|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
IP
|
$300.99
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.64 |
| Max. Negotiated Rate |
$300.99 |
| Rate for Payer: Aetna Commercial |
$270.89
|
| Rate for Payer: ASR ASR |
$291.96
|
| Rate for Payer: ASR Commercial |
$291.96
|
| Rate for Payer: BCBS Trust/PPO |
$245.28
|
| Rate for Payer: BCN Commercial |
$233.36
|
| Rate for Payer: Cash Price |
$240.79
|
| Rate for Payer: Cofinity Commercial |
$282.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.79
|
| Rate for Payer: Healthscope Commercial |
$300.99
|
| Rate for Payer: Healthscope Whirlpool |
$291.96
|
| Rate for Payer: Mclaren Commercial |
$270.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.84
|
| Rate for Payer: Nomi Health Commercial |
$246.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.87
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$92.19
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.92 |
| Max. Negotiated Rate |
$194.85 |
| Rate for Payer: Aetna Commercial |
$82.97
|
| Rate for Payer: Aetna Medicare |
$125.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: ASR ASR |
$89.42
|
| Rate for Payer: ASR Commercial |
$89.42
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCBS Trust/PPO |
$75.49
|
| Rate for Payer: BCN Commercial |
$71.47
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cofinity Commercial |
$86.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$92.19
|
| Rate for Payer: Healthscope Whirlpool |
$89.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.71
|
| Rate for Payer: Mclaren Commercial |
$82.97
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.36
|
| Rate for Payer: Nomi Health Commercial |
$75.60
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$138.28
|
| Rate for Payer: PHP Medicaid |
$67.38
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.78
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health Narrow Network |
$64.63
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$194.85
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP DNSP |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$67.38
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$92.19
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.92 |
| Max. Negotiated Rate |
$92.19 |
| Rate for Payer: Aetna Commercial |
$82.97
|
| Rate for Payer: ASR ASR |
$89.42
|
| Rate for Payer: ASR Commercial |
$89.42
|
| Rate for Payer: BCBS Trust/PPO |
$75.13
|
| Rate for Payer: BCN Commercial |
$71.47
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cofinity Commercial |
$86.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.75
|
| Rate for Payer: Healthscope Commercial |
$92.19
|
| Rate for Payer: Healthscope Whirlpool |
$89.42
|
| Rate for Payer: Mclaren Commercial |
$82.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.36
|
| Rate for Payer: Nomi Health Commercial |
$75.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.13
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
OP
|
$261.73
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$261.73 |
| Rate for Payer: Aetna Commercial |
$235.56
|
| Rate for Payer: Aetna Medicare |
$130.87
|
| Rate for Payer: ASR ASR |
$253.88
|
| Rate for Payer: ASR Commercial |
$253.88
|
| Rate for Payer: BCBS Complete |
$104.69
|
| Rate for Payer: BCBS Trust/PPO |
$214.33
|
| Rate for Payer: BCN Commercial |
$202.92
|
| Rate for Payer: Cash Price |
$209.38
|
| Rate for Payer: Cofinity Commercial |
$246.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.38
|
| Rate for Payer: Healthscope Commercial |
$261.73
|
| Rate for Payer: Healthscope Whirlpool |
$253.88
|
| Rate for Payer: Mclaren Commercial |
$235.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.47
|
| Rate for Payer: Nomi Health Commercial |
$214.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.33
|
| Rate for Payer: Priority Health Narrow Network |
$183.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.32
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
IP
|
$261.73
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$170.12 |
| Max. Negotiated Rate |
$261.73 |
| Rate for Payer: Aetna Commercial |
$235.56
|
| Rate for Payer: ASR ASR |
$253.88
|
| Rate for Payer: ASR Commercial |
$253.88
|
| Rate for Payer: BCBS Trust/PPO |
$213.28
|
| Rate for Payer: BCN Commercial |
$202.92
|
| Rate for Payer: Cash Price |
$209.38
|
| Rate for Payer: Cofinity Commercial |
$246.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.38
|
| Rate for Payer: Healthscope Commercial |
$261.73
|
| Rate for Payer: Healthscope Whirlpool |
$253.88
|
| Rate for Payer: Mclaren Commercial |
$235.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.47
|
| Rate for Payer: Nomi Health Commercial |
$214.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.32
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
47100017
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$438.00 |
| Rate for Payer: Aetna Commercial |
$394.20
|
| 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 |
$424.86
|
| Rate for Payer: ASR Commercial |
$424.86
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCBS Trust/PPO |
$358.68
|
| Rate for Payer: BCN Commercial |
$339.58
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cofinity Commercial |
$411.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$438.00
|
| Rate for Payer: Healthscope Whirlpool |
$424.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$152.59
|
| Rate for Payer: Mclaren Commercial |
$394.20
|
| 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 |
$372.30
|
| Rate for Payer: Nomi Health Commercial |
$359.16
|
| 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 |
$284.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$383.78
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health Narrow Network |
$307.04
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.44
|
| 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 EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
47100017
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$284.70 |
| Max. Negotiated Rate |
$438.00 |
| Rate for Payer: Aetna Commercial |
$394.20
|
| Rate for Payer: ASR ASR |
$424.86
|
| Rate for Payer: ASR Commercial |
$424.86
|
| Rate for Payer: BCBS Trust/PPO |
$356.93
|
| Rate for Payer: BCN Commercial |
$339.58
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cofinity Commercial |
$411.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.40
|
| Rate for Payer: Healthscope Commercial |
$438.00
|
| Rate for Payer: Healthscope Whirlpool |
$424.86
|
| Rate for Payer: Mclaren Commercial |
$394.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.30
|
| Rate for Payer: Nomi Health Commercial |
$359.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.44
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
47100018
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: ASR Commercial |
$72.75
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS Trust/PPO |
$61.42
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.72
|
| Rate for Payer: Priority Health Narrow Network |
$52.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
47100018
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: ASR Commercial |
$72.75
|
| Rate for Payer: BCBS Trust/PPO |
$61.12
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Facility
|
OP
|
$39.78
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$39.78 |
| Rate for Payer: Aetna Commercial |
$35.80
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: ASR ASR |
$38.59
|
| Rate for Payer: ASR Commercial |
$38.59
|
| Rate for Payer: BCBS Complete |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$32.58
|
| Rate for Payer: BCN Commercial |
$30.84
|
| Rate for Payer: Cash Price |
$31.82
|
| Rate for Payer: Cofinity Commercial |
$37.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$39.78
|
| Rate for Payer: Healthscope Whirlpool |
$38.59
|
| Rate for Payer: Mclaren Commercial |
$35.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.81
|
| Rate for Payer: Nomi Health Commercial |
$32.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.86
|
| Rate for Payer: Priority Health Narrow Network |
$27.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.01
|
|
|
HC EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Facility
|
IP
|
$39.78
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$25.86 |
| Max. Negotiated Rate |
$39.78 |
| Rate for Payer: Aetna Commercial |
$35.80
|
| Rate for Payer: ASR ASR |
$38.59
|
| Rate for Payer: ASR Commercial |
$38.59
|
| Rate for Payer: BCBS Trust/PPO |
$32.42
|
| Rate for Payer: BCN Commercial |
$30.84
|
| Rate for Payer: Cash Price |
$31.82
|
| Rate for Payer: Cofinity Commercial |
$37.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$39.78
|
| Rate for Payer: Healthscope Whirlpool |
$38.59
|
| Rate for Payer: Mclaren Commercial |
$35.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.81
|
| Rate for Payer: Nomi Health Commercial |
$32.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.01
|
|
|
HC EVAL ORAL SPEECH ADDL 30 MIN
|
Facility
|
OP
|
$116.69
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
44400015
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$46.68 |
| Max. Negotiated Rate |
$116.69 |
| Rate for Payer: Aetna Commercial |
$105.02
|
| Rate for Payer: Aetna Medicare |
$58.34
|
| Rate for Payer: ASR ASR |
$113.19
|
| Rate for Payer: ASR Commercial |
$113.19
|
| Rate for Payer: BCBS Complete |
$46.68
|
| Rate for Payer: BCBS Trust/PPO |
$95.56
|
| Rate for Payer: BCN Commercial |
$90.47
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cofinity Commercial |
$109.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.35
|
| Rate for Payer: Healthscope Commercial |
$116.69
|
| Rate for Payer: Healthscope Whirlpool |
$113.19
|
| Rate for Payer: Mclaren Commercial |
$105.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.19
|
| Rate for Payer: Nomi Health Commercial |
$95.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.24
|
| Rate for Payer: Priority Health Narrow Network |
$81.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.69
|
|
|
HC EVAL ORAL SPEECH ADDL 30 MIN
|
Facility
|
IP
|
$116.69
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
44400015
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$75.85 |
| Max. Negotiated Rate |
$116.69 |
| Rate for Payer: Aetna Commercial |
$105.02
|
| Rate for Payer: ASR ASR |
$113.19
|
| Rate for Payer: ASR Commercial |
$113.19
|
| Rate for Payer: BCBS Trust/PPO |
$95.09
|
| Rate for Payer: BCN Commercial |
$90.47
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cofinity Commercial |
$109.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.35
|
| Rate for Payer: Healthscope Commercial |
$116.69
|
| Rate for Payer: Healthscope Whirlpool |
$113.19
|
| Rate for Payer: Mclaren Commercial |
$105.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.19
|
| Rate for Payer: Nomi Health Commercial |
$95.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.69
|
|
|
HC EVAL ORAL SPEECH DEVICE
|
Facility
|
IP
|
$302.96
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
44400014
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$196.92 |
| Max. Negotiated Rate |
$302.96 |
| Rate for Payer: Aetna Commercial |
$272.66
|
| Rate for Payer: ASR ASR |
$293.87
|
| Rate for Payer: ASR Commercial |
$293.87
|
| Rate for Payer: BCBS Trust/PPO |
$246.88
|
| Rate for Payer: BCN Commercial |
$234.88
|
| Rate for Payer: Cash Price |
$242.37
|
| Rate for Payer: Cofinity Commercial |
$284.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.37
|
| Rate for Payer: Healthscope Commercial |
$302.96
|
| Rate for Payer: Healthscope Whirlpool |
$293.87
|
| Rate for Payer: Mclaren Commercial |
$272.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.52
|
| Rate for Payer: Nomi Health Commercial |
$248.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.60
|
|
|
HC EVAL ORAL SPEECH DEVICE
|
Facility
|
OP
|
$302.96
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
44400014
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$121.18 |
| Max. Negotiated Rate |
$302.96 |
| Rate for Payer: Aetna Commercial |
$272.66
|
| Rate for Payer: Aetna Medicare |
$151.48
|
| Rate for Payer: ASR ASR |
$293.87
|
| Rate for Payer: ASR Commercial |
$293.87
|
| Rate for Payer: BCBS Complete |
$121.18
|
| Rate for Payer: BCBS Trust/PPO |
$248.09
|
| Rate for Payer: BCN Commercial |
$234.88
|
| Rate for Payer: Cash Price |
$242.37
|
| Rate for Payer: Cofinity Commercial |
$284.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.37
|
| Rate for Payer: Healthscope Commercial |
$302.96
|
| Rate for Payer: Healthscope Whirlpool |
$293.87
|
| Rate for Payer: Mclaren Commercial |
$272.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.52
|
| Rate for Payer: Nomi Health Commercial |
$248.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.45
|
| Rate for Payer: Priority Health Narrow Network |
$212.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.60
|
|
|
HC EVENT MONITOR
|
Facility
|
OP
|
$510.24
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
48000003
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$510.24 |
| Rate for Payer: Aetna Commercial |
$459.22
|
| Rate for Payer: Aetna Medicare |
$36.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.46
|
| Rate for Payer: ASR ASR |
$494.93
|
| Rate for Payer: ASR Commercial |
$494.93
|
| Rate for Payer: BCBS Complete |
$20.47
|
| Rate for Payer: BCBS MAPPO |
$36.37
|
| Rate for Payer: BCBS Trust/PPO |
$417.84
|
| Rate for Payer: BCN Commercial |
$395.59
|
| Rate for Payer: BCN Medicare Advantage |
$36.37
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cofinity Commercial |
$479.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.37
|
| Rate for Payer: Healthscope Commercial |
$510.24
|
| Rate for Payer: Healthscope Whirlpool |
$494.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$36.37
|
| Rate for Payer: Mclaren Commercial |
$459.22
|
| Rate for Payer: Mclaren Medicaid |
$19.49
|
| Rate for Payer: Mclaren Medicare |
$36.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.19
|
| Rate for Payer: Meridian Medicaid |
$20.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: Nomi Health Commercial |
$418.40
|
| Rate for Payer: PACE Medicare |
$34.55
|
| Rate for Payer: PACE SWMI |
$36.37
|
| Rate for Payer: PHP Commercial |
$40.01
|
| Rate for Payer: PHP Medicaid |
$19.49
|
| Rate for Payer: PHP Medicare Advantage |
$36.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$447.07
|
| Rate for Payer: Priority Health Medicare |
$36.37
|
| Rate for Payer: Priority Health Narrow Network |
$357.68
|
| Rate for Payer: Railroad Medicare Medicare |
$36.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.37
|
| Rate for Payer: UHC Exchange |
$56.37
|
| Rate for Payer: UHC Medicare Advantage |
$36.37
|
| Rate for Payer: UHCCP DNSP |
$36.37
|
| Rate for Payer: UHCCP Medicaid |
$19.49
|
| Rate for Payer: VA VA |
$36.37
|
|
|
HC EVENT MONITOR
|
Facility
|
IP
|
$510.24
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
48000003
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$331.66 |
| Max. Negotiated Rate |
$510.24 |
| Rate for Payer: Aetna Commercial |
$459.22
|
| Rate for Payer: ASR ASR |
$494.93
|
| Rate for Payer: ASR Commercial |
$494.93
|
| Rate for Payer: BCBS Trust/PPO |
$415.79
|
| Rate for Payer: BCN Commercial |
$395.59
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cofinity Commercial |
$479.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Healthscope Commercial |
$510.24
|
| Rate for Payer: Healthscope Whirlpool |
$494.93
|
| Rate for Payer: Mclaren Commercial |
$459.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: Nomi Health Commercial |
$418.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.01
|
|
|
HC EVEROLIMUS
|
Facility
|
IP
|
$69.71
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
30100626
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.31 |
| Max. Negotiated Rate |
$69.71 |
| Rate for Payer: Aetna Commercial |
$62.74
|
| Rate for Payer: ASR ASR |
$67.62
|
| Rate for Payer: ASR Commercial |
$67.62
|
| Rate for Payer: BCBS Trust/PPO |
$56.81
|
| Rate for Payer: BCN Commercial |
$54.05
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cofinity Commercial |
$65.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.77
|
| Rate for Payer: Healthscope Commercial |
$69.71
|
| Rate for Payer: Healthscope Whirlpool |
$67.62
|
| Rate for Payer: Mclaren Commercial |
$62.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.25
|
| Rate for Payer: Nomi Health Commercial |
$57.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.34
|
|
|
HC EVEROLIMUS
|
Facility
|
OP
|
$69.71
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
30100626
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$69.71 |
| Rate for Payer: Aetna Commercial |
$62.74
|
| 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 |
$67.62
|
| Rate for Payer: ASR Commercial |
$67.62
|
| Rate for Payer: BCBS Complete |
$7.73
|
| Rate for Payer: BCBS MAPPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$57.09
|
| Rate for Payer: BCN Commercial |
$54.05
|
| Rate for Payer: BCN Medicare Advantage |
$13.73
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cofinity Commercial |
$65.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.73
|
| Rate for Payer: Healthscope Commercial |
$69.71
|
| Rate for Payer: Healthscope Whirlpool |
$67.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.73
|
| Rate for Payer: Mclaren Commercial |
$62.74
|
| Rate for Payer: Mclaren Medicaid |
$7.36
|
| Rate for Payer: Mclaren Medicare |
$13.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.42
|
| Rate for Payer: Meridian Medicaid |
$7.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.25
|
| Rate for Payer: Nomi Health Commercial |
$57.16
|
| 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 |
$7.36
|
| Rate for Payer: PHP Medicare Advantage |
$13.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.08
|
| Rate for Payer: Priority Health Medicare |
$13.73
|
| Rate for Payer: Priority Health Narrow Network |
$48.87
|
| Rate for Payer: Railroad Medicare Medicare |
$13.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.73
|
| Rate for Payer: UHC Exchange |
$21.28
|
| Rate for Payer: UHC Medicare Advantage |
$13.73
|
| Rate for Payer: UHCCP DNSP |
$13.73
|
| Rate for Payer: UHCCP Medicaid |
$7.36
|
| Rate for Payer: VA VA |
$13.73
|
|
|
HC EVOKED AUDITORY TEST COMPLETE
|
Facility
|
IP
|
$286.62
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
76100506
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$186.30 |
| Max. Negotiated Rate |
$286.62 |
| Rate for Payer: Aetna Commercial |
$257.96
|
| Rate for Payer: ASR ASR |
$278.02
|
| Rate for Payer: ASR Commercial |
$278.02
|
| Rate for Payer: BCBS Trust/PPO |
$233.57
|
| Rate for Payer: BCN Commercial |
$222.22
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cofinity Commercial |
$269.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.30
|
| Rate for Payer: Healthscope Commercial |
$286.62
|
| Rate for Payer: Healthscope Whirlpool |
$278.02
|
| Rate for Payer: Mclaren Commercial |
$257.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.63
|
| Rate for Payer: Nomi Health Commercial |
$235.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.23
|
|
|
HC EVOKED AUDITORY TEST COMPLETE
|
Facility
|
OP
|
$286.62
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
76100506
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$470.74 |
| Rate for Payer: Aetna Commercial |
$257.96
|
| 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 |
$278.02
|
| Rate for Payer: ASR Commercial |
$278.02
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$234.71
|
| Rate for Payer: BCN Commercial |
$222.22
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cofinity Commercial |
$269.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$286.62
|
| Rate for Payer: Healthscope Whirlpool |
$278.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$257.96
|
| 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 |
$243.63
|
| Rate for Payer: Nomi Health Commercial |
$235.03
|
| 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 |
$186.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.14
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$200.92
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.23
|
| 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 EVOKED AUDITORY TEST LIMITED
|
Facility
|
IP
|
$286.62
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
76100507
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$186.30 |
| Max. Negotiated Rate |
$286.62 |
| Rate for Payer: Aetna Commercial |
$257.96
|
| Rate for Payer: ASR ASR |
$278.02
|
| Rate for Payer: ASR Commercial |
$278.02
|
| Rate for Payer: BCBS Trust/PPO |
$233.57
|
| Rate for Payer: BCN Commercial |
$222.22
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cofinity Commercial |
$269.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.30
|
| Rate for Payer: Healthscope Commercial |
$286.62
|
| Rate for Payer: Healthscope Whirlpool |
$278.02
|
| Rate for Payer: Mclaren Commercial |
$257.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.63
|
| Rate for Payer: Nomi Health Commercial |
$235.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.23
|
|
|
HC EVOKED AUDITORY TEST LIMITED
|
Facility
|
OP
|
$286.62
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
76100507
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$470.74 |
| Rate for Payer: Aetna Commercial |
$257.96
|
| 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 |
$278.02
|
| Rate for Payer: ASR Commercial |
$278.02
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$234.71
|
| Rate for Payer: BCN Commercial |
$222.22
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cofinity Commercial |
$269.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$286.62
|
| Rate for Payer: Healthscope Whirlpool |
$278.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$257.96
|
| 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 |
$243.63
|
| Rate for Payer: Nomi Health Commercial |
$235.03
|
| 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 |
$186.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.14
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$200.92
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.23
|
| 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 EVOKED OTOACOUSTIC EMISNS LIMITD
|
Facility
|
OP
|
$785.40
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
76100489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$785.40 |
| Rate for Payer: Aetna Commercial |
$706.86
|
| 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 |
$761.84
|
| Rate for Payer: ASR Commercial |
$761.84
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCBS Trust/PPO |
$643.16
|
| Rate for Payer: BCN Commercial |
$608.92
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$628.32
|
| Rate for Payer: Cash Price |
$628.32
|
| Rate for Payer: Cofinity Commercial |
$738.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$785.40
|
| Rate for Payer: Healthscope Whirlpool |
$761.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.70
|
| Rate for Payer: Mclaren Commercial |
$706.86
|
| 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 |
$667.59
|
| Rate for Payer: Nomi Health Commercial |
$644.03
|
| 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 |
$510.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$688.17
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health Narrow Network |
$550.57
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$691.15
|
| 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 EVOKED OTOACOUSTIC EMISNS LIMITD
|
Facility
|
IP
|
$785.40
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
76100489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.51 |
| Max. Negotiated Rate |
$785.40 |
| Rate for Payer: Aetna Commercial |
$706.86
|
| Rate for Payer: ASR ASR |
$761.84
|
| Rate for Payer: ASR Commercial |
$761.84
|
| Rate for Payer: BCBS Trust/PPO |
$640.02
|
| Rate for Payer: BCN Commercial |
$608.92
|
| Rate for Payer: Cash Price |
$628.32
|
| Rate for Payer: Cofinity Commercial |
$738.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.32
|
| Rate for Payer: Healthscope Commercial |
$785.40
|
| Rate for Payer: Healthscope Whirlpool |
$761.84
|
| Rate for Payer: Mclaren Commercial |
$706.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$667.59
|
| Rate for Payer: Nomi Health Commercial |
$644.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$691.15
|
|
