|
HC PSORALEN TREATED WASHED PLATELETS
|
Facility
|
IP
|
$2,194.62
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000086
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,382.61 |
| Max. Negotiated Rate |
$1,975.16 |
| Rate for Payer: Aetna Commercial |
$1,865.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,426.50
|
| Rate for Payer: Cash Price |
$1,755.70
|
| Rate for Payer: Cofinity Commercial |
$1,536.23
|
| Rate for Payer: Cofinity Commercial |
$1,887.37
|
| Rate for Payer: Healthscope Commercial |
$1,975.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,865.43
|
| Rate for Payer: PHP Commercial |
$1,865.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,536.23
|
| Rate for Payer: Priority Health SBD |
$1,382.61
|
|
|
HC PSORALEN TREATED WASHED PLATELETS
|
Facility
|
OP
|
$2,194.62
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000086
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$281.61 |
| Max. Negotiated Rate |
$1,975.16 |
| Rate for Payer: Aetna Commercial |
$1,865.43
|
| Rate for Payer: Aetna Medicare |
$535.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,426.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$643.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$643.54
|
| Rate for Payer: BCBS Complete |
$295.72
|
| Rate for Payer: BCBS MAPPO |
$514.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,679.17
|
| Rate for Payer: BCN Medicare Advantage |
$514.83
|
| Rate for Payer: Cash Price |
$1,755.70
|
| Rate for Payer: Cash Price |
$1,755.70
|
| Rate for Payer: Cofinity Commercial |
$1,887.37
|
| Rate for Payer: Cofinity Commercial |
$1,536.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$514.83
|
| Rate for Payer: Healthscope Commercial |
$1,975.16
|
| Rate for Payer: Mclaren Medicaid |
$281.61
|
| Rate for Payer: Mclaren Medicare |
$514.83
|
| Rate for Payer: Meridian Medicaid |
$295.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$540.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$592.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,865.43
|
| Rate for Payer: PACE Medicare |
$489.09
|
| Rate for Payer: PACE SWMI |
$514.83
|
| Rate for Payer: PHP Commercial |
$1,865.43
|
| Rate for Payer: PHP Medicare Advantage |
$514.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,536.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,817.43
|
| Rate for Payer: Priority Health Medicare |
$514.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,453.94
|
| Rate for Payer: Priority Health SBD |
$1,382.61
|
| Rate for Payer: Railroad Medicare Medicare |
$514.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$514.83
|
| Rate for Payer: UHC Medicare Advantage |
$530.27
|
| Rate for Payer: VA VA |
$514.83
|
|
|
HC PSYCH COLLAB CARE MGMT EA ADD 30 MIN
|
Facility
|
OP
|
$87.72
|
|
|
Service Code
|
CPT 99494
|
| Hospital Charge Code |
51000094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$133.72 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: BCBS Complete |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$133.72
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$75.44
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Healthscope Commercial |
$78.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.56
|
| Rate for Payer: PHP Commercial |
$74.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.40
|
| Rate for Payer: Priority Health SBD |
$55.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.94
|
| Rate for Payer: UHC Exchange |
$39.95
|
|
|
HC PSYCH COLLAB CARE MGMT EA ADD 30 MIN
|
Facility
|
IP
|
$87.72
|
|
|
Service Code
|
CPT 99494
|
| Hospital Charge Code |
51000094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.26 |
| Max. Negotiated Rate |
$78.95 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$75.44
|
| Rate for Payer: Healthscope Commercial |
$78.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.56
|
| Rate for Payer: PHP Commercial |
$74.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.40
|
| Rate for Payer: Priority Health SBD |
$55.26
|
|
|
HC PSYCH COLLAB CARE MGMT INIT 70 MIN
|
Facility
|
OP
|
$93.84
|
|
|
Service Code
|
CPT 99492
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.38 |
| Max. Negotiated Rate |
$363.30 |
| Rate for Payer: Aetna Commercial |
$79.76
|
| Rate for Payer: Aetna Medicare |
$82.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.14
|
| Rate for Payer: BCBS Complete |
$45.56
|
| Rate for Payer: BCBS MAPPO |
$79.31
|
| Rate for Payer: BCBS Trust/PPO |
$363.30
|
| Rate for Payer: BCN Medicare Advantage |
$79.31
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cofinity Commercial |
$65.69
|
| Rate for Payer: Cofinity Commercial |
$80.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.31
|
| Rate for Payer: Healthscope Commercial |
$84.46
|
| Rate for Payer: Mclaren Medicaid |
$43.38
|
| Rate for Payer: Mclaren Medicare |
$79.31
|
| Rate for Payer: Meridian Medicaid |
$45.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.76
|
| Rate for Payer: PACE Medicare |
$75.34
|
| Rate for Payer: PACE SWMI |
$79.31
|
| Rate for Payer: PHP Commercial |
$79.76
|
| Rate for Payer: PHP Medicare Advantage |
$79.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.97
|
| Rate for Payer: Priority Health Medicare |
$79.31
|
| Rate for Payer: Priority Health Narrow Network |
$186.38
|
| Rate for Payer: Priority Health SBD |
$59.12
|
| Rate for Payer: Railroad Medicare Medicare |
$79.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.31
|
| Rate for Payer: UHC Exchange |
$91.36
|
| Rate for Payer: UHC Medicare Advantage |
$81.69
|
| Rate for Payer: VA VA |
$79.31
|
|
|
HC PSYCH COLLAB CARE MGMT INIT 70 MIN
|
Facility
|
IP
|
$93.84
|
|
|
Service Code
|
CPT 99492
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.12 |
| Max. Negotiated Rate |
$84.46 |
| Rate for Payer: Aetna Commercial |
$79.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.00
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cofinity Commercial |
$65.69
|
| Rate for Payer: Cofinity Commercial |
$80.70
|
| Rate for Payer: Healthscope Commercial |
$84.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.76
|
| Rate for Payer: PHP Commercial |
$79.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.69
|
| Rate for Payer: Priority Health SBD |
$59.12
|
|
|
HC PSYCH COLLAB CARE MGMT SUBSEQ 60 MIN
|
Facility
|
IP
|
$103.22
|
|
|
Service Code
|
CPT 99493
|
| Hospital Charge Code |
51000093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.03 |
| Max. Negotiated Rate |
$92.90 |
| Rate for Payer: Aetna Commercial |
$87.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.09
|
| Rate for Payer: Cash Price |
$82.58
|
| Rate for Payer: Cofinity Commercial |
$72.25
|
| Rate for Payer: Cofinity Commercial |
$88.77
|
| Rate for Payer: Healthscope Commercial |
$92.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.74
|
| Rate for Payer: PHP Commercial |
$87.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.25
|
| Rate for Payer: Priority Health SBD |
$65.03
|
|
|
HC PSYCH COLLAB CARE MGMT SUBSEQ 60 MIN
|
Facility
|
OP
|
$103.22
|
|
|
Service Code
|
CPT 99493
|
| Hospital Charge Code |
51000093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.03 |
| Max. Negotiated Rate |
$264.71 |
| Rate for Payer: Aetna Commercial |
$87.74
|
| Rate for Payer: Aetna Medicare |
$147.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.34
|
| Rate for Payer: BCBS Complete |
$81.49
|
| Rate for Payer: BCBS MAPPO |
$141.87
|
| Rate for Payer: BCBS Trust/PPO |
$264.71
|
| Rate for Payer: BCN Medicare Advantage |
$141.87
|
| Rate for Payer: Cash Price |
$82.58
|
| Rate for Payer: Cash Price |
$82.58
|
| Rate for Payer: Cofinity Commercial |
$72.25
|
| Rate for Payer: Cofinity Commercial |
$88.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.87
|
| Rate for Payer: Healthscope Commercial |
$92.90
|
| Rate for Payer: Mclaren Medicaid |
$77.60
|
| Rate for Payer: Mclaren Medicare |
$141.87
|
| Rate for Payer: Meridian Medicaid |
$81.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.74
|
| Rate for Payer: PACE Medicare |
$134.78
|
| Rate for Payer: PACE SWMI |
$141.87
|
| Rate for Payer: PHP Commercial |
$87.74
|
| Rate for Payer: PHP Medicare Advantage |
$141.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.97
|
| Rate for Payer: Priority Health Medicare |
$141.87
|
| Rate for Payer: Priority Health Narrow Network |
$186.38
|
| Rate for Payer: Priority Health SBD |
$65.03
|
| Rate for Payer: Railroad Medicare Medicare |
$141.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.87
|
| Rate for Payer: UHC Exchange |
$99.87
|
| Rate for Payer: UHC Medicare Advantage |
$146.13
|
| Rate for Payer: VA VA |
$141.87
|
|
|
HC PSYCH DIAGNOSTIC EVAL W/MED SVCS
|
Facility
|
IP
|
$194.82
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
91400008
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$122.74 |
| Max. Negotiated Rate |
$175.34 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.63
|
| Rate for Payer: Cash Price |
$155.86
|
| Rate for Payer: Cofinity Commercial |
$136.37
|
| Rate for Payer: Cofinity Commercial |
$167.55
|
| Rate for Payer: Healthscope Commercial |
$175.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.60
|
| Rate for Payer: PHP Commercial |
$165.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.37
|
| Rate for Payer: Priority Health SBD |
$122.74
|
|
|
HC PSYCH DIAGNOSTIC EVAL W/MED SVCS
|
Facility
|
OP
|
$194.82
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
91400008
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$416.61 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: Aetna Medicare |
$147.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.34
|
| Rate for Payer: BCBS Complete |
$81.49
|
| Rate for Payer: BCBS MAPPO |
$141.87
|
| Rate for Payer: BCN Medicare Advantage |
$141.87
|
| Rate for Payer: Cash Price |
$155.86
|
| Rate for Payer: Cash Price |
$155.86
|
| Rate for Payer: Cofinity Commercial |
$167.55
|
| Rate for Payer: Cofinity Commercial |
$136.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.87
|
| Rate for Payer: Healthscope Commercial |
$175.34
|
| Rate for Payer: Mclaren Medicaid |
$77.60
|
| Rate for Payer: Mclaren Medicare |
$141.87
|
| Rate for Payer: Meridian Medicaid |
$81.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.60
|
| Rate for Payer: PACE Medicare |
$134.78
|
| Rate for Payer: PACE SWMI |
$141.87
|
| Rate for Payer: PHP Commercial |
$165.60
|
| Rate for Payer: PHP Medicare Advantage |
$141.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$416.61
|
| Rate for Payer: Priority Health Medicare |
$141.87
|
| Rate for Payer: Priority Health Narrow Network |
$333.29
|
| Rate for Payer: Priority Health SBD |
$122.74
|
| Rate for Payer: Railroad Medicare Medicare |
$141.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.87
|
| Rate for Payer: UHC Exchange |
$166.34
|
| Rate for Payer: UHC Medicare Advantage |
$146.13
|
| Rate for Payer: VA VA |
$141.87
|
|
|
HC PSYCHIATRIC DIAG EVAL
|
Facility
|
IP
|
$194.82
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
91400004
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$122.74 |
| Max. Negotiated Rate |
$175.34 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.63
|
| Rate for Payer: Cash Price |
$155.86
|
| Rate for Payer: Cofinity Commercial |
$136.37
|
| Rate for Payer: Cofinity Commercial |
$167.55
|
| Rate for Payer: Healthscope Commercial |
$175.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.60
|
| Rate for Payer: PHP Commercial |
$165.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.37
|
| Rate for Payer: Priority Health SBD |
$122.74
|
|
|
HC PSYCHIATRIC DIAG EVAL
|
Facility
|
OP
|
$194.82
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
91400004
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$416.61 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: Aetna Medicare |
$147.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.34
|
| Rate for Payer: BCBS Complete |
$81.49
|
| Rate for Payer: BCBS MAPPO |
$141.87
|
| Rate for Payer: BCN Medicare Advantage |
$141.87
|
| Rate for Payer: Cash Price |
$155.86
|
| Rate for Payer: Cash Price |
$155.86
|
| Rate for Payer: Cofinity Commercial |
$136.37
|
| Rate for Payer: Cofinity Commercial |
$167.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.87
|
| Rate for Payer: Healthscope Commercial |
$175.34
|
| Rate for Payer: Mclaren Medicaid |
$77.60
|
| Rate for Payer: Mclaren Medicare |
$141.87
|
| Rate for Payer: Meridian Medicaid |
$81.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.60
|
| Rate for Payer: PACE Medicare |
$134.78
|
| Rate for Payer: PACE SWMI |
$141.87
|
| Rate for Payer: PHP Commercial |
$165.60
|
| Rate for Payer: PHP Medicare Advantage |
$141.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$416.61
|
| Rate for Payer: Priority Health Medicare |
$141.87
|
| Rate for Payer: Priority Health Narrow Network |
$333.29
|
| Rate for Payer: Priority Health SBD |
$122.74
|
| Rate for Payer: Railroad Medicare Medicare |
$141.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.87
|
| Rate for Payer: UHC Exchange |
$145.06
|
| Rate for Payer: UHC Medicare Advantage |
$146.13
|
| Rate for Payer: VA VA |
$141.87
|
|
|
HC PSYCH/NEUROPSYCH TEST BY PHYS 30 MIN
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 96136
|
| Hospital Charge Code |
91800009
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
|
|
HC PSYCH/NEUROPSYCH TEST BY PHYS 30 MIN
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 96136
|
| Hospital Charge Code |
91800009
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$351.10 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.10
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health Narrow Network |
$280.88
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$22.59
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
HC PSYCH/NEUROPSYCH TEST BY TECH 30 MIN
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 96138
|
| Hospital Charge Code |
91800011
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$845.03 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$368.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.16
|
| Rate for Payer: BCBS Complete |
$203.64
|
| Rate for Payer: BCBS MAPPO |
$354.53
|
| Rate for Payer: BCN Medicare Advantage |
$354.53
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.53
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$193.93
|
| Rate for Payer: Mclaren Medicare |
$354.53
|
| Rate for Payer: Meridian Medicaid |
$203.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$336.80
|
| Rate for Payer: PACE SWMI |
$354.53
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$354.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.03
|
| Rate for Payer: Priority Health Medicare |
$354.53
|
| Rate for Payer: Priority Health Narrow Network |
$676.02
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: Railroad Medicare Medicare |
$354.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.53
|
| Rate for Payer: UHC Exchange |
$33.73
|
| Rate for Payer: UHC Medicare Advantage |
$365.17
|
| Rate for Payer: VA VA |
$354.53
|
|
|
HC PSYCH/NEUROPSYCH TEST BY TECH 30 MIN
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 96138
|
| Hospital Charge Code |
91800011
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
|
|
HC PSYCH/NEUROPSYCH TEST BY TECH EA ADDL 30 MIN
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT 96139
|
| Hospital Charge Code |
91800012
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$9.64
|
|
|
HC PSYCH/NEUROPSYCH TEST BY TECH EA ADDL 30 MIN
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT 96139
|
| Hospital Charge Code |
91800012
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$38.18 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: BCBS Complete |
$6.12
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$9.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.18
|
| Rate for Payer: UHC Exchange |
$34.71
|
|
|
HC PSYCH/NEUROPSYCH TEST PHYS EA ADDL 30 MIN
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT 96137
|
| Hospital Charge Code |
91800010
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$9.64
|
|
|
HC PSYCH/NEUROPSYCH TEST PHYS EA ADDL 30 MIN
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT 96137
|
| Hospital Charge Code |
91800010
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: BCBS Complete |
$6.12
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$9.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.08
|
| Rate for Payer: UHC Exchange |
$17.35
|
|
|
HC PSYCH/NEUROPSYCH TEST SINGLE AUTOMATED
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 96146
|
| Hospital Charge Code |
91800013
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
|
|
HC PSYCH/NEUROPSYCH TEST SINGLE AUTOMATED
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 96146
|
| Hospital Charge Code |
91800013
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$27.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.11
|
| Rate for Payer: BCBS Complete |
$15.22
|
| Rate for Payer: BCBS MAPPO |
$26.49
|
| Rate for Payer: BCN Medicare Advantage |
$26.49
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$14.49
|
| Rate for Payer: Mclaren Medicare |
$26.49
|
| Rate for Payer: Meridian Medicaid |
$15.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$25.17
|
| Rate for Payer: PACE SWMI |
$26.49
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$26.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.91
|
| Rate for Payer: Priority Health Medicare |
$26.49
|
| Rate for Payer: Priority Health Narrow Network |
$61.53
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: Railroad Medicare Medicare |
$26.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.49
|
| Rate for Payer: UHC Exchange |
$2.29
|
| Rate for Payer: UHC Medicare Advantage |
$27.28
|
| Rate for Payer: VA VA |
$26.49
|
|
|
HC PSYCHOLOGICAL TEST EVAL PHYS/QHP 1ST HOUR
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 96130
|
| Hospital Charge Code |
91800450
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$106.42 |
| Max. Negotiated Rate |
$824.04 |
| Rate for Payer: Aetna Commercial |
$595.00
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cofinity Commercial |
$602.00
|
| Rate for Payer: Cofinity Commercial |
$490.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$630.00
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.00
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$595.00
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$824.04
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health Narrow Network |
$659.23
|
| Rate for Payer: Priority Health SBD |
$441.00
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$106.42
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC PSYCHOLOGICAL TEST EVAL PHYS/QHP 1ST HOUR
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
CPT 96130
|
| Hospital Charge Code |
91800450
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna Commercial |
$595.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cofinity Commercial |
$490.00
|
| Rate for Payer: Cofinity Commercial |
$602.00
|
| Rate for Payer: Healthscope Commercial |
$630.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.00
|
| Rate for Payer: PHP Commercial |
$595.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.00
|
| Rate for Payer: Priority Health SBD |
$441.00
|
|
|
HC PSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HOUR
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 96131
|
| Hospital Charge Code |
91800449
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$335.16 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna Commercial |
$452.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.80
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cofinity Commercial |
$372.40
|
| Rate for Payer: Cofinity Commercial |
$457.52
|
| Rate for Payer: Healthscope Commercial |
$478.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$452.20
|
| Rate for Payer: PHP Commercial |
$452.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.40
|
| Rate for Payer: Priority Health SBD |
$335.16
|
|
