|
HC ATYPICAL PNEUMO EVAL C PNEUM IGM
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
30200243
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$15.85 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna Medicare |
$12.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.85
|
| Rate for Payer: ASR ASR |
$14.84
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: BCBS MAPPO |
$12.68
|
| Rate for Payer: BCBS Trust/PPO |
$11.86
|
| Rate for Payer: BCN Commercial |
$11.86
|
| Rate for Payer: BCN Medicare Advantage |
$12.68
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.68
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Healthscope Whirlpool |
$14.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.68
|
| Rate for Payer: Mclaren Commercial |
$13.77
|
| Rate for Payer: Mclaren Medicaid |
$6.94
|
| Rate for Payer: Mclaren Medicare |
$12.68
|
| Rate for Payer: Meridian Medicaid |
$7.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PACE Medicare |
$12.05
|
| Rate for Payer: PACE SWMI |
$12.68
|
| Rate for Payer: PHP Commercial |
$13.95
|
| Rate for Payer: PHP Medicaid |
$6.94
|
| Rate for Payer: PHP Medicare Advantage |
$12.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.92
|
| Rate for Payer: Priority Health Medicare |
$12.68
|
| Rate for Payer: Priority Health Narrow Network |
$10.86
|
| Rate for Payer: Railroad Medicare Medicare |
$12.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.46
|
| Rate for Payer: UHC Medicare Advantage |
$13.06
|
| Rate for Payer: VA VA |
$12.68
|
|
|
HC ATYPICAL PNEUMO EVAL L PNEUM
|
Facility
|
IP
|
$21.42
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
30200302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$21.42 |
| Rate for Payer: Aetna Commercial |
$19.28
|
| Rate for Payer: ASR ASR |
$20.78
|
| Rate for Payer: BCBS Trust/PPO |
$16.61
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$20.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$21.42
|
| Rate for Payer: Healthscope Whirlpool |
$20.78
|
| Rate for Payer: Mclaren Commercial |
$19.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.85
|
|
|
HC ATYPICAL PNEUMO EVAL L PNEUM
|
Facility
|
OP
|
$21.42
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
30200302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$77.99 |
| Rate for Payer: Aetna Commercial |
$19.28
|
| Rate for Payer: Aetna Medicare |
$15.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: ASR ASR |
$20.78
|
| Rate for Payer: BCBS Complete |
$8.79
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$16.61
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$20.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$21.42
|
| Rate for Payer: Healthscope Whirlpool |
$20.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.30
|
| Rate for Payer: Mclaren Commercial |
$19.28
|
| Rate for Payer: Mclaren Medicaid |
$8.37
|
| Rate for Payer: Mclaren Medicare |
$15.30
|
| Rate for Payer: Meridian Medicaid |
$8.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.21
|
| Rate for Payer: PACE Medicare |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$16.83
|
| Rate for Payer: PHP Medicaid |
$8.37
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.99
|
| Rate for Payer: Priority Health Medicare |
$15.30
|
| Rate for Payer: Priority Health Narrow Network |
$62.39
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.85
|
| Rate for Payer: UHC Medicare Advantage |
$15.76
|
| Rate for Payer: VA VA |
$15.30
|
|
|
HC ATYPICAL PNEUMO EVAL M PNEUM
|
Facility
|
OP
|
$14.28
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$55.93 |
| Rate for Payer: Aetna Commercial |
$12.85
|
| Rate for Payer: Aetna Medicare |
$13.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.55
|
| Rate for Payer: ASR ASR |
$13.85
|
| Rate for Payer: BCBS Complete |
$7.61
|
| Rate for Payer: BCBS MAPPO |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$11.07
|
| Rate for Payer: BCN Commercial |
$11.07
|
| Rate for Payer: BCN Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.24
|
| Rate for Payer: Healthscope Commercial |
$14.28
|
| Rate for Payer: Healthscope Whirlpool |
$13.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.24
|
| Rate for Payer: Mclaren Commercial |
$12.85
|
| Rate for Payer: Mclaren Medicaid |
$7.24
|
| Rate for Payer: Mclaren Medicare |
$13.24
|
| Rate for Payer: Meridian Medicaid |
$7.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.14
|
| Rate for Payer: PACE Medicare |
$12.58
|
| Rate for Payer: PACE SWMI |
$13.24
|
| Rate for Payer: PHP Commercial |
$14.56
|
| Rate for Payer: PHP Medicaid |
$7.24
|
| Rate for Payer: PHP Medicare Advantage |
$13.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.93
|
| Rate for Payer: Priority Health Medicare |
$13.24
|
| Rate for Payer: Priority Health Narrow Network |
$44.74
|
| Rate for Payer: Railroad Medicare Medicare |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.57
|
| Rate for Payer: UHC Medicare Advantage |
$13.64
|
| Rate for Payer: VA VA |
$13.24
|
|
|
HC ATYPICAL PNEUMO EVAL M PNEUM
|
Facility
|
IP
|
$14.28
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$14.28 |
| Rate for Payer: Aetna Commercial |
$12.85
|
| Rate for Payer: ASR ASR |
$13.85
|
| Rate for Payer: BCBS Trust/PPO |
$11.07
|
| Rate for Payer: BCN Commercial |
$11.07
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Healthscope Commercial |
$14.28
|
| Rate for Payer: Healthscope Whirlpool |
$13.85
|
| Rate for Payer: Mclaren Commercial |
$12.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.57
|
|
|
HC ATYPICAL PNEUMO EVALUATION
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200241
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: ASR ASR |
$14.84
|
| Rate for Payer: BCBS Trust/PPO |
$11.86
|
| Rate for Payer: BCN Commercial |
$11.86
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Healthscope Whirlpool |
$14.84
|
| Rate for Payer: Mclaren Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.46
|
|
|
HC ATYPICAL PNEUMO EVALUATION
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200241
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna Medicare |
$11.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.78
|
| Rate for Payer: ASR ASR |
$14.84
|
| Rate for Payer: BCBS Complete |
$6.79
|
| Rate for Payer: BCBS MAPPO |
$11.82
|
| Rate for Payer: BCBS Trust/PPO |
$11.86
|
| Rate for Payer: BCN Commercial |
$11.86
|
| Rate for Payer: BCN Medicare Advantage |
$11.82
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.82
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Healthscope Whirlpool |
$14.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.82
|
| Rate for Payer: Mclaren Commercial |
$13.77
|
| Rate for Payer: Mclaren Medicaid |
$6.47
|
| Rate for Payer: Mclaren Medicare |
$11.82
|
| Rate for Payer: Meridian Medicaid |
$6.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PACE Medicare |
$11.23
|
| Rate for Payer: PACE SWMI |
$11.82
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: PHP Medicaid |
$6.47
|
| Rate for Payer: PHP Medicare Advantage |
$11.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.92
|
| Rate for Payer: Priority Health Medicare |
$11.82
|
| Rate for Payer: Priority Health Narrow Network |
$10.86
|
| Rate for Payer: Railroad Medicare Medicare |
$11.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.46
|
| Rate for Payer: UHC Medicare Advantage |
$12.17
|
| Rate for Payer: VA VA |
$11.82
|
|
|
HC AUDIOMETRY AIR AND BONE
|
Facility
|
IP
|
$208.01
|
|
|
Service Code
|
CPT 92553
|
| Hospital Charge Code |
47100010
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$145.61 |
| Max. Negotiated Rate |
$208.01 |
| Rate for Payer: Aetna Commercial |
$187.21
|
| Rate for Payer: ASR ASR |
$201.77
|
| Rate for Payer: BCBS Trust/PPO |
$161.27
|
| Rate for Payer: BCN Commercial |
$161.27
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cofinity Commercial |
$195.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.41
|
| Rate for Payer: Healthscope Commercial |
$208.01
|
| Rate for Payer: Healthscope Whirlpool |
$201.77
|
| Rate for Payer: Mclaren Commercial |
$187.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.05
|
|
|
HC AUDIOMETRY AIR AND BONE
|
Facility
|
OP
|
$208.01
|
|
|
Service Code
|
CPT 92553
|
| Hospital Charge Code |
47100010
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$208.01 |
| Rate for Payer: Aetna Commercial |
$187.21
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$201.77
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$161.27
|
| Rate for Payer: BCN Commercial |
$161.27
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cofinity Commercial |
$195.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$208.01
|
| Rate for Payer: Healthscope Whirlpool |
$201.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.85
|
| Rate for Payer: Mclaren Commercial |
$187.21
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.81
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$152.74
|
| Rate for Payer: PHP Medicaid |
$75.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.29
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$147.69
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.05
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.85
|
|
|
HC AUDITORY EVOKED POTENTIAL SCREENING
|
Facility
|
OP
|
$251.11
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
47100015
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$100.44 |
| Max. Negotiated Rate |
$251.11 |
| Rate for Payer: Aetna Commercial |
$226.00
|
| Rate for Payer: ASR ASR |
$243.58
|
| Rate for Payer: BCBS Complete |
$100.44
|
| Rate for Payer: BCBS Trust/PPO |
$194.69
|
| Rate for Payer: BCN Commercial |
$194.69
|
| Rate for Payer: Cash Price |
$200.89
|
| Rate for Payer: Cofinity Commercial |
$236.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.89
|
| Rate for Payer: Healthscope Commercial |
$251.11
|
| Rate for Payer: Healthscope Whirlpool |
$243.58
|
| Rate for Payer: Mclaren Commercial |
$226.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.51
|
| Rate for Payer: Priority Health Narrow Network |
$178.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.98
|
|
|
HC AUDITORY EVOKED POTENTIAL SCREENING
|
Facility
|
IP
|
$251.11
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
47100015
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$175.78 |
| Max. Negotiated Rate |
$251.11 |
| Rate for Payer: Aetna Commercial |
$226.00
|
| Rate for Payer: ASR ASR |
$243.58
|
| Rate for Payer: BCBS Trust/PPO |
$194.69
|
| Rate for Payer: BCN Commercial |
$194.69
|
| Rate for Payer: Cash Price |
$200.89
|
| Rate for Payer: Cofinity Commercial |
$236.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.89
|
| Rate for Payer: Healthscope Commercial |
$251.11
|
| Rate for Payer: Healthscope Whirlpool |
$243.58
|
| Rate for Payer: Mclaren Commercial |
$226.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.98
|
|
|
HC AUDITORY EVOK POT NEURODIAGNOSTIC W I&R
|
Facility
|
OP
|
$674.35
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
47000001
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$674.35 |
| Rate for Payer: Aetna Commercial |
$606.92
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$654.12
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$522.82
|
| Rate for Payer: BCN Commercial |
$522.82
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$539.48
|
| Rate for Payer: Cash Price |
$539.48
|
| Rate for Payer: Cofinity Commercial |
$633.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$674.35
|
| Rate for Payer: Healthscope Whirlpool |
$654.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$606.92
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.20
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$613.66
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$478.79
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$593.43
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
HC AUDITORY EVOK POT NEURODIAGNOSTIC W I&R
|
Facility
|
IP
|
$674.35
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
47000001
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$472.04 |
| Max. Negotiated Rate |
$674.35 |
| Rate for Payer: Aetna Commercial |
$606.92
|
| Rate for Payer: ASR ASR |
$654.12
|
| Rate for Payer: BCBS Trust/PPO |
$522.82
|
| Rate for Payer: BCN Commercial |
$522.82
|
| Rate for Payer: Cash Price |
$539.48
|
| Rate for Payer: Cofinity Commercial |
$633.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.48
|
| Rate for Payer: Healthscope Commercial |
$674.35
|
| Rate for Payer: Healthscope Whirlpool |
$654.12
|
| Rate for Payer: Mclaren Commercial |
$606.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$593.43
|
|
|
HC AUDITORY EVOK POT THRESHOLD MULTI FREQ
|
Facility
|
OP
|
$674.35
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$674.35 |
| Rate for Payer: Aetna Commercial |
$606.92
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: ASR ASR |
$654.12
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$522.82
|
| Rate for Payer: BCN Commercial |
$522.82
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$539.48
|
| Rate for Payer: Cash Price |
$539.48
|
| Rate for Payer: Cofinity Commercial |
$633.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Healthscope Commercial |
$674.35
|
| Rate for Payer: Healthscope Whirlpool |
$654.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$279.00
|
| Rate for Payer: Mclaren Commercial |
$606.92
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.20
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Commercial |
$306.90
|
| Rate for Payer: PHP Medicaid |
$152.61
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$613.66
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$478.79
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$593.43
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
HC AUDITORY EVOK POT THRESHOLD MULTI FREQ
|
Facility
|
IP
|
$674.35
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$472.04 |
| Max. Negotiated Rate |
$674.35 |
| Rate for Payer: Aetna Commercial |
$606.92
|
| Rate for Payer: ASR ASR |
$654.12
|
| Rate for Payer: BCBS Trust/PPO |
$522.82
|
| Rate for Payer: BCN Commercial |
$522.82
|
| Rate for Payer: Cash Price |
$539.48
|
| Rate for Payer: Cofinity Commercial |
$633.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.48
|
| Rate for Payer: Healthscope Commercial |
$674.35
|
| Rate for Payer: Healthscope Whirlpool |
$654.12
|
| Rate for Payer: Mclaren Commercial |
$606.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$593.43
|
|
|
HC AUDITORY FUNCTION 60 MIN
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 92620
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna Commercial |
$148.50
|
| Rate for Payer: ASR ASR |
$160.05
|
| Rate for Payer: BCBS Trust/PPO |
$127.92
|
| Rate for Payer: BCN Commercial |
$127.92
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$155.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.00
|
| Rate for Payer: Healthscope Commercial |
$165.00
|
| Rate for Payer: Healthscope Whirlpool |
$160.05
|
| Rate for Payer: Mclaren Commercial |
$148.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.20
|
|
|
HC AUDITORY FUNCTION 60 MIN
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 92620
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$148.50
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$160.05
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$127.92
|
| Rate for Payer: BCN Commercial |
$127.92
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$155.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$165.00
|
| Rate for Payer: Healthscope Whirlpool |
$160.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.85
|
| Rate for Payer: Mclaren Commercial |
$148.50
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.25
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$152.74
|
| Rate for Payer: PHP Medicaid |
$75.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.15
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$117.15
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.20
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.85
|
|
|
HC AUD SCREEN PURE TONE AIR ONLY
|
Facility
|
IP
|
$58.79
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
47100003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$41.15 |
| Max. Negotiated Rate |
$58.79 |
| Rate for Payer: Aetna Commercial |
$52.91
|
| Rate for Payer: ASR ASR |
$57.03
|
| Rate for Payer: BCBS Trust/PPO |
$45.58
|
| Rate for Payer: BCN Commercial |
$45.58
|
| Rate for Payer: Cash Price |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$55.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.03
|
| Rate for Payer: Healthscope Commercial |
$58.79
|
| Rate for Payer: Healthscope Whirlpool |
$57.03
|
| Rate for Payer: Mclaren Commercial |
$52.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.74
|
|
|
HC AUD SCREEN PURE TONE AIR ONLY
|
Facility
|
OP
|
$58.79
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
47100003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$58.79 |
| Rate for Payer: Aetna Commercial |
$52.91
|
| Rate for Payer: ASR ASR |
$57.03
|
| Rate for Payer: BCBS Complete |
$23.52
|
| Rate for Payer: BCBS Trust/PPO |
$45.58
|
| Rate for Payer: BCN Commercial |
$45.58
|
| Rate for Payer: Cash Price |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$55.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.03
|
| Rate for Payer: Healthscope Commercial |
$58.79
|
| Rate for Payer: Healthscope Whirlpool |
$57.03
|
| Rate for Payer: Mclaren Commercial |
$52.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.50
|
| Rate for Payer: Priority Health Narrow Network |
$41.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.74
|
|
|
HC AUD VERTICAL ELECTRODE USE
|
Facility
|
OP
|
$54.03
|
|
|
Service Code
|
CPT 92547
|
| Hospital Charge Code |
47100004
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$21.61 |
| Max. Negotiated Rate |
$54.03 |
| Rate for Payer: Aetna Commercial |
$48.63
|
| Rate for Payer: ASR ASR |
$52.41
|
| Rate for Payer: BCBS Complete |
$21.61
|
| Rate for Payer: BCBS Trust/PPO |
$41.89
|
| Rate for Payer: BCN Commercial |
$41.89
|
| Rate for Payer: Cash Price |
$43.22
|
| Rate for Payer: Cofinity Commercial |
$50.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.22
|
| Rate for Payer: Healthscope Commercial |
$54.03
|
| Rate for Payer: Healthscope Whirlpool |
$52.41
|
| Rate for Payer: Mclaren Commercial |
$48.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.17
|
| Rate for Payer: Priority Health Narrow Network |
$38.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.55
|
|
|
HC AUD VERTICAL ELECTRODE USE
|
Facility
|
IP
|
$54.03
|
|
|
Service Code
|
CPT 92547
|
| Hospital Charge Code |
47100004
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$37.82 |
| Max. Negotiated Rate |
$54.03 |
| Rate for Payer: Aetna Commercial |
$48.63
|
| Rate for Payer: ASR ASR |
$52.41
|
| Rate for Payer: BCBS Trust/PPO |
$41.89
|
| Rate for Payer: BCN Commercial |
$41.89
|
| Rate for Payer: Cash Price |
$43.22
|
| Rate for Payer: Cofinity Commercial |
$50.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.22
|
| Rate for Payer: Healthscope Commercial |
$54.03
|
| Rate for Payer: Healthscope Whirlpool |
$52.41
|
| Rate for Payer: Mclaren Commercial |
$48.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.55
|
|
|
HC AUD VESTIBULAR EVAL BASIC
|
Facility
|
IP
|
$454.36
|
|
|
Service Code
|
CPT 92540
|
| Hospital Charge Code |
47100005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$318.05 |
| Max. Negotiated Rate |
$454.36 |
| Rate for Payer: Aetna Commercial |
$408.92
|
| Rate for Payer: ASR ASR |
$440.73
|
| Rate for Payer: BCBS Trust/PPO |
$352.27
|
| Rate for Payer: BCN Commercial |
$352.27
|
| Rate for Payer: Cash Price |
$363.49
|
| Rate for Payer: Cofinity Commercial |
$427.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.49
|
| Rate for Payer: Healthscope Commercial |
$454.36
|
| Rate for Payer: Healthscope Whirlpool |
$440.73
|
| Rate for Payer: Mclaren Commercial |
$408.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$386.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$399.84
|
|
|
HC AUD VESTIBULAR EVAL BASIC
|
Facility
|
OP
|
$454.36
|
|
|
Service Code
|
CPT 92540
|
| Hospital Charge Code |
47100005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$454.36 |
| Rate for Payer: Aetna Commercial |
$408.92
|
| Rate for Payer: Aetna Medicare |
$138.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.56
|
| Rate for Payer: ASR ASR |
$440.73
|
| Rate for Payer: BCBS Complete |
$79.76
|
| Rate for Payer: BCBS MAPPO |
$138.85
|
| Rate for Payer: BCBS Trust/PPO |
$352.27
|
| Rate for Payer: BCN Commercial |
$352.27
|
| Rate for Payer: BCN Medicare Advantage |
$138.85
|
| Rate for Payer: Cash Price |
$363.49
|
| Rate for Payer: Cash Price |
$363.49
|
| Rate for Payer: Cofinity Commercial |
$427.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$454.36
|
| Rate for Payer: Healthscope Whirlpool |
$440.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.85
|
| Rate for Payer: Mclaren Commercial |
$408.92
|
| Rate for Payer: Mclaren Medicaid |
$75.95
|
| Rate for Payer: Mclaren Medicare |
$138.85
|
| Rate for Payer: Meridian Medicaid |
$79.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$386.21
|
| Rate for Payer: PACE Medicare |
$131.91
|
| Rate for Payer: PACE SWMI |
$138.85
|
| Rate for Payer: PHP Commercial |
$152.74
|
| Rate for Payer: PHP Medicaid |
$75.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$413.47
|
| Rate for Payer: Priority Health Medicare |
$138.85
|
| Rate for Payer: Priority Health Narrow Network |
$322.60
|
| Rate for Payer: Railroad Medicare Medicare |
$138.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$399.84
|
| Rate for Payer: UHC Medicare Advantage |
$143.02
|
| Rate for Payer: VA VA |
$138.85
|
|
|
HC AUTOLOGOUS UNIT
|
Facility
|
OP
|
$809.10
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
39000040
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$69.66 |
| Max. Negotiated Rate |
$809.10 |
| Rate for Payer: Aetna Commercial |
$728.19
|
| Rate for Payer: Aetna Medicare |
$127.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.19
|
| Rate for Payer: ASR ASR |
$784.83
|
| Rate for Payer: BCBS Complete |
$73.15
|
| Rate for Payer: BCBS MAPPO |
$127.35
|
| Rate for Payer: BCBS Trust/PPO |
$627.30
|
| Rate for Payer: BCN Commercial |
$627.30
|
| Rate for Payer: BCN Medicare Advantage |
$127.35
|
| Rate for Payer: Cash Price |
$647.28
|
| Rate for Payer: Cash Price |
$647.28
|
| Rate for Payer: Cofinity Commercial |
$760.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$647.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.35
|
| Rate for Payer: Healthscope Commercial |
$809.10
|
| Rate for Payer: Healthscope Whirlpool |
$784.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$127.35
|
| Rate for Payer: Mclaren Commercial |
$728.19
|
| Rate for Payer: Mclaren Medicaid |
$69.66
|
| Rate for Payer: Mclaren Medicare |
$127.35
|
| Rate for Payer: Meridian Medicaid |
$73.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$133.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$687.74
|
| Rate for Payer: PACE Medicare |
$120.98
|
| Rate for Payer: PACE SWMI |
$127.35
|
| Rate for Payer: PHP Commercial |
$140.08
|
| Rate for Payer: PHP Medicaid |
$69.66
|
| Rate for Payer: PHP Medicare Advantage |
$127.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$736.28
|
| Rate for Payer: Priority Health Medicare |
$127.35
|
| Rate for Payer: Priority Health Narrow Network |
$574.46
|
| Rate for Payer: Railroad Medicare Medicare |
$127.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$712.01
|
| Rate for Payer: UHC Medicare Advantage |
$131.17
|
| Rate for Payer: VA VA |
$127.35
|
|
|
HC AUTOLOGOUS UNIT
|
Facility
|
IP
|
$809.10
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
39000040
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$566.37 |
| Max. Negotiated Rate |
$809.10 |
| Rate for Payer: Aetna Commercial |
$728.19
|
| Rate for Payer: ASR ASR |
$784.83
|
| Rate for Payer: BCBS Trust/PPO |
$627.30
|
| Rate for Payer: BCN Commercial |
$627.30
|
| Rate for Payer: Cash Price |
$647.28
|
| Rate for Payer: Cofinity Commercial |
$760.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$647.28
|
| Rate for Payer: Healthscope Commercial |
$809.10
|
| Rate for Payer: Healthscope Whirlpool |
$784.83
|
| Rate for Payer: Mclaren Commercial |
$728.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$687.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$712.01
|
|
