|
HC PROTOPORPHYRINS, FRACTIONATION, WB
|
Facility
|
IP
|
$88.08
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.49 |
| Max. Negotiated Rate |
$79.27 |
| Rate for Payer: Aetna Commercial |
$74.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.25
|
| Rate for Payer: Cash Price |
$70.46
|
| Rate for Payer: Cofinity Advantage |
$61.66
|
| Rate for Payer: Cofinity Commercial |
$75.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.46
|
| Rate for Payer: Healthscope Commercial |
$79.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.06
|
| Rate for Payer: PHP Commercial |
$74.87
|
| Rate for Payer: Priority Health SBD |
$55.49
|
|
|
HC PROTOPORPHYRINS, FRACTIONATION, WB
|
Facility
|
OP
|
$88.08
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$79.27 |
| Rate for Payer: Aetna Commercial |
$74.87
|
| Rate for Payer: Aetna Medicare |
$25.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: BCBS Complete |
$13.23
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$25.69
|
| Rate for Payer: BCN Commercial |
$25.69
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$70.46
|
| Rate for Payer: Cash Price |
$70.46
|
| Rate for Payer: Cofinity Advantage |
$61.66
|
| Rate for Payer: Cofinity Commercial |
$75.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$79.27
|
| Rate for Payer: Mclaren Medicaid |
$12.60
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: Meridian Medicaid |
$25.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.87
|
| Rate for Payer: Nomi Health Commercial |
$36.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.06
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$74.87
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.09
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health SBD |
$55.49
|
| Rate for Payer: Priority Health Tiered Network |
$19.27
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.14
|
| Rate for Payer: UHC Core |
$36.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.09
|
| Rate for Payer: UHC Exchange |
$36.14
|
| Rate for Payer: UHC Medicaid |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$12.60
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC PSA ANNUAL SCREEN
|
Facility
|
OP
|
$71.07
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
30000044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$63.96 |
| Rate for Payer: Aetna Commercial |
$60.41
|
| Rate for Payer: Aetna Medicare |
$20.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.14
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: BCBS MAPPO |
$19.31
|
| Rate for Payer: BCBS Trust/PPO |
$20.58
|
| Rate for Payer: BCN Commercial |
$20.58
|
| Rate for Payer: BCN Medicare Advantage |
$19.31
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cofinity Advantage |
$49.75
|
| Rate for Payer: Cofinity Commercial |
$61.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.31
|
| Rate for Payer: Healthscope Commercial |
$63.96
|
| Rate for Payer: Mclaren Medicaid |
$10.10
|
| Rate for Payer: Mclaren Medicare |
$19.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.28
|
| Rate for Payer: Meridian Medicaid |
$20.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.41
|
| Rate for Payer: Nomi Health Commercial |
$57.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.30
|
| Rate for Payer: PACE Medicare |
$18.34
|
| Rate for Payer: PACE SWMI |
$19.31
|
| Rate for Payer: PHP Commercial |
$60.41
|
| Rate for Payer: PHP Medicare Advantage |
$19.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19.31
|
| Rate for Payer: Priority Health Medicare |
$19.31
|
| Rate for Payer: Priority Health SBD |
$44.77
|
| Rate for Payer: Priority Health Tiered Network |
$15.45
|
| Rate for Payer: Railroad Medicare Medicare |
$19.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.97
|
| Rate for Payer: UHC Core |
$28.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19.31
|
| Rate for Payer: UHC Exchange |
$28.97
|
| Rate for Payer: UHC Medicaid |
$10.10
|
| Rate for Payer: UHCCP Medicaid |
$10.10
|
| Rate for Payer: VA VA |
$19.31
|
|
|
HC PSA ANNUAL SCREEN
|
Facility
|
IP
|
$71.07
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
30000044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.77 |
| Max. Negotiated Rate |
$63.96 |
| Rate for Payer: Aetna Commercial |
$60.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.20
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cofinity Advantage |
$49.75
|
| Rate for Payer: Cofinity Commercial |
$61.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.86
|
| Rate for Payer: Healthscope Commercial |
$63.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.30
|
| Rate for Payer: PHP Commercial |
$60.41
|
| Rate for Payer: Priority Health SBD |
$44.77
|
|
|
HC PSA FREE
|
Facility
|
IP
|
$71.07
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
30100405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.77 |
| Max. Negotiated Rate |
$63.96 |
| Rate for Payer: Aetna Commercial |
$60.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.20
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cofinity Advantage |
$49.75
|
| Rate for Payer: Cofinity Commercial |
$61.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.86
|
| Rate for Payer: Healthscope Commercial |
$63.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.30
|
| Rate for Payer: PHP Commercial |
$60.41
|
| Rate for Payer: Priority Health SBD |
$44.77
|
|
|
HC PSA FREE
|
Facility
|
OP
|
$71.07
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
30100405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$63.96 |
| Rate for Payer: Aetna Commercial |
$60.41
|
| Rate for Payer: Aetna Medicare |
$19.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.99
|
| Rate for Payer: BCBS Complete |
$10.10
|
| Rate for Payer: BCBS MAPPO |
$18.39
|
| Rate for Payer: BCBS Trust/PPO |
$19.60
|
| Rate for Payer: BCN Commercial |
$19.60
|
| Rate for Payer: BCN Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cofinity Advantage |
$49.75
|
| Rate for Payer: Cofinity Commercial |
$61.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.39
|
| Rate for Payer: Healthscope Commercial |
$63.96
|
| Rate for Payer: Mclaren Medicaid |
$9.62
|
| Rate for Payer: Mclaren Medicare |
$18.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.31
|
| Rate for Payer: Meridian Medicaid |
$19.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.41
|
| Rate for Payer: Nomi Health Commercial |
$27.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.30
|
| Rate for Payer: PACE Medicare |
$17.47
|
| Rate for Payer: PACE SWMI |
$18.39
|
| Rate for Payer: PHP Commercial |
$60.41
|
| Rate for Payer: PHP Medicare Advantage |
$18.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.39
|
| Rate for Payer: Priority Health Medicare |
$18.39
|
| Rate for Payer: Priority Health SBD |
$44.77
|
| Rate for Payer: Priority Health Tiered Network |
$14.71
|
| Rate for Payer: Railroad Medicare Medicare |
$18.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.59
|
| Rate for Payer: UHC Core |
$27.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.39
|
| Rate for Payer: UHC Exchange |
$27.59
|
| Rate for Payer: UHC Medicaid |
$9.62
|
| Rate for Payer: UHCCP Medicaid |
$9.62
|
| Rate for Payer: VA VA |
$18.39
|
|
|
HC PSA TOTAL
|
Facility
|
IP
|
$71.07
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
30100403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.77 |
| Max. Negotiated Rate |
$63.96 |
| Rate for Payer: Aetna Commercial |
$60.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.20
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cofinity Advantage |
$49.75
|
| Rate for Payer: Cofinity Commercial |
$61.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.86
|
| Rate for Payer: Healthscope Commercial |
$63.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.30
|
| Rate for Payer: PHP Commercial |
$60.41
|
| Rate for Payer: Priority Health SBD |
$44.77
|
|
|
HC PSA TOTAL
|
Facility
|
OP
|
$71.07
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
30100403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$63.96 |
| Rate for Payer: Aetna Commercial |
$60.41
|
| Rate for Payer: Aetna Medicare |
$19.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.99
|
| Rate for Payer: BCBS Complete |
$10.10
|
| Rate for Payer: BCBS MAPPO |
$18.39
|
| Rate for Payer: BCBS Trust/PPO |
$19.60
|
| Rate for Payer: BCN Commercial |
$19.60
|
| Rate for Payer: BCN Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cash Price |
$56.86
|
| Rate for Payer: Cofinity Advantage |
$49.75
|
| Rate for Payer: Cofinity Commercial |
$61.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.39
|
| Rate for Payer: Healthscope Commercial |
$63.96
|
| Rate for Payer: Mclaren Medicaid |
$9.62
|
| Rate for Payer: Mclaren Medicare |
$18.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.31
|
| Rate for Payer: Meridian Medicaid |
$19.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.41
|
| Rate for Payer: Nomi Health Commercial |
$27.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.30
|
| Rate for Payer: PACE Medicare |
$17.47
|
| Rate for Payer: PACE SWMI |
$18.39
|
| Rate for Payer: PHP Commercial |
$60.41
|
| Rate for Payer: PHP Medicare Advantage |
$18.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.39
|
| Rate for Payer: Priority Health Medicare |
$18.39
|
| Rate for Payer: Priority Health SBD |
$44.77
|
| Rate for Payer: Priority Health Tiered Network |
$14.71
|
| Rate for Payer: Railroad Medicare Medicare |
$18.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.59
|
| Rate for Payer: UHC Core |
$27.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.39
|
| Rate for Payer: UHC Exchange |
$27.59
|
| Rate for Payer: UHC Medicaid |
$9.62
|
| Rate for Payer: UHCCP Medicaid |
$9.62
|
| Rate for Payer: VA VA |
$18.39
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
OP
|
$1,091.96
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.90 |
| Max. Negotiated Rate |
$2,021.35 |
| Rate for Payer: Aetna Commercial |
$928.17
|
| Rate for Payer: Aetna Medicare |
$650.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$709.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.31
|
| Rate for Payer: BCBS Complete |
$343.28
|
| Rate for Payer: BCBS MAPPO |
$625.05
|
| Rate for Payer: BCBS Trust/PPO |
$423.27
|
| Rate for Payer: BCN Commercial |
$423.27
|
| Rate for Payer: BCN Medicare Advantage |
$625.05
|
| Rate for Payer: Cash Price |
$873.57
|
| Rate for Payer: Cash Price |
$873.57
|
| Rate for Payer: Cash Price |
$873.57
|
| Rate for Payer: Cofinity Advantage |
$764.37
|
| Rate for Payer: Cofinity Commercial |
$939.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.05
|
| Rate for Payer: Healthscope Commercial |
$982.76
|
| Rate for Payer: Mclaren Medicaid |
$326.90
|
| Rate for Payer: Mclaren Medicare |
$625.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.30
|
| Rate for Payer: Meridian Medicaid |
$656.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$718.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.17
|
| Rate for Payer: Nomi Health Commercial |
$1,875.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.97
|
| Rate for Payer: PACE Medicare |
$593.80
|
| Rate for Payer: PACE SWMI |
$625.05
|
| Rate for Payer: PHP Commercial |
$928.17
|
| Rate for Payer: PHP Medicare Advantage |
$625.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,021.35
|
| Rate for Payer: Priority Health Medicare |
$625.05
|
| Rate for Payer: Priority Health SBD |
$687.93
|
| Rate for Payer: Priority Health Tiered Network |
$1,617.08
|
| Rate for Payer: Railroad Medicare Medicare |
$625.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$625.05
|
| Rate for Payer: UHC Medicaid |
$326.90
|
| Rate for Payer: UHCCP Medicaid |
$326.90
|
| Rate for Payer: VA VA |
$625.05
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
IP
|
$1,091.96
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$687.93 |
| Max. Negotiated Rate |
$982.76 |
| Rate for Payer: Aetna Commercial |
$928.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$709.77
|
| Rate for Payer: Cash Price |
$873.57
|
| Rate for Payer: Cofinity Advantage |
$764.37
|
| Rate for Payer: Cofinity Commercial |
$939.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.57
|
| Rate for Payer: Healthscope Commercial |
$982.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.97
|
| Rate for Payer: PHP Commercial |
$928.17
|
| Rate for Payer: Priority Health SBD |
$687.93
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.43 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health SBD |
$33.43
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$8.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.84
|
| Rate for Payer: BCBS Complete |
$4.32
|
| Rate for Payer: BCBS MAPPO |
$7.87
|
| Rate for Payer: BCBS Trust/PPO |
$8.39
|
| Rate for Payer: BCN Commercial |
$8.39
|
| Rate for Payer: BCN Medicare Advantage |
$7.87
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.87
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$4.12
|
| Rate for Payer: Mclaren Medicare |
$7.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.26
|
| Rate for Payer: Meridian Medicaid |
$8.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$11.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$7.48
|
| Rate for Payer: PACE SWMI |
$7.87
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: PHP Medicare Advantage |
$7.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7.87
|
| Rate for Payer: Priority Health Medicare |
$7.87
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: Priority Health Tiered Network |
$6.30
|
| Rate for Payer: Railroad Medicare Medicare |
$7.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.81
|
| Rate for Payer: UHC Core |
$11.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.87
|
| Rate for Payer: UHC Exchange |
$11.81
|
| Rate for Payer: UHC Medicaid |
$4.12
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: VA VA |
$7.87
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
OP
|
$5,910.14
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$447.50 |
| Max. Negotiated Rate |
$5,319.13 |
| Rate for Payer: Aetna Commercial |
$5,023.62
|
| Rate for Payer: Aetna Medicare |
$889.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,841.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,069.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,069.56
|
| Rate for Payer: BCBS Complete |
$469.92
|
| Rate for Payer: BCBS MAPPO |
$855.65
|
| Rate for Payer: BCBS Trust/PPO |
$3,781.11
|
| Rate for Payer: BCN Commercial |
$3,781.11
|
| Rate for Payer: BCN Medicare Advantage |
$855.65
|
| Rate for Payer: Cash Price |
$4,728.11
|
| Rate for Payer: Cash Price |
$4,728.11
|
| Rate for Payer: Cofinity Advantage |
$4,137.10
|
| Rate for Payer: Cofinity Commercial |
$5,082.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,728.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$855.65
|
| Rate for Payer: Healthscope Commercial |
$5,319.13
|
| Rate for Payer: Mclaren Medicaid |
$447.50
|
| Rate for Payer: Mclaren Medicare |
$855.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$898.43
|
| Rate for Payer: Meridian Medicaid |
$898.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$984.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$941.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,023.62
|
| Rate for Payer: Nomi Health Commercial |
$2,566.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,432.60
|
| Rate for Payer: PACE Medicare |
$812.87
|
| Rate for Payer: PACE SWMI |
$855.65
|
| Rate for Payer: PHP Commercial |
$5,023.62
|
| Rate for Payer: PHP Medicare Advantage |
$855.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$447.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,767.09
|
| Rate for Payer: Priority Health Medicare |
$855.65
|
| Rate for Payer: Priority Health SBD |
$3,723.39
|
| Rate for Payer: Priority Health Tiered Network |
$2,213.67
|
| Rate for Payer: Railroad Medicare Medicare |
$855.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,841.59
|
| Rate for Payer: UHC Core |
$3,079.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$855.65
|
| Rate for Payer: UHC Exchange |
$2,322.69
|
| Rate for Payer: UHC Medicaid |
$447.50
|
| Rate for Payer: UHCCP Medicaid |
$447.50
|
| Rate for Payer: VA VA |
$855.65
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
IP
|
$5,910.14
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$3,723.39 |
| Max. Negotiated Rate |
$5,319.13 |
| Rate for Payer: Aetna Commercial |
$5,023.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,841.59
|
| Rate for Payer: Cash Price |
$4,728.11
|
| Rate for Payer: Cofinity Advantage |
$4,137.10
|
| Rate for Payer: Cofinity Commercial |
$5,082.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,728.11
|
| Rate for Payer: Healthscope Commercial |
$5,319.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,023.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,432.60
|
| Rate for Payer: PHP Commercial |
$5,023.62
|
| Rate for Payer: Priority Health SBD |
$3,723.39
|
|
|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
IP
|
$6,102.68
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$3,844.69 |
| Max. Negotiated Rate |
$5,492.41 |
| Rate for Payer: Aetna Commercial |
$5,187.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,966.74
|
| Rate for Payer: Cash Price |
$4,882.14
|
| Rate for Payer: Cofinity Advantage |
$4,271.88
|
| Rate for Payer: Cofinity Commercial |
$5,248.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,882.14
|
| Rate for Payer: Healthscope Commercial |
$5,492.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,187.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,577.01
|
| Rate for Payer: PHP Commercial |
$5,187.28
|
| Rate for Payer: Priority Health SBD |
$3,844.69
|
|
|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
OP
|
$6,102.68
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$447.50 |
| Max. Negotiated Rate |
$5,492.41 |
| Rate for Payer: Aetna Commercial |
$5,187.28
|
| Rate for Payer: Aetna Medicare |
$889.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,966.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,069.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,069.56
|
| Rate for Payer: BCBS Complete |
$469.92
|
| Rate for Payer: BCBS MAPPO |
$855.65
|
| Rate for Payer: BCBS Trust/PPO |
$3,991.34
|
| Rate for Payer: BCN Commercial |
$3,991.34
|
| Rate for Payer: BCN Medicare Advantage |
$855.65
|
| Rate for Payer: Cash Price |
$4,882.14
|
| Rate for Payer: Cash Price |
$4,882.14
|
| Rate for Payer: Cofinity Advantage |
$4,271.88
|
| Rate for Payer: Cofinity Commercial |
$5,248.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,882.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$855.65
|
| Rate for Payer: Healthscope Commercial |
$5,492.41
|
| Rate for Payer: Mclaren Medicaid |
$447.50
|
| Rate for Payer: Mclaren Medicare |
$855.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$898.43
|
| Rate for Payer: Meridian Medicaid |
$898.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$984.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$941.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,187.28
|
| Rate for Payer: Nomi Health Commercial |
$2,566.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,577.01
|
| Rate for Payer: PACE Medicare |
$812.87
|
| Rate for Payer: PACE SWMI |
$855.65
|
| Rate for Payer: PHP Commercial |
$5,187.28
|
| Rate for Payer: PHP Medicare Advantage |
$855.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$447.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,767.09
|
| Rate for Payer: Priority Health Medicare |
$855.65
|
| Rate for Payer: Priority Health SBD |
$3,844.69
|
| Rate for Payer: Priority Health Tiered Network |
$2,213.67
|
| Rate for Payer: Railroad Medicare Medicare |
$855.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,966.74
|
| Rate for Payer: UHC Core |
$3,179.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$855.65
|
| Rate for Payer: UHC Exchange |
$2,398.35
|
| Rate for Payer: UHC Medicaid |
$447.50
|
| Rate for Payer: UHCCP Medicaid |
$447.50
|
| Rate for Payer: VA VA |
$855.65
|
|
|
HC PSORALEN
|
Facility
|
OP
|
$2,200.05
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$309.83 |
| Max. Negotiated Rate |
$1,980.05 |
| Rate for Payer: Aetna Commercial |
$1,870.04
|
| Rate for Payer: Aetna Medicare |
$616.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,430.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$740.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$740.51
|
| Rate for Payer: BCBS Complete |
$325.35
|
| Rate for Payer: BCBS MAPPO |
$592.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,632.46
|
| Rate for Payer: BCN Commercial |
$1,632.46
|
| Rate for Payer: BCN Medicare Advantage |
$592.41
|
| Rate for Payer: Cash Price |
$1,760.04
|
| Rate for Payer: Cash Price |
$1,760.04
|
| Rate for Payer: Cofinity Advantage |
$1,540.04
|
| Rate for Payer: Cofinity Commercial |
$1,892.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,760.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$592.41
|
| Rate for Payer: Healthscope Commercial |
$1,980.05
|
| Rate for Payer: Mclaren Medicaid |
$309.83
|
| Rate for Payer: Mclaren Medicare |
$592.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$622.03
|
| Rate for Payer: Meridian Medicaid |
$622.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$681.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$651.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,870.04
|
| Rate for Payer: Nomi Health Commercial |
$1,777.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,650.04
|
| Rate for Payer: PACE Medicare |
$562.79
|
| Rate for Payer: PACE SWMI |
$592.41
|
| Rate for Payer: PHP Commercial |
$1,870.04
|
| Rate for Payer: PHP Medicare Advantage |
$592.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$309.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,915.80
|
| Rate for Payer: Priority Health Medicare |
$592.41
|
| Rate for Payer: Priority Health SBD |
$1,386.03
|
| Rate for Payer: Priority Health Tiered Network |
$1,532.64
|
| Rate for Payer: Railroad Medicare Medicare |
$592.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,430.03
|
| Rate for Payer: UHC Core |
$1,146.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$592.41
|
| Rate for Payer: UHC Exchange |
$864.62
|
| Rate for Payer: UHC Medicaid |
$309.83
|
| Rate for Payer: UHCCP Medicaid |
$309.83
|
| Rate for Payer: VA VA |
$592.41
|
|
|
HC PSORALEN
|
Facility
|
IP
|
$2,200.05
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,386.03 |
| Max. Negotiated Rate |
$1,980.05 |
| Rate for Payer: Aetna Commercial |
$1,870.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,430.03
|
| Rate for Payer: Cash Price |
$1,760.04
|
| Rate for Payer: Cofinity Advantage |
$1,540.04
|
| Rate for Payer: Cofinity Commercial |
$1,892.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,760.04
|
| Rate for Payer: Healthscope Commercial |
$1,980.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,870.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,650.04
|
| Rate for Payer: PHP Commercial |
$1,870.04
|
| Rate for Payer: Priority Health SBD |
$1,386.03
|
|
|
HC PSORALEN TREATED WASHED PLATELETS
|
Facility
|
OP
|
$2,283.28
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000086
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$309.83 |
| Max. Negotiated Rate |
$2,054.95 |
| Rate for Payer: Aetna Commercial |
$1,940.79
|
| Rate for Payer: Aetna Medicare |
$616.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,484.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$740.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$740.51
|
| Rate for Payer: BCBS Complete |
$325.35
|
| Rate for Payer: BCBS MAPPO |
$592.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,632.46
|
| Rate for Payer: BCN Commercial |
$1,632.46
|
| Rate for Payer: BCN Medicare Advantage |
$592.41
|
| Rate for Payer: Cash Price |
$1,826.62
|
| Rate for Payer: Cash Price |
$1,826.62
|
| Rate for Payer: Cofinity Advantage |
$1,598.30
|
| Rate for Payer: Cofinity Commercial |
$1,963.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,826.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$592.41
|
| Rate for Payer: Healthscope Commercial |
$2,054.95
|
| Rate for Payer: Mclaren Medicaid |
$309.83
|
| Rate for Payer: Mclaren Medicare |
$592.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$622.03
|
| Rate for Payer: Meridian Medicaid |
$622.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$681.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$651.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,940.79
|
| Rate for Payer: Nomi Health Commercial |
$1,777.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,712.46
|
| Rate for Payer: PACE Medicare |
$562.79
|
| Rate for Payer: PACE SWMI |
$592.41
|
| Rate for Payer: PHP Commercial |
$1,940.79
|
| Rate for Payer: PHP Medicare Advantage |
$592.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$309.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,915.80
|
| Rate for Payer: Priority Health Medicare |
$592.41
|
| Rate for Payer: Priority Health SBD |
$1,438.47
|
| Rate for Payer: Priority Health Tiered Network |
$1,532.64
|
| Rate for Payer: Railroad Medicare Medicare |
$592.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,484.13
|
| Rate for Payer: UHC Core |
$1,189.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$592.41
|
| Rate for Payer: UHC Exchange |
$897.33
|
| Rate for Payer: UHC Medicaid |
$309.83
|
| Rate for Payer: UHCCP Medicaid |
$309.83
|
| Rate for Payer: VA VA |
$592.41
|
|
|
HC PSORALEN TREATED WASHED PLATELETS
|
Facility
|
IP
|
$2,283.28
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000086
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,438.47 |
| Max. Negotiated Rate |
$2,054.95 |
| Rate for Payer: Aetna Commercial |
$1,940.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,484.13
|
| Rate for Payer: Cash Price |
$1,826.62
|
| Rate for Payer: Cofinity Advantage |
$1,598.30
|
| Rate for Payer: Cofinity Commercial |
$1,963.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,826.62
|
| Rate for Payer: Healthscope Commercial |
$2,054.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,940.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,712.46
|
| Rate for Payer: PHP Commercial |
$1,940.79
|
| Rate for Payer: Priority Health SBD |
$1,438.47
|
|
|
HC PSYCH COLLAB CARE MGMT EA ADD 30 MIN
|
Facility
|
IP
|
$91.26
|
|
|
Service Code
|
CPT 99494
|
| Hospital Charge Code |
51000094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.49 |
| Max. Negotiated Rate |
$82.13 |
| Rate for Payer: Aetna Commercial |
$77.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.32
|
| Rate for Payer: Cash Price |
$73.01
|
| Rate for Payer: Cofinity Advantage |
$63.88
|
| Rate for Payer: Cofinity Commercial |
$78.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.01
|
| Rate for Payer: Healthscope Commercial |
$82.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.44
|
| Rate for Payer: PHP Commercial |
$77.57
|
| Rate for Payer: Priority Health SBD |
$57.49
|
|
|
HC PSYCH COLLAB CARE MGMT EA ADD 30 MIN
|
Facility
|
OP
|
$91.26
|
|
|
Service Code
|
CPT 99494
|
| Hospital Charge Code |
51000094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.87 |
| Max. Negotiated Rate |
$127.92 |
| Rate for Payer: Aetna Commercial |
$77.57
|
| Rate for Payer: Aetna Medicare |
$45.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.32
|
| Rate for Payer: BCBS Complete |
$36.50
|
| Rate for Payer: BCBS Trust/PPO |
$127.92
|
| Rate for Payer: BCN Commercial |
$127.92
|
| Rate for Payer: Cash Price |
$73.01
|
| Rate for Payer: Cash Price |
$73.01
|
| Rate for Payer: Cofinity Advantage |
$63.88
|
| Rate for Payer: Cofinity Commercial |
$78.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.01
|
| Rate for Payer: Healthscope Commercial |
$82.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.44
|
| Rate for Payer: PHP Commercial |
$77.57
|
| Rate for Payer: Priority Health SBD |
$57.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.32
|
| Rate for Payer: UHC Core |
$47.55
|
| Rate for Payer: UHC Exchange |
$35.87
|
|
|
HC PSYCH COLLAB CARE MGMT INIT 70 MIN
|
Facility
|
IP
|
$97.63
|
|
|
Service Code
|
CPT 99492
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.51 |
| Max. Negotiated Rate |
$87.87 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.46
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cofinity Advantage |
$68.34
|
| Rate for Payer: Cofinity Commercial |
$83.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.10
|
| Rate for Payer: Healthscope Commercial |
$87.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.22
|
| Rate for Payer: PHP Commercial |
$82.99
|
| Rate for Payer: Priority Health SBD |
$61.51
|
|
|
HC PSYCH COLLAB CARE MGMT INIT 70 MIN
|
Facility
|
OP
|
$97.63
|
|
|
Service Code
|
CPT 99492
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$347.55 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna Medicare |
$105.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.53
|
| Rate for Payer: BCBS Complete |
$55.59
|
| Rate for Payer: BCBS MAPPO |
$101.22
|
| Rate for Payer: BCBS Trust/PPO |
$347.55
|
| Rate for Payer: BCN Commercial |
$347.55
|
| Rate for Payer: BCN Medicare Advantage |
$101.22
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cofinity Advantage |
$68.34
|
| Rate for Payer: Cofinity Commercial |
$83.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.22
|
| Rate for Payer: Healthscope Commercial |
$87.87
|
| Rate for Payer: Mclaren Medicaid |
$52.94
|
| Rate for Payer: Mclaren Medicare |
$101.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.28
|
| Rate for Payer: Meridian Medicaid |
$106.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.99
|
| Rate for Payer: Nomi Health Commercial |
$303.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.22
|
| Rate for Payer: PACE Medicare |
$96.16
|
| Rate for Payer: PACE SWMI |
$101.22
|
| Rate for Payer: PHP Commercial |
$82.99
|
| Rate for Payer: PHP Medicare Advantage |
$101.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$327.36
|
| Rate for Payer: Priority Health Medicare |
$101.22
|
| Rate for Payer: Priority Health SBD |
$61.51
|
| Rate for Payer: Priority Health Tiered Network |
$261.89
|
| Rate for Payer: Railroad Medicare Medicare |
$101.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.46
|
| Rate for Payer: UHC Core |
$50.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.22
|
| Rate for Payer: UHC Exchange |
$38.37
|
| Rate for Payer: UHC Medicaid |
$52.94
|
| Rate for Payer: UHCCP Medicaid |
$52.94
|
| Rate for Payer: VA VA |
$101.22
|
|
|
HC PSYCH COLLAB CARE MGMT SUBSEQ 60 MIN
|
Facility
|
IP
|
$126.34
|
|
|
Service Code
|
CPT 99493
|
| Hospital Charge Code |
51000093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.59 |
| Max. Negotiated Rate |
$113.71 |
| Rate for Payer: Aetna Commercial |
$107.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.12
|
| Rate for Payer: Cash Price |
$101.07
|
| Rate for Payer: Cofinity Advantage |
$88.44
|
| Rate for Payer: Cofinity Commercial |
$108.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.07
|
| Rate for Payer: Healthscope Commercial |
$113.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.75
|
| Rate for Payer: PHP Commercial |
$107.39
|
| Rate for Payer: Priority Health SBD |
$79.59
|
|
