|
HC HCG SERUM QUANTITATIVE
|
Facility
|
IP
|
$64.73
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
30100465
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.55 |
| Max. Negotiated Rate |
$64.73 |
| Rate for Payer: Aetna Commercial |
$58.26
|
| Rate for Payer: ASR ASR |
$62.79
|
| Rate for Payer: BCBS Trust/PPO |
$53.16
|
| Rate for Payer: BCN Commercial |
$53.16
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cofinity Commercial |
$60.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.78
|
| Rate for Payer: Healthscope Commercial |
$62.79
|
| Rate for Payer: Healthscope Whirlpool |
$64.73
|
| Rate for Payer: Mclaren Commercial |
$58.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.02
|
| Rate for Payer: Nomi Health Commercial |
$53.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.96
|
|
|
HC HCG SERUM QUANTITATIVE
|
Facility
|
OP
|
$64.73
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
30100465
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$473.34 |
| Rate for Payer: Aetna Commercial |
$58.26
|
| Rate for Payer: Aetna Medicare |
$15.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: ASR ASR |
$62.79
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCBS Trust/PPO |
$53.37
|
| Rate for Payer: BCN Commercial |
$53.37
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cofinity Commercial |
$60.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$62.79
|
| Rate for Payer: Healthscope Whirlpool |
$64.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$58.26
|
| Rate for Payer: Mclaren Medicaid |
$15.05
|
| Rate for Payer: Mclaren Medicare |
$15.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.02
|
| Rate for Payer: Nomi Health Commercial |
$53.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.55
|
| Rate for Payer: PACE Medicare |
$14.30
|
| Rate for Payer: PACE SWMI |
$15.05
|
| Rate for Payer: PHP Commercial |
$16.55
|
| Rate for Payer: PHP Medicaid |
$8.07
|
| Rate for Payer: PHP Medicare Advantage |
$15.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$473.34
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health Narrow Network |
$378.67
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.05
|
| Rate for Payer: UHC Exchange |
$23.33
|
| Rate for Payer: UHC Medicaid |
$7.87
|
| Rate for Payer: UHCCP DNSP |
$15.05
|
| Rate for Payer: UHCCP Medicaid |
$7.87
|
| Rate for Payer: VA VA |
$15.05
|
|
|
HC HCV GENOTYPE RESOLUTION
|
Facility
|
IP
|
$411.56
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600262
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$308.67 |
| Max. Negotiated Rate |
$411.56 |
| Rate for Payer: Aetna Commercial |
$370.40
|
| Rate for Payer: ASR ASR |
$399.21
|
| Rate for Payer: BCBS Trust/PPO |
$337.97
|
| Rate for Payer: BCN Commercial |
$337.97
|
| Rate for Payer: Cash Price |
$329.25
|
| Rate for Payer: Cofinity Commercial |
$386.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.25
|
| Rate for Payer: Healthscope Commercial |
$399.21
|
| Rate for Payer: Healthscope Whirlpool |
$411.56
|
| Rate for Payer: Mclaren Commercial |
$370.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.83
|
| Rate for Payer: Nomi Health Commercial |
$337.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$308.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$362.17
|
|
|
HC HCV GENOTYPE RESOLUTION
|
Facility
|
OP
|
$411.56
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600262
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$134.65 |
| Max. Negotiated Rate |
$877.65 |
| Rate for Payer: Aetna Commercial |
$370.40
|
| Rate for Payer: Aetna Medicare |
$257.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$321.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$321.81
|
| Rate for Payer: ASR ASR |
$399.21
|
| Rate for Payer: BCBS Complete |
$141.39
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCBS Trust/PPO |
$339.33
|
| Rate for Payer: BCN Commercial |
$339.33
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$329.25
|
| Rate for Payer: Cash Price |
$329.25
|
| Rate for Payer: Cofinity Commercial |
$386.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Healthscope Commercial |
$399.21
|
| Rate for Payer: Healthscope Whirlpool |
$411.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$257.45
|
| Rate for Payer: Mclaren Commercial |
$370.40
|
| Rate for Payer: Mclaren Medicaid |
$257.45
|
| Rate for Payer: Mclaren Medicare |
$257.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.32
|
| Rate for Payer: Meridian Medicaid |
$141.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$283.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.83
|
| Rate for Payer: Nomi Health Commercial |
$337.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$308.67
|
| Rate for Payer: PACE Medicare |
$244.58
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PHP Commercial |
$283.19
|
| Rate for Payer: PHP Medicaid |
$137.99
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$877.65
|
| Rate for Payer: Priority Health Medicare |
$257.45
|
| Rate for Payer: Priority Health Narrow Network |
$702.12
|
| Rate for Payer: Railroad Medicare Medicare |
$257.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$362.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$257.45
|
| Rate for Payer: UHC Exchange |
$399.05
|
| Rate for Payer: UHC Medicaid |
$134.65
|
| Rate for Payer: UHCCP DNSP |
$257.45
|
| Rate for Payer: UHCCP Medicaid |
$134.65
|
| Rate for Payer: VA VA |
$257.45
|
|
|
HC HDL CHOLESTEROL
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.87 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: ASR ASR |
$30.88
|
| Rate for Payer: BCBS Trust/PPO |
$26.14
|
| Rate for Payer: BCN Commercial |
$26.14
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$29.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$30.88
|
| Rate for Payer: Healthscope Whirlpool |
$31.83
|
| Rate for Payer: Mclaren Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.01
|
|
|
HC HDL CHOLESTEROL
|
Facility
|
OP
|
$31.83
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$38.74 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna Medicare |
$8.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.24
|
| Rate for Payer: ASR ASR |
$30.88
|
| Rate for Payer: BCBS Complete |
$4.50
|
| Rate for Payer: BCBS MAPPO |
$8.19
|
| Rate for Payer: BCBS Trust/PPO |
$26.24
|
| Rate for Payer: BCN Commercial |
$26.24
|
| Rate for Payer: BCN Medicare Advantage |
$8.19
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$29.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$30.88
|
| Rate for Payer: Healthscope Whirlpool |
$31.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.19
|
| Rate for Payer: Mclaren Commercial |
$28.65
|
| Rate for Payer: Mclaren Medicaid |
$8.19
|
| Rate for Payer: Mclaren Medicare |
$8.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.60
|
| Rate for Payer: Meridian Medicaid |
$4.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$26.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PACE Medicare |
$7.78
|
| Rate for Payer: PACE SWMI |
$8.19
|
| Rate for Payer: PHP Commercial |
$9.01
|
| Rate for Payer: PHP Medicaid |
$4.39
|
| Rate for Payer: PHP Medicare Advantage |
$8.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$38.74
|
| Rate for Payer: Priority Health Medicare |
$8.19
|
| Rate for Payer: Priority Health Narrow Network |
$31.00
|
| Rate for Payer: Railroad Medicare Medicare |
$8.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.19
|
| Rate for Payer: UHC Exchange |
$12.69
|
| Rate for Payer: UHC Medicaid |
$4.28
|
| Rate for Payer: UHCCP DNSP |
$8.19
|
| Rate for Payer: UHCCP Medicaid |
$4.28
|
| Rate for Payer: VA VA |
$8.19
|
|
|
HC HDL CHOLESTEROL LMPP
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.43
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
|
|
HC HDL CHOLESTEROL LMPP
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$38.74 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: Aetna Medicare |
$8.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.24
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Complete |
$4.50
|
| Rate for Payer: BCBS MAPPO |
$8.19
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: BCN Medicare Advantage |
$8.19
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.19
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Mclaren Medicaid |
$8.19
|
| Rate for Payer: Mclaren Medicare |
$8.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.60
|
| Rate for Payer: Meridian Medicaid |
$4.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Medicare |
$7.78
|
| Rate for Payer: PACE SWMI |
$8.19
|
| Rate for Payer: PHP Commercial |
$9.01
|
| Rate for Payer: PHP Medicaid |
$4.39
|
| Rate for Payer: PHP Medicare Advantage |
$8.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$38.74
|
| Rate for Payer: Priority Health Medicare |
$8.19
|
| Rate for Payer: Priority Health Narrow Network |
$31.00
|
| Rate for Payer: Railroad Medicare Medicare |
$8.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.19
|
| Rate for Payer: UHC Exchange |
$12.69
|
| Rate for Payer: UHC Medicaid |
$4.28
|
| Rate for Payer: UHCCP DNSP |
$8.19
|
| Rate for Payer: UHCCP Medicaid |
$4.28
|
| Rate for Payer: VA VA |
$8.19
|
|
|
HC HDR 1 CHANNEL
|
Facility
|
OP
|
$2,029.45
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
33300055
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$362.95 |
| Max. Negotiated Rate |
$2,029.45 |
| Rate for Payer: Aetna Commercial |
$1,826.51
|
| Rate for Payer: Aetna Medicare |
$693.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$867.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$867.46
|
| Rate for Payer: ASR ASR |
$1,968.57
|
| Rate for Payer: BCBS Complete |
$381.13
|
| Rate for Payer: BCBS MAPPO |
$693.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,673.28
|
| Rate for Payer: BCN Commercial |
$1,673.28
|
| Rate for Payer: BCN Medicare Advantage |
$693.97
|
| Rate for Payer: Cash Price |
$1,623.56
|
| Rate for Payer: Cash Price |
$1,623.56
|
| Rate for Payer: Cofinity Commercial |
$1,907.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,623.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$693.97
|
| Rate for Payer: Healthscope Commercial |
$1,968.57
|
| Rate for Payer: Healthscope Whirlpool |
$2,029.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$693.97
|
| Rate for Payer: Mclaren Commercial |
$1,826.51
|
| Rate for Payer: Mclaren Medicaid |
$693.97
|
| Rate for Payer: Mclaren Medicare |
$693.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$728.67
|
| Rate for Payer: Meridian Medicaid |
$381.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$798.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$763.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,725.03
|
| Rate for Payer: Nomi Health Commercial |
$1,664.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,522.09
|
| Rate for Payer: PACE Medicare |
$659.27
|
| Rate for Payer: PACE SWMI |
$693.97
|
| Rate for Payer: PHP Commercial |
$763.37
|
| Rate for Payer: PHP Medicaid |
$371.97
|
| Rate for Payer: PHP Medicare Advantage |
$693.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,778.20
|
| Rate for Payer: Priority Health Medicare |
$693.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,422.64
|
| Rate for Payer: Railroad Medicare Medicare |
$693.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,785.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$693.97
|
| Rate for Payer: UHC Exchange |
$1,075.65
|
| Rate for Payer: UHC Medicaid |
$362.95
|
| Rate for Payer: UHCCP DNSP |
$693.97
|
| Rate for Payer: UHCCP Medicaid |
$362.95
|
| Rate for Payer: VA VA |
$693.97
|
|
|
HC HDR 1 CHANNEL
|
Facility
|
IP
|
$2,029.45
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
33300055
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,522.09 |
| Max. Negotiated Rate |
$2,029.45 |
| Rate for Payer: Aetna Commercial |
$1,826.51
|
| Rate for Payer: ASR ASR |
$1,968.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,666.58
|
| Rate for Payer: BCN Commercial |
$1,666.58
|
| Rate for Payer: Cash Price |
$1,623.56
|
| Rate for Payer: Cofinity Commercial |
$1,907.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,623.56
|
| Rate for Payer: Healthscope Commercial |
$1,968.57
|
| Rate for Payer: Healthscope Whirlpool |
$2,029.45
|
| Rate for Payer: Mclaren Commercial |
$1,826.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,725.03
|
| Rate for Payer: Nomi Health Commercial |
$1,664.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,522.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,785.92
|
|
|
HC HDR 2-12 CHANNELS
|
Facility
|
IP
|
$2,254.25
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,690.69 |
| Max. Negotiated Rate |
$2,254.25 |
| Rate for Payer: Aetna Commercial |
$2,028.83
|
| Rate for Payer: ASR ASR |
$2,186.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,851.19
|
| Rate for Payer: BCN Commercial |
$1,851.19
|
| Rate for Payer: Cash Price |
$1,803.40
|
| Rate for Payer: Cofinity Commercial |
$2,118.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.40
|
| Rate for Payer: Healthscope Commercial |
$2,186.62
|
| Rate for Payer: Healthscope Whirlpool |
$2,254.25
|
| Rate for Payer: Mclaren Commercial |
$2,028.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,916.11
|
| Rate for Payer: Nomi Health Commercial |
$1,848.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,690.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,983.74
|
|
|
HC HDR 2-12 CHANNELS
|
Facility
|
OP
|
$2,254.25
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$362.95 |
| Max. Negotiated Rate |
$2,254.25 |
| Rate for Payer: Aetna Commercial |
$2,028.83
|
| Rate for Payer: Aetna Medicare |
$693.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$867.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$867.46
|
| Rate for Payer: ASR ASR |
$2,186.62
|
| Rate for Payer: BCBS Complete |
$381.13
|
| Rate for Payer: BCBS MAPPO |
$693.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,858.63
|
| Rate for Payer: BCN Commercial |
$1,858.63
|
| Rate for Payer: BCN Medicare Advantage |
$693.97
|
| Rate for Payer: Cash Price |
$1,803.40
|
| Rate for Payer: Cash Price |
$1,803.40
|
| Rate for Payer: Cofinity Commercial |
$2,118.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$693.97
|
| Rate for Payer: Healthscope Commercial |
$2,186.62
|
| Rate for Payer: Healthscope Whirlpool |
$2,254.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$693.97
|
| Rate for Payer: Mclaren Commercial |
$2,028.83
|
| Rate for Payer: Mclaren Medicaid |
$693.97
|
| Rate for Payer: Mclaren Medicare |
$693.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$728.67
|
| Rate for Payer: Meridian Medicaid |
$381.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$798.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$763.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,916.11
|
| Rate for Payer: Nomi Health Commercial |
$1,848.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,690.69
|
| Rate for Payer: PACE Medicare |
$659.27
|
| Rate for Payer: PACE SWMI |
$693.97
|
| Rate for Payer: PHP Commercial |
$763.37
|
| Rate for Payer: PHP Medicaid |
$371.97
|
| Rate for Payer: PHP Medicare Advantage |
$693.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,975.17
|
| Rate for Payer: Priority Health Medicare |
$693.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,580.23
|
| Rate for Payer: Railroad Medicare Medicare |
$693.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,983.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$693.97
|
| Rate for Payer: UHC Exchange |
$1,075.65
|
| Rate for Payer: UHC Medicaid |
$362.95
|
| Rate for Payer: UHCCP DNSP |
$693.97
|
| Rate for Payer: UHCCP Medicaid |
$362.95
|
| Rate for Payer: VA VA |
$693.97
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
IP
|
$573.66
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.25 |
| Max. Negotiated Rate |
$573.66 |
| Rate for Payer: Aetna Commercial |
$516.29
|
| Rate for Payer: ASR ASR |
$556.45
|
| Rate for Payer: BCBS Trust/PPO |
$471.09
|
| Rate for Payer: BCN Commercial |
$471.09
|
| Rate for Payer: Cash Price |
$458.93
|
| Rate for Payer: Cofinity Commercial |
$539.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.93
|
| Rate for Payer: Healthscope Commercial |
$556.45
|
| Rate for Payer: Healthscope Whirlpool |
$573.66
|
| Rate for Payer: Mclaren Commercial |
$516.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.61
|
| Rate for Payer: Nomi Health Commercial |
$470.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$430.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$504.82
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
OP
|
$573.66
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.34 |
| Max. Negotiated Rate |
$573.66 |
| Rate for Payer: Aetna Commercial |
$516.29
|
| Rate for Payer: Aetna Medicare |
$348.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.81
|
| Rate for Payer: ASR ASR |
$556.45
|
| Rate for Payer: BCBS Complete |
$191.48
|
| Rate for Payer: BCBS MAPPO |
$348.65
|
| Rate for Payer: BCBS Trust/PPO |
$472.98
|
| Rate for Payer: BCN Commercial |
$472.98
|
| Rate for Payer: BCN Medicare Advantage |
$348.65
|
| Rate for Payer: Cash Price |
$458.93
|
| Rate for Payer: Cash Price |
$458.93
|
| Rate for Payer: Cofinity Commercial |
$539.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.65
|
| Rate for Payer: Healthscope Commercial |
$556.45
|
| Rate for Payer: Healthscope Whirlpool |
$573.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$348.65
|
| Rate for Payer: Mclaren Commercial |
$516.29
|
| Rate for Payer: Mclaren Medicaid |
$348.65
|
| Rate for Payer: Mclaren Medicare |
$348.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$366.08
|
| Rate for Payer: Meridian Medicaid |
$191.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$383.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.61
|
| Rate for Payer: Nomi Health Commercial |
$470.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$430.25
|
| Rate for Payer: PACE Medicare |
$331.22
|
| Rate for Payer: PACE SWMI |
$348.65
|
| Rate for Payer: PHP Commercial |
$383.51
|
| Rate for Payer: PHP Medicaid |
$186.88
|
| Rate for Payer: PHP Medicare Advantage |
$348.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$182.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$502.64
|
| Rate for Payer: Priority Health Medicare |
$348.65
|
| Rate for Payer: Priority Health Narrow Network |
$402.14
|
| Rate for Payer: Railroad Medicare Medicare |
$348.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$504.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$348.65
|
| Rate for Payer: UHC Exchange |
$540.41
|
| Rate for Payer: UHC Medicaid |
$182.34
|
| Rate for Payer: UHCCP DNSP |
$348.65
|
| Rate for Payer: UHCCP Medicaid |
$182.34
|
| Rate for Payer: VA VA |
$348.65
|
|
|
HC HDR OVER 12 CHANNELS
|
Facility
|
IP
|
$2,487.67
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,865.75 |
| Max. Negotiated Rate |
$2,487.67 |
| Rate for Payer: Aetna Commercial |
$2,238.90
|
| Rate for Payer: ASR ASR |
$2,413.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,042.87
|
| Rate for Payer: BCN Commercial |
$2,042.87
|
| Rate for Payer: Cash Price |
$1,990.14
|
| Rate for Payer: Cofinity Commercial |
$2,338.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,990.14
|
| Rate for Payer: Healthscope Commercial |
$2,413.04
|
| Rate for Payer: Healthscope Whirlpool |
$2,487.67
|
| Rate for Payer: Mclaren Commercial |
$2,238.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,114.52
|
| Rate for Payer: Nomi Health Commercial |
$2,039.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,865.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,189.15
|
|
|
HC HDR OVER 12 CHANNELS
|
Facility
|
OP
|
$2,487.67
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$362.95 |
| Max. Negotiated Rate |
$2,487.67 |
| Rate for Payer: Aetna Commercial |
$2,238.90
|
| Rate for Payer: Aetna Medicare |
$693.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$867.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$867.46
|
| Rate for Payer: ASR ASR |
$2,413.04
|
| Rate for Payer: BCBS Complete |
$381.13
|
| Rate for Payer: BCBS MAPPO |
$693.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,051.08
|
| Rate for Payer: BCN Commercial |
$2,051.08
|
| Rate for Payer: BCN Medicare Advantage |
$693.97
|
| Rate for Payer: Cash Price |
$1,990.14
|
| Rate for Payer: Cash Price |
$1,990.14
|
| Rate for Payer: Cofinity Commercial |
$2,338.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,990.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$693.97
|
| Rate for Payer: Healthscope Commercial |
$2,413.04
|
| Rate for Payer: Healthscope Whirlpool |
$2,487.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$693.97
|
| Rate for Payer: Mclaren Commercial |
$2,238.90
|
| Rate for Payer: Mclaren Medicaid |
$693.97
|
| Rate for Payer: Mclaren Medicare |
$693.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$728.67
|
| Rate for Payer: Meridian Medicaid |
$381.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$798.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$763.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,114.52
|
| Rate for Payer: Nomi Health Commercial |
$2,039.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,865.75
|
| Rate for Payer: PACE Medicare |
$659.27
|
| Rate for Payer: PACE SWMI |
$693.97
|
| Rate for Payer: PHP Commercial |
$763.37
|
| Rate for Payer: PHP Medicaid |
$371.97
|
| Rate for Payer: PHP Medicare Advantage |
$693.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,179.70
|
| Rate for Payer: Priority Health Medicare |
$693.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,743.86
|
| Rate for Payer: Railroad Medicare Medicare |
$693.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,189.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$693.97
|
| Rate for Payer: UHC Exchange |
$1,075.65
|
| Rate for Payer: UHC Medicaid |
$362.95
|
| Rate for Payer: UHCCP DNSP |
$693.97
|
| Rate for Payer: UHCCP Medicaid |
$362.95
|
| Rate for Payer: VA VA |
$693.97
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
OP
|
$491.40
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$200.99 |
| Max. Negotiated Rate |
$595.68 |
| Rate for Payer: Aetna Commercial |
$442.26
|
| Rate for Payer: Aetna Medicare |
$384.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$480.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$480.39
|
| Rate for Payer: ASR ASR |
$476.66
|
| Rate for Payer: BCBS Complete |
$211.06
|
| Rate for Payer: BCBS MAPPO |
$384.31
|
| Rate for Payer: BCBS Trust/PPO |
$405.16
|
| Rate for Payer: BCN Commercial |
$405.16
|
| Rate for Payer: BCN Medicare Advantage |
$384.31
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cofinity Commercial |
$461.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.31
|
| Rate for Payer: Healthscope Commercial |
$476.66
|
| Rate for Payer: Healthscope Whirlpool |
$491.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$384.31
|
| Rate for Payer: Mclaren Commercial |
$442.26
|
| Rate for Payer: Mclaren Medicaid |
$384.31
|
| Rate for Payer: Mclaren Medicare |
$384.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.53
|
| Rate for Payer: Meridian Medicaid |
$211.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$422.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.69
|
| Rate for Payer: Nomi Health Commercial |
$402.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.55
|
| Rate for Payer: PACE Medicare |
$365.09
|
| Rate for Payer: PACE SWMI |
$384.31
|
| Rate for Payer: PHP Commercial |
$422.74
|
| Rate for Payer: PHP Medicaid |
$205.99
|
| Rate for Payer: PHP Medicare Advantage |
$384.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$430.56
|
| Rate for Payer: Priority Health Medicare |
$384.31
|
| Rate for Payer: Priority Health Narrow Network |
$344.47
|
| Rate for Payer: Railroad Medicare Medicare |
$384.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$384.31
|
| Rate for Payer: UHC Exchange |
$595.68
|
| Rate for Payer: UHC Medicaid |
$200.99
|
| Rate for Payer: UHCCP DNSP |
$384.31
|
| Rate for Payer: UHCCP Medicaid |
$200.99
|
| Rate for Payer: VA VA |
$384.31
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
IP
|
$491.40
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$368.55 |
| Max. Negotiated Rate |
$491.40 |
| Rate for Payer: Aetna Commercial |
$442.26
|
| Rate for Payer: ASR ASR |
$476.66
|
| Rate for Payer: BCBS Trust/PPO |
$403.54
|
| Rate for Payer: BCN Commercial |
$403.54
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cofinity Commercial |
$461.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.12
|
| Rate for Payer: Healthscope Commercial |
$476.66
|
| Rate for Payer: Healthscope Whirlpool |
$491.40
|
| Rate for Payer: Mclaren Commercial |
$442.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.69
|
| Rate for Payer: Nomi Health Commercial |
$402.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.43
|
|
|
HC HDR SKIN SURFACE 2 OR MORE CHANNELS
|
Facility
|
IP
|
$552.83
|
|
|
Service Code
|
CPT 77768
|
| Hospital Charge Code |
33300054
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$414.62 |
| Max. Negotiated Rate |
$552.83 |
| Rate for Payer: Aetna Commercial |
$497.55
|
| Rate for Payer: ASR ASR |
$536.25
|
| Rate for Payer: BCBS Trust/PPO |
$453.98
|
| Rate for Payer: BCN Commercial |
$453.98
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cofinity Commercial |
$519.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.26
|
| Rate for Payer: Healthscope Commercial |
$536.25
|
| Rate for Payer: Healthscope Whirlpool |
$552.83
|
| Rate for Payer: Mclaren Commercial |
$497.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.91
|
| Rate for Payer: Nomi Health Commercial |
$453.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$486.49
|
|
|
HC HDR SKIN SURFACE 2 OR MORE CHANNELS
|
Facility
|
OP
|
$552.83
|
|
|
Service Code
|
CPT 77768
|
| Hospital Charge Code |
33300054
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$200.99 |
| Max. Negotiated Rate |
$595.68 |
| Rate for Payer: Aetna Commercial |
$497.55
|
| Rate for Payer: Aetna Medicare |
$384.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$480.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$480.39
|
| Rate for Payer: ASR ASR |
$536.25
|
| Rate for Payer: BCBS Complete |
$211.06
|
| Rate for Payer: BCBS MAPPO |
$384.31
|
| Rate for Payer: BCBS Trust/PPO |
$455.81
|
| Rate for Payer: BCN Commercial |
$455.81
|
| Rate for Payer: BCN Medicare Advantage |
$384.31
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cofinity Commercial |
$519.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.31
|
| Rate for Payer: Healthscope Commercial |
$536.25
|
| Rate for Payer: Healthscope Whirlpool |
$552.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$384.31
|
| Rate for Payer: Mclaren Commercial |
$497.55
|
| Rate for Payer: Mclaren Medicaid |
$384.31
|
| Rate for Payer: Mclaren Medicare |
$384.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.53
|
| Rate for Payer: Meridian Medicaid |
$211.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$422.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.91
|
| Rate for Payer: Nomi Health Commercial |
$453.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.62
|
| Rate for Payer: PACE Medicare |
$365.09
|
| Rate for Payer: PACE SWMI |
$384.31
|
| Rate for Payer: PHP Commercial |
$422.74
|
| Rate for Payer: PHP Medicaid |
$205.99
|
| Rate for Payer: PHP Medicare Advantage |
$384.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$484.39
|
| Rate for Payer: Priority Health Medicare |
$384.31
|
| Rate for Payer: Priority Health Narrow Network |
$387.53
|
| Rate for Payer: Railroad Medicare Medicare |
$384.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$486.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$384.31
|
| Rate for Payer: UHC Exchange |
$595.68
|
| Rate for Payer: UHC Medicaid |
$200.99
|
| Rate for Payer: UHCCP DNSP |
$384.31
|
| Rate for Payer: UHCCP Medicaid |
$200.99
|
| Rate for Payer: VA VA |
$384.31
|
|
|
HC HEALTH & BEHAV ASSESS OR REASSESS
|
Facility
|
IP
|
$125.23
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
91400009
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$93.92 |
| Max. Negotiated Rate |
$125.23 |
| Rate for Payer: Aetna Commercial |
$112.71
|
| Rate for Payer: ASR ASR |
$121.47
|
| Rate for Payer: BCBS Trust/PPO |
$102.84
|
| Rate for Payer: BCN Commercial |
$102.84
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cofinity Commercial |
$117.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.18
|
| Rate for Payer: Healthscope Commercial |
$121.47
|
| Rate for Payer: Healthscope Whirlpool |
$125.23
|
| Rate for Payer: Mclaren Commercial |
$112.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.45
|
| Rate for Payer: Nomi Health Commercial |
$102.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.92
|
|
|
HC HEALTH & BEHAV ASSESS OR REASSESS
|
Facility
|
OP
|
$125.23
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
91400009
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$126.53 |
| Rate for Payer: Aetna Commercial |
$112.71
|
| Rate for Payer: Aetna Medicare |
$101.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.53
|
| Rate for Payer: ASR ASR |
$121.47
|
| Rate for Payer: BCBS Complete |
$55.59
|
| Rate for Payer: BCBS MAPPO |
$101.22
|
| Rate for Payer: BCBS Trust/PPO |
$103.25
|
| Rate for Payer: BCN Commercial |
$103.25
|
| Rate for Payer: BCN Medicare Advantage |
$101.22
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cofinity Commercial |
$117.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.22
|
| Rate for Payer: Healthscope Commercial |
$121.47
|
| Rate for Payer: Healthscope Whirlpool |
$125.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$101.22
|
| Rate for Payer: Mclaren Commercial |
$112.71
|
| Rate for Payer: Mclaren Medicaid |
$101.22
|
| Rate for Payer: Mclaren Medicare |
$101.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.28
|
| Rate for Payer: Meridian Medicaid |
$55.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.45
|
| Rate for Payer: Nomi Health Commercial |
$102.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.92
|
| Rate for Payer: PACE Medicare |
$96.16
|
| Rate for Payer: PACE SWMI |
$101.22
|
| Rate for Payer: PHP Commercial |
$111.34
|
| Rate for Payer: PHP Medicaid |
$54.25
|
| Rate for Payer: PHP Medicare Advantage |
$101.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$99.13
|
| Rate for Payer: Priority Health Medicare |
$101.22
|
| Rate for Payer: Priority Health Narrow Network |
$79.30
|
| Rate for Payer: Railroad Medicare Medicare |
$101.22
|
| Rate for Payer: UHC Medicaid |
$52.94
|
| Rate for Payer: UHCCP DNSP |
$101.22
|
| Rate for Payer: UHCCP Medicaid |
$52.94
|
| Rate for Payer: VA VA |
$101.22
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV EA ADD 15 MIN
|
Facility
|
IP
|
$62.61
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
91400011
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$46.96 |
| Max. Negotiated Rate |
$62.61 |
| Rate for Payer: Aetna Commercial |
$56.35
|
| Rate for Payer: ASR ASR |
$60.73
|
| Rate for Payer: BCBS Trust/PPO |
$51.42
|
| Rate for Payer: BCN Commercial |
$51.42
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cofinity Commercial |
$58.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.09
|
| Rate for Payer: Healthscope Commercial |
$60.73
|
| Rate for Payer: Healthscope Whirlpool |
$62.61
|
| Rate for Payer: Mclaren Commercial |
$56.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.22
|
| Rate for Payer: Nomi Health Commercial |
$51.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.96
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV EA ADD 15 MIN
|
Facility
|
OP
|
$62.61
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
91400011
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$62.61 |
| Rate for Payer: Aetna Commercial |
$56.35
|
| Rate for Payer: Aetna Medicare |
$23.17
|
| Rate for Payer: ASR ASR |
$60.73
|
| Rate for Payer: BCBS Complete |
$25.04
|
| Rate for Payer: BCBS Trust/PPO |
$51.62
|
| Rate for Payer: BCN Commercial |
$51.62
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cofinity Commercial |
$58.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.09
|
| Rate for Payer: Healthscope Commercial |
$60.73
|
| Rate for Payer: Healthscope Whirlpool |
$62.61
|
| Rate for Payer: Mclaren Commercial |
$56.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.22
|
| Rate for Payer: Nomi Health Commercial |
$51.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$26.87
|
| Rate for Payer: Priority Health Narrow Network |
$21.50
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV INIT 30 MIN
|
Facility
|
IP
|
$125.23
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
91400010
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$93.92 |
| Max. Negotiated Rate |
$125.23 |
| Rate for Payer: Aetna Commercial |
$112.71
|
| Rate for Payer: ASR ASR |
$121.47
|
| Rate for Payer: BCBS Trust/PPO |
$102.84
|
| Rate for Payer: BCN Commercial |
$102.84
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cofinity Commercial |
$117.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.18
|
| Rate for Payer: Healthscope Commercial |
$121.47
|
| Rate for Payer: Healthscope Whirlpool |
$125.23
|
| Rate for Payer: Mclaren Commercial |
$112.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.45
|
| Rate for Payer: Nomi Health Commercial |
$102.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.92
|
|
