|
HC PSYCH/NEUROPSYCH TEST BY TECH 30 MIN
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 96138
|
| Hospital Charge Code |
91800011
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$1,095.50 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$404.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$486.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$486.48
|
| Rate for Payer: BCBS Complete |
$219.03
|
| Rate for Payer: BCBS MAPPO |
$389.18
|
| Rate for Payer: BCN Medicare Advantage |
$389.18
|
| 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 |
$389.18
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$208.60
|
| Rate for Payer: Mclaren Medicare |
$389.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$408.64
|
| Rate for Payer: Meridian Medicaid |
$219.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$447.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PACE Medicare |
$369.72
|
| Rate for Payer: PACE SWMI |
$389.18
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$389.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health Medicare |
$389.18
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: Railroad Medicare Medicare |
$389.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,095.50
|
| Rate for Payer: UHC Core |
$19.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.18
|
| Rate for Payer: UHC Exchange |
$19.25
|
| Rate for Payer: UHC Medicare Advantage |
$389.18
|
| Rate for Payer: UHCCP Medicaid |
$219.11
|
| Rate for Payer: VA VA |
$389.18
|
|
|
HC PSYCH/NEUROPSYCH TEST BY TECH 30 MIN
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 96138
|
| Hospital Charge Code |
91800011
|
|
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
|
|
|
HC PSYCH/NEUROPSYCH TEST BY TECH EA ADDL 30 MIN
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 96139
|
| Hospital Charge Code |
91800012
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.15
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$10.93
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health SBD |
$9.83
|
|
|
HC PSYCH/NEUROPSYCH TEST BY TECH EA ADDL 30 MIN
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT 96139
|
| Hospital Charge Code |
91800012
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna Medicare |
$7.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.15
|
| Rate for Payer: BCBS Complete |
$6.24
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$10.93
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health SBD |
$9.83
|
| Rate for Payer: UHC Core |
$11.55
|
| Rate for Payer: UHC Exchange |
$11.55
|
|
|
HC PSYCH/NEUROPSYCH TEST PHYS EA ADDL 30 MIN
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT 96137
|
| Hospital Charge Code |
91800010
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna Medicare |
$7.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.15
|
| Rate for Payer: BCBS Complete |
$6.24
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$10.93
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health SBD |
$9.83
|
| Rate for Payer: UHC Core |
$11.55
|
| Rate for Payer: UHC Exchange |
$11.55
|
|
|
HC PSYCH/NEUROPSYCH TEST PHYS EA ADDL 30 MIN
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 96137
|
| Hospital Charge Code |
91800010
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.15
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$10.93
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health SBD |
$9.83
|
|
|
HC PSYCH/NEUROPSYCH TEST SINGLE AUTOMATED
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 96146
|
| Hospital Charge Code |
91800013
|
|
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
|
|
|
HC PSYCH/NEUROPSYCH TEST SINGLE AUTOMATED
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 96146
|
| Hospital Charge Code |
91800013
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$67.22 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| 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 |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.22
|
| Rate for Payer: UHC Core |
$19.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Exchange |
$19.25
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$13.44
|
| Rate for Payer: VA VA |
$23.88
|
|
|
HC PSYCHOLOGICAL TEST EVAL PHYS/QHP 1ST HOUR
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 96130
|
| Hospital Charge Code |
91800450
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$449.82 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Aetna Commercial |
$606.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.10
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$499.80
|
| Rate for Payer: Cofinity Commercial |
$614.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$499.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.20
|
| Rate for Payer: Healthscope Commercial |
$642.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$606.90
|
| Rate for Payer: PHP Commercial |
$606.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health SBD |
$449.82
|
|
|
HC PSYCHOLOGICAL TEST EVAL PHYS/QHP 1ST HOUR
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT 96130
|
| Hospital Charge Code |
91800450
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna Commercial |
$606.90
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$499.80
|
| Rate for Payer: Cofinity Commercial |
$614.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$499.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$642.60
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$606.90
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$606.90
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$449.82
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$528.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$528.36
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC PSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HOUR
|
Facility
|
OP
|
$542.64
|
|
|
Service Code
|
CPT 96131
|
| Hospital Charge Code |
91800449
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$217.06 |
| Max. Negotiated Rate |
$488.38 |
| Rate for Payer: Aetna Commercial |
$461.24
|
| Rate for Payer: Aetna Medicare |
$271.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.72
|
| Rate for Payer: BCBS Complete |
$217.06
|
| Rate for Payer: Cash Price |
$434.11
|
| Rate for Payer: Cofinity Commercial |
$379.85
|
| Rate for Payer: Cofinity Commercial |
$466.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$379.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.11
|
| Rate for Payer: Healthscope Commercial |
$488.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.24
|
| Rate for Payer: PHP Commercial |
$461.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.72
|
| Rate for Payer: Priority Health SBD |
$341.86
|
| Rate for Payer: UHC Core |
$401.55
|
| Rate for Payer: UHC Exchange |
$401.55
|
|
|
HC PSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HOUR
|
Facility
|
IP
|
$542.64
|
|
|
Service Code
|
CPT 96131
|
| Hospital Charge Code |
91800449
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$341.86 |
| Max. Negotiated Rate |
$488.38 |
| Rate for Payer: Aetna Commercial |
$461.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.72
|
| Rate for Payer: Cash Price |
$434.11
|
| Rate for Payer: Cofinity Commercial |
$379.85
|
| Rate for Payer: Cofinity Commercial |
$466.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$379.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.11
|
| Rate for Payer: Healthscope Commercial |
$488.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.24
|
| Rate for Payer: PHP Commercial |
$461.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.72
|
| Rate for Payer: Priority Health SBD |
$341.86
|
|
|
HC PSYCHOTHERAPY 30 MIN W/PATIENT
|
Facility
|
OP
|
$86.96
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
91400001
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$441.09 |
| Rate for Payer: Aetna Commercial |
$73.92
|
| Rate for Payer: Aetna Medicare |
$162.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.52
|
| 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 |
$69.57
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Cofinity Commercial |
$74.79
|
| Rate for Payer: Cofinity Commercial |
$60.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.70
|
| Rate for Payer: Healthscope Commercial |
$78.26
|
| 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 |
$73.92
|
| Rate for Payer: PACE Medicare |
$148.87
|
| Rate for Payer: PACE SWMI |
$156.70
|
| Rate for Payer: PHP Commercial |
$73.92
|
| 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 |
$56.52
|
| Rate for Payer: Priority Health Medicare |
$156.70
|
| Rate for Payer: Priority Health SBD |
$54.78
|
| 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 PSYCHOTHERAPY 30 MIN W/PATIENT
|
Facility
|
IP
|
$86.96
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
91400001
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$78.26 |
| Rate for Payer: Aetna Commercial |
$73.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.52
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Cofinity Commercial |
$60.87
|
| Rate for Payer: Cofinity Commercial |
$74.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.57
|
| Rate for Payer: Healthscope Commercial |
$78.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.92
|
| Rate for Payer: PHP Commercial |
$73.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.52
|
| Rate for Payer: Priority Health SBD |
$54.78
|
|
|
HC PSYCHOTHERAPY 45 MIN W/PATIENT
|
Facility
|
IP
|
$156.11
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
91400002
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$98.35 |
| Max. Negotiated Rate |
$140.50 |
| Rate for Payer: Aetna Commercial |
$132.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.47
|
| Rate for Payer: Cash Price |
$124.89
|
| Rate for Payer: Cofinity Commercial |
$109.28
|
| Rate for Payer: Cofinity Commercial |
$134.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.89
|
| Rate for Payer: Healthscope Commercial |
$140.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.69
|
| Rate for Payer: PHP Commercial |
$132.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.47
|
| Rate for Payer: Priority Health SBD |
$98.35
|
|
|
HC PSYCHOTHERAPY 45 MIN W/PATIENT
|
Facility
|
OP
|
$156.11
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
91400002
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$83.99 |
| Max. Negotiated Rate |
$441.09 |
| Rate for Payer: Aetna Commercial |
$132.69
|
| Rate for Payer: Aetna Medicare |
$162.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.47
|
| 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 |
$124.89
|
| Rate for Payer: Cash Price |
$124.89
|
| Rate for Payer: Cofinity Commercial |
$134.25
|
| Rate for Payer: Cofinity Commercial |
$109.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.70
|
| Rate for Payer: Healthscope Commercial |
$140.50
|
| 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 |
$132.69
|
| Rate for Payer: PACE Medicare |
$148.87
|
| Rate for Payer: PACE SWMI |
$156.70
|
| Rate for Payer: PHP Commercial |
$132.69
|
| 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 |
$101.47
|
| Rate for Payer: Priority Health Medicare |
$156.70
|
| Rate for Payer: Priority Health SBD |
$98.35
|
| 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 PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
OP
|
$131.09
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
91400005
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$82.59 |
| Max. Negotiated Rate |
$441.09 |
| Rate for Payer: Aetna Commercial |
$111.43
|
| Rate for Payer: Aetna Medicare |
$162.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.21
|
| 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 |
$104.87
|
| Rate for Payer: Cash Price |
$104.87
|
| Rate for Payer: Cofinity Commercial |
$91.76
|
| Rate for Payer: Cofinity Commercial |
$112.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.70
|
| Rate for Payer: Healthscope Commercial |
$117.98
|
| 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 |
$111.43
|
| Rate for Payer: PACE Medicare |
$148.87
|
| Rate for Payer: PACE SWMI |
$156.70
|
| Rate for Payer: PHP Commercial |
$111.43
|
| 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 |
$85.21
|
| Rate for Payer: Priority Health Medicare |
$156.70
|
| Rate for Payer: Priority Health SBD |
$82.59
|
| 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 PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
IP
|
$131.09
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
91400005
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$82.59 |
| Max. Negotiated Rate |
$117.98 |
| Rate for Payer: Aetna Commercial |
$111.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.21
|
| Rate for Payer: Cash Price |
$104.87
|
| Rate for Payer: Cofinity Commercial |
$112.74
|
| Rate for Payer: Cofinity Commercial |
$91.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.87
|
| Rate for Payer: Healthscope Commercial |
$117.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.43
|
| Rate for Payer: PHP Commercial |
$111.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.21
|
| Rate for Payer: Priority Health SBD |
$82.59
|
|
|
HC PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
91400012
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$22.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: BCBS Complete |
$18.36
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health SBD |
$28.92
|
|
|
HC PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
91400012
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$28.92 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health SBD |
$28.92
|
|
|
HC PSYCHOTHERAPY FOR CRISIS EA ADDL 15 MIN
|
Facility
|
IP
|
$118.32
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
91400014
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$74.54 |
| Max. Negotiated Rate |
$106.49 |
| Rate for Payer: Aetna Commercial |
$100.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.91
|
| Rate for Payer: Cash Price |
$94.66
|
| Rate for Payer: Cofinity Commercial |
$101.76
|
| Rate for Payer: Cofinity Commercial |
$82.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.66
|
| Rate for Payer: Healthscope Commercial |
$106.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.57
|
| Rate for Payer: PHP Commercial |
$100.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.91
|
| Rate for Payer: Priority Health SBD |
$74.54
|
|
|
HC PSYCHOTHERAPY FOR CRISIS EA ADDL 15 MIN
|
Facility
|
OP
|
$118.32
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
91400014
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$47.33 |
| Max. Negotiated Rate |
$106.49 |
| Rate for Payer: Aetna Commercial |
$100.57
|
| Rate for Payer: Aetna Medicare |
$59.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.91
|
| Rate for Payer: BCBS Complete |
$47.33
|
| Rate for Payer: Cash Price |
$94.66
|
| Rate for Payer: Cofinity Commercial |
$101.76
|
| Rate for Payer: Cofinity Commercial |
$82.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.66
|
| Rate for Payer: Healthscope Commercial |
$106.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.57
|
| Rate for Payer: PHP Commercial |
$100.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.91
|
| Rate for Payer: Priority Health SBD |
$74.54
|
|
|
HC PSYCHOTHERAPY FOR CRISIS FIRST 60 MIN
|
Facility
|
IP
|
$229.50
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
91400003
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$144.59 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Aetna Commercial |
$195.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.18
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$160.65
|
| Rate for Payer: Cofinity Commercial |
$197.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.60
|
| Rate for Payer: Healthscope Commercial |
$206.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.07
|
| Rate for Payer: PHP Commercial |
$195.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.18
|
| Rate for Payer: Priority Health SBD |
$144.59
|
|
|
HC PSYCHOTHERAPY FOR CRISIS FIRST 60 MIN
|
Facility
|
OP
|
$229.50
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
91400003
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$83.99 |
| Max. Negotiated Rate |
$441.09 |
| Rate for Payer: Aetna Commercial |
$195.07
|
| Rate for Payer: Aetna Medicare |
$162.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.18
|
| 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 |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$197.37
|
| Rate for Payer: Cofinity Commercial |
$160.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.70
|
| Rate for Payer: Healthscope Commercial |
$206.55
|
| 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 |
$195.07
|
| Rate for Payer: PACE Medicare |
$148.87
|
| Rate for Payer: PACE SWMI |
$156.70
|
| Rate for Payer: PHP Commercial |
$195.07
|
| 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 |
$149.18
|
| Rate for Payer: Priority Health Medicare |
$156.70
|
| Rate for Payer: Priority Health SBD |
$144.59
|
| 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 PTCA ADD/BRANCH
|
Facility
|
IP
|
$7,290.61
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
48100099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,593.08 |
| Max. Negotiated Rate |
$6,561.55 |
| Rate for Payer: Aetna Commercial |
$6,197.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,738.90
|
| Rate for Payer: Cash Price |
$5,832.49
|
| Rate for Payer: Cofinity Commercial |
$5,103.43
|
| Rate for Payer: Cofinity Commercial |
$6,269.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,103.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,832.49
|
| Rate for Payer: Healthscope Commercial |
$6,561.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,197.02
|
| Rate for Payer: PHP Commercial |
$6,197.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,738.90
|
| Rate for Payer: Priority Health SBD |
$4,593.08
|
|
