|
HC PSA TOTAL
|
Facility
|
OP
|
$69.68
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
30100403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$62.71 |
| Rate for Payer: Aetna Commercial |
$59.23
|
| Rate for Payer: Aetna Medicare |
$19.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.29
|
| 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 |
$10.35
|
| Rate for Payer: BCBS MAPPO |
$18.39
|
| Rate for Payer: BCN Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cofinity Commercial |
$59.92
|
| Rate for Payer: Cofinity Commercial |
$48.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.39
|
| Rate for Payer: Healthscope Commercial |
$62.71
|
| Rate for Payer: Mclaren Medicaid |
$9.86
|
| 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 |
$10.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.23
|
| Rate for Payer: PACE Medicare |
$17.47
|
| Rate for Payer: PACE SWMI |
$18.39
|
| Rate for Payer: PHP Commercial |
$59.23
|
| Rate for Payer: PHP Medicare Advantage |
$18.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: Priority Health Medicare |
$18.39
|
| Rate for Payer: Priority Health SBD |
$43.90
|
| Rate for Payer: Railroad Medicare Medicare |
$18.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.39
|
| Rate for Payer: UHC Medicare Advantage |
$18.39
|
| Rate for Payer: UHCCP Medicaid |
$10.35
|
| Rate for Payer: VA VA |
$18.39
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
IP
|
$1,039.96
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$655.17 |
| Max. Negotiated Rate |
$935.96 |
| Rate for Payer: Aetna Commercial |
$883.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$675.97
|
| Rate for Payer: Cash Price |
$831.97
|
| Rate for Payer: Cofinity Commercial |
$727.97
|
| Rate for Payer: Cofinity Commercial |
$894.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$727.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$831.97
|
| Rate for Payer: Healthscope Commercial |
$935.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$883.97
|
| Rate for Payer: PHP Commercial |
$883.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.97
|
| Rate for Payer: Priority Health SBD |
$655.17
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
OP
|
$1,039.96
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$323.20 |
| Max. Negotiated Rate |
$1,697.33 |
| Rate for Payer: Aetna Commercial |
$883.97
|
| Rate for Payer: Aetna Medicare |
$627.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$675.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$753.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$753.73
|
| Rate for Payer: BCBS Complete |
$339.36
|
| Rate for Payer: BCBS MAPPO |
$602.98
|
| Rate for Payer: BCN Medicare Advantage |
$602.98
|
| Rate for Payer: Cash Price |
$831.97
|
| Rate for Payer: Cash Price |
$831.97
|
| Rate for Payer: Cofinity Commercial |
$727.97
|
| Rate for Payer: Cofinity Commercial |
$894.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$727.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$831.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.98
|
| Rate for Payer: Healthscope Commercial |
$935.96
|
| Rate for Payer: Mclaren Medicaid |
$323.20
|
| Rate for Payer: Mclaren Medicare |
$602.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.13
|
| Rate for Payer: Meridian Medicaid |
$339.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$693.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$883.97
|
| Rate for Payer: PACE Medicare |
$572.83
|
| Rate for Payer: PACE SWMI |
$602.98
|
| Rate for Payer: PHP Commercial |
$883.97
|
| Rate for Payer: PHP Medicare Advantage |
$602.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$323.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.97
|
| Rate for Payer: Priority Health Medicare |
$602.98
|
| Rate for Payer: Priority Health SBD |
$655.17
|
| Rate for Payer: Railroad Medicare Medicare |
$602.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,697.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.98
|
| Rate for Payer: UHC Medicare Advantage |
$602.98
|
| Rate for Payer: UHCCP Medicaid |
$339.48
|
| Rate for Payer: VA VA |
$602.98
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$8.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| 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 |
$4.43
|
| Rate for Payer: BCBS MAPPO |
$7.87
|
| Rate for Payer: BCN Medicare Advantage |
$7.87
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.87
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$4.22
|
| 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 |
$4.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PACE Medicare |
$7.48
|
| Rate for Payer: PACE SWMI |
$7.87
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$7.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health Medicare |
$7.87
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: Railroad Medicare Medicare |
$7.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.87
|
| Rate for Payer: UHC Medicare Advantage |
$7.87
|
| Rate for Payer: UHCCP Medicaid |
$4.43
|
| Rate for Payer: VA VA |
$7.87
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
OP
|
$5,794.25
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$531.84 |
| Max. Negotiated Rate |
$5,214.82 |
| Rate for Payer: Aetna Commercial |
$4,925.11
|
| Rate for Payer: Aetna Medicare |
$1,031.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,766.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,240.30
|
| Rate for Payer: BCBS Complete |
$558.43
|
| Rate for Payer: BCBS MAPPO |
$992.24
|
| Rate for Payer: BCN Medicare Advantage |
$992.24
|
| Rate for Payer: Cash Price |
$4,635.40
|
| Rate for Payer: Cash Price |
$4,635.40
|
| Rate for Payer: Cofinity Commercial |
$4,983.06
|
| Rate for Payer: Cofinity Commercial |
$4,055.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,055.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,635.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.24
|
| Rate for Payer: Healthscope Commercial |
$5,214.82
|
| Rate for Payer: Mclaren Medicaid |
$531.84
|
| Rate for Payer: Mclaren Medicare |
$992.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,041.85
|
| Rate for Payer: Meridian Medicaid |
$558.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,141.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,925.11
|
| Rate for Payer: PACE Medicare |
$942.63
|
| Rate for Payer: PACE SWMI |
$992.24
|
| Rate for Payer: PHP Commercial |
$4,925.11
|
| Rate for Payer: PHP Medicare Advantage |
$992.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$531.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,766.26
|
| Rate for Payer: Priority Health Medicare |
$992.24
|
| Rate for Payer: Priority Health SBD |
$3,650.38
|
| Rate for Payer: Railroad Medicare Medicare |
$992.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,793.06
|
| Rate for Payer: UHC Core |
$4,287.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$992.24
|
| Rate for Payer: UHC Exchange |
$4,287.74
|
| Rate for Payer: UHC Medicare Advantage |
$992.24
|
| Rate for Payer: UHCCP Medicaid |
$558.63
|
| Rate for Payer: VA VA |
$992.24
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
IP
|
$5,794.25
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$3,650.38 |
| Max. Negotiated Rate |
$5,214.82 |
| Rate for Payer: Aetna Commercial |
$4,925.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,766.26
|
| Rate for Payer: Cash Price |
$4,635.40
|
| Rate for Payer: Cofinity Commercial |
$4,055.97
|
| Rate for Payer: Cofinity Commercial |
$4,983.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,055.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,635.40
|
| Rate for Payer: Healthscope Commercial |
$5,214.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,925.11
|
| Rate for Payer: PHP Commercial |
$4,925.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,766.26
|
| Rate for Payer: Priority Health SBD |
$3,650.38
|
|
|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
OP
|
$5,983.02
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$531.84 |
| Max. Negotiated Rate |
$5,384.72 |
| Rate for Payer: Aetna Commercial |
$5,085.57
|
| Rate for Payer: Aetna Medicare |
$1,031.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,888.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,240.30
|
| Rate for Payer: BCBS Complete |
$558.43
|
| Rate for Payer: BCBS MAPPO |
$992.24
|
| Rate for Payer: BCN Medicare Advantage |
$992.24
|
| Rate for Payer: Cash Price |
$4,786.42
|
| Rate for Payer: Cash Price |
$4,786.42
|
| Rate for Payer: Cofinity Commercial |
$5,145.40
|
| Rate for Payer: Cofinity Commercial |
$4,188.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,188.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,786.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.24
|
| Rate for Payer: Healthscope Commercial |
$5,384.72
|
| Rate for Payer: Mclaren Medicaid |
$531.84
|
| Rate for Payer: Mclaren Medicare |
$992.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,041.85
|
| Rate for Payer: Meridian Medicaid |
$558.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,141.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,085.57
|
| Rate for Payer: PACE Medicare |
$942.63
|
| Rate for Payer: PACE SWMI |
$992.24
|
| Rate for Payer: PHP Commercial |
$5,085.57
|
| Rate for Payer: PHP Medicare Advantage |
$992.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$531.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,888.96
|
| Rate for Payer: Priority Health Medicare |
$992.24
|
| Rate for Payer: Priority Health SBD |
$3,769.30
|
| Rate for Payer: Railroad Medicare Medicare |
$992.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,793.06
|
| Rate for Payer: UHC Core |
$4,427.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$992.24
|
| Rate for Payer: UHC Exchange |
$4,427.43
|
| Rate for Payer: UHC Medicare Advantage |
$992.24
|
| Rate for Payer: UHCCP Medicaid |
$558.63
|
| Rate for Payer: VA VA |
$992.24
|
|
|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
IP
|
$5,983.02
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$3,769.30 |
| Max. Negotiated Rate |
$5,384.72 |
| Rate for Payer: Aetna Commercial |
$5,085.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,888.96
|
| Rate for Payer: Cash Price |
$4,786.42
|
| Rate for Payer: Cofinity Commercial |
$4,188.11
|
| Rate for Payer: Cofinity Commercial |
$5,145.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,188.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,786.42
|
| Rate for Payer: Healthscope Commercial |
$5,384.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,085.57
|
| Rate for Payer: PHP Commercial |
$5,085.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,888.96
|
| Rate for Payer: Priority Health SBD |
$3,769.30
|
|
|
HC PSORALEN
|
Facility
|
IP
|
$2,156.91
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,358.85 |
| Max. Negotiated Rate |
$1,941.22 |
| Rate for Payer: Aetna Commercial |
$1,833.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,401.99
|
| Rate for Payer: Cash Price |
$1,725.53
|
| Rate for Payer: Cofinity Commercial |
$1,509.84
|
| Rate for Payer: Cofinity Commercial |
$1,854.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,509.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,725.53
|
| Rate for Payer: Healthscope Commercial |
$1,941.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,833.37
|
| Rate for Payer: PHP Commercial |
$1,833.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,401.99
|
| Rate for Payer: Priority Health SBD |
$1,358.85
|
|
|
HC PSORALEN
|
Facility
|
OP
|
$2,156.91
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$307.00 |
| Max. Negotiated Rate |
$1,941.22 |
| Rate for Payer: Aetna Commercial |
$1,833.37
|
| Rate for Payer: Aetna Medicare |
$595.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,401.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$715.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$715.95
|
| Rate for Payer: BCBS Complete |
$322.35
|
| Rate for Payer: BCBS MAPPO |
$572.76
|
| Rate for Payer: BCN Medicare Advantage |
$572.76
|
| Rate for Payer: Cash Price |
$1,725.53
|
| Rate for Payer: Cash Price |
$1,725.53
|
| Rate for Payer: Cofinity Commercial |
$1,854.94
|
| Rate for Payer: Cofinity Commercial |
$1,509.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,509.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,725.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$572.76
|
| Rate for Payer: Healthscope Commercial |
$1,941.22
|
| Rate for Payer: Mclaren Medicaid |
$307.00
|
| Rate for Payer: Mclaren Medicare |
$572.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.40
|
| Rate for Payer: Meridian Medicaid |
$322.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$658.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,833.37
|
| Rate for Payer: PACE Medicare |
$544.12
|
| Rate for Payer: PACE SWMI |
$572.76
|
| Rate for Payer: PHP Commercial |
$1,833.37
|
| Rate for Payer: PHP Medicare Advantage |
$572.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$307.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,401.99
|
| Rate for Payer: Priority Health Medicare |
$572.76
|
| Rate for Payer: Priority Health SBD |
$1,358.85
|
| Rate for Payer: Railroad Medicare Medicare |
$572.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,612.26
|
| Rate for Payer: UHC Core |
$1,596.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$572.76
|
| Rate for Payer: UHC Exchange |
$1,596.11
|
| Rate for Payer: UHC Medicare Advantage |
$572.76
|
| Rate for Payer: UHCCP Medicaid |
$322.46
|
| Rate for Payer: VA VA |
$572.76
|
|
|
HC PSORALEN TREATED WASHED PLATELETS
|
Facility
|
IP
|
$2,238.51
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000086
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,410.26 |
| Max. Negotiated Rate |
$2,014.66 |
| Rate for Payer: Aetna Commercial |
$1,902.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,455.03
|
| Rate for Payer: Cash Price |
$1,790.81
|
| Rate for Payer: Cofinity Commercial |
$1,566.96
|
| Rate for Payer: Cofinity Commercial |
$1,925.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,566.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,790.81
|
| Rate for Payer: Healthscope Commercial |
$2,014.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,902.73
|
| Rate for Payer: PHP Commercial |
$1,902.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,455.03
|
| Rate for Payer: Priority Health SBD |
$1,410.26
|
|
|
HC PSORALEN TREATED WASHED PLATELETS
|
Facility
|
OP
|
$2,238.51
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000086
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$307.00 |
| Max. Negotiated Rate |
$2,014.66 |
| Rate for Payer: Aetna Commercial |
$1,902.73
|
| Rate for Payer: Aetna Medicare |
$595.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,455.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$715.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$715.95
|
| Rate for Payer: BCBS Complete |
$322.35
|
| Rate for Payer: BCBS MAPPO |
$572.76
|
| Rate for Payer: BCN Medicare Advantage |
$572.76
|
| Rate for Payer: Cash Price |
$1,790.81
|
| Rate for Payer: Cash Price |
$1,790.81
|
| Rate for Payer: Cofinity Commercial |
$1,925.12
|
| Rate for Payer: Cofinity Commercial |
$1,566.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,566.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,790.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$572.76
|
| Rate for Payer: Healthscope Commercial |
$2,014.66
|
| Rate for Payer: Mclaren Medicaid |
$307.00
|
| Rate for Payer: Mclaren Medicare |
$572.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.40
|
| Rate for Payer: Meridian Medicaid |
$322.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$658.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,902.73
|
| Rate for Payer: PACE Medicare |
$544.12
|
| Rate for Payer: PACE SWMI |
$572.76
|
| Rate for Payer: PHP Commercial |
$1,902.73
|
| Rate for Payer: PHP Medicare Advantage |
$572.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$307.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,455.03
|
| Rate for Payer: Priority Health Medicare |
$572.76
|
| Rate for Payer: Priority Health SBD |
$1,410.26
|
| Rate for Payer: Railroad Medicare Medicare |
$572.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,612.26
|
| Rate for Payer: UHC Core |
$1,656.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$572.76
|
| Rate for Payer: UHC Exchange |
$1,656.50
|
| Rate for Payer: UHC Medicare Advantage |
$572.76
|
| Rate for Payer: UHCCP Medicaid |
$322.46
|
| Rate for Payer: VA VA |
$572.76
|
|
|
HC PSYCH COLLAB CARE MGMT EA ADD 30 MIN
|
Facility
|
IP
|
$89.47
|
|
|
Service Code
|
CPT 99494
|
| Hospital Charge Code |
51000094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.37 |
| Max. Negotiated Rate |
$80.52 |
| Rate for Payer: Aetna Commercial |
$76.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.16
|
| Rate for Payer: Cash Price |
$71.58
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Cofinity Commercial |
$76.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.58
|
| Rate for Payer: Healthscope Commercial |
$80.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.05
|
| Rate for Payer: PHP Commercial |
$76.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.16
|
| Rate for Payer: Priority Health SBD |
$56.37
|
|
|
HC PSYCH COLLAB CARE MGMT EA ADD 30 MIN
|
Facility
|
OP
|
$89.47
|
|
|
Service Code
|
CPT 99494
|
| Hospital Charge Code |
51000094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.79 |
| Max. Negotiated Rate |
$80.52 |
| Rate for Payer: Aetna Commercial |
$76.05
|
| Rate for Payer: Aetna Medicare |
$44.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.16
|
| Rate for Payer: BCBS Complete |
$35.79
|
| Rate for Payer: Cash Price |
$71.58
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Cofinity Commercial |
$76.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.58
|
| Rate for Payer: Healthscope Commercial |
$80.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.05
|
| Rate for Payer: PHP Commercial |
$76.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.16
|
| Rate for Payer: Priority Health SBD |
$56.37
|
|
|
HC PSYCH COLLAB CARE MGMT INIT 70 MIN
|
Facility
|
OP
|
$95.72
|
|
|
Service Code
|
CPT 99492
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$253.93 |
| Rate for Payer: Aetna Commercial |
$81.36
|
| Rate for Payer: Aetna Medicare |
$93.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.76
|
| Rate for Payer: BCBS Complete |
$50.77
|
| Rate for Payer: BCBS MAPPO |
$90.21
|
| Rate for Payer: BCN Medicare Advantage |
$90.21
|
| Rate for Payer: Cash Price |
$76.58
|
| Rate for Payer: Cash Price |
$76.58
|
| Rate for Payer: Cofinity Commercial |
$67.00
|
| Rate for Payer: Cofinity Commercial |
$82.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.21
|
| Rate for Payer: Healthscope Commercial |
$86.15
|
| Rate for Payer: Mclaren Medicaid |
$48.35
|
| Rate for Payer: Mclaren Medicare |
$90.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.72
|
| Rate for Payer: Meridian Medicaid |
$50.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.36
|
| Rate for Payer: PACE Medicare |
$85.70
|
| Rate for Payer: PACE SWMI |
$90.21
|
| Rate for Payer: PHP Commercial |
$81.36
|
| Rate for Payer: PHP Medicare Advantage |
$90.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.22
|
| Rate for Payer: Priority Health Medicare |
$90.21
|
| Rate for Payer: Priority Health SBD |
$60.30
|
| Rate for Payer: Railroad Medicare Medicare |
$90.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.21
|
| Rate for Payer: UHC Medicare Advantage |
$90.21
|
| Rate for Payer: UHCCP Medicaid |
$50.79
|
| Rate for Payer: VA VA |
$90.21
|
|
|
HC PSYCH COLLAB CARE MGMT INIT 70 MIN
|
Facility
|
IP
|
$95.72
|
|
|
Service Code
|
CPT 99492
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.30 |
| Max. Negotiated Rate |
$86.15 |
| Rate for Payer: Aetna Commercial |
$81.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.22
|
| Rate for Payer: Cash Price |
$76.58
|
| Rate for Payer: Cofinity Commercial |
$67.00
|
| Rate for Payer: Cofinity Commercial |
$82.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.58
|
| Rate for Payer: Healthscope Commercial |
$86.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.36
|
| Rate for Payer: PHP Commercial |
$81.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.22
|
| Rate for Payer: Priority Health SBD |
$60.30
|
|
|
HC PSYCH COLLAB CARE MGMT SUBSEQ 60 MIN
|
Facility
|
OP
|
$105.28
|
|
|
Service Code
|
CPT 99493
|
| Hospital Charge Code |
51000093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$253.93 |
| Rate for Payer: Aetna Commercial |
$89.49
|
| Rate for Payer: Aetna Medicare |
$93.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.76
|
| Rate for Payer: BCBS Complete |
$50.77
|
| Rate for Payer: BCBS MAPPO |
$90.21
|
| Rate for Payer: BCN Medicare Advantage |
$90.21
|
| Rate for Payer: Cash Price |
$84.22
|
| Rate for Payer: Cash Price |
$84.22
|
| Rate for Payer: Cofinity Commercial |
$90.54
|
| Rate for Payer: Cofinity Commercial |
$73.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.21
|
| Rate for Payer: Healthscope Commercial |
$94.75
|
| Rate for Payer: Mclaren Medicaid |
$48.35
|
| Rate for Payer: Mclaren Medicare |
$90.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.72
|
| Rate for Payer: Meridian Medicaid |
$50.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.49
|
| Rate for Payer: PACE Medicare |
$85.70
|
| Rate for Payer: PACE SWMI |
$90.21
|
| Rate for Payer: PHP Commercial |
$89.49
|
| Rate for Payer: PHP Medicare Advantage |
$90.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.43
|
| Rate for Payer: Priority Health Medicare |
$90.21
|
| Rate for Payer: Priority Health SBD |
$66.33
|
| Rate for Payer: Railroad Medicare Medicare |
$90.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.21
|
| Rate for Payer: UHC Medicare Advantage |
$90.21
|
| Rate for Payer: UHCCP Medicaid |
$50.79
|
| Rate for Payer: VA VA |
$90.21
|
|
|
HC PSYCH COLLAB CARE MGMT SUBSEQ 60 MIN
|
Facility
|
IP
|
$105.28
|
|
|
Service Code
|
CPT 99493
|
| Hospital Charge Code |
51000093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.33 |
| Max. Negotiated Rate |
$94.75 |
| Rate for Payer: Aetna Commercial |
$89.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.43
|
| Rate for Payer: Cash Price |
$84.22
|
| Rate for Payer: Cofinity Commercial |
$73.70
|
| Rate for Payer: Cofinity Commercial |
$90.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.22
|
| Rate for Payer: Healthscope Commercial |
$94.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.49
|
| Rate for Payer: PHP Commercial |
$89.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.43
|
| Rate for Payer: Priority Health SBD |
$66.33
|
|
|
HC PSYCH DIAGNOSTIC EVAL W/MED SVCS
|
Facility
|
OP
|
$198.72
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
91400008
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$83.99 |
| Max. Negotiated Rate |
$441.09 |
| Rate for Payer: Aetna Commercial |
$168.91
|
| Rate for Payer: Aetna Medicare |
$162.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$195.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$195.88
|
| Rate for Payer: BCBS Complete |
$88.19
|
| Rate for Payer: BCBS MAPPO |
$156.70
|
| Rate for Payer: BCN Medicare Advantage |
$156.70
|
| Rate for Payer: Cash Price |
$158.98
|
| Rate for Payer: Cash Price |
$158.98
|
| Rate for Payer: Cofinity Commercial |
$170.90
|
| Rate for Payer: Cofinity Commercial |
$139.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.70
|
| Rate for Payer: Healthscope Commercial |
$178.85
|
| Rate for Payer: Mclaren Medicaid |
$83.99
|
| Rate for Payer: Mclaren Medicare |
$156.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$164.53
|
| Rate for Payer: Meridian Medicaid |
$88.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.91
|
| Rate for Payer: PACE Medicare |
$148.87
|
| Rate for Payer: PACE SWMI |
$156.70
|
| Rate for Payer: PHP Commercial |
$168.91
|
| Rate for Payer: PHP Medicare Advantage |
$156.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.17
|
| Rate for Payer: Priority Health Medicare |
$156.70
|
| Rate for Payer: Priority Health SBD |
$125.19
|
| Rate for Payer: Railroad Medicare Medicare |
$156.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$156.70
|
| Rate for Payer: UHC Medicare Advantage |
$156.70
|
| Rate for Payer: UHCCP Medicaid |
$88.22
|
| Rate for Payer: VA VA |
$156.70
|
|
|
HC PSYCH DIAGNOSTIC EVAL W/MED SVCS
|
Facility
|
IP
|
$198.72
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
91400008
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$125.19 |
| Max. Negotiated Rate |
$178.85 |
| Rate for Payer: Aetna Commercial |
$168.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.17
|
| Rate for Payer: Cash Price |
$158.98
|
| Rate for Payer: Cofinity Commercial |
$139.10
|
| Rate for Payer: Cofinity Commercial |
$170.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.98
|
| Rate for Payer: Healthscope Commercial |
$178.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.91
|
| Rate for Payer: PHP Commercial |
$168.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.17
|
| Rate for Payer: Priority Health SBD |
$125.19
|
|
|
HC PSYCHIATRIC DIAG EVAL
|
Facility
|
OP
|
$198.72
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
91400004
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$83.99 |
| Max. Negotiated Rate |
$441.09 |
| Rate for Payer: Aetna Commercial |
$168.91
|
| Rate for Payer: Aetna Medicare |
$162.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$195.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$195.88
|
| Rate for Payer: BCBS Complete |
$88.19
|
| Rate for Payer: BCBS MAPPO |
$156.70
|
| Rate for Payer: BCN Medicare Advantage |
$156.70
|
| Rate for Payer: Cash Price |
$158.98
|
| Rate for Payer: Cash Price |
$158.98
|
| Rate for Payer: Cofinity Commercial |
$170.90
|
| Rate for Payer: Cofinity Commercial |
$139.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.70
|
| Rate for Payer: Healthscope Commercial |
$178.85
|
| Rate for Payer: Mclaren Medicaid |
$83.99
|
| Rate for Payer: Mclaren Medicare |
$156.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$164.53
|
| Rate for Payer: Meridian Medicaid |
$88.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.91
|
| Rate for Payer: PACE Medicare |
$148.87
|
| Rate for Payer: PACE SWMI |
$156.70
|
| Rate for Payer: PHP Commercial |
$168.91
|
| Rate for Payer: PHP Medicare Advantage |
$156.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.17
|
| Rate for Payer: Priority Health Medicare |
$156.70
|
| Rate for Payer: Priority Health SBD |
$125.19
|
| Rate for Payer: Railroad Medicare Medicare |
$156.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$156.70
|
| Rate for Payer: UHC Medicare Advantage |
$156.70
|
| Rate for Payer: UHCCP Medicaid |
$88.22
|
| Rate for Payer: VA VA |
$156.70
|
|
|
HC PSYCHIATRIC DIAG EVAL
|
Facility
|
IP
|
$198.72
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
91400004
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$125.19 |
| Max. Negotiated Rate |
$178.85 |
| Rate for Payer: Aetna Commercial |
$168.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.17
|
| Rate for Payer: Cash Price |
$158.98
|
| Rate for Payer: Cofinity Commercial |
$139.10
|
| Rate for Payer: Cofinity Commercial |
$170.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.98
|
| Rate for Payer: Healthscope Commercial |
$178.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.91
|
| Rate for Payer: PHP Commercial |
$168.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.17
|
| Rate for Payer: Priority Health SBD |
$125.19
|
|
|
HC PSYCH/NEUROPSYCH TEST BY PHYS 30 MIN
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 96136
|
| Hospital Charge Code |
91800009
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Core |
$19.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$19.25
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$70.77
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC PSYCH/NEUROPSYCH TEST BY PHYS 30 MIN
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 96136
|
| Hospital Charge Code |
91800009
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
|
