|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
OP
|
$6,102.68
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$447.50 |
| Max. Negotiated Rate |
$6,102.68 |
| Rate for Payer: Aetna Commercial |
$5,492.41
|
| Rate for Payer: Aetna Medicare |
$855.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,069.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,069.56
|
| Rate for Payer: ASR ASR |
$5,919.60
|
| Rate for Payer: BCBS Complete |
$469.92
|
| Rate for Payer: BCBS MAPPO |
$855.65
|
| Rate for Payer: BCBS Trust/PPO |
$5,031.66
|
| Rate for Payer: BCN Commercial |
$5,031.66
|
| Rate for Payer: BCN Medicare Advantage |
$855.65
|
| Rate for Payer: Cash Price |
$4,882.14
|
| Rate for Payer: Cash Price |
$4,882.14
|
| Rate for Payer: Cofinity Commercial |
$5,736.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,882.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$855.65
|
| Rate for Payer: Healthscope Commercial |
$5,919.60
|
| Rate for Payer: Healthscope Whirlpool |
$6,102.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$855.65
|
| Rate for Payer: Mclaren Commercial |
$5,492.41
|
| Rate for Payer: Mclaren Medicaid |
$855.65
|
| Rate for Payer: Mclaren Medicare |
$855.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$898.43
|
| Rate for Payer: Meridian Medicaid |
$469.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$984.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$941.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,187.28
|
| Rate for Payer: Nomi Health Commercial |
$5,004.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,577.01
|
| Rate for Payer: PACE Medicare |
$812.87
|
| Rate for Payer: PACE SWMI |
$855.65
|
| Rate for Payer: PHP Commercial |
$941.22
|
| Rate for Payer: PHP Medicaid |
$458.63
|
| Rate for Payer: PHP Medicare Advantage |
$855.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$447.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,017.54
|
| Rate for Payer: Priority Health Medicare |
$855.65
|
| Rate for Payer: Priority Health Narrow Network |
$814.04
|
| Rate for Payer: Railroad Medicare Medicare |
$855.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,370.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$855.65
|
| Rate for Payer: UHC Exchange |
$1,326.26
|
| Rate for Payer: UHC Medicaid |
$447.50
|
| Rate for Payer: UHCCP DNSP |
$855.65
|
| Rate for Payer: UHCCP Medicaid |
$447.50
|
| Rate for Payer: VA VA |
$855.65
|
|
|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
IP
|
$6,102.68
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$4,577.01 |
| Max. Negotiated Rate |
$6,102.68 |
| Rate for Payer: Aetna Commercial |
$5,492.41
|
| Rate for Payer: ASR ASR |
$5,919.60
|
| Rate for Payer: BCBS Trust/PPO |
$5,011.52
|
| Rate for Payer: BCN Commercial |
$5,011.52
|
| Rate for Payer: Cash Price |
$4,882.14
|
| Rate for Payer: Cofinity Commercial |
$5,736.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,882.14
|
| Rate for Payer: Healthscope Commercial |
$5,919.60
|
| Rate for Payer: Healthscope Whirlpool |
$6,102.68
|
| Rate for Payer: Mclaren Commercial |
$5,492.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,187.28
|
| Rate for Payer: Nomi Health Commercial |
$5,004.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,577.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,370.36
|
|
|
HC PSORALEN
|
Facility
|
OP
|
$2,200.05
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$309.83 |
| Max. Negotiated Rate |
$2,200.05 |
| Rate for Payer: Aetna Commercial |
$1,980.05
|
| Rate for Payer: Aetna Medicare |
$592.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$740.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$740.51
|
| Rate for Payer: ASR ASR |
$2,134.05
|
| Rate for Payer: BCBS Complete |
$325.35
|
| Rate for Payer: BCBS MAPPO |
$592.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,813.94
|
| Rate for Payer: BCN Commercial |
$1,813.94
|
| Rate for Payer: BCN Medicare Advantage |
$592.41
|
| Rate for Payer: Cash Price |
$1,760.04
|
| Rate for Payer: Cash Price |
$1,760.04
|
| Rate for Payer: Cofinity Commercial |
$2,068.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,760.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$592.41
|
| Rate for Payer: Healthscope Commercial |
$2,134.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,200.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$592.41
|
| Rate for Payer: Mclaren Commercial |
$1,980.05
|
| Rate for Payer: Mclaren Medicaid |
$592.41
|
| Rate for Payer: Mclaren Medicare |
$592.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$622.03
|
| Rate for Payer: Meridian Medicaid |
$325.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$681.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$651.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,870.04
|
| Rate for Payer: Nomi Health Commercial |
$1,804.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,650.04
|
| Rate for Payer: PACE Medicare |
$562.79
|
| Rate for Payer: PACE SWMI |
$592.41
|
| Rate for Payer: PHP Commercial |
$651.65
|
| Rate for Payer: PHP Medicaid |
$317.53
|
| Rate for Payer: PHP Medicare Advantage |
$592.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$309.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$788.41
|
| Rate for Payer: Priority Health Medicare |
$592.41
|
| Rate for Payer: Priority Health Narrow Network |
$630.73
|
| Rate for Payer: Railroad Medicare Medicare |
$592.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,936.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$592.41
|
| Rate for Payer: UHC Exchange |
$918.24
|
| Rate for Payer: UHC Medicaid |
$309.83
|
| Rate for Payer: UHCCP DNSP |
$592.41
|
| Rate for Payer: UHCCP Medicaid |
$309.83
|
| Rate for Payer: VA VA |
$592.41
|
|
|
HC PSORALEN
|
Facility
|
IP
|
$2,200.05
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,650.04 |
| Max. Negotiated Rate |
$2,200.05 |
| Rate for Payer: Aetna Commercial |
$1,980.05
|
| Rate for Payer: ASR ASR |
$2,134.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,806.68
|
| Rate for Payer: BCN Commercial |
$1,806.68
|
| Rate for Payer: Cash Price |
$1,760.04
|
| Rate for Payer: Cofinity Commercial |
$2,068.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,760.04
|
| Rate for Payer: Healthscope Commercial |
$2,134.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,200.05
|
| Rate for Payer: Mclaren Commercial |
$1,980.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,870.04
|
| Rate for Payer: Nomi Health Commercial |
$1,804.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,650.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,936.04
|
|
|
HC PSORALEN TREATED WASHED PLATELETS
|
Facility
|
IP
|
$2,283.28
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000086
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,712.46 |
| Max. Negotiated Rate |
$2,283.28 |
| Rate for Payer: Aetna Commercial |
$2,054.95
|
| Rate for Payer: ASR ASR |
$2,214.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,875.03
|
| Rate for Payer: BCN Commercial |
$1,875.03
|
| Rate for Payer: Cash Price |
$1,826.62
|
| Rate for Payer: Cofinity Commercial |
$2,146.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,826.62
|
| Rate for Payer: Healthscope Commercial |
$2,214.78
|
| Rate for Payer: Healthscope Whirlpool |
$2,283.28
|
| Rate for Payer: Mclaren Commercial |
$2,054.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,940.79
|
| Rate for Payer: Nomi Health Commercial |
$1,872.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,712.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,009.29
|
|
|
HC PSORALEN TREATED WASHED PLATELETS
|
Facility
|
OP
|
$2,283.28
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000086
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$309.83 |
| Max. Negotiated Rate |
$2,283.28 |
| Rate for Payer: Aetna Commercial |
$2,054.95
|
| Rate for Payer: Aetna Medicare |
$592.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$740.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$740.51
|
| Rate for Payer: ASR ASR |
$2,214.78
|
| Rate for Payer: BCBS Complete |
$325.35
|
| Rate for Payer: BCBS MAPPO |
$592.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,882.56
|
| Rate for Payer: BCN Commercial |
$1,882.56
|
| Rate for Payer: BCN Medicare Advantage |
$592.41
|
| Rate for Payer: Cash Price |
$1,826.62
|
| Rate for Payer: Cash Price |
$1,826.62
|
| Rate for Payer: Cofinity Commercial |
$2,146.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,826.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$592.41
|
| Rate for Payer: Healthscope Commercial |
$2,214.78
|
| Rate for Payer: Healthscope Whirlpool |
$2,283.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$592.41
|
| Rate for Payer: Mclaren Commercial |
$2,054.95
|
| Rate for Payer: Mclaren Medicaid |
$592.41
|
| Rate for Payer: Mclaren Medicare |
$592.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$622.03
|
| Rate for Payer: Meridian Medicaid |
$325.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$681.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$651.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,940.79
|
| Rate for Payer: Nomi Health Commercial |
$1,872.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,712.46
|
| Rate for Payer: PACE Medicare |
$562.79
|
| Rate for Payer: PACE SWMI |
$592.41
|
| Rate for Payer: PHP Commercial |
$651.65
|
| Rate for Payer: PHP Medicaid |
$317.53
|
| Rate for Payer: PHP Medicare Advantage |
$592.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$309.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$788.41
|
| Rate for Payer: Priority Health Medicare |
$592.41
|
| Rate for Payer: Priority Health Narrow Network |
$630.73
|
| Rate for Payer: Railroad Medicare Medicare |
$592.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,009.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$592.41
|
| Rate for Payer: UHC Exchange |
$918.24
|
| Rate for Payer: UHC Medicaid |
$309.83
|
| Rate for Payer: UHCCP DNSP |
$592.41
|
| Rate for Payer: UHCCP Medicaid |
$309.83
|
| Rate for Payer: VA VA |
$592.41
|
|
|
HC PSYCH COLLAB CARE MGMT EA ADD 30 MIN
|
Facility
|
IP
|
$91.26
|
|
|
Service Code
|
CPT 99494
|
| Hospital Charge Code |
51000094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.44 |
| Max. Negotiated Rate |
$91.26 |
| Rate for Payer: Aetna Commercial |
$82.13
|
| Rate for Payer: ASR ASR |
$88.52
|
| Rate for Payer: BCBS Trust/PPO |
$74.94
|
| Rate for Payer: BCN Commercial |
$74.94
|
| Rate for Payer: Cash Price |
$73.01
|
| Rate for Payer: Cofinity Commercial |
$85.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.01
|
| Rate for Payer: Healthscope Commercial |
$88.52
|
| Rate for Payer: Healthscope Whirlpool |
$91.26
|
| Rate for Payer: Mclaren Commercial |
$82.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.57
|
| Rate for Payer: Nomi Health Commercial |
$74.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.31
|
|
|
HC PSYCH COLLAB CARE MGMT EA ADD 30 MIN
|
Facility
|
OP
|
$91.26
|
|
|
Service Code
|
CPT 99494
|
| Hospital Charge Code |
51000094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.77 |
| Max. Negotiated Rate |
$91.26 |
| Rate for Payer: Aetna Commercial |
$82.13
|
| Rate for Payer: Aetna Medicare |
$33.77
|
| Rate for Payer: ASR ASR |
$88.52
|
| Rate for Payer: BCBS Complete |
$36.50
|
| Rate for Payer: BCBS Trust/PPO |
$75.24
|
| Rate for Payer: BCN Commercial |
$75.24
|
| Rate for Payer: Cash Price |
$73.01
|
| Rate for Payer: Cofinity Commercial |
$85.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.01
|
| Rate for Payer: Healthscope Commercial |
$88.52
|
| Rate for Payer: Healthscope Whirlpool |
$91.26
|
| Rate for Payer: Mclaren Commercial |
$82.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.57
|
| Rate for Payer: Nomi Health Commercial |
$74.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$79.96
|
| Rate for Payer: Priority Health Narrow Network |
$63.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.31
|
|
|
HC PSYCH COLLAB CARE MGMT INIT 70 MIN
|
Facility
|
OP
|
$97.63
|
|
|
Service Code
|
CPT 99492
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$156.89 |
| Rate for Payer: Aetna Commercial |
$87.87
|
| 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 |
$94.70
|
| Rate for Payer: BCBS Complete |
$55.59
|
| Rate for Payer: BCBS MAPPO |
$101.22
|
| Rate for Payer: BCBS Trust/PPO |
$80.50
|
| Rate for Payer: BCN Commercial |
$80.50
|
| Rate for Payer: BCN Medicare Advantage |
$101.22
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cofinity Commercial |
$91.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.22
|
| Rate for Payer: Healthscope Commercial |
$94.70
|
| Rate for Payer: Healthscope Whirlpool |
$97.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$101.22
|
| Rate for Payer: Mclaren Commercial |
$87.87
|
| 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 |
$82.99
|
| Rate for Payer: Nomi Health Commercial |
$80.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.22
|
| 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 |
$90.81
|
| Rate for Payer: Priority Health Medicare |
$101.22
|
| Rate for Payer: Priority Health Narrow Network |
$72.65
|
| Rate for Payer: Railroad Medicare Medicare |
$101.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.22
|
| Rate for Payer: UHC Exchange |
$156.89
|
| 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 PSYCH COLLAB CARE MGMT INIT 70 MIN
|
Facility
|
IP
|
$97.63
|
|
|
Service Code
|
CPT 99492
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.22 |
| Max. Negotiated Rate |
$97.63 |
| Rate for Payer: Aetna Commercial |
$87.87
|
| Rate for Payer: ASR ASR |
$94.70
|
| Rate for Payer: BCBS Trust/PPO |
$80.17
|
| Rate for Payer: BCN Commercial |
$80.17
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cofinity Commercial |
$91.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.10
|
| Rate for Payer: Healthscope Commercial |
$94.70
|
| Rate for Payer: Healthscope Whirlpool |
$97.63
|
| Rate for Payer: Mclaren Commercial |
$87.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.99
|
| Rate for Payer: Nomi Health Commercial |
$80.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.91
|
|
|
HC PSYCH COLLAB CARE MGMT SUBSEQ 60 MIN
|
Facility
|
IP
|
$126.34
|
|
|
Service Code
|
CPT 99493
|
| Hospital Charge Code |
51000093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.75 |
| Max. Negotiated Rate |
$126.34 |
| Rate for Payer: Aetna Commercial |
$113.71
|
| Rate for Payer: ASR ASR |
$122.55
|
| Rate for Payer: BCBS Trust/PPO |
$103.75
|
| Rate for Payer: BCN Commercial |
$103.75
|
| Rate for Payer: Cash Price |
$101.07
|
| Rate for Payer: Cofinity Commercial |
$118.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.07
|
| Rate for Payer: Healthscope Commercial |
$122.55
|
| Rate for Payer: Healthscope Whirlpool |
$126.34
|
| Rate for Payer: Mclaren Commercial |
$113.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.39
|
| Rate for Payer: Nomi Health Commercial |
$103.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.18
|
|
|
HC PSYCH COLLAB CARE MGMT SUBSEQ 60 MIN
|
Facility
|
OP
|
$126.34
|
|
|
Service Code
|
CPT 99493
|
| Hospital Charge Code |
51000093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$156.89 |
| Rate for Payer: Aetna Commercial |
$113.71
|
| 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 |
$122.55
|
| Rate for Payer: BCBS Complete |
$55.59
|
| Rate for Payer: BCBS MAPPO |
$101.22
|
| Rate for Payer: BCBS Trust/PPO |
$104.17
|
| Rate for Payer: BCN Commercial |
$104.17
|
| Rate for Payer: BCN Medicare Advantage |
$101.22
|
| Rate for Payer: Cash Price |
$101.07
|
| Rate for Payer: Cash Price |
$101.07
|
| Rate for Payer: Cofinity Commercial |
$118.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.22
|
| Rate for Payer: Healthscope Commercial |
$122.55
|
| Rate for Payer: Healthscope Whirlpool |
$126.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$101.22
|
| Rate for Payer: Mclaren Commercial |
$113.71
|
| 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 |
$107.39
|
| Rate for Payer: Nomi Health Commercial |
$103.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.75
|
| 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 |
$90.81
|
| Rate for Payer: Priority Health Medicare |
$101.22
|
| Rate for Payer: Priority Health Narrow Network |
$72.65
|
| Rate for Payer: Railroad Medicare Medicare |
$101.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.22
|
| Rate for Payer: UHC Exchange |
$156.89
|
| 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 PSYCH DIAGNOSTIC EVAL W/MED SVCS
|
Facility
|
IP
|
$202.69
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
91400008
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$152.02 |
| Max. Negotiated Rate |
$202.69 |
| Rate for Payer: Aetna Commercial |
$182.42
|
| Rate for Payer: ASR ASR |
$196.61
|
| Rate for Payer: BCBS Trust/PPO |
$166.45
|
| Rate for Payer: BCN Commercial |
$166.45
|
| Rate for Payer: Cash Price |
$162.15
|
| Rate for Payer: Cofinity Commercial |
$190.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.15
|
| Rate for Payer: Healthscope Commercial |
$196.61
|
| Rate for Payer: Healthscope Whirlpool |
$202.69
|
| Rate for Payer: Mclaren Commercial |
$182.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.29
|
| Rate for Payer: Nomi Health Commercial |
$166.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.02
|
|
|
HC PSYCH DIAGNOSTIC EVAL W/MED SVCS
|
Facility
|
OP
|
$202.69
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
91400008
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$221.07 |
| Rate for Payer: Aetna Commercial |
$182.42
|
| Rate for Payer: Aetna Medicare |
$176.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.07
|
| Rate for Payer: ASR ASR |
$196.61
|
| Rate for Payer: BCBS Complete |
$97.13
|
| Rate for Payer: BCBS MAPPO |
$176.86
|
| Rate for Payer: BCBS Trust/PPO |
$167.12
|
| Rate for Payer: BCN Commercial |
$167.12
|
| Rate for Payer: BCN Medicare Advantage |
$176.86
|
| Rate for Payer: Cash Price |
$162.15
|
| Rate for Payer: Cash Price |
$162.15
|
| Rate for Payer: Cofinity Commercial |
$190.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.86
|
| Rate for Payer: Healthscope Commercial |
$196.61
|
| Rate for Payer: Healthscope Whirlpool |
$202.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$176.86
|
| Rate for Payer: Mclaren Commercial |
$182.42
|
| Rate for Payer: Mclaren Medicaid |
$176.86
|
| Rate for Payer: Mclaren Medicare |
$176.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.70
|
| Rate for Payer: Meridian Medicaid |
$97.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$194.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.29
|
| Rate for Payer: Nomi Health Commercial |
$166.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.02
|
| Rate for Payer: PACE Medicare |
$168.02
|
| Rate for Payer: PACE SWMI |
$176.86
|
| Rate for Payer: PHP Commercial |
$194.55
|
| Rate for Payer: PHP Medicaid |
$94.80
|
| Rate for Payer: PHP Medicare Advantage |
$176.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$139.05
|
| Rate for Payer: Priority Health Medicare |
$176.86
|
| Rate for Payer: Priority Health Narrow Network |
$111.24
|
| Rate for Payer: Railroad Medicare Medicare |
$176.86
|
| Rate for Payer: UHC Medicaid |
$92.50
|
| Rate for Payer: UHCCP DNSP |
$176.86
|
| Rate for Payer: UHCCP Medicaid |
$92.50
|
| Rate for Payer: VA VA |
$176.86
|
|
|
HC PSYCHIATRIC DIAG EVAL
|
Facility
|
IP
|
$202.69
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
91400004
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$152.02 |
| Max. Negotiated Rate |
$202.69 |
| Rate for Payer: Aetna Commercial |
$182.42
|
| Rate for Payer: ASR ASR |
$196.61
|
| Rate for Payer: BCBS Trust/PPO |
$166.45
|
| Rate for Payer: BCN Commercial |
$166.45
|
| Rate for Payer: Cash Price |
$162.15
|
| Rate for Payer: Cofinity Commercial |
$190.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.15
|
| Rate for Payer: Healthscope Commercial |
$196.61
|
| Rate for Payer: Healthscope Whirlpool |
$202.69
|
| Rate for Payer: Mclaren Commercial |
$182.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.29
|
| Rate for Payer: Nomi Health Commercial |
$166.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.02
|
|
|
HC PSYCHIATRIC DIAG EVAL
|
Facility
|
OP
|
$202.69
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
91400004
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$221.07 |
| Rate for Payer: Aetna Commercial |
$182.42
|
| Rate for Payer: Aetna Medicare |
$176.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.07
|
| Rate for Payer: ASR ASR |
$196.61
|
| Rate for Payer: BCBS Complete |
$97.13
|
| Rate for Payer: BCBS MAPPO |
$176.86
|
| Rate for Payer: BCBS Trust/PPO |
$167.12
|
| Rate for Payer: BCN Commercial |
$167.12
|
| Rate for Payer: BCN Medicare Advantage |
$176.86
|
| Rate for Payer: Cash Price |
$162.15
|
| Rate for Payer: Cash Price |
$162.15
|
| Rate for Payer: Cofinity Commercial |
$190.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.86
|
| Rate for Payer: Healthscope Commercial |
$196.61
|
| Rate for Payer: Healthscope Whirlpool |
$202.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$176.86
|
| Rate for Payer: Mclaren Commercial |
$182.42
|
| Rate for Payer: Mclaren Medicaid |
$176.86
|
| Rate for Payer: Mclaren Medicare |
$176.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.70
|
| Rate for Payer: Meridian Medicaid |
$97.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$194.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.29
|
| Rate for Payer: Nomi Health Commercial |
$166.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.02
|
| Rate for Payer: PACE Medicare |
$168.02
|
| Rate for Payer: PACE SWMI |
$176.86
|
| Rate for Payer: PHP Commercial |
$194.55
|
| Rate for Payer: PHP Medicaid |
$94.80
|
| Rate for Payer: PHP Medicare Advantage |
$176.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$139.05
|
| Rate for Payer: Priority Health Medicare |
$176.86
|
| Rate for Payer: Priority Health Narrow Network |
$111.24
|
| Rate for Payer: Railroad Medicare Medicare |
$176.86
|
| Rate for Payer: UHC Medicaid |
$92.50
|
| Rate for Payer: UHCCP DNSP |
$176.86
|
| Rate for Payer: UHCCP Medicaid |
$92.50
|
| Rate for Payer: VA VA |
$176.86
|
|
|
HC PSYCH/NEUROPSYCH TEST BY PHYS 30 MIN
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 96136
|
| Hospital Charge Code |
91800009
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$19.90 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$21.79
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
HC PSYCH/NEUROPSYCH TEST BY PHYS 30 MIN
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 96136
|
| Hospital Charge Code |
91800009
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$205.48 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$132.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$21.87
|
| Rate for Payer: BCN Commercial |
$21.87
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$132.57
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$72.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$145.83
|
| Rate for Payer: PHP Medicaid |
$71.06
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21.67
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Narrow Network |
$17.34
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$205.48
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP DNSP |
$132.57
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC PSYCH/NEUROPSYCH TEST BY TECH 30 MIN
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 96138
|
| Hospital Charge Code |
91800011
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$19.90 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$21.79
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
HC PSYCH/NEUROPSYCH TEST BY TECH 30 MIN
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 96138
|
| Hospital Charge Code |
91800011
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$689.94 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$445.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$556.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$556.40
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Complete |
$244.46
|
| Rate for Payer: BCBS MAPPO |
$445.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.87
|
| Rate for Payer: BCN Commercial |
$21.87
|
| Rate for Payer: BCN Medicare Advantage |
$445.12
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.12
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$445.12
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$445.12
|
| Rate for Payer: Mclaren Medicare |
$445.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.38
|
| Rate for Payer: Meridian Medicaid |
$244.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$511.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$489.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$422.86
|
| Rate for Payer: PACE SWMI |
$445.12
|
| Rate for Payer: PHP Commercial |
$489.63
|
| Rate for Payer: PHP Medicaid |
$238.58
|
| Rate for Payer: PHP Medicare Advantage |
$445.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21.67
|
| Rate for Payer: Priority Health Medicare |
$445.12
|
| Rate for Payer: Priority Health Narrow Network |
$17.34
|
| Rate for Payer: Railroad Medicare Medicare |
$445.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$445.12
|
| Rate for Payer: UHC Exchange |
$689.94
|
| Rate for Payer: UHC Medicaid |
$232.80
|
| Rate for Payer: UHCCP DNSP |
$445.12
|
| Rate for Payer: UHCCP Medicaid |
$232.80
|
| Rate for Payer: VA VA |
$445.12
|
|
|
HC PSYCH/NEUROPSYCH TEST BY TECH EA ADDL 30 MIN
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
CPT 96139
|
| Hospital Charge Code |
91800012
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$15.92 |
| Rate for Payer: Aetna Commercial |
$14.33
|
| Rate for Payer: Aetna Medicare |
$5.89
|
| Rate for Payer: ASR ASR |
$15.44
|
| Rate for Payer: BCBS Complete |
$6.37
|
| Rate for Payer: BCBS Trust/PPO |
$13.13
|
| Rate for Payer: BCN Commercial |
$13.13
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$15.44
|
| Rate for Payer: Healthscope Whirlpool |
$15.92
|
| Rate for Payer: Mclaren Commercial |
$14.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Nomi Health Commercial |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.95
|
| Rate for Payer: Priority Health Narrow Network |
$11.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.01
|
|
|
HC PSYCH/NEUROPSYCH TEST BY TECH EA ADDL 30 MIN
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
CPT 96139
|
| Hospital Charge Code |
91800012
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$15.92 |
| Rate for Payer: Aetna Commercial |
$14.33
|
| Rate for Payer: ASR ASR |
$15.44
|
| Rate for Payer: BCBS Trust/PPO |
$13.07
|
| Rate for Payer: BCN Commercial |
$13.07
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$15.44
|
| Rate for Payer: Healthscope Whirlpool |
$15.92
|
| Rate for Payer: Mclaren Commercial |
$14.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Nomi Health Commercial |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.01
|
|
|
HC PSYCH/NEUROPSYCH TEST PHYS EA ADDL 30 MIN
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
CPT 96137
|
| Hospital Charge Code |
91800010
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$15.92 |
| Rate for Payer: Aetna Commercial |
$14.33
|
| Rate for Payer: ASR ASR |
$15.44
|
| Rate for Payer: BCBS Trust/PPO |
$13.07
|
| Rate for Payer: BCN Commercial |
$13.07
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$15.44
|
| Rate for Payer: Healthscope Whirlpool |
$15.92
|
| Rate for Payer: Mclaren Commercial |
$14.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Nomi Health Commercial |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.01
|
|
|
HC PSYCH/NEUROPSYCH TEST PHYS EA ADDL 30 MIN
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
CPT 96137
|
| Hospital Charge Code |
91800010
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$15.92 |
| Rate for Payer: Aetna Commercial |
$14.33
|
| Rate for Payer: Aetna Medicare |
$5.89
|
| Rate for Payer: ASR ASR |
$15.44
|
| Rate for Payer: BCBS Complete |
$6.37
|
| Rate for Payer: BCBS Trust/PPO |
$13.13
|
| Rate for Payer: BCN Commercial |
$13.13
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$15.44
|
| Rate for Payer: Healthscope Whirlpool |
$15.92
|
| Rate for Payer: Mclaren Commercial |
$14.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Nomi Health Commercial |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.95
|
| Rate for Payer: Priority Health Narrow Network |
$11.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.01
|
|
|
HC PSYCH/NEUROPSYCH TEST SINGLE AUTOMATED
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 96146
|
| Hospital Charge Code |
91800013
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$19.90 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$21.79
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
