|
HC SPECIMEN CONCENTRATION FOR INFECTIOUS AGENTS
|
Facility
|
OP
|
$44.94
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
30600068
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$44.94 |
| Rate for Payer: Aetna Commercial |
$40.45
|
| 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 |
$43.59
|
| Rate for Payer: BCBS Complete |
$3.67
|
| Rate for Payer: BCBS MAPPO |
$6.68
|
| Rate for Payer: BCBS Trust/PPO |
$37.05
|
| Rate for Payer: BCN Commercial |
$37.05
|
| Rate for Payer: BCN Medicare Advantage |
$6.68
|
| Rate for Payer: Cash Price |
$35.95
|
| Rate for Payer: Cash Price |
$35.95
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$43.59
|
| Rate for Payer: Healthscope Whirlpool |
$44.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.68
|
| Rate for Payer: Mclaren Commercial |
$40.45
|
| Rate for Payer: Mclaren Medicaid |
$6.68
|
| Rate for Payer: Mclaren Medicare |
$6.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.01
|
| Rate for Payer: Meridian Medicaid |
$3.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.20
|
| Rate for Payer: Nomi Health Commercial |
$36.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.70
|
| 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 |
$3.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.01
|
| Rate for Payer: Priority Health Medicare |
$6.68
|
| Rate for Payer: Priority Health Narrow Network |
$18.40
|
| Rate for Payer: Railroad Medicare Medicare |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.68
|
| Rate for Payer: UHC Exchange |
$10.35
|
| Rate for Payer: UHC Medicaid |
$3.49
|
| Rate for Payer: UHCCP DNSP |
$6.68
|
| Rate for Payer: UHCCP Medicaid |
$3.49
|
| Rate for Payer: VA VA |
$6.68
|
|
|
HC SPEC PHYSICS CONSULT
|
Facility
|
IP
|
$567.74
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
33300017
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$425.81 |
| Max. Negotiated Rate |
$567.74 |
| Rate for Payer: Aetna Commercial |
$510.97
|
| Rate for Payer: ASR ASR |
$550.71
|
| Rate for Payer: BCBS Trust/PPO |
$466.23
|
| Rate for Payer: BCN Commercial |
$466.23
|
| Rate for Payer: Cash Price |
$454.19
|
| Rate for Payer: Cofinity Commercial |
$533.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.19
|
| Rate for Payer: Healthscope Commercial |
$550.71
|
| Rate for Payer: Healthscope Whirlpool |
$567.74
|
| Rate for Payer: Mclaren Commercial |
$510.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.58
|
| Rate for Payer: Nomi Health Commercial |
$465.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$425.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$499.61
|
|
|
HC SPEC PHYSICS CONSULT
|
Facility
|
OP
|
$567.74
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
33300017
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$70.05 |
| Max. Negotiated Rate |
$567.74 |
| Rate for Payer: Aetna Commercial |
$510.97
|
| Rate for Payer: Aetna Medicare |
$133.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.41
|
| Rate for Payer: ASR ASR |
$550.71
|
| Rate for Payer: BCBS Complete |
$73.55
|
| Rate for Payer: BCBS MAPPO |
$133.93
|
| Rate for Payer: BCBS Trust/PPO |
$468.10
|
| Rate for Payer: BCN Commercial |
$468.10
|
| Rate for Payer: BCN Medicare Advantage |
$133.93
|
| Rate for Payer: Cash Price |
$454.19
|
| Rate for Payer: Cash Price |
$454.19
|
| Rate for Payer: Cofinity Commercial |
$533.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.93
|
| Rate for Payer: Healthscope Commercial |
$550.71
|
| Rate for Payer: Healthscope Whirlpool |
$567.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$133.93
|
| Rate for Payer: Mclaren Commercial |
$510.97
|
| Rate for Payer: Mclaren Medicaid |
$133.93
|
| Rate for Payer: Mclaren Medicare |
$133.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.63
|
| Rate for Payer: Meridian Medicaid |
$73.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.58
|
| Rate for Payer: Nomi Health Commercial |
$465.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$425.81
|
| Rate for Payer: PACE Medicare |
$127.23
|
| Rate for Payer: PACE SWMI |
$133.93
|
| Rate for Payer: PHP Commercial |
$147.32
|
| Rate for Payer: PHP Medicaid |
$71.79
|
| Rate for Payer: PHP Medicare Advantage |
$133.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$497.45
|
| Rate for Payer: Priority Health Medicare |
$133.93
|
| Rate for Payer: Priority Health Narrow Network |
$397.99
|
| Rate for Payer: Railroad Medicare Medicare |
$133.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$499.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.93
|
| Rate for Payer: UHC Exchange |
$207.59
|
| Rate for Payer: UHC Medicaid |
$70.05
|
| Rate for Payer: UHCCP DNSP |
$133.93
|
| Rate for Payer: UHCCP Medicaid |
$70.05
|
| Rate for Payer: VA VA |
$133.93
|
|
|
HC SPECTRAL DOPPLER
|
Facility
|
OP
|
$503.46
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
48000006
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$186.28 |
| Max. Negotiated Rate |
$503.46 |
| Rate for Payer: Aetna Commercial |
$453.11
|
| Rate for Payer: Aetna Medicare |
$186.28
|
| Rate for Payer: ASR ASR |
$488.36
|
| Rate for Payer: BCBS Complete |
$201.38
|
| Rate for Payer: BCBS Trust/PPO |
$415.10
|
| Rate for Payer: BCN Commercial |
$415.10
|
| Rate for Payer: Cash Price |
$402.77
|
| Rate for Payer: Cash Price |
$402.77
|
| Rate for Payer: Cofinity Commercial |
$473.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.77
|
| Rate for Payer: Healthscope Commercial |
$488.36
|
| Rate for Payer: Healthscope Whirlpool |
$503.46
|
| Rate for Payer: Mclaren Commercial |
$453.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.94
|
| Rate for Payer: Nomi Health Commercial |
$412.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$377.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$430.36
|
| Rate for Payer: Priority Health Narrow Network |
$344.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$443.04
|
|
|
HC SPECTRAL DOPPLER
|
Facility
|
IP
|
$503.46
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
48000006
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$377.60 |
| Max. Negotiated Rate |
$503.46 |
| Rate for Payer: Aetna Commercial |
$453.11
|
| Rate for Payer: ASR ASR |
$488.36
|
| Rate for Payer: BCBS Trust/PPO |
$413.44
|
| Rate for Payer: BCN Commercial |
$413.44
|
| Rate for Payer: Cash Price |
$402.77
|
| Rate for Payer: Cofinity Commercial |
$473.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.77
|
| Rate for Payer: Healthscope Commercial |
$488.36
|
| Rate for Payer: Healthscope Whirlpool |
$503.46
|
| Rate for Payer: Mclaren Commercial |
$453.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.94
|
| Rate for Payer: Nomi Health Commercial |
$412.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$377.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$443.04
|
|
|
HC SPEC TX PROCEDURE
|
Facility
|
IP
|
$1,619.40
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
33300026
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,214.55 |
| Max. Negotiated Rate |
$1,619.40 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: ASR ASR |
$1,570.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,329.85
|
| Rate for Payer: BCN Commercial |
$1,329.85
|
| Rate for Payer: Cash Price |
$1,295.52
|
| Rate for Payer: Cofinity Commercial |
$1,522.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,295.52
|
| Rate for Payer: Healthscope Commercial |
$1,570.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,619.40
|
| Rate for Payer: Mclaren Commercial |
$1,457.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,376.49
|
| Rate for Payer: Nomi Health Commercial |
$1,327.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,214.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,425.07
|
|
|
HC SPEC TX PROCEDURE
|
Facility
|
OP
|
$1,619.40
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
33300026
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$287.94 |
| Max. Negotiated Rate |
$1,619.40 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Aetna Medicare |
$550.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$688.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$688.20
|
| Rate for Payer: ASR ASR |
$1,570.82
|
| Rate for Payer: BCBS Complete |
$302.37
|
| Rate for Payer: BCBS MAPPO |
$550.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,335.20
|
| Rate for Payer: BCN Commercial |
$1,335.20
|
| Rate for Payer: BCN Medicare Advantage |
$550.56
|
| Rate for Payer: Cash Price |
$1,295.52
|
| Rate for Payer: Cash Price |
$1,295.52
|
| Rate for Payer: Cofinity Commercial |
$1,522.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,295.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.56
|
| Rate for Payer: Healthscope Commercial |
$1,570.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,619.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$550.56
|
| Rate for Payer: Mclaren Commercial |
$1,457.46
|
| Rate for Payer: Mclaren Medicaid |
$550.56
|
| Rate for Payer: Mclaren Medicare |
$550.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.09
|
| Rate for Payer: Meridian Medicaid |
$302.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$633.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$605.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,376.49
|
| Rate for Payer: Nomi Health Commercial |
$1,327.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,214.55
|
| Rate for Payer: PACE Medicare |
$523.03
|
| Rate for Payer: PACE SWMI |
$550.56
|
| Rate for Payer: PHP Commercial |
$605.62
|
| Rate for Payer: PHP Medicaid |
$295.10
|
| Rate for Payer: PHP Medicare Advantage |
$550.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,418.92
|
| Rate for Payer: Priority Health Medicare |
$550.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,135.20
|
| Rate for Payer: Railroad Medicare Medicare |
$550.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,425.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$550.56
|
| Rate for Payer: UHC Exchange |
$853.37
|
| Rate for Payer: UHC Medicaid |
$287.94
|
| Rate for Payer: UHCCP DNSP |
$550.56
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| Rate for Payer: VA VA |
$550.56
|
|
|
HC SPEECH AUDIOMETRY COMPLETE
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 92556
|
| Hospital Charge Code |
76100502
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$67.63 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: BCBS Trust/PPO |
$55.54
|
| Rate for Payer: BCN Commercial |
$55.54
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$65.60
|
| Rate for Payer: Healthscope Whirlpool |
$67.63
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
|
|
HC SPEECH AUDIOMETRY COMPLETE
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 92556
|
| Hospital Charge Code |
76100502
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$91.11 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: Aetna Medicare |
$58.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$55.76
|
| Rate for Payer: BCN Commercial |
$55.76
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$65.60
|
| Rate for Payer: Healthscope Whirlpool |
$67.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.78
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$32.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$64.66
|
| Rate for Payer: PHP Medicaid |
$31.51
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$59.26
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Narrow Network |
$47.41
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$91.11
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP DNSP |
$58.78
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC SPEECH EVAL
|
Facility
|
IP
|
$667.13
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
44400009
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$500.35 |
| Max. Negotiated Rate |
$667.13 |
| Rate for Payer: Aetna Commercial |
$600.42
|
| Rate for Payer: ASR ASR |
$647.12
|
| Rate for Payer: BCBS Trust/PPO |
$547.85
|
| Rate for Payer: BCN Commercial |
$547.85
|
| Rate for Payer: Cash Price |
$533.70
|
| Rate for Payer: Cofinity Commercial |
$627.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.70
|
| Rate for Payer: Healthscope Commercial |
$647.12
|
| Rate for Payer: Healthscope Whirlpool |
$667.13
|
| Rate for Payer: Mclaren Commercial |
$600.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$567.06
|
| Rate for Payer: Nomi Health Commercial |
$547.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$500.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$587.07
|
|
|
HC SPEECH EVAL
|
Facility
|
OP
|
$667.13
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
44400009
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$221.80 |
| Max. Negotiated Rate |
$667.13 |
| Rate for Payer: Aetna Commercial |
$600.42
|
| Rate for Payer: Aetna Medicare |
$246.84
|
| Rate for Payer: ASR ASR |
$647.12
|
| Rate for Payer: BCBS Complete |
$266.85
|
| Rate for Payer: BCBS Trust/PPO |
$550.05
|
| Rate for Payer: BCN Commercial |
$550.05
|
| Rate for Payer: Cash Price |
$533.70
|
| Rate for Payer: Cash Price |
$533.70
|
| Rate for Payer: Cofinity Commercial |
$627.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.70
|
| Rate for Payer: Healthscope Commercial |
$647.12
|
| Rate for Payer: Healthscope Whirlpool |
$667.13
|
| Rate for Payer: Mclaren Commercial |
$600.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$533.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$567.06
|
| Rate for Payer: Nomi Health Commercial |
$547.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$500.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$277.25
|
| Rate for Payer: Priority Health Narrow Network |
$221.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$587.07
|
|
|
HC SPEECH FLUENCY EVAL
|
Facility
|
IP
|
$354.68
|
|
|
Service Code
|
CPT 92521
|
| Hospital Charge Code |
44400012
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$266.01 |
| Max. Negotiated Rate |
$354.68 |
| Rate for Payer: Aetna Commercial |
$319.21
|
| Rate for Payer: ASR ASR |
$344.04
|
| Rate for Payer: BCBS Trust/PPO |
$291.26
|
| Rate for Payer: BCN Commercial |
$291.26
|
| Rate for Payer: Cash Price |
$283.74
|
| Rate for Payer: Cofinity Commercial |
$333.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.74
|
| Rate for Payer: Healthscope Commercial |
$344.04
|
| Rate for Payer: Healthscope Whirlpool |
$354.68
|
| Rate for Payer: Mclaren Commercial |
$319.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.48
|
| Rate for Payer: Nomi Health Commercial |
$290.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.12
|
|
|
HC SPEECH FLUENCY EVAL
|
Facility
|
OP
|
$354.68
|
|
|
Service Code
|
CPT 92521
|
| Hospital Charge Code |
44400012
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$131.23 |
| Max. Negotiated Rate |
$354.68 |
| Rate for Payer: Aetna Commercial |
$319.21
|
| Rate for Payer: Aetna Medicare |
$131.23
|
| Rate for Payer: ASR ASR |
$344.04
|
| Rate for Payer: BCBS Complete |
$141.87
|
| Rate for Payer: BCBS Trust/PPO |
$292.43
|
| Rate for Payer: BCN Commercial |
$292.43
|
| Rate for Payer: Cash Price |
$283.74
|
| Rate for Payer: Cash Price |
$283.74
|
| Rate for Payer: Cofinity Commercial |
$333.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.74
|
| Rate for Payer: Healthscope Commercial |
$344.04
|
| Rate for Payer: Healthscope Whirlpool |
$354.68
|
| Rate for Payer: Mclaren Commercial |
$319.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$283.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.48
|
| Rate for Payer: Nomi Health Commercial |
$290.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$164.41
|
| Rate for Payer: Priority Health Narrow Network |
$131.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.12
|
|
|
HC SPEECH/LANGUAGE/HEARING THERAPY
|
Facility
|
IP
|
$223.98
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
44000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$167.99 |
| Max. Negotiated Rate |
$223.98 |
| Rate for Payer: Aetna Commercial |
$201.58
|
| Rate for Payer: ASR ASR |
$217.26
|
| Rate for Payer: BCBS Trust/PPO |
$183.93
|
| Rate for Payer: BCN Commercial |
$183.93
|
| Rate for Payer: Cash Price |
$179.18
|
| Rate for Payer: Cofinity Commercial |
$210.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.18
|
| Rate for Payer: Healthscope Commercial |
$217.26
|
| Rate for Payer: Healthscope Whirlpool |
$223.98
|
| Rate for Payer: Mclaren Commercial |
$201.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.38
|
| Rate for Payer: Nomi Health Commercial |
$183.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.10
|
|
|
HC SPEECH/LANGUAGE/HEARING THERAPY
|
Facility
|
OP
|
$223.98
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
44000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$82.87 |
| Max. Negotiated Rate |
$225.16 |
| Rate for Payer: Aetna Commercial |
$201.58
|
| Rate for Payer: Aetna Medicare |
$82.87
|
| Rate for Payer: ASR ASR |
$217.26
|
| Rate for Payer: BCBS Complete |
$89.59
|
| Rate for Payer: BCBS Trust/PPO |
$184.67
|
| Rate for Payer: BCN Commercial |
$184.67
|
| Rate for Payer: Cash Price |
$179.18
|
| Rate for Payer: Cash Price |
$179.18
|
| Rate for Payer: Cofinity Commercial |
$210.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.18
|
| Rate for Payer: Healthscope Commercial |
$217.26
|
| Rate for Payer: Healthscope Whirlpool |
$223.98
|
| Rate for Payer: Mclaren Commercial |
$201.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.38
|
| Rate for Payer: Nomi Health Commercial |
$183.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$225.16
|
| Rate for Payer: Priority Health Narrow Network |
$180.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.10
|
|
|
HC SPEECH SOUND PRODUCTION EVAL
|
Facility
|
IP
|
$311.47
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
44400010
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$233.60 |
| Max. Negotiated Rate |
$311.47 |
| Rate for Payer: Aetna Commercial |
$280.32
|
| Rate for Payer: ASR ASR |
$302.13
|
| Rate for Payer: BCBS Trust/PPO |
$255.78
|
| Rate for Payer: BCN Commercial |
$255.78
|
| Rate for Payer: Cash Price |
$249.18
|
| Rate for Payer: Cofinity Commercial |
$292.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.18
|
| Rate for Payer: Healthscope Commercial |
$302.13
|
| Rate for Payer: Healthscope Whirlpool |
$311.47
|
| Rate for Payer: Mclaren Commercial |
$280.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.75
|
| Rate for Payer: Nomi Health Commercial |
$255.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.09
|
|
|
HC SPEECH SOUND PRODUCTION EVAL
|
Facility
|
OP
|
$311.47
|
|
|
Service Code
|
CPT 92522
|
| Hospital Charge Code |
44400010
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$106.77 |
| Max. Negotiated Rate |
$311.47 |
| Rate for Payer: Aetna Commercial |
$280.32
|
| Rate for Payer: Aetna Medicare |
$115.24
|
| Rate for Payer: ASR ASR |
$302.13
|
| Rate for Payer: BCBS Complete |
$124.59
|
| Rate for Payer: BCBS Trust/PPO |
$256.81
|
| Rate for Payer: BCN Commercial |
$256.81
|
| Rate for Payer: Cash Price |
$249.18
|
| Rate for Payer: Cash Price |
$249.18
|
| Rate for Payer: Cofinity Commercial |
$292.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.18
|
| Rate for Payer: Healthscope Commercial |
$302.13
|
| Rate for Payer: Healthscope Whirlpool |
$311.47
|
| Rate for Payer: Mclaren Commercial |
$280.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.75
|
| Rate for Payer: Nomi Health Commercial |
$255.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$133.47
|
| Rate for Payer: Priority Health Narrow Network |
$106.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.09
|
|
|
HC SPEECH THRESHOLD AUDIOMETRY
|
Facility
|
OP
|
$51.12
|
|
|
Service Code
|
CPT 92555
|
| Hospital Charge Code |
47100011
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$91.11 |
| Rate for Payer: Aetna Commercial |
$46.01
|
| Rate for Payer: Aetna Medicare |
$58.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: ASR ASR |
$49.59
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$42.15
|
| Rate for Payer: BCN Commercial |
$42.15
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$40.90
|
| Rate for Payer: Cash Price |
$40.90
|
| Rate for Payer: Cofinity Commercial |
$48.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$49.59
|
| Rate for Payer: Healthscope Whirlpool |
$51.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$58.78
|
| Rate for Payer: Mclaren Commercial |
$46.01
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$32.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.45
|
| Rate for Payer: Nomi Health Commercial |
$41.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.34
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$64.66
|
| Rate for Payer: PHP Medicaid |
$31.51
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44.79
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Narrow Network |
$35.84
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$91.11
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP DNSP |
$58.78
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC SPEECH THRESHOLD AUDIOMETRY
|
Facility
|
IP
|
$51.12
|
|
|
Service Code
|
CPT 92555
|
| Hospital Charge Code |
47100011
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$38.34 |
| Max. Negotiated Rate |
$51.12 |
| Rate for Payer: Aetna Commercial |
$46.01
|
| Rate for Payer: ASR ASR |
$49.59
|
| Rate for Payer: BCBS Trust/PPO |
$41.98
|
| Rate for Payer: BCN Commercial |
$41.98
|
| Rate for Payer: Cash Price |
$40.90
|
| Rate for Payer: Cofinity Commercial |
$48.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.90
|
| Rate for Payer: Healthscope Commercial |
$49.59
|
| Rate for Payer: Healthscope Whirlpool |
$51.12
|
| Rate for Payer: Mclaren Commercial |
$46.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.45
|
| Rate for Payer: Nomi Health Commercial |
$41.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.99
|
|
|
HC SPEECH VIDEO FLUORO EVAL
|
Facility
|
IP
|
$404.95
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
44000004
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$303.71 |
| Max. Negotiated Rate |
$404.95 |
| Rate for Payer: Aetna Commercial |
$364.45
|
| Rate for Payer: ASR ASR |
$392.80
|
| Rate for Payer: BCBS Trust/PPO |
$332.54
|
| Rate for Payer: BCN Commercial |
$332.54
|
| Rate for Payer: Cash Price |
$323.96
|
| Rate for Payer: Cofinity Commercial |
$380.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.96
|
| Rate for Payer: Healthscope Commercial |
$392.80
|
| Rate for Payer: Healthscope Whirlpool |
$404.95
|
| Rate for Payer: Mclaren Commercial |
$364.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.21
|
| Rate for Payer: Nomi Health Commercial |
$332.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$356.36
|
|
|
HC SPEECH VIDEO FLUORO EVAL
|
Facility
|
OP
|
$404.95
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
44000004
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$149.83 |
| Max. Negotiated Rate |
$404.95 |
| Rate for Payer: Aetna Commercial |
$364.45
|
| Rate for Payer: Aetna Medicare |
$149.83
|
| Rate for Payer: ASR ASR |
$392.80
|
| Rate for Payer: BCBS Complete |
$161.98
|
| Rate for Payer: BCBS Trust/PPO |
$333.88
|
| Rate for Payer: BCN Commercial |
$333.88
|
| Rate for Payer: Cash Price |
$323.96
|
| Rate for Payer: Cash Price |
$323.96
|
| Rate for Payer: Cofinity Commercial |
$380.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.96
|
| Rate for Payer: Healthscope Commercial |
$392.80
|
| Rate for Payer: Healthscope Whirlpool |
$404.95
|
| Rate for Payer: Mclaren Commercial |
$364.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.21
|
| Rate for Payer: Nomi Health Commercial |
$332.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$308.70
|
| Rate for Payer: Priority Health Narrow Network |
$246.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$356.36
|
|
|
HC SPEECH VOICE EVALUATION
|
Facility
|
IP
|
$318.60
|
|
|
Service Code
|
CPT 92524
|
| Hospital Charge Code |
44400011
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$238.95 |
| Max. Negotiated Rate |
$318.60 |
| Rate for Payer: Aetna Commercial |
$286.74
|
| Rate for Payer: ASR ASR |
$309.04
|
| Rate for Payer: BCBS Trust/PPO |
$261.63
|
| Rate for Payer: BCN Commercial |
$261.63
|
| Rate for Payer: Cash Price |
$254.88
|
| Rate for Payer: Cofinity Commercial |
$299.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.88
|
| Rate for Payer: Healthscope Commercial |
$309.04
|
| Rate for Payer: Healthscope Whirlpool |
$318.60
|
| Rate for Payer: Mclaren Commercial |
$286.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.81
|
| Rate for Payer: Nomi Health Commercial |
$261.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$280.37
|
|
|
HC SPEECH VOICE EVALUATION
|
Facility
|
OP
|
$318.60
|
|
|
Service Code
|
CPT 92524
|
| Hospital Charge Code |
44400011
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$111.32 |
| Max. Negotiated Rate |
$318.60 |
| Rate for Payer: Aetna Commercial |
$286.74
|
| Rate for Payer: Aetna Medicare |
$117.88
|
| Rate for Payer: ASR ASR |
$309.04
|
| Rate for Payer: BCBS Complete |
$127.44
|
| Rate for Payer: BCBS Trust/PPO |
$262.69
|
| Rate for Payer: BCN Commercial |
$262.69
|
| Rate for Payer: Cash Price |
$254.88
|
| Rate for Payer: Cash Price |
$254.88
|
| Rate for Payer: Cofinity Commercial |
$299.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.88
|
| Rate for Payer: Healthscope Commercial |
$309.04
|
| Rate for Payer: Healthscope Whirlpool |
$318.60
|
| Rate for Payer: Mclaren Commercial |
$286.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.81
|
| Rate for Payer: Nomi Health Commercial |
$261.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$139.15
|
| Rate for Payer: Priority Health Narrow Network |
$111.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$280.37
|
|
|
HC SPIKE BLOOD ACCESS
|
Facility
|
OP
|
$16.39
|
|
| Hospital Charge Code |
27000669
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: Aetna Commercial |
$14.75
|
| Rate for Payer: Aetna Medicare |
$6.06
|
| Rate for Payer: ASR ASR |
$15.90
|
| Rate for Payer: BCBS Complete |
$6.56
|
| Rate for Payer: BCBS Trust/PPO |
$13.51
|
| Rate for Payer: BCN Commercial |
$13.51
|
| Rate for Payer: Cash Price |
$13.11
|
| Rate for Payer: Cofinity Commercial |
$15.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.11
|
| Rate for Payer: Healthscope Commercial |
$15.90
|
| Rate for Payer: Healthscope Whirlpool |
$16.39
|
| Rate for Payer: Mclaren Commercial |
$14.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.93
|
| Rate for Payer: Nomi Health Commercial |
$13.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14.36
|
| Rate for Payer: Priority Health Narrow Network |
$11.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.42
|
|
|
HC SPIKE BLOOD ACCESS
|
Facility
|
IP
|
$16.39
|
|
| Hospital Charge Code |
27000669
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: Aetna Commercial |
$14.75
|
| Rate for Payer: ASR ASR |
$15.90
|
| Rate for Payer: BCBS Trust/PPO |
$13.46
|
| Rate for Payer: BCN Commercial |
$13.46
|
| Rate for Payer: Cash Price |
$13.11
|
| Rate for Payer: Cofinity Commercial |
$15.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.11
|
| Rate for Payer: Healthscope Commercial |
$15.90
|
| Rate for Payer: Healthscope Whirlpool |
$16.39
|
| Rate for Payer: Mclaren Commercial |
$14.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.93
|
| Rate for Payer: Nomi Health Commercial |
$13.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.42
|
|
