|
HC PSA FREE
|
Facility
|
OP
|
$68.31
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
30100405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$68.31 |
| Rate for Payer: Aetna Commercial |
$61.48
|
| Rate for Payer: Aetna Medicare |
$18.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.99
|
| Rate for Payer: ASR ASR |
$66.26
|
| Rate for Payer: BCBS Complete |
$10.56
|
| Rate for Payer: BCBS MAPPO |
$18.39
|
| Rate for Payer: BCBS Trust/PPO |
$52.96
|
| Rate for Payer: BCN Commercial |
$52.96
|
| Rate for Payer: BCN Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cofinity Commercial |
$64.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.39
|
| Rate for Payer: Healthscope Commercial |
$68.31
|
| Rate for Payer: Healthscope Whirlpool |
$66.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.39
|
| Rate for Payer: Mclaren Commercial |
$61.48
|
| Rate for Payer: Mclaren Medicaid |
$10.06
|
| Rate for Payer: Mclaren Medicare |
$18.39
|
| Rate for Payer: Meridian Medicaid |
$10.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.06
|
| Rate for Payer: PACE Medicare |
$17.47
|
| Rate for Payer: PACE SWMI |
$18.39
|
| Rate for Payer: PHP Commercial |
$20.23
|
| Rate for Payer: PHP Medicaid |
$10.06
|
| Rate for Payer: PHP Medicare Advantage |
$18.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.36
|
| Rate for Payer: Priority Health Medicare |
$18.39
|
| Rate for Payer: Priority Health Narrow Network |
$42.69
|
| Rate for Payer: Railroad Medicare Medicare |
$18.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.11
|
| Rate for Payer: UHC Medicare Advantage |
$18.94
|
| Rate for Payer: VA VA |
$18.39
|
|
|
HC PSA TOTAL
|
Facility
|
IP
|
$68.31
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
30100403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$68.31 |
| Rate for Payer: Aetna Commercial |
$61.48
|
| Rate for Payer: ASR ASR |
$66.26
|
| Rate for Payer: BCBS Trust/PPO |
$52.96
|
| Rate for Payer: BCN Commercial |
$52.96
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cofinity Commercial |
$64.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.65
|
| Rate for Payer: Healthscope Commercial |
$68.31
|
| Rate for Payer: Healthscope Whirlpool |
$66.26
|
| Rate for Payer: Mclaren Commercial |
$61.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.11
|
|
|
HC PSA TOTAL
|
Facility
|
OP
|
$68.31
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
30100403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$92.87 |
| Rate for Payer: Aetna Commercial |
$61.48
|
| Rate for Payer: Aetna Medicare |
$18.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.99
|
| Rate for Payer: ASR ASR |
$66.26
|
| Rate for Payer: BCBS Complete |
$10.56
|
| Rate for Payer: BCBS MAPPO |
$18.39
|
| Rate for Payer: BCBS Trust/PPO |
$52.96
|
| Rate for Payer: BCN Commercial |
$52.96
|
| Rate for Payer: BCN Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cofinity Commercial |
$64.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.39
|
| Rate for Payer: Healthscope Commercial |
$68.31
|
| Rate for Payer: Healthscope Whirlpool |
$66.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.39
|
| Rate for Payer: Mclaren Commercial |
$61.48
|
| Rate for Payer: Mclaren Medicaid |
$10.06
|
| Rate for Payer: Mclaren Medicare |
$18.39
|
| Rate for Payer: Meridian Medicaid |
$10.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.06
|
| Rate for Payer: PACE Medicare |
$17.47
|
| Rate for Payer: PACE SWMI |
$18.39
|
| Rate for Payer: PHP Commercial |
$20.23
|
| Rate for Payer: PHP Medicaid |
$10.06
|
| Rate for Payer: PHP Medicare Advantage |
$18.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.87
|
| Rate for Payer: Priority Health Medicare |
$18.39
|
| Rate for Payer: Priority Health Narrow Network |
$74.30
|
| Rate for Payer: Railroad Medicare Medicare |
$18.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.11
|
| Rate for Payer: UHC Medicare Advantage |
$18.94
|
| Rate for Payer: VA VA |
$18.39
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
IP
|
$1,019.57
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$713.70 |
| Max. Negotiated Rate |
$1,019.57 |
| Rate for Payer: Aetna Commercial |
$917.61
|
| Rate for Payer: ASR ASR |
$988.98
|
| Rate for Payer: BCBS Trust/PPO |
$790.47
|
| Rate for Payer: BCN Commercial |
$790.47
|
| Rate for Payer: Cash Price |
$815.66
|
| Rate for Payer: Cofinity Commercial |
$958.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$815.66
|
| Rate for Payer: Healthscope Commercial |
$1,019.57
|
| Rate for Payer: Healthscope Whirlpool |
$988.98
|
| Rate for Payer: Mclaren Commercial |
$917.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$866.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.22
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
OP
|
$1,019.57
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$305.44 |
| Max. Negotiated Rate |
$1,019.57 |
| Rate for Payer: Aetna Commercial |
$917.61
|
| Rate for Payer: Aetna Medicare |
$558.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.00
|
| Rate for Payer: ASR ASR |
$988.98
|
| Rate for Payer: BCBS Complete |
$320.74
|
| Rate for Payer: BCBS MAPPO |
$558.40
|
| Rate for Payer: BCBS Trust/PPO |
$790.47
|
| Rate for Payer: BCN Commercial |
$790.47
|
| Rate for Payer: BCN Medicare Advantage |
$558.40
|
| Rate for Payer: Cash Price |
$815.66
|
| Rate for Payer: Cash Price |
$815.66
|
| Rate for Payer: Cofinity Commercial |
$958.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$815.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.40
|
| Rate for Payer: Healthscope Commercial |
$1,019.57
|
| Rate for Payer: Healthscope Whirlpool |
$988.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$558.40
|
| Rate for Payer: Mclaren Commercial |
$917.61
|
| Rate for Payer: Mclaren Medicaid |
$305.44
|
| Rate for Payer: Mclaren Medicare |
$558.40
|
| Rate for Payer: Meridian Medicaid |
$320.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$866.63
|
| Rate for Payer: PACE Medicare |
$530.48
|
| Rate for Payer: PACE SWMI |
$558.40
|
| Rate for Payer: PHP Commercial |
$614.24
|
| Rate for Payer: PHP Medicaid |
$305.44
|
| Rate for Payer: PHP Medicare Advantage |
$558.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$927.81
|
| Rate for Payer: Priority Health Medicare |
$558.40
|
| Rate for Payer: Priority Health Narrow Network |
$723.89
|
| Rate for Payer: Railroad Medicare Medicare |
$558.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.22
|
| Rate for Payer: UHC Medicare Advantage |
$575.15
|
| Rate for Payer: VA VA |
$558.40
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$7.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.84
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Complete |
$4.52
|
| Rate for Payer: BCBS MAPPO |
$7.87
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: BCN Medicare Advantage |
$7.87
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.87
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.87
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$4.30
|
| Rate for Payer: Mclaren Medicare |
$7.87
|
| Rate for Payer: Meridian Medicaid |
$4.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$7.48
|
| Rate for Payer: PACE SWMI |
$7.87
|
| Rate for Payer: PHP Commercial |
$8.66
|
| Rate for Payer: PHP Medicaid |
$4.30
|
| Rate for Payer: PHP Medicare Advantage |
$7.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.41
|
| Rate for Payer: Priority Health Medicare |
$7.87
|
| Rate for Payer: Priority Health Narrow Network |
$36.21
|
| Rate for Payer: Railroad Medicare Medicare |
$7.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
| Rate for Payer: UHC Medicare Advantage |
$8.11
|
| Rate for Payer: VA VA |
$7.87
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
OP
|
$5,680.64
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$508.36 |
| Max. Negotiated Rate |
$5,680.64 |
| Rate for Payer: Aetna Commercial |
$5,112.58
|
| Rate for Payer: Aetna Medicare |
$929.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,161.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,161.70
|
| Rate for Payer: ASR ASR |
$5,510.22
|
| Rate for Payer: BCBS Complete |
$533.82
|
| Rate for Payer: BCBS MAPPO |
$929.36
|
| Rate for Payer: BCBS Trust/PPO |
$4,404.20
|
| Rate for Payer: BCN Commercial |
$4,404.20
|
| Rate for Payer: BCN Medicare Advantage |
$929.36
|
| Rate for Payer: Cash Price |
$4,544.51
|
| Rate for Payer: Cash Price |
$4,544.51
|
| Rate for Payer: Cofinity Commercial |
$5,339.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,544.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$929.36
|
| Rate for Payer: Healthscope Commercial |
$5,680.64
|
| Rate for Payer: Healthscope Whirlpool |
$5,510.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$929.36
|
| Rate for Payer: Mclaren Commercial |
$5,112.58
|
| Rate for Payer: Mclaren Medicaid |
$508.36
|
| Rate for Payer: Mclaren Medicare |
$929.36
|
| Rate for Payer: Meridian Medicaid |
$533.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$975.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,068.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,828.54
|
| Rate for Payer: PACE Medicare |
$882.89
|
| Rate for Payer: PACE SWMI |
$929.36
|
| Rate for Payer: PHP Commercial |
$1,022.30
|
| Rate for Payer: PHP Medicaid |
$508.36
|
| Rate for Payer: PHP Medicare Advantage |
$929.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,976.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$862.56
|
| Rate for Payer: Priority Health Medicare |
$929.36
|
| Rate for Payer: Priority Health Narrow Network |
$690.05
|
| Rate for Payer: Railroad Medicare Medicare |
$929.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,998.96
|
| Rate for Payer: UHC Medicare Advantage |
$957.24
|
| Rate for Payer: VA VA |
$929.36
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
IP
|
$5,680.64
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$3,976.45 |
| Max. Negotiated Rate |
$5,680.64 |
| Rate for Payer: Aetna Commercial |
$5,112.58
|
| Rate for Payer: ASR ASR |
$5,510.22
|
| Rate for Payer: BCBS Trust/PPO |
$4,404.20
|
| Rate for Payer: BCN Commercial |
$4,404.20
|
| Rate for Payer: Cash Price |
$4,544.51
|
| Rate for Payer: Cofinity Commercial |
$5,339.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,544.51
|
| Rate for Payer: Healthscope Commercial |
$5,680.64
|
| Rate for Payer: Healthscope Whirlpool |
$5,510.22
|
| Rate for Payer: Mclaren Commercial |
$5,112.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,828.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,976.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,998.96
|
|
|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
OP
|
$5,865.71
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$508.36 |
| Max. Negotiated Rate |
$5,865.71 |
| Rate for Payer: Aetna Commercial |
$5,279.14
|
| Rate for Payer: Aetna Medicare |
$929.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,161.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,161.70
|
| Rate for Payer: ASR ASR |
$5,689.74
|
| Rate for Payer: BCBS Complete |
$533.82
|
| Rate for Payer: BCBS MAPPO |
$929.36
|
| Rate for Payer: BCBS Trust/PPO |
$4,547.68
|
| Rate for Payer: BCN Commercial |
$4,547.68
|
| Rate for Payer: BCN Medicare Advantage |
$929.36
|
| Rate for Payer: Cash Price |
$4,692.57
|
| Rate for Payer: Cash Price |
$4,692.57
|
| Rate for Payer: Cofinity Commercial |
$5,513.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,692.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$929.36
|
| Rate for Payer: Healthscope Commercial |
$5,865.71
|
| Rate for Payer: Healthscope Whirlpool |
$5,689.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$929.36
|
| Rate for Payer: Mclaren Commercial |
$5,279.14
|
| Rate for Payer: Mclaren Medicaid |
$508.36
|
| Rate for Payer: Mclaren Medicare |
$929.36
|
| Rate for Payer: Meridian Medicaid |
$533.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$975.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,068.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,985.85
|
| Rate for Payer: PACE Medicare |
$882.89
|
| Rate for Payer: PACE SWMI |
$929.36
|
| Rate for Payer: PHP Commercial |
$1,022.30
|
| Rate for Payer: PHP Medicaid |
$508.36
|
| Rate for Payer: PHP Medicare Advantage |
$929.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,106.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$862.56
|
| Rate for Payer: Priority Health Medicare |
$929.36
|
| Rate for Payer: Priority Health Narrow Network |
$690.05
|
| Rate for Payer: Railroad Medicare Medicare |
$929.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,161.82
|
| Rate for Payer: UHC Medicare Advantage |
$957.24
|
| Rate for Payer: VA VA |
$929.36
|
|
|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
IP
|
$5,865.71
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$4,106.00 |
| Max. Negotiated Rate |
$5,865.71 |
| Rate for Payer: Aetna Commercial |
$5,279.14
|
| Rate for Payer: ASR ASR |
$5,689.74
|
| Rate for Payer: BCBS Trust/PPO |
$4,547.68
|
| Rate for Payer: BCN Commercial |
$4,547.68
|
| Rate for Payer: Cash Price |
$4,692.57
|
| Rate for Payer: Cofinity Commercial |
$5,513.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,692.57
|
| Rate for Payer: Healthscope Commercial |
$5,865.71
|
| Rate for Payer: Healthscope Whirlpool |
$5,689.74
|
| Rate for Payer: Mclaren Commercial |
$5,279.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,985.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,106.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,161.82
|
|
|
HC PSORALEN
|
Facility
|
IP
|
$2,114.62
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,480.23 |
| Max. Negotiated Rate |
$2,114.62 |
| Rate for Payer: Aetna Commercial |
$1,903.16
|
| Rate for Payer: ASR ASR |
$2,051.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,639.46
|
| Rate for Payer: BCN Commercial |
$1,639.46
|
| Rate for Payer: Cash Price |
$1,691.70
|
| Rate for Payer: Cofinity Commercial |
$1,987.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,691.70
|
| Rate for Payer: Healthscope Commercial |
$2,114.62
|
| Rate for Payer: Healthscope Whirlpool |
$2,051.18
|
| Rate for Payer: Mclaren Commercial |
$1,903.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,797.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,860.87
|
|
|
HC PSORALEN
|
Facility
|
OP
|
$2,114.62
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$281.32 |
| Max. Negotiated Rate |
$2,114.62 |
| Rate for Payer: Aetna Commercial |
$1,903.16
|
| Rate for Payer: Aetna Medicare |
$514.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$642.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$642.88
|
| Rate for Payer: ASR ASR |
$2,051.18
|
| Rate for Payer: BCBS Complete |
$295.41
|
| Rate for Payer: BCBS MAPPO |
$514.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,639.46
|
| Rate for Payer: BCN Commercial |
$1,639.46
|
| Rate for Payer: BCN Medicare Advantage |
$514.30
|
| Rate for Payer: Cash Price |
$1,691.70
|
| Rate for Payer: Cash Price |
$1,691.70
|
| Rate for Payer: Cofinity Commercial |
$1,987.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,691.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$514.30
|
| Rate for Payer: Healthscope Commercial |
$2,114.62
|
| Rate for Payer: Healthscope Whirlpool |
$2,051.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$514.30
|
| Rate for Payer: Mclaren Commercial |
$1,903.16
|
| Rate for Payer: Mclaren Medicaid |
$281.32
|
| Rate for Payer: Mclaren Medicare |
$514.30
|
| Rate for Payer: Meridian Medicaid |
$295.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$540.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$591.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,797.43
|
| Rate for Payer: PACE Medicare |
$488.58
|
| Rate for Payer: PACE SWMI |
$514.30
|
| Rate for Payer: PHP Commercial |
$565.73
|
| Rate for Payer: PHP Medicaid |
$281.32
|
| Rate for Payer: PHP Medicare Advantage |
$514.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$668.33
|
| Rate for Payer: Priority Health Medicare |
$514.30
|
| Rate for Payer: Priority Health Narrow Network |
$534.66
|
| Rate for Payer: Railroad Medicare Medicare |
$514.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,860.87
|
| Rate for Payer: UHC Medicare Advantage |
$529.73
|
| Rate for Payer: VA VA |
$514.30
|
|
|
HC PSORALEN TREATED WASHED PLATELETS
|
Facility
|
OP
|
$2,194.62
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000086
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$281.32 |
| Max. Negotiated Rate |
$2,194.62 |
| Rate for Payer: Aetna Commercial |
$1,975.16
|
| Rate for Payer: Aetna Medicare |
$514.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$642.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$642.88
|
| Rate for Payer: ASR ASR |
$2,128.78
|
| Rate for Payer: BCBS Complete |
$295.41
|
| Rate for Payer: BCBS MAPPO |
$514.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,701.49
|
| Rate for Payer: BCN Commercial |
$1,701.49
|
| Rate for Payer: BCN Medicare Advantage |
$514.30
|
| Rate for Payer: Cash Price |
$1,755.70
|
| Rate for Payer: Cash Price |
$1,755.70
|
| Rate for Payer: Cofinity Commercial |
$2,062.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,755.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$514.30
|
| Rate for Payer: Healthscope Commercial |
$2,194.62
|
| Rate for Payer: Healthscope Whirlpool |
$2,128.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$514.30
|
| Rate for Payer: Mclaren Commercial |
$1,975.16
|
| Rate for Payer: Mclaren Medicaid |
$281.32
|
| Rate for Payer: Mclaren Medicare |
$514.30
|
| Rate for Payer: Meridian Medicaid |
$295.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$540.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$591.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,865.43
|
| Rate for Payer: PACE Medicare |
$488.58
|
| Rate for Payer: PACE SWMI |
$514.30
|
| Rate for Payer: PHP Commercial |
$565.73
|
| Rate for Payer: PHP Medicaid |
$281.32
|
| Rate for Payer: PHP Medicare Advantage |
$514.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,536.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$668.33
|
| Rate for Payer: Priority Health Medicare |
$514.30
|
| Rate for Payer: Priority Health Narrow Network |
$534.66
|
| Rate for Payer: Railroad Medicare Medicare |
$514.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,931.27
|
| Rate for Payer: UHC Medicare Advantage |
$529.73
|
| Rate for Payer: VA VA |
$514.30
|
|
|
HC PSORALEN TREATED WASHED PLATELETS
|
Facility
|
IP
|
$2,194.62
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000086
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,536.23 |
| Max. Negotiated Rate |
$2,194.62 |
| Rate for Payer: Aetna Commercial |
$1,975.16
|
| Rate for Payer: ASR ASR |
$2,128.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,701.49
|
| Rate for Payer: BCN Commercial |
$1,701.49
|
| Rate for Payer: Cash Price |
$1,755.70
|
| Rate for Payer: Cofinity Commercial |
$2,062.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,755.70
|
| Rate for Payer: Healthscope Commercial |
$2,194.62
|
| Rate for Payer: Healthscope Whirlpool |
$2,128.78
|
| Rate for Payer: Mclaren Commercial |
$1,975.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,865.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,536.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,931.27
|
|
|
HC PSYCH COLLAB CARE MGMT EA ADD 30 MIN
|
Facility
|
OP
|
$87.72
|
|
|
Service Code
|
CPT 99494
|
| Hospital Charge Code |
51000094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Aetna Commercial |
$78.95
|
| Rate for Payer: ASR ASR |
$85.09
|
| Rate for Payer: BCBS Complete |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$68.01
|
| Rate for Payer: BCN Commercial |
$68.01
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$82.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$87.72
|
| Rate for Payer: Healthscope Whirlpool |
$85.09
|
| Rate for Payer: Mclaren Commercial |
$78.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.83
|
| Rate for Payer: Priority Health Narrow Network |
$62.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.19
|
|
|
HC PSYCH COLLAB CARE MGMT EA ADD 30 MIN
|
Facility
|
IP
|
$87.72
|
|
|
Service Code
|
CPT 99494
|
| Hospital Charge Code |
51000094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.40 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Aetna Commercial |
$78.95
|
| Rate for Payer: ASR ASR |
$85.09
|
| Rate for Payer: BCBS Trust/PPO |
$68.01
|
| Rate for Payer: BCN Commercial |
$68.01
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$82.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$87.72
|
| Rate for Payer: Healthscope Whirlpool |
$85.09
|
| Rate for Payer: Mclaren Commercial |
$78.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.19
|
|
|
HC PSYCH COLLAB CARE MGMT INIT 70 MIN
|
Facility
|
IP
|
$93.84
|
|
|
Service Code
|
CPT 99492
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.69 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$84.46
|
| Rate for Payer: ASR ASR |
$91.02
|
| Rate for Payer: BCBS Trust/PPO |
$72.75
|
| Rate for Payer: BCN Commercial |
$72.75
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cofinity Commercial |
$88.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.07
|
| Rate for Payer: Healthscope Commercial |
$93.84
|
| Rate for Payer: Healthscope Whirlpool |
$91.02
|
| Rate for Payer: Mclaren Commercial |
$84.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.58
|
|
|
HC PSYCH COLLAB CARE MGMT INIT 70 MIN
|
Facility
|
OP
|
$93.84
|
|
|
Service Code
|
CPT 99492
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.34 |
| Max. Negotiated Rate |
$99.04 |
| Rate for Payer: Aetna Commercial |
$84.46
|
| Rate for Payer: Aetna Medicare |
$79.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.04
|
| Rate for Payer: ASR ASR |
$91.02
|
| Rate for Payer: BCBS Complete |
$45.51
|
| Rate for Payer: BCBS MAPPO |
$79.23
|
| Rate for Payer: BCBS Trust/PPO |
$72.75
|
| Rate for Payer: BCN Commercial |
$72.75
|
| Rate for Payer: BCN Medicare Advantage |
$79.23
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cofinity Commercial |
$88.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.23
|
| Rate for Payer: Healthscope Commercial |
$93.84
|
| Rate for Payer: Healthscope Whirlpool |
$91.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$79.23
|
| Rate for Payer: Mclaren Commercial |
$84.46
|
| Rate for Payer: Mclaren Medicaid |
$43.34
|
| Rate for Payer: Mclaren Medicare |
$79.23
|
| Rate for Payer: Meridian Medicaid |
$45.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.76
|
| Rate for Payer: PACE Medicare |
$75.27
|
| Rate for Payer: PACE SWMI |
$79.23
|
| Rate for Payer: PHP Commercial |
$87.15
|
| Rate for Payer: PHP Medicaid |
$43.34
|
| Rate for Payer: PHP Medicare Advantage |
$79.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.98
|
| Rate for Payer: Priority Health Medicare |
$79.23
|
| Rate for Payer: Priority Health Narrow Network |
$61.58
|
| Rate for Payer: Railroad Medicare Medicare |
$79.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.58
|
| Rate for Payer: UHC Medicare Advantage |
$81.61
|
| Rate for Payer: VA VA |
$79.23
|
|
|
HC PSYCH COLLAB CARE MGMT SUBSEQ 60 MIN
|
Facility
|
OP
|
$103.22
|
|
|
Service Code
|
CPT 99493
|
| Hospital Charge Code |
51000093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.58 |
| Max. Negotiated Rate |
$177.15 |
| Rate for Payer: Aetna Commercial |
$92.90
|
| Rate for Payer: Aetna Medicare |
$141.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.15
|
| Rate for Payer: ASR ASR |
$100.12
|
| Rate for Payer: BCBS Complete |
$81.40
|
| Rate for Payer: BCBS MAPPO |
$141.72
|
| Rate for Payer: BCBS Trust/PPO |
$80.03
|
| Rate for Payer: BCN Commercial |
$80.03
|
| Rate for Payer: BCN Medicare Advantage |
$141.72
|
| Rate for Payer: Cash Price |
$82.58
|
| Rate for Payer: Cash Price |
$82.58
|
| Rate for Payer: Cofinity Commercial |
$97.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.72
|
| Rate for Payer: Healthscope Commercial |
$103.22
|
| Rate for Payer: Healthscope Whirlpool |
$100.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$141.72
|
| Rate for Payer: Mclaren Commercial |
$92.90
|
| Rate for Payer: Mclaren Medicaid |
$77.52
|
| Rate for Payer: Mclaren Medicare |
$141.72
|
| Rate for Payer: Meridian Medicaid |
$81.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.74
|
| Rate for Payer: PACE Medicare |
$134.63
|
| Rate for Payer: PACE SWMI |
$141.72
|
| Rate for Payer: PHP Commercial |
$155.89
|
| Rate for Payer: PHP Medicaid |
$77.52
|
| Rate for Payer: PHP Medicare Advantage |
$141.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.98
|
| Rate for Payer: Priority Health Medicare |
$141.72
|
| Rate for Payer: Priority Health Narrow Network |
$61.58
|
| Rate for Payer: Railroad Medicare Medicare |
$141.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.83
|
| Rate for Payer: UHC Medicare Advantage |
$145.97
|
| Rate for Payer: VA VA |
$141.72
|
|
|
HC PSYCH COLLAB CARE MGMT SUBSEQ 60 MIN
|
Facility
|
IP
|
$103.22
|
|
|
Service Code
|
CPT 99493
|
| Hospital Charge Code |
51000093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.25 |
| Max. Negotiated Rate |
$103.22 |
| Rate for Payer: Aetna Commercial |
$92.90
|
| Rate for Payer: ASR ASR |
$100.12
|
| Rate for Payer: BCBS Trust/PPO |
$80.03
|
| Rate for Payer: BCN Commercial |
$80.03
|
| Rate for Payer: Cash Price |
$82.58
|
| Rate for Payer: Cofinity Commercial |
$97.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.58
|
| Rate for Payer: Healthscope Commercial |
$103.22
|
| Rate for Payer: Healthscope Whirlpool |
$100.12
|
| Rate for Payer: Mclaren Commercial |
$92.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.83
|
|
|
HC PSYCH DIAGNOSTIC EVAL W/MED SVCS
|
Facility
|
OP
|
$194.82
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
91400008
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$77.52 |
| Max. Negotiated Rate |
$194.82 |
| Rate for Payer: Aetna Commercial |
$175.34
|
| Rate for Payer: Aetna Medicare |
$141.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.15
|
| Rate for Payer: ASR ASR |
$188.98
|
| Rate for Payer: BCBS Complete |
$81.40
|
| Rate for Payer: BCBS MAPPO |
$141.72
|
| Rate for Payer: BCBS Trust/PPO |
$151.04
|
| Rate for Payer: BCN Commercial |
$151.04
|
| Rate for Payer: BCN Medicare Advantage |
$141.72
|
| Rate for Payer: Cash Price |
$155.86
|
| Rate for Payer: Cash Price |
$155.86
|
| Rate for Payer: Cofinity Commercial |
$183.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.72
|
| Rate for Payer: Healthscope Commercial |
$194.82
|
| Rate for Payer: Healthscope Whirlpool |
$188.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$141.72
|
| Rate for Payer: Mclaren Commercial |
$175.34
|
| Rate for Payer: Mclaren Medicaid |
$77.52
|
| Rate for Payer: Mclaren Medicare |
$141.72
|
| Rate for Payer: Meridian Medicaid |
$81.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.60
|
| Rate for Payer: PACE Medicare |
$134.63
|
| Rate for Payer: PACE SWMI |
$141.72
|
| Rate for Payer: PHP Commercial |
$155.89
|
| Rate for Payer: PHP Medicaid |
$77.52
|
| Rate for Payer: PHP Medicare Advantage |
$141.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.87
|
| Rate for Payer: Priority Health Medicare |
$141.72
|
| Rate for Payer: Priority Health Narrow Network |
$94.30
|
| Rate for Payer: Railroad Medicare Medicare |
$141.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.44
|
| Rate for Payer: UHC Medicare Advantage |
$145.97
|
| Rate for Payer: VA VA |
$141.72
|
|
|
HC PSYCH DIAGNOSTIC EVAL W/MED SVCS
|
Facility
|
IP
|
$194.82
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
91400008
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$136.37 |
| Max. Negotiated Rate |
$194.82 |
| Rate for Payer: Aetna Commercial |
$175.34
|
| Rate for Payer: ASR ASR |
$188.98
|
| Rate for Payer: BCBS Trust/PPO |
$151.04
|
| Rate for Payer: BCN Commercial |
$151.04
|
| Rate for Payer: Cash Price |
$155.86
|
| Rate for Payer: Cofinity Commercial |
$183.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.86
|
| Rate for Payer: Healthscope Commercial |
$194.82
|
| Rate for Payer: Healthscope Whirlpool |
$188.98
|
| Rate for Payer: Mclaren Commercial |
$175.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.44
|
|
|
HC PSYCHIATRIC DIAG EVAL
|
Facility
|
IP
|
$194.82
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
91400004
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$136.37 |
| Max. Negotiated Rate |
$194.82 |
| Rate for Payer: Aetna Commercial |
$175.34
|
| Rate for Payer: ASR ASR |
$188.98
|
| Rate for Payer: BCBS Trust/PPO |
$151.04
|
| Rate for Payer: BCN Commercial |
$151.04
|
| Rate for Payer: Cash Price |
$155.86
|
| Rate for Payer: Cofinity Commercial |
$183.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.86
|
| Rate for Payer: Healthscope Commercial |
$194.82
|
| Rate for Payer: Healthscope Whirlpool |
$188.98
|
| Rate for Payer: Mclaren Commercial |
$175.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.44
|
|
|
HC PSYCHIATRIC DIAG EVAL
|
Facility
|
OP
|
$194.82
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
91400004
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$77.52 |
| Max. Negotiated Rate |
$194.82 |
| Rate for Payer: Aetna Commercial |
$175.34
|
| Rate for Payer: Aetna Medicare |
$141.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.15
|
| Rate for Payer: ASR ASR |
$188.98
|
| Rate for Payer: BCBS Complete |
$81.40
|
| Rate for Payer: BCBS MAPPO |
$141.72
|
| Rate for Payer: BCBS Trust/PPO |
$151.04
|
| Rate for Payer: BCN Commercial |
$151.04
|
| Rate for Payer: BCN Medicare Advantage |
$141.72
|
| Rate for Payer: Cash Price |
$155.86
|
| Rate for Payer: Cash Price |
$155.86
|
| Rate for Payer: Cofinity Commercial |
$183.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.72
|
| Rate for Payer: Healthscope Commercial |
$194.82
|
| Rate for Payer: Healthscope Whirlpool |
$188.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$141.72
|
| Rate for Payer: Mclaren Commercial |
$175.34
|
| Rate for Payer: Mclaren Medicaid |
$77.52
|
| Rate for Payer: Mclaren Medicare |
$141.72
|
| Rate for Payer: Meridian Medicaid |
$81.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.60
|
| Rate for Payer: PACE Medicare |
$134.63
|
| Rate for Payer: PACE SWMI |
$141.72
|
| Rate for Payer: PHP Commercial |
$155.89
|
| Rate for Payer: PHP Medicaid |
$77.52
|
| Rate for Payer: PHP Medicare Advantage |
$141.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.87
|
| Rate for Payer: Priority Health Medicare |
$141.72
|
| Rate for Payer: Priority Health Narrow Network |
$94.30
|
| Rate for Payer: Railroad Medicare Medicare |
$141.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.44
|
| Rate for Payer: UHC Medicare Advantage |
$145.97
|
| Rate for Payer: VA VA |
$141.72
|
|
