthscope Commercial |
$114.40
|
| Rate for Payer: Healthscope Whirlpool |
$110.97
|
| Rate for Payer: Mclaren Commercial |
$102.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.10
|
| Rate for Payer: Priority Health Narrow Network |
$81.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.67
|
|
|
HC EVAL ORAL SPEECH DEVICE
|
Facility
|
OP
|
$297.02
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
44400014
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$118.81 |
| Max. Negotiated Rate |
$297.02 |
| Rate for Payer: Aetna Commercial |
$267.32
|
| Rate for Payer: ASR ASR |
$288.11
|
| Rate for Payer: BCBS Complete |
$118.81
|
| Rate for Payer: BCBS Trust/PPO |
$230.28
|
| Rate for Payer: BCN Commercial |
$230.28
|
| Rate for Payer: Cash Price |
$237.62
|
| Rate for Payer: Cofinity Commercial |
$279.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.62
|
| Rate for Payer: Healthscope Commercial |
$297.02
|
| Rate for Payer: Healthscope Whirlpool |
$288.11
|
| Rate for Payer: Mclaren Commercial |
$267.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$252.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.29
|
| Rate for Payer: Priority Health Narrow Network |
$210.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.38
|
|
|
HC EVAL ORAL SPEECH DEVICE
|
Facility
|
IP
|
$297.02
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
44400014
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$207.91 |
| Max. Negotiated Rate |
$297.02 |
| Rate for Payer: Aetna Commercial |
$267.32
|
| Rate for Payer: ASR ASR |
$288.11
|
| Rate for Payer: BCBS Trust/PPO |
$230.28
|
| Rate for Payer: BCN Commercial |
$230.28
|
| Rate for Payer: Cash Price |
$237.62
|
| Rate for Payer: Cofinity Commercial |
$279.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.62
|
| Rate for Payer: Healthscope Commercial |
$297.02
|
| Rate for Payer: Healthscope Whirlpool |
$288.11
|
| Rate for Payer: Mclaren Commercial |
$267.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$252.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.38
|
|
|
HC EVENT MONITOR
|
Facility
|
IP
|
$500.24
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
48000003
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$350.17 |
| Max. Negotiated Rate |
$500.24 |
| Rate for Payer: Aetna Commercial |
$450.22
|
| Rate for Payer: ASR ASR |
$485.23
|
| Rate for Payer: BCBS Trust/PPO |
$387.84
|
| Rate for Payer: BCN Commercial |
$387.84
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cofinity Commercial |
$470.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.19
|
| Rate for Payer: Healthscope Commercial |
$500.24
|
| Rate for Payer: Healthscope Whirlpool |
$485.23
|
| Rate for Payer: Mclaren Commercial |
$450.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.21
|
|
|
HC EVENT MONITOR
|
Facility
|
OP
|
$500.24
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
48000003
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$500.24 |
| Rate for Payer: Aetna Commercial |
$450.22
|
| Rate for Payer: Aetna Medicare |
$33.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.90
|
| Rate for Payer: ASR ASR |
$485.23
|
| Rate for Payer: BCBS Complete |
$19.25
|
| Rate for Payer: BCBS MAPPO |
$33.52
|
| Rate for Payer: BCBS Trust/PPO |
$387.84
|
| Rate for Payer: BCN Commercial |
$387.84
|
| Rate for Payer: BCN Medicare Advantage |
$33.52
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cofinity Commercial |
$470.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.52
|
| Rate for Payer: Healthscope Commercial |
$500.24
|
| Rate for Payer: Healthscope Whirlpool |
$485.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$33.52
|
| Rate for Payer: Mclaren Commercial |
$450.22
|
| Rate for Payer: Mclaren Medicaid |
$18.34
|
| Rate for Payer: Mclaren Medicare |
$33.52
|
| Rate for Payer: Meridian Medicaid |
$19.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.20
|
| Rate for Payer: PACE Medicare |
$31.84
|
| Rate for Payer: PACE SWMI |
$33.52
|
| Rate for Payer: PHP Commercial |
$36.87
|
| Rate for Payer: PHP Medicaid |
$18.34
|
| Rate for Payer: PHP Medicare Advantage |
$33.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$455.22
|
| Rate for Payer: Priority Health Medicare |
$33.52
|
| Rate for Payer: Priority Health Narrow Network |
$355.17
|
| Rate for Payer: Railroad Medicare Medicare |
$33.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.21
|
| Rate for Payer: UHC Medicare Advantage |
$34.53
|
| Rate for Payer: VA VA |
$33.52
|
|
|
HC EVEROLIMUS
|
Facility
|
OP
|
$68.34
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
30100626
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$68.34 |
| Rate for Payer: Aetna Commercial |
$61.51
|
| Rate for Payer: Aetna Medicare |
$13.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.16
|
| Rate for Payer: ASR ASR |
$66.29
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: BCBS MAPPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$52.98
|
| Rate for Payer: BCN Commercial |
$52.98
|
| Rate for Payer: BCN Medicare Advantage |
$13.73
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$64.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.73
|
| Rate for Payer: Healthscope Commercial |
$68.34
|
| Rate for Payer: Healthscope Whirlpool |
$66.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.73
|
| Rate for Payer: Mclaren Commercial |
$61.51
|
| Rate for Payer: Mclaren Medicaid |
$7.51
|
| Rate for Payer: Mclaren Medicare |
$13.73
|
| Rate for Payer: Meridian Medicaid |
$7.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.09
|
| Rate for Payer: PACE Medicare |
$13.04
|
| Rate for Payer: PACE SWMI |
$13.73
|
| Rate for Payer: PHP Commercial |
$15.10
|
| Rate for Payer: PHP Medicaid |
$7.51
|
| Rate for Payer: PHP Medicare Advantage |
$13.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.04
|
| Rate for Payer: Priority Health Medicare |
$13.73
|
| Rate for Payer: Priority Health Narrow Network |
$16.03
|
| Rate for Payer: Railroad Medicare Medicare |
$13.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.14
|
| Rate for Payer: UHC Medicare Advantage |
$14.14
|
| Rate for Payer: VA VA |
$13.73
|
|
|
HC EVEROLIMUS
|
Facility
|
IP
|
$68.34
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
30100626
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$68.34 |
| Rate for Payer: Aetna Commercial |
$61.51
|
| Rate for Payer: ASR ASR |
$66.29
|
| Rate for Payer: BCBS Trust/PPO |
$52.98
|
| Rate for Payer: BCN Commercial |
$52.98
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$64.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Healthscope Commercial |
$68.34
|
| Rate for Payer: Healthscope Whirlpool |
$66.29
|
| Rate for Payer: Mclaren Commercial |
$61.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.14
|
|
|
HC EVOKED AUDITORY TEST COMPLETE
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
76100506
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$348.75 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$272.57
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$217.86
|
| Rate for Payer: BCN Commercial |
$217.86
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$264.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$281.00
|
| Rate for Payer: Healthscope Whirlpool |
$272.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$252.90
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.85
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.71
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$199.51
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.28
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
HC EVOKED AUDITORY TEST COMPLETE
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
76100506
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$196.70 |
| Max. Negotiated Rate |
$281.00 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: ASR ASR |
$272.57
|
| Rate for Payer: BCBS Trust/PPO |
$217.86
|
| Rate for Payer: BCN Commercial |
$217.86
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$264.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Healthscope Commercial |
$281.00
|
| Rate for Payer: Healthscope Whirlpool |
$272.57
|
| Rate for Payer: Mclaren Commercial |
$252.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.28
|
|
|
HC EVOKED AUDITORY TEST LIMITED
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
76100507
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$196.70 |
| Max. Negotiated Rate |
$281.00 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: ASR ASR |
$272.57
|
| Rate for Payer: BCBS Trust/PPO |
$217.86
|
| Rate for Payer: BCN Commercial |
$217.86
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$264.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Healthscope Commercial |
$281.00
|
| Rate for Payer: Healthscope Whirlpool |
$272.57
|
| Rate for Payer: Mclaren Commercial |
$252.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.28
|
|
|
HC EVOKED AUDITORY TEST LIMITED
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
76100507
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$348.75 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$272.57
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$217.86
|
| Rate for Payer: BCN Commercial |
$217.86
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$264.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$281.00
|
| Rate for Payer: Healthscope Whirlpool |
$272.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$252.90
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.85
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.71
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$199.51
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.28
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
HC EVOKED OTOACOUSTIC EMISNS LIMITD
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
76100489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$746.90
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$596.98
|
| Rate for Payer: BCN Commercial |
$596.98
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cofinity Commercial |
$723.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$770.00
|
| Rate for Payer: Healthscope Whirlpool |
$746.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$693.00
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$654.50
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$539.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$700.70
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$546.70
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$677.60
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
