|
HC PSYCHIATRIC DIAG EVAL
|
Facility
|
OP
|
$194.82
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
91400004
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$46.27 |
| Max. Negotiated Rate |
$175.34 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: Aetna Medicare |
$50.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.88
|
| Rate for Payer: BCBS Complete |
$109.82
|
| Rate for Payer: BCBS MAPPO |
$48.70
|
| Rate for Payer: BCBS Trust/PPO |
$151.47
|
| Rate for Payer: BCN Commercial |
$151.47
|
| Rate for Payer: BCN Medicare Advantage |
$48.70
|
| Rate for Payer: Cash Price |
$155.86
|
| Rate for Payer: Cash Price |
$155.86
|
| Rate for Payer: Cofinity Commercial |
$167.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.70
|
| Rate for Payer: Healthscope Commercial |
$175.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.12
|
| Rate for Payer: Mclaren Medicaid |
$104.59
|
| Rate for Payer: Meridian Medicaid |
$109.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.60
|
| Rate for Payer: PACE Senior Care Partners |
$46.27
|
| Rate for Payer: PACE SWMI |
$48.70
|
| Rate for Payer: PHP Commercial |
$165.60
|
| Rate for Payer: PHP Medicare Advantage |
$48.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.49
|
| Rate for Payer: Priority Health Medicare |
$48.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.82
|
| Rate for Payer: Railroad Medicare Medicare |
$48.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.44
|
| Rate for Payer: UHC Core |
$162.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.70
|
| Rate for Payer: UHC Medicare Advantage |
$50.17
|
| Rate for Payer: VA VA |
$48.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.12
|
|
|
HC PSYCH/NEUROPSYCH TEST BY PHYS 30 MIN
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 96136
|
| Hospital Charge Code |
91800009
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$87.99 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$6.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.97
|
| Rate for Payer: BCBS Complete |
$87.99
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$19.83
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Mclaren Medicaid |
$83.80
|
| Rate for Payer: Meridian Medicaid |
$87.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Medicare |
$6.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.38
|
| Rate for Payer: UHC Medicare Advantage |
$6.57
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC PSYCH/NEUROPSYCH TEST BY PHYS 30 MIN
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 96136
|
| Hospital Charge Code |
91800009
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$19.71
|
| Rate for Payer: BCN Commercial |
$19.71
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC PSYCH/NEUROPSYCH TEST BY TECH 30 MIN
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 96138
|
| Hospital Charge Code |
91800011
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$274.44 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$6.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.97
|
| Rate for Payer: BCBS Complete |
$274.44
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$19.83
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Mclaren Medicaid |
$261.37
|
| Rate for Payer: Meridian Medicaid |
$274.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Medicare |
$6.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.38
|
| Rate for Payer: UHC Medicare Advantage |
$6.57
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC PSYCH/NEUROPSYCH TEST BY TECH 30 MIN
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 96138
|
| Hospital Charge Code |
91800011
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$19.71
|
| Rate for Payer: BCN Commercial |
$19.71
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC PSYCH/NEUROPSYCH TEST BY TECH EA ADDL 30 MIN
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT 96139
|
| Hospital Charge Code |
91800012
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: BCBS Trust/PPO |
$11.82
|
| Rate for Payer: BCN Commercial |
$11.82
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.46
|
| Rate for Payer: UHC Core |
$12.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.48
|
|
|
HC PSYCH/NEUROPSYCH TEST BY TECH EA ADDL 30 MIN
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT 96139
|
| Hospital Charge Code |
91800012
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna Medicare |
$3.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.78
|
| Rate for Payer: BCBS Complete |
$6.12
|
| Rate for Payer: BCBS MAPPO |
$3.82
|
| Rate for Payer: BCBS Trust/PPO |
$11.90
|
| Rate for Payer: BCN Commercial |
$11.90
|
| Rate for Payer: BCN Medicare Advantage |
$3.82
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.82
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PACE Senior Care Partners |
$3.63
|
| Rate for Payer: PACE SWMI |
$3.82
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: PHP Medicare Advantage |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.31
|
| Rate for Payer: Priority Health Medicare |
$3.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.33
|
| Rate for Payer: Railroad Medicare Medicare |
$3.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.46
|
| Rate for Payer: UHC Core |
$12.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.82
|
| Rate for Payer: UHC Medicare Advantage |
$3.94
|
| Rate for Payer: VA VA |
$3.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.48
|
|
|
HC PSYCH/NEUROPSYCH TEST PHYS EA ADDL 30 MIN
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT 96137
|
| Hospital Charge Code |
91800010
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna Medicare |
$3.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.78
|
| Rate for Payer: BCBS Complete |
$6.12
|
| Rate for Payer: BCBS MAPPO |
$3.82
|
| Rate for Payer: BCBS Trust/PPO |
$11.90
|
| Rate for Payer: BCN Commercial |
$11.90
|
| Rate for Payer: BCN Medicare Advantage |
$3.82
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.82
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PACE Senior Care Partners |
$3.63
|
| Rate for Payer: PACE SWMI |
$3.82
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: PHP Medicare Advantage |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.31
|
| Rate for Payer: Priority Health Medicare |
$3.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.33
|
| Rate for Payer: Railroad Medicare Medicare |
$3.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.46
|
| Rate for Payer: UHC Core |
$12.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.82
|
| Rate for Payer: UHC Medicare Advantage |
$3.94
|
| Rate for Payer: VA VA |
$3.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.48
|
|
|
HC PSYCH/NEUROPSYCH TEST PHYS EA ADDL 30 MIN
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT 96137
|
| Hospital Charge Code |
91800010
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: BCBS Trust/PPO |
$11.82
|
| Rate for Payer: BCN Commercial |
$11.82
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.46
|
| Rate for Payer: UHC Core |
$12.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.48
|
|
|
HC PSYCH/NEUROPSYCH TEST SINGLE AUTOMATED
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 96146
|
| Hospital Charge Code |
91800013
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$19.71
|
| Rate for Payer: BCN Commercial |
$19.71
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC PSYCH/NEUROPSYCH TEST SINGLE AUTOMATED
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 96146
|
| Hospital Charge Code |
91800013
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$6.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.97
|
| Rate for Payer: BCBS Complete |
$20.51
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$19.83
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Mclaren Medicaid |
$19.53
|
| Rate for Payer: Meridian Medicaid |
$20.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Medicare |
$6.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.38
|
| Rate for Payer: UHC Medicare Advantage |
$6.57
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC PSYCHOLOGICAL TEST EVAL PHYS/QHP 1ST HOUR
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
CPT 96130
|
| Hospital Charge Code |
91800450
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$426.93 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna Commercial |
$595.00
|
| Rate for Payer: BCBS Trust/PPO |
$540.96
|
| Rate for Payer: BCN Commercial |
$540.96
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cofinity Commercial |
$602.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.00
|
| Rate for Payer: Healthscope Commercial |
$630.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$525.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.00
|
| Rate for Payer: PHP Commercial |
$595.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$609.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$426.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$616.00
|
| Rate for Payer: UHC Core |
$584.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$525.00
|
|
|
HC PSYCHOLOGICAL TEST EVAL PHYS/QHP 1ST HOUR
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 96130
|
| Hospital Charge Code |
91800450
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$166.25 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna Commercial |
$595.00
|
| Rate for Payer: Aetna Medicare |
$182.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.75
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$175.00
|
| Rate for Payer: BCBS Trust/PPO |
$544.25
|
| Rate for Payer: BCN Commercial |
$544.25
|
| Rate for Payer: BCN Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cofinity Commercial |
$602.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.00
|
| Rate for Payer: Healthscope Commercial |
$630.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$525.00
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$183.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.00
|
| Rate for Payer: PACE Senior Care Partners |
$166.25
|
| Rate for Payer: PACE SWMI |
$175.00
|
| Rate for Payer: PHP Commercial |
$595.00
|
| Rate for Payer: PHP Medicare Advantage |
$175.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$609.00
|
| Rate for Payer: Priority Health Medicare |
$175.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$426.93
|
| Rate for Payer: Railroad Medicare Medicare |
$175.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$616.00
|
| Rate for Payer: UHC Core |
$584.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$175.00
|
| Rate for Payer: UHC Medicare Advantage |
$180.25
|
| Rate for Payer: VA VA |
$175.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$525.00
|
|
|
HC PSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HOUR
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 96131
|
| Hospital Charge Code |
91800449
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$324.47 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna Commercial |
$452.20
|
| Rate for Payer: BCBS Trust/PPO |
$411.13
|
| Rate for Payer: BCN Commercial |
$411.13
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cofinity Commercial |
$457.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.60
|
| Rate for Payer: Healthscope Commercial |
$478.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$399.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$452.20
|
| Rate for Payer: PHP Commercial |
$452.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$462.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$468.16
|
| Rate for Payer: UHC Core |
$444.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$399.00
|
|
|
HC PSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HOUR
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT 96131
|
| Hospital Charge Code |
91800449
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$126.35 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna Commercial |
$452.20
|
| Rate for Payer: Aetna Medicare |
$138.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$166.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$166.25
|
| Rate for Payer: BCBS Complete |
$212.80
|
| Rate for Payer: BCBS MAPPO |
$133.00
|
| Rate for Payer: BCBS Trust/PPO |
$413.63
|
| Rate for Payer: BCN Commercial |
$413.63
|
| Rate for Payer: BCN Medicare Advantage |
$133.00
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cofinity Commercial |
$457.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.00
|
| Rate for Payer: Healthscope Commercial |
$478.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$399.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$139.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$452.20
|
| Rate for Payer: PACE Senior Care Partners |
$126.35
|
| Rate for Payer: PACE SWMI |
$133.00
|
| Rate for Payer: PHP Commercial |
$452.20
|
| Rate for Payer: PHP Medicare Advantage |
$133.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$462.84
|
| Rate for Payer: Priority Health Medicare |
$133.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.47
|
| Rate for Payer: Railroad Medicare Medicare |
$133.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$468.16
|
| Rate for Payer: UHC Core |
$444.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.00
|
| Rate for Payer: UHC Medicare Advantage |
$136.99
|
| Rate for Payer: VA VA |
$133.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$399.00
|
|
|
HC PSYCHOTHERAPY 30 MIN W/PATIENT
|
Facility
|
OP
|
$85.25
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
91400001
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$109.82 |
| Rate for Payer: Aetna Commercial |
$72.46
|
| Rate for Payer: Aetna Medicare |
$22.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.64
|
| Rate for Payer: BCBS Complete |
$109.82
|
| Rate for Payer: BCBS MAPPO |
$21.31
|
| Rate for Payer: BCBS Trust/PPO |
$66.28
|
| Rate for Payer: BCN Commercial |
$66.28
|
| Rate for Payer: BCN Medicare Advantage |
$21.31
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cofinity Commercial |
$73.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.31
|
| Rate for Payer: Healthscope Commercial |
$76.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.94
|
| Rate for Payer: Mclaren Medicaid |
$104.59
|
| Rate for Payer: Meridian Medicaid |
$109.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.46
|
| Rate for Payer: PACE Senior Care Partners |
$20.25
|
| Rate for Payer: PACE SWMI |
$21.31
|
| Rate for Payer: PHP Commercial |
$72.46
|
| Rate for Payer: PHP Medicare Advantage |
$21.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.17
|
| Rate for Payer: Priority Health Medicare |
$21.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.99
|
| Rate for Payer: Railroad Medicare Medicare |
$21.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.02
|
| Rate for Payer: UHC Core |
$71.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.31
|
| Rate for Payer: UHC Medicare Advantage |
$21.95
|
| Rate for Payer: VA VA |
$21.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.94
|
|
|
HC PSYCHOTHERAPY 30 MIN W/PATIENT
|
Facility
|
IP
|
$85.25
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
91400001
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$51.99 |
| Max. Negotiated Rate |
$76.72 |
| Rate for Payer: Aetna Commercial |
$72.46
|
| Rate for Payer: BCBS Trust/PPO |
$65.88
|
| Rate for Payer: BCN Commercial |
$65.88
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cofinity Commercial |
$73.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.20
|
| Rate for Payer: Healthscope Commercial |
$76.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.46
|
| Rate for Payer: PHP Commercial |
$72.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.02
|
| Rate for Payer: UHC Core |
$71.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.94
|
|
|
HC PSYCHOTHERAPY 45 MIN W/PATIENT
|
Facility
|
OP
|
$153.05
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
91400002
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$36.35 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: Aetna Commercial |
$130.09
|
| Rate for Payer: Aetna Medicare |
$39.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.83
|
| Rate for Payer: BCBS Complete |
$109.82
|
| Rate for Payer: BCBS MAPPO |
$38.26
|
| Rate for Payer: BCBS Trust/PPO |
$119.00
|
| Rate for Payer: BCN Commercial |
$119.00
|
| Rate for Payer: BCN Medicare Advantage |
$38.26
|
| Rate for Payer: Cash Price |
$122.44
|
| Rate for Payer: Cash Price |
$122.44
|
| Rate for Payer: Cofinity Commercial |
$131.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.26
|
| Rate for Payer: Healthscope Commercial |
$137.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.79
|
| Rate for Payer: Mclaren Medicaid |
$104.59
|
| Rate for Payer: Meridian Medicaid |
$109.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.09
|
| Rate for Payer: PACE Senior Care Partners |
$36.35
|
| Rate for Payer: PACE SWMI |
$38.26
|
| Rate for Payer: PHP Commercial |
$130.09
|
| Rate for Payer: PHP Medicare Advantage |
$38.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.15
|
| Rate for Payer: Priority Health Medicare |
$38.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.35
|
| Rate for Payer: Railroad Medicare Medicare |
$38.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.68
|
| Rate for Payer: UHC Core |
$127.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.26
|
| Rate for Payer: UHC Medicare Advantage |
$39.41
|
| Rate for Payer: VA VA |
$38.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.79
|
|
|
HC PSYCHOTHERAPY 45 MIN W/PATIENT
|
Facility
|
IP
|
$153.05
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
91400002
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$93.35 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: Aetna Commercial |
$130.09
|
| Rate for Payer: BCBS Trust/PPO |
$118.28
|
| Rate for Payer: BCN Commercial |
$118.28
|
| Rate for Payer: Cash Price |
$122.44
|
| Rate for Payer: Cofinity Commercial |
$131.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.44
|
| Rate for Payer: Healthscope Commercial |
$137.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.09
|
| Rate for Payer: PHP Commercial |
$130.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.68
|
| Rate for Payer: UHC Core |
$127.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.79
|
|
|
HC PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
OP
|
$128.52
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
91400005
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$30.52 |
| Max. Negotiated Rate |
$115.67 |
| Rate for Payer: Aetna Commercial |
$109.24
|
| Rate for Payer: Aetna Medicare |
$33.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.16
|
| Rate for Payer: BCBS Complete |
$109.82
|
| Rate for Payer: BCBS MAPPO |
$32.13
|
| Rate for Payer: BCBS Trust/PPO |
$99.92
|
| Rate for Payer: BCN Commercial |
$99.92
|
| Rate for Payer: BCN Medicare Advantage |
$32.13
|
| Rate for Payer: Cash Price |
$102.82
|
| Rate for Payer: Cash Price |
$102.82
|
| Rate for Payer: Cofinity Commercial |
$110.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.13
|
| Rate for Payer: Healthscope Commercial |
$115.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.39
|
| Rate for Payer: Mclaren Medicaid |
$104.59
|
| Rate for Payer: Meridian Medicaid |
$109.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.24
|
| Rate for Payer: PACE Senior Care Partners |
$30.52
|
| Rate for Payer: PACE SWMI |
$32.13
|
| Rate for Payer: PHP Commercial |
$109.24
|
| Rate for Payer: PHP Medicare Advantage |
$32.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.81
|
| Rate for Payer: Priority Health Medicare |
$32.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.38
|
| Rate for Payer: Railroad Medicare Medicare |
$32.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.10
|
| Rate for Payer: UHC Core |
$107.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.13
|
| Rate for Payer: UHC Medicare Advantage |
$33.09
|
| Rate for Payer: VA VA |
$32.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.39
|
|
|
HC PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
IP
|
$128.52
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
91400005
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$115.67 |
| Rate for Payer: Aetna Commercial |
$109.24
|
| Rate for Payer: BCBS Trust/PPO |
$99.32
|
| Rate for Payer: BCN Commercial |
$99.32
|
| Rate for Payer: Cash Price |
$102.82
|
| Rate for Payer: Cofinity Commercial |
$110.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.82
|
| Rate for Payer: Healthscope Commercial |
$115.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.24
|
| Rate for Payer: PHP Commercial |
$109.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.10
|
| Rate for Payer: UHC Core |
$107.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.39
|
|
|
HC PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
91400012
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.06
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$11.25
|
| Rate for Payer: BCBS Trust/PPO |
$34.99
|
| Rate for Payer: BCN Commercial |
$34.99
|
| Rate for Payer: BCN Medicare Advantage |
$11.25
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.25
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PACE Senior Care Partners |
$10.69
|
| Rate for Payer: PACE SWMI |
$11.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: PHP Medicare Advantage |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.15
|
| Rate for Payer: Priority Health Medicare |
$11.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.45
|
| Rate for Payer: Railroad Medicare Medicare |
$11.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.60
|
| Rate for Payer: UHC Core |
$37.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.25
|
| Rate for Payer: UHC Medicare Advantage |
$11.59
|
| Rate for Payer: VA VA |
$11.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
HC PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
91400012
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$34.78
|
| Rate for Payer: BCN Commercial |
$34.78
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.60
|
| Rate for Payer: UHC Core |
$37.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
HC PSYCHOTHERAPY FOR CRISIS EA ADDL 15 MIN
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
91400014
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna Commercial |
$98.60
|
| Rate for Payer: Aetna Medicare |
$30.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.25
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: BCBS MAPPO |
$29.00
|
| Rate for Payer: BCBS Trust/PPO |
$90.19
|
| Rate for Payer: BCN Commercial |
$90.19
|
| Rate for Payer: BCN Medicare Advantage |
$29.00
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cofinity Commercial |
$99.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.00
|
| Rate for Payer: Healthscope Commercial |
$104.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.60
|
| Rate for Payer: PACE Senior Care Partners |
$27.55
|
| Rate for Payer: PACE SWMI |
$29.00
|
| Rate for Payer: PHP Commercial |
$98.60
|
| Rate for Payer: PHP Medicare Advantage |
$29.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.92
|
| Rate for Payer: Priority Health Medicare |
$29.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.75
|
| Rate for Payer: Railroad Medicare Medicare |
$29.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.08
|
| Rate for Payer: UHC Core |
$96.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.00
|
| Rate for Payer: UHC Medicare Advantage |
$29.87
|
| Rate for Payer: VA VA |
$29.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.00
|
|
|
HC PSYCHOTHERAPY FOR CRISIS EA ADDL 15 MIN
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
91400014
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$70.75 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna Commercial |
$98.60
|
| Rate for Payer: BCBS Trust/PPO |
$89.64
|
| Rate for Payer: BCN Commercial |
$89.64
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cofinity Commercial |
$99.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.80
|
| Rate for Payer: Healthscope Commercial |
$104.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.60
|
| Rate for Payer: PHP Commercial |
$98.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.08
|
| Rate for Payer: UHC Core |
$96.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.00
|
|
