|
HC SP AORTAGRAM ABDOMEN W RUNOFF
|
Facility
|
IP
|
$3,202.09
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
32000177
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,241.46 |
| Max. Negotiated Rate |
$3,202.09 |
| Rate for Payer: Aetna Commercial |
$2,881.88
|
| Rate for Payer: ASR ASR |
$3,106.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,482.58
|
| Rate for Payer: BCN Commercial |
$2,482.58
|
| Rate for Payer: Cash Price |
$2,561.67
|
| Rate for Payer: Cofinity Commercial |
$3,009.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,561.67
|
| Rate for Payer: Healthscope Commercial |
$3,202.09
|
| Rate for Payer: Healthscope Whirlpool |
$3,106.03
|
| Rate for Payer: Mclaren Commercial |
$2,881.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,721.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,241.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,817.84
|
|
|
HC SP AORTAGRAM ABDOMEN W RUNOFF
|
Facility
|
OP
|
$3,202.09
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
32000177
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,549.81 |
| Max. Negotiated Rate |
$3,541.61 |
| Rate for Payer: Aetna Commercial |
$2,881.88
|
| Rate for Payer: Aetna Medicare |
$2,833.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: ASR ASR |
$3,106.03
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,482.58
|
| Rate for Payer: BCN Commercial |
$2,482.58
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$2,561.67
|
| Rate for Payer: Cash Price |
$2,561.67
|
| Rate for Payer: Cofinity Commercial |
$3,009.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,561.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$3,202.09
|
| Rate for Payer: Healthscope Whirlpool |
$3,106.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,833.29
|
| Rate for Payer: Mclaren Commercial |
$2,881.88
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,721.78
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Commercial |
$3,116.62
|
| Rate for Payer: PHP Medicaid |
$1,549.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,241.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,913.90
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,273.48
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,817.84
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
HC SPECIAL DOSIMETRY
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 77331
|
| Hospital Charge Code |
33300013
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Aetna Commercial |
$116.10
|
| Rate for Payer: Aetna Commercial |
$135.86
|
| Rate for Payer: ASR ASR |
$125.13
|
| Rate for Payer: ASR ASR |
$146.43
|
| Rate for Payer: BCBS Trust/PPO |
$117.04
|
| Rate for Payer: BCBS Trust/PPO |
$100.01
|
| Rate for Payer: BCN Commercial |
$117.04
|
| Rate for Payer: BCN Commercial |
$100.01
|
| Rate for Payer: Cash Price |
$120.77
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$141.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.20
|
| Rate for Payer: Healthscope Commercial |
$129.00
|
| Rate for Payer: Healthscope Commercial |
$150.96
|
| Rate for Payer: Healthscope Whirlpool |
$146.43
|
| Rate for Payer: Healthscope Whirlpool |
$125.13
|
| Rate for Payer: Mclaren Commercial |
$135.86
|
| Rate for Payer: Mclaren Commercial |
$116.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.84
|
|
|
HC SPECIAL DOSIMETRY
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 77331
|
| Hospital Charge Code |
33300013
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$65.97 |
| Max. Negotiated Rate |
$150.76 |
| Rate for Payer: Aetna Commercial |
$116.10
|
| Rate for Payer: Aetna Commercial |
$135.86
|
| Rate for Payer: Aetna Medicare |
$120.61
|
| Rate for Payer: Aetna Medicare |
$120.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
| Rate for Payer: ASR ASR |
$125.13
|
| Rate for Payer: ASR ASR |
$146.43
|
| Rate for Payer: BCBS Complete |
$69.28
|
| Rate for Payer: BCBS Complete |
$69.28
|
| Rate for Payer: BCBS MAPPO |
$120.61
|
| Rate for Payer: BCBS MAPPO |
$120.61
|
| Rate for Payer: BCBS Trust/PPO |
$100.01
|
| Rate for Payer: BCBS Trust/PPO |
$117.04
|
| Rate for Payer: BCN Commercial |
$117.04
|
| Rate for Payer: BCN Commercial |
$100.01
|
| Rate for Payer: BCN Medicare Advantage |
$120.61
|
| Rate for Payer: BCN Medicare Advantage |
$120.61
|
| Rate for Payer: Cash Price |
$120.77
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$120.77
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$141.90
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
| Rate for Payer: Healthscope Commercial |
$150.96
|
| Rate for Payer: Healthscope Commercial |
$129.00
|
| Rate for Payer: Healthscope Whirlpool |
$125.13
|
| Rate for Payer: Healthscope Whirlpool |
$146.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$120.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$120.61
|
| Rate for Payer: Mclaren Commercial |
$116.10
|
| Rate for Payer: Mclaren Commercial |
$135.86
|
| Rate for Payer: Mclaren Medicaid |
$65.97
|
| Rate for Payer: Mclaren Medicaid |
$65.97
|
| Rate for Payer: Mclaren Medicare |
$120.61
|
| Rate for Payer: Mclaren Medicare |
$120.61
|
| Rate for Payer: Meridian Medicaid |
$69.28
|
| Rate for Payer: Meridian Medicaid |
$69.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.65
|
| Rate for Payer: PACE Medicare |
$114.58
|
| Rate for Payer: PACE Medicare |
$114.58
|
| Rate for Payer: PACE SWMI |
$120.61
|
| Rate for Payer: PACE SWMI |
$120.61
|
| Rate for Payer: PHP Commercial |
$132.67
|
| Rate for Payer: PHP Commercial |
$132.67
|
| Rate for Payer: PHP Medicaid |
$65.97
|
| Rate for Payer: PHP Medicaid |
$65.97
|
| Rate for Payer: PHP Medicare Advantage |
$120.61
|
| Rate for Payer: PHP Medicare Advantage |
$120.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.37
|
| Rate for Payer: Priority Health Medicare |
$120.61
|
| Rate for Payer: Priority Health Medicare |
$120.61
|
| Rate for Payer: Priority Health Narrow Network |
$91.59
|
| Rate for Payer: Priority Health Narrow Network |
$107.18
|
| Rate for Payer: Railroad Medicare Medicare |
$120.61
|
| Rate for Payer: Railroad Medicare Medicare |
$120.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.84
|
| Rate for Payer: UHC Medicare Advantage |
$124.23
|
| Rate for Payer: UHC Medicare Advantage |
$124.23
|
| Rate for Payer: VA VA |
$120.61
|
| Rate for Payer: VA VA |
$120.61
|
|
|
HC SPECIAL STAINS
|
Facility
|
OP
|
$187.96
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
31000053
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.35 |
| Max. Negotiated Rate |
$187.96 |
| Rate for Payer: Aetna Commercial |
$169.16
|
| Rate for Payer: Aetna Medicare |
$48.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.21
|
| Rate for Payer: ASR ASR |
$182.32
|
| Rate for Payer: BCBS Complete |
$27.67
|
| Rate for Payer: BCBS MAPPO |
$48.17
|
| Rate for Payer: BCBS Trust/PPO |
$145.73
|
| Rate for Payer: BCN Commercial |
$145.73
|
| Rate for Payer: BCN Medicare Advantage |
$48.17
|
| Rate for Payer: Cash Price |
$150.37
|
| Rate for Payer: Cash Price |
$150.37
|
| Rate for Payer: Cofinity Commercial |
$176.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.17
|
| Rate for Payer: Healthscope Commercial |
$187.96
|
| Rate for Payer: Healthscope Whirlpool |
$182.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$48.17
|
| Rate for Payer: Mclaren Commercial |
$169.16
|
| Rate for Payer: Mclaren Medicaid |
$26.35
|
| Rate for Payer: Mclaren Medicare |
$48.17
|
| Rate for Payer: Meridian Medicaid |
$27.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$159.77
|
| Rate for Payer: PACE Medicare |
$45.76
|
| Rate for Payer: PACE SWMI |
$48.17
|
| Rate for Payer: PHP Commercial |
$52.99
|
| Rate for Payer: PHP Medicaid |
$26.35
|
| Rate for Payer: PHP Medicare Advantage |
$48.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.86
|
| Rate for Payer: Priority Health Medicare |
$48.17
|
| Rate for Payer: Priority Health Narrow Network |
$89.49
|
| Rate for Payer: Railroad Medicare Medicare |
$48.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.40
|
| Rate for Payer: UHC Medicare Advantage |
$49.62
|
| Rate for Payer: VA VA |
$48.17
|
|
|
HC SPECIAL STAINS
|
Facility
|
IP
|
$187.96
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
31000053
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$131.57 |
| Max. Negotiated Rate |
$187.96 |
| Rate for Payer: Aetna Commercial |
$169.16
|
| Rate for Payer: ASR ASR |
$182.32
|
| Rate for Payer: BCBS Trust/PPO |
$145.73
|
| Rate for Payer: BCN Commercial |
$145.73
|
| Rate for Payer: Cash Price |
$150.37
|
| Rate for Payer: Cofinity Commercial |
$176.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.37
|
| Rate for Payer: Healthscope Commercial |
$187.96
|
| Rate for Payer: Healthscope Whirlpool |
$182.32
|
| Rate for Payer: Mclaren Commercial |
$169.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$159.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.40
|
|
|
HC SPECIAL STAINS II
|
Facility
|
OP
|
$180.58
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
31000054
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$180.58 |
| Rate for Payer: Aetna Commercial |
$162.52
|
| Rate for Payer: Aetna Medicare |
$54.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.96
|
| Rate for Payer: ASR ASR |
$175.16
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$140.00
|
| Rate for Payer: BCN Commercial |
$140.00
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Cash Price |
$144.46
|
| Rate for Payer: Cash Price |
$144.46
|
| Rate for Payer: Cofinity Commercial |
$169.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Healthscope Commercial |
$180.58
|
| Rate for Payer: Healthscope Whirlpool |
$175.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$54.37
|
| Rate for Payer: Mclaren Commercial |
$162.52
|
| Rate for Payer: Mclaren Medicaid |
$29.74
|
| Rate for Payer: Mclaren Medicare |
$54.37
|
| Rate for Payer: Meridian Medicaid |
$31.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.49
|
| Rate for Payer: PACE Medicare |
$51.65
|
| Rate for Payer: PACE SWMI |
$54.37
|
| Rate for Payer: PHP Commercial |
$59.81
|
| Rate for Payer: PHP Medicaid |
$29.74
|
| Rate for Payer: PHP Medicare Advantage |
$54.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.86
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$89.49
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.91
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: VA VA |
$54.37
|
|
|
HC SPECIAL STAINS II
|
Facility
|
IP
|
$180.58
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
31000054
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$126.41 |
| Max. Negotiated Rate |
$180.58 |
| Rate for Payer: Aetna Commercial |
$162.52
|
| Rate for Payer: ASR ASR |
$175.16
|
| Rate for Payer: BCBS Trust/PPO |
$140.00
|
| Rate for Payer: BCN Commercial |
$140.00
|
| Rate for Payer: Cash Price |
$144.46
|
| Rate for Payer: Cofinity Commercial |
$169.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.46
|
| Rate for Payer: Healthscope Commercial |
$180.58
|
| Rate for Payer: Healthscope Whirlpool |
$175.16
|
| Rate for Payer: Mclaren Commercial |
$162.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.91
|
|
|
HC SPECIFIC GRAVITY FLUID NOT URINE
|
Facility
|
IP
|
$12.10
|
|
|
Service Code
|
CPT 84315
|
| Hospital Charge Code |
30100426
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna Commercial |
$10.89
|
| Rate for Payer: ASR ASR |
$11.74
|
| Rate for Payer: BCBS Trust/PPO |
$9.38
|
| Rate for Payer: BCN Commercial |
$9.38
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cofinity Commercial |
$11.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Healthscope Commercial |
$12.10
|
| Rate for Payer: Healthscope Whirlpool |
$11.74
|
| Rate for Payer: Mclaren Commercial |
$10.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.65
|
|
|
HC SPECIFIC GRAVITY FLUID NOT URINE
|
Facility
|
OP
|
$12.10
|
|
|
Service Code
|
CPT 84315
|
| Hospital Charge Code |
30100426
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$12.83 |
| Rate for Payer: Aetna Commercial |
$10.89
|
| Rate for Payer: Aetna Medicare |
$3.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.10
|
| Rate for Payer: ASR ASR |
$11.74
|
| Rate for Payer: BCBS Complete |
$1.88
|
| Rate for Payer: BCBS MAPPO |
$3.28
|
| Rate for Payer: BCBS Trust/PPO |
$9.38
|
| Rate for Payer: BCN Commercial |
$9.38
|
| Rate for Payer: BCN Medicare Advantage |
$3.28
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cofinity Commercial |
$11.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.28
|
| Rate for Payer: Healthscope Commercial |
$12.10
|
| Rate for Payer: Healthscope Whirlpool |
$11.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.28
|
| Rate for Payer: Mclaren Commercial |
$10.89
|
| Rate for Payer: Mclaren Medicaid |
$1.79
|
| Rate for Payer: Mclaren Medicare |
$3.28
|
| Rate for Payer: Meridian Medicaid |
$1.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.28
|
| Rate for Payer: PACE Medicare |
$3.12
|
| Rate for Payer: PACE SWMI |
$3.28
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: PHP Medicaid |
$1.79
|
| Rate for Payer: PHP Medicare Advantage |
$3.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.83
|
| Rate for Payer: Priority Health Medicare |
$3.28
|
| Rate for Payer: Priority Health Narrow Network |
$10.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.65
|
| Rate for Payer: UHC Medicare Advantage |
$3.38
|
| Rate for Payer: VA VA |
$3.28
|
|
|
HC SPECIMEN CONCENTRATION FOR INFECTIOUS AGENTS
|
Facility
|
IP
|
$43.20
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
30600068
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.24 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$38.88
|
| Rate for Payer: ASR ASR |
$41.90
|
| Rate for Payer: BCBS Trust/PPO |
$33.49
|
| Rate for Payer: BCN Commercial |
$33.49
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Cofinity Commercial |
$40.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.56
|
| Rate for Payer: Healthscope Commercial |
$43.20
|
| Rate for Payer: Healthscope Whirlpool |
$41.90
|
| Rate for Payer: Mclaren Commercial |
$38.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.02
|
|
|
HC SPECIMEN CONCENTRATION FOR INFECTIOUS AGENTS
|
Facility
|
OP
|
$43.20
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
30600068
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$38.88
|
| Rate for Payer: Aetna Medicare |
$6.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.35
|
| Rate for Payer: ASR ASR |
$41.90
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: BCBS MAPPO |
$6.68
|
| Rate for Payer: BCBS Trust/PPO |
$33.49
|
| Rate for Payer: BCN Commercial |
$33.49
|
| Rate for Payer: BCN Medicare Advantage |
$6.68
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Cofinity Commercial |
$40.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$43.20
|
| Rate for Payer: Healthscope Whirlpool |
$41.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.68
|
| Rate for Payer: Mclaren Commercial |
$38.88
|
| Rate for Payer: Mclaren Medicaid |
$3.65
|
| Rate for Payer: Mclaren Medicare |
$6.68
|
| Rate for Payer: Meridian Medicaid |
$3.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.72
|
| Rate for Payer: PACE Medicare |
$6.35
|
| Rate for Payer: PACE SWMI |
$6.68
|
| Rate for Payer: PHP Commercial |
$7.35
|
| Rate for Payer: PHP Medicaid |
$3.65
|
| Rate for Payer: PHP Medicare Advantage |
$6.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.50
|
| Rate for Payer: Priority Health Medicare |
$6.68
|
| Rate for Payer: Priority Health Narrow Network |
$15.60
|
| Rate for Payer: Railroad Medicare Medicare |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.02
|
| Rate for Payer: UHC Medicare Advantage |
$6.88
|
| Rate for Payer: VA VA |
$6.68
|
|
|
HC SPEC PHYSICS CONSULT
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
33300017
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$65.97 |
| Max. Negotiated Rate |
$826.00 |
| Rate for Payer: Aetna Commercial |
$743.40
|
| Rate for Payer: Aetna Commercial |
$491.13
|
| Rate for Payer: Aetna Medicare |
$120.61
|
| Rate for Payer: Aetna Medicare |
$120.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
| Rate for Payer: ASR ASR |
$529.33
|
| Rate for Payer: ASR ASR |
$801.22
|
| Rate for Payer: BCBS Complete |
$69.28
|
| Rate for Payer: BCBS Complete |
$69.28
|
| Rate for Payer: BCBS MAPPO |
$120.61
|
| Rate for Payer: BCBS MAPPO |
$120.61
|
| Rate for Payer: BCBS Trust/PPO |
$640.40
|
| Rate for Payer: BCBS Trust/PPO |
$423.08
|
| Rate for Payer: BCN Commercial |
$640.40
|
| Rate for Payer: BCN Commercial |
$423.08
|
| Rate for Payer: BCN Medicare Advantage |
$120.61
|
| Rate for Payer: BCN Medicare Advantage |
$120.61
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cash Price |
$436.56
|
| Rate for Payer: Cash Price |
$436.56
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cofinity Commercial |
$512.96
|
| Rate for Payer: Cofinity Commercial |
$776.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
| Rate for Payer: Healthscope Commercial |
$545.70
|
| Rate for Payer: Healthscope Commercial |
$826.00
|
| Rate for Payer: Healthscope Whirlpool |
$801.22
|
| Rate for Payer: Healthscope Whirlpool |
$529.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$120.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$120.61
|
| Rate for Payer: Mclaren Commercial |
$743.40
|
| Rate for Payer: Mclaren Commercial |
$491.13
|
| Rate for Payer: Mclaren Medicaid |
$65.97
|
| Rate for Payer: Mclaren Medicaid |
$65.97
|
| Rate for Payer: Mclaren Medicare |
$120.61
|
| Rate for Payer: Mclaren Medicare |
$120.61
|
| Rate for Payer: Meridian Medicaid |
$69.28
|
| Rate for Payer: Meridian Medicaid |
$69.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$702.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$463.84
|
| Rate for Payer: PACE Medicare |
$114.58
|
| Rate for Payer: PACE Medicare |
$114.58
|
| Rate for Payer: PACE SWMI |
$120.61
|
| Rate for Payer: PACE SWMI |
$120.61
|
| Rate for Payer: PHP Commercial |
$132.67
|
| Rate for Payer: PHP Commercial |
$132.67
|
| Rate for Payer: PHP Medicaid |
$65.97
|
| Rate for Payer: PHP Medicaid |
$65.97
|
| Rate for Payer: PHP Medicare Advantage |
$120.61
|
| Rate for Payer: PHP Medicare Advantage |
$120.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$751.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$496.59
|
| Rate for Payer: Priority Health Medicare |
$120.61
|
| Rate for Payer: Priority Health Medicare |
$120.61
|
| Rate for Payer: Priority Health Narrow Network |
$387.45
|
| Rate for Payer: Priority Health Narrow Network |
$586.46
|
| Rate for Payer: Railroad Medicare Medicare |
$120.61
|
| Rate for Payer: Railroad Medicare Medicare |
$120.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$726.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.22
|
| Rate for Payer: UHC Medicare Advantage |
$124.23
|
| Rate for Payer: UHC Medicare Advantage |
$124.23
|
| Rate for Payer: VA VA |
$120.61
|
| Rate for Payer: VA VA |
$120.61
|
|
|
HC SPEC PHYSICS CONSULT
|
Facility
|
IP
|
$545.70
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
33300017
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$381.99 |
| Max. Negotiated Rate |
$545.70 |
| Rate for Payer: Aetna Commercial |
$491.13
|
| Rate for Payer: Aetna Commercial |
$743.40
|
| Rate for Payer: ASR ASR |
$801.22
|
| Rate for Payer: ASR ASR |
$529.33
|
| Rate for Payer: BCBS Trust/PPO |
$640.40
|
| Rate for Payer: BCBS Trust/PPO |
$423.08
|
| Rate for Payer: BCN Commercial |
$640.40
|
| Rate for Payer: BCN Commercial |
$423.08
|
| Rate for Payer: Cash Price |
$436.56
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cofinity Commercial |
$776.44
|
| Rate for Payer: Cofinity Commercial |
$512.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.56
|
| Rate for Payer: Healthscope Commercial |
$826.00
|
| Rate for Payer: Healthscope Commercial |
$545.70
|
| Rate for Payer: Healthscope Whirlpool |
$801.22
|
| Rate for Payer: Healthscope Whirlpool |
$529.33
|
| Rate for Payer: Mclaren Commercial |
$743.40
|
| Rate for Payer: Mclaren Commercial |
$491.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$702.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$463.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$726.88
|
|
|
HC SPECTRAL DOPPLER
|
Facility
|
OP
|
$483.91
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
48000006
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$193.56 |
| Max. Negotiated Rate |
$483.91 |
| Rate for Payer: Aetna Commercial |
$435.52
|
| Rate for Payer: ASR ASR |
$469.39
|
| Rate for Payer: BCBS Complete |
$193.56
|
| Rate for Payer: BCBS Trust/PPO |
$375.18
|
| Rate for Payer: BCN Commercial |
$375.18
|
| Rate for Payer: Cash Price |
$387.13
|
| Rate for Payer: Cash Price |
$387.13
|
| Rate for Payer: Cofinity Commercial |
$454.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.13
|
| Rate for Payer: Healthscope Commercial |
$483.91
|
| Rate for Payer: Healthscope Whirlpool |
$469.39
|
| Rate for Payer: Mclaren Commercial |
$435.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$411.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$364.81
|
| Rate for Payer: Priority Health Narrow Network |
$291.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$425.84
|
|
|
HC SPECTRAL DOPPLER
|
Facility
|
IP
|
$483.91
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
48000006
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$338.74 |
| Max. Negotiated Rate |
$483.91 |
| Rate for Payer: Aetna Commercial |
$435.52
|
| Rate for Payer: ASR ASR |
$469.39
|
| Rate for Payer: BCBS Trust/PPO |
$375.18
|
| Rate for Payer: BCN Commercial |
$375.18
|
| Rate for Payer: Cash Price |
$387.13
|
| Rate for Payer: Cofinity Commercial |
$454.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.13
|
| Rate for Payer: Healthscope Commercial |
$483.91
|
| Rate for Payer: Healthscope Whirlpool |
$469.39
|
| Rate for Payer: Mclaren Commercial |
$435.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$411.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$425.84
|
|
|
HC SPEC TX PROCEDURE
|
Facility
|
IP
|
$1,556.52
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
33300026
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,089.56 |
| Max. Negotiated Rate |
$1,556.52 |
| Rate for Payer: Aetna Commercial |
$1,400.87
|
| Rate for Payer: Aetna Commercial |
$2,104.20
|
| Rate for Payer: ASR ASR |
$2,267.86
|
| Rate for Payer: ASR ASR |
$1,509.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,206.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,812.65
|
| Rate for Payer: BCN Commercial |
$1,812.65
|
| Rate for Payer: BCN Commercial |
$1,206.77
|
| Rate for Payer: Cash Price |
$1,245.22
|
| Rate for Payer: Cash Price |
$1,870.40
|
| Rate for Payer: Cofinity Commercial |
$2,197.72
|
| Rate for Payer: Cofinity Commercial |
$1,463.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,245.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,870.40
|
| Rate for Payer: Healthscope Commercial |
$2,338.00
|
| Rate for Payer: Healthscope Commercial |
$1,556.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,509.82
|
| Rate for Payer: Healthscope Whirlpool |
$2,267.86
|
| Rate for Payer: Mclaren Commercial |
$2,104.20
|
| Rate for Payer: Mclaren Commercial |
$1,400.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,987.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,323.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,089.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,636.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,057.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,369.74
|
|
|
HC SPEC TX PROCEDURE
|
Facility
|
OP
|
$1,556.52
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
33300026
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$286.22 |
| Max. Negotiated Rate |
$1,556.52 |
| Rate for Payer: Aetna Commercial |
$1,400.87
|
| Rate for Payer: Aetna Commercial |
$2,104.20
|
| Rate for Payer: Aetna Medicare |
$523.25
|
| Rate for Payer: Aetna Medicare |
$523.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$654.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$654.06
|
| Rate for Payer: ASR ASR |
$1,509.82
|
| Rate for Payer: ASR ASR |
$2,267.86
|
| Rate for Payer: BCBS Complete |
$300.55
|
| Rate for Payer: BCBS Complete |
$300.55
|
| Rate for Payer: BCBS MAPPO |
$523.25
|
| Rate for Payer: BCBS MAPPO |
$523.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,812.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,206.77
|
| Rate for Payer: BCN Commercial |
$1,206.77
|
| Rate for Payer: BCN Commercial |
$1,812.65
|
| Rate for Payer: BCN Medicare Advantage |
$523.25
|
| Rate for Payer: BCN Medicare Advantage |
$523.25
|
| Rate for Payer: Cash Price |
$1,245.22
|
| Rate for Payer: Cash Price |
$1,870.40
|
| Rate for Payer: Cash Price |
$1,245.22
|
| Rate for Payer: Cash Price |
$1,870.40
|
| Rate for Payer: Cofinity Commercial |
$2,197.72
|
| Rate for Payer: Cofinity Commercial |
$1,463.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,245.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,870.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$523.25
|
| Rate for Payer: Healthscope Commercial |
$2,338.00
|
| Rate for Payer: Healthscope Commercial |
$1,556.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,509.82
|
| Rate for Payer: Healthscope Whirlpool |
$2,267.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$523.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$523.25
|
| Rate for Payer: Mclaren Commercial |
$2,104.20
|
| Rate for Payer: Mclaren Commercial |
$1,400.87
|
| Rate for Payer: Mclaren Medicaid |
$286.22
|
| Rate for Payer: Mclaren Medicaid |
$286.22
|
| Rate for Payer: Mclaren Medicare |
$523.25
|
| Rate for Payer: Mclaren Medicare |
$523.25
|
| Rate for Payer: Meridian Medicaid |
$300.55
|
| Rate for Payer: Meridian Medicaid |
$300.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$549.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$601.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$601.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,987.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,323.04
|
| Rate for Payer: PACE Medicare |
$497.09
|
| Rate for Payer: PACE Medicare |
$497.09
|
| Rate for Payer: PACE SWMI |
$523.25
|
| Rate for Payer: PACE SWMI |
$523.25
|
| Rate for Payer: PHP Commercial |
$575.58
|
| Rate for Payer: PHP Commercial |
$575.58
|
| Rate for Payer: PHP Medicaid |
$286.22
|
| Rate for Payer: PHP Medicaid |
$286.22
|
| Rate for Payer: PHP Medicare Advantage |
$523.25
|
| Rate for Payer: PHP Medicare Advantage |
$523.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,636.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,089.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,127.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,416.43
|
| Rate for Payer: Priority Health Medicare |
$523.25
|
| Rate for Payer: Priority Health Medicare |
$523.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,105.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,659.98
|
| Rate for Payer: Railroad Medicare Medicare |
$523.25
|
| Rate for Payer: Railroad Medicare Medicare |
$523.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,369.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,057.44
|
| Rate for Payer: UHC Medicare Advantage |
$538.95
|
| Rate for Payer: UHC Medicare Advantage |
$538.95
|
| Rate for Payer: VA VA |
$523.25
|
| Rate for Payer: VA VA |
$523.25
|
|
|
HC SPEECH AUDIOMETRY COMPLETE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 92556
|
| Hospital Charge Code |
76100502
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial |
$58.50
|
| Rate for Payer: ASR ASR |
$63.05
|
| Rate for Payer: BCBS Trust/PPO |
$50.39
|
| Rate for Payer: BCN Commercial |
$50.39
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$61.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$65.00
|
| Rate for Payer: Healthscope Whirlpool |
$63.05
|
| Rate for Payer: Mclaren Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.20
|
|
|
HC SPEECH AUDIOMETRY COMPLETE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 92556
|
| Hospital Charge Code |
76100502
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$67.96 |
| Rate for Payer: Aetna Commercial |
$58.50
|
| Rate for Payer: Aetna Medicare |
$54.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.96
|
| Rate for Payer: ASR ASR |
$63.05
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$50.39
|
| Rate for Payer: BCN Commercial |
$50.39
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$61.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Healthscope Commercial |
$65.00
|
| Rate for Payer: Healthscope Whirlpool |
$63.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$54.37
|
| Rate for Payer: Mclaren Commercial |
$58.50
|
| Rate for Payer: Mclaren Medicaid |
$29.74
|
| Rate for Payer: Mclaren Medicare |
$54.37
|
| Rate for Payer: Meridian Medicaid |
$31.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PACE Medicare |
$51.65
|
| Rate for Payer: PACE SWMI |
$54.37
|
| Rate for Payer: PHP Commercial |
$59.81
|
| Rate for Payer: PHP Medicaid |
$29.74
|
| Rate for Payer: PHP Medicare Advantage |
$54.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.15
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$46.15
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.20
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: VA VA |
$54.37
|
|
|
HC SPEECH EVAL
|
Facility
|
IP
|
$575.48
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
44400009
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$402.84 |
| Max. Negotiated Rate |
$575.48 |
| Rate for Payer: Aetna Commercial |
$517.93
|
| Rate for Payer: ASR ASR |
$558.22
|
| Rate for Payer: BCBS Trust/PPO |
$446.17
|
| Rate for Payer: BCN Commercial |
$446.17
|
| Rate for Payer: Cash Price |
$460.38
|
| Rate for Payer: Cofinity Commercial |
$540.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.38
|
| Rate for Payer: Healthscope Commercial |
$575.48
|
| Rate for Payer: Healthscope Whirlpool |
$558.22
|
| Rate for Payer: Mclaren Commercial |
$517.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$489.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$402.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$506.42
|
|
|
HC SPEECH EVAL
|
Facility
|
OP
|
$575.48
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
44400009
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$188.02 |
| Max. Negotiated Rate |
$575.48 |
| Rate for Payer: Aetna Commercial |
$517.93
|
| Rate for Payer: ASR ASR |
$558.22
|
| Rate for Payer: BCBS Complete |
$230.19
|
| Rate for Payer: BCBS Trust/PPO |
$446.17
|
| Rate for Payer: BCN Commercial |
$446.17
|
| Rate for Payer: Cash Price |
$460.38
|
| Rate for Payer: Cash Price |
$460.38
|
| Rate for Payer: Cofinity Commercial |
$540.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.38
|
| Rate for Payer: Healthscope Commercial |
$575.48
|
| Rate for Payer: Healthscope Whirlpool |
$558.22
|
| Rate for Payer: Mclaren Commercial |
$517.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$489.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$402.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$188.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$506.42
|
|
|
HC SPEECH FLUENCY EVAL
|
Facility
|
IP
|
$289.77
|
|
|
Service Code
|
CPT 92521
|
| Hospital Charge Code |
44400012
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$202.84 |
| Max. Negotiated Rate |
$289.77 |
| Rate for Payer: Aetna Commercial |
$260.79
|
| Rate for Payer: ASR ASR |
$281.08
|
| Rate for Payer: BCBS Trust/PPO |
$224.66
|
| Rate for Payer: BCN Commercial |
$224.66
|
| Rate for Payer: Cash Price |
$231.82
|
| Rate for Payer: Cofinity Commercial |
$272.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.82
|
| Rate for Payer: Healthscope Commercial |
$289.77
|
| Rate for Payer: Healthscope Whirlpool |
$281.08
|
| Rate for Payer: Mclaren Commercial |
$260.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.00
|
|
|
HC SPEECH FLUENCY EVAL
|
Facility
|
OP
|
$289.77
|
|
|
Service Code
|
CPT 92521
|
| Hospital Charge Code |
44400012
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$111.49 |
| Max. Negotiated Rate |
$289.77 |
| Rate for Payer: Aetna Commercial |
$260.79
|
| Rate for Payer: ASR ASR |
$281.08
|
| Rate for Payer: BCBS Complete |
$115.91
|
| Rate for Payer: BCBS Trust/PPO |
$224.66
|
| Rate for Payer: BCN Commercial |
$224.66
|
| Rate for Payer: Cash Price |
$231.82
|
| Rate for Payer: Cash Price |
$231.82
|
| Rate for Payer: Cofinity Commercial |
$272.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.82
|
| Rate for Payer: Healthscope Commercial |
$289.77
|
| Rate for Payer: Healthscope Whirlpool |
$281.08
|
| Rate for Payer: Mclaren Commercial |
$260.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.36
|
| Rate for Payer: Priority Health Narrow Network |
$111.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.00
|
|
|
HC SPEECH/LANGUAGE/HEARING THERAPY
|
Facility
|
OP
|
$212.16
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
44000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$84.86 |
| Max. Negotiated Rate |
$212.16 |
| Rate for Payer: Aetna Commercial |
$190.94
|
| Rate for Payer: ASR ASR |
$205.80
|
| Rate for Payer: BCBS Complete |
$84.86
|
| Rate for Payer: BCBS Trust/PPO |
$164.49
|
| Rate for Payer: BCN Commercial |
$164.49
|
| Rate for Payer: Cash Price |
$169.73
|
| Rate for Payer: Cash Price |
$169.73
|
| Rate for Payer: Cofinity Commercial |
$199.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.73
|
| Rate for Payer: Healthscope Commercial |
$212.16
|
| Rate for Payer: Healthscope Whirlpool |
$205.80
|
| Rate for Payer: Mclaren Commercial |
$190.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.87
|
| Rate for Payer: Priority Health Narrow Network |
$152.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.70
|
|
