|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
OP
|
$1,039.96
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$324.69 |
| Max. Negotiated Rate |
$1,039.96 |
| Rate for Payer: Aetna Commercial |
$935.96
|
| Rate for Payer: Aetna Medicare |
$605.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$757.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$757.20
|
| Rate for Payer: ASR ASR |
$1,008.76
|
| Rate for Payer: ASR Commercial |
$1,008.76
|
| Rate for Payer: BCBS Complete |
$340.92
|
| Rate for Payer: BCBS MAPPO |
$605.76
|
| Rate for Payer: BCBS Trust/PPO |
$851.62
|
| Rate for Payer: BCN Commercial |
$806.28
|
| Rate for Payer: BCN Medicare Advantage |
$605.76
|
| Rate for Payer: Cash Price |
$831.97
|
| Rate for Payer: Cash Price |
$831.97
|
| Rate for Payer: Cofinity Commercial |
$977.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$831.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$605.76
|
| Rate for Payer: Healthscope Commercial |
$1,039.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,008.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$605.76
|
| Rate for Payer: Mclaren Commercial |
$935.96
|
| Rate for Payer: Mclaren Medicaid |
$324.69
|
| Rate for Payer: Mclaren Medicare |
$605.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$636.05
|
| Rate for Payer: Meridian Medicaid |
$340.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$696.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$883.97
|
| Rate for Payer: Nomi Health Commercial |
$852.77
|
| Rate for Payer: PACE Medicare |
$575.47
|
| Rate for Payer: PACE SWMI |
$605.76
|
| Rate for Payer: PHP Commercial |
$666.34
|
| Rate for Payer: PHP Medicaid |
$324.69
|
| Rate for Payer: PHP Medicare Advantage |
$605.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$324.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$911.21
|
| Rate for Payer: Priority Health Medicare |
$605.76
|
| Rate for Payer: Priority Health Narrow Network |
$729.01
|
| Rate for Payer: Railroad Medicare Medicare |
$605.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$915.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.76
|
| Rate for Payer: UHC Exchange |
$938.93
|
| Rate for Payer: UHC Medicare Advantage |
$605.76
|
| Rate for Payer: UHCCP DNSP |
$605.76
|
| Rate for Payer: UHCCP Medicaid |
$324.69
|
| Rate for Payer: VA VA |
$605.76
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
IP
|
$1,039.96
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$675.97 |
| Max. Negotiated Rate |
$1,039.96 |
| Rate for Payer: Aetna Commercial |
$935.96
|
| Rate for Payer: ASR ASR |
$1,008.76
|
| Rate for Payer: ASR Commercial |
$1,008.76
|
| Rate for Payer: BCBS Trust/PPO |
$847.46
|
| Rate for Payer: BCN Commercial |
$806.28
|
| Rate for Payer: Cash Price |
$831.97
|
| Rate for Payer: Cofinity Commercial |
$977.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$831.97
|
| Rate for Payer: Healthscope Commercial |
$1,039.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,008.76
|
| Rate for Payer: Mclaren Commercial |
$935.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$883.97
|
| Rate for Payer: Nomi Health Commercial |
$852.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$915.16
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| 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 |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$4.43
|
| Rate for Payer: BCBS MAPPO |
$7.87
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$7.87
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.87
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.87
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$4.22
|
| Rate for Payer: Mclaren Medicare |
$7.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.26
|
| Rate for Payer: Meridian Medicaid |
$4.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| 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 |
$4.22
|
| Rate for Payer: PHP Medicare Advantage |
$7.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$7.87
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$7.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.87
|
| Rate for Payer: UHC Exchange |
$12.20
|
| Rate for Payer: UHC Medicare Advantage |
$7.87
|
| Rate for Payer: UHCCP DNSP |
$7.87
|
| Rate for Payer: UHCCP Medicaid |
$4.22
|
| Rate for Payer: VA VA |
$7.87
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
OP
|
$5,794.25
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$534.30 |
| Max. Negotiated Rate |
$5,794.25 |
| Rate for Payer: Aetna Commercial |
$5,214.82
|
| Rate for Payer: Aetna Medicare |
$996.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,246.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,246.02
|
| Rate for Payer: ASR ASR |
$5,620.42
|
| Rate for Payer: ASR Commercial |
$5,620.42
|
| Rate for Payer: BCBS Complete |
$561.01
|
| Rate for Payer: BCBS MAPPO |
$996.82
|
| Rate for Payer: BCBS Trust/PPO |
$4,744.91
|
| Rate for Payer: BCN Commercial |
$4,492.28
|
| Rate for Payer: BCN Medicare Advantage |
$996.82
|
| Rate for Payer: Cash Price |
$4,635.40
|
| Rate for Payer: Cash Price |
$4,635.40
|
| Rate for Payer: Cofinity Commercial |
$5,446.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,635.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$996.82
|
| Rate for Payer: Healthscope Commercial |
$5,794.25
|
| Rate for Payer: Healthscope Whirlpool |
$5,620.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$996.82
|
| Rate for Payer: Mclaren Commercial |
$5,214.82
|
| Rate for Payer: Mclaren Medicaid |
$534.30
|
| Rate for Payer: Mclaren Medicare |
$996.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,046.66
|
| Rate for Payer: Meridian Medicaid |
$561.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,146.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,925.11
|
| Rate for Payer: Nomi Health Commercial |
$4,751.28
|
| Rate for Payer: PACE Medicare |
$946.98
|
| Rate for Payer: PACE SWMI |
$996.82
|
| Rate for Payer: PHP Commercial |
$1,096.50
|
| Rate for Payer: PHP Medicaid |
$534.30
|
| Rate for Payer: PHP Medicare Advantage |
$996.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$534.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,766.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$922.94
|
| Rate for Payer: Priority Health Medicare |
$996.82
|
| Rate for Payer: Priority Health Narrow Network |
$738.35
|
| Rate for Payer: Railroad Medicare Medicare |
$996.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,098.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$996.82
|
| Rate for Payer: UHC Exchange |
$1,545.07
|
| Rate for Payer: UHC Medicare Advantage |
$996.82
|
| Rate for Payer: UHCCP DNSP |
$996.82
|
| Rate for Payer: UHCCP Medicaid |
$534.30
|
| Rate for Payer: VA VA |
$996.82
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
IP
|
$5,794.25
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$3,766.26 |
| Max. Negotiated Rate |
$5,794.25 |
| Rate for Payer: Aetna Commercial |
$5,214.82
|
| Rate for Payer: ASR ASR |
$5,620.42
|
| Rate for Payer: ASR Commercial |
$5,620.42
|
| Rate for Payer: BCBS Trust/PPO |
$4,721.73
|
| Rate for Payer: BCN Commercial |
$4,492.28
|
| Rate for Payer: Cash Price |
$4,635.40
|
| Rate for Payer: Cofinity Commercial |
$5,446.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,635.40
|
| Rate for Payer: Healthscope Commercial |
$5,794.25
|
| Rate for Payer: Healthscope Whirlpool |
$5,620.42
|
| Rate for Payer: Mclaren Commercial |
$5,214.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,925.11
|
| Rate for Payer: Nomi Health Commercial |
$4,751.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,766.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,098.94
|
|
|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
OP
|
$5,983.02
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$534.30 |
| Max. Negotiated Rate |
$5,983.02 |
| Rate for Payer: Aetna Commercial |
$5,384.72
|
| Rate for Payer: Aetna Medicare |
$996.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,246.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,246.02
|
| Rate for Payer: ASR ASR |
$5,803.53
|
| Rate for Payer: ASR Commercial |
$5,803.53
|
| Rate for Payer: BCBS Complete |
$561.01
|
| Rate for Payer: BCBS MAPPO |
$996.82
|
| Rate for Payer: BCBS Trust/PPO |
$4,899.50
|
| Rate for Payer: BCN Commercial |
$4,638.64
|
| Rate for Payer: BCN Medicare Advantage |
$996.82
|
| Rate for Payer: Cash Price |
$4,786.42
|
| Rate for Payer: Cash Price |
$4,786.42
|
| Rate for Payer: Cofinity Commercial |
$5,624.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,786.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$996.82
|
| Rate for Payer: Healthscope Commercial |
$5,983.02
|
| Rate for Payer: Healthscope Whirlpool |
$5,803.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$996.82
|
| Rate for Payer: Mclaren Commercial |
$5,384.72
|
| Rate for Payer: Mclaren Medicaid |
$534.30
|
| Rate for Payer: Mclaren Medicare |
$996.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,046.66
|
| Rate for Payer: Meridian Medicaid |
$561.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,146.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,085.57
|
| Rate for Payer: Nomi Health Commercial |
$4,906.08
|
| Rate for Payer: PACE Medicare |
$946.98
|
| Rate for Payer: PACE SWMI |
$996.82
|
| Rate for Payer: PHP Commercial |
$1,096.50
|
| Rate for Payer: PHP Medicaid |
$534.30
|
| Rate for Payer: PHP Medicare Advantage |
$996.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$534.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,888.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$922.94
|
| Rate for Payer: Priority Health Medicare |
$996.82
|
| Rate for Payer: Priority Health Narrow Network |
$738.35
|
| Rate for Payer: Railroad Medicare Medicare |
$996.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,265.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$996.82
|
| Rate for Payer: UHC Exchange |
$1,545.07
|
| Rate for Payer: UHC Medicare Advantage |
$996.82
|
| Rate for Payer: UHCCP DNSP |
$996.82
|
| Rate for Payer: UHCCP Medicaid |
$534.30
|
| Rate for Payer: VA VA |
$996.82
|
|
|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
IP
|
$5,983.02
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$3,888.96 |
| Max. Negotiated Rate |
$5,983.02 |
| Rate for Payer: Aetna Commercial |
$5,384.72
|
| Rate for Payer: ASR ASR |
$5,803.53
|
| Rate for Payer: ASR Commercial |
$5,803.53
|
| Rate for Payer: BCBS Trust/PPO |
$4,875.56
|
| Rate for Payer: BCN Commercial |
$4,638.64
|
| Rate for Payer: Cash Price |
$4,786.42
|
| Rate for Payer: Cofinity Commercial |
$5,624.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,786.42
|
| Rate for Payer: Healthscope Commercial |
$5,983.02
|
| Rate for Payer: Healthscope Whirlpool |
$5,803.53
|
| Rate for Payer: Mclaren Commercial |
$5,384.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,085.57
|
| Rate for Payer: Nomi Health Commercial |
$4,906.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,888.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,265.06
|
|
|
HC PSORALEN
|
Facility
|
IP
|
$2,156.91
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,401.99 |
| Max. Negotiated Rate |
$2,156.91 |
| Rate for Payer: Aetna Commercial |
$1,941.22
|
| Rate for Payer: ASR ASR |
$2,092.20
|
| Rate for Payer: ASR Commercial |
$2,092.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,757.67
|
| Rate for Payer: BCN Commercial |
$1,672.25
|
| Rate for Payer: Cash Price |
$1,725.53
|
| Rate for Payer: Cofinity Commercial |
$2,027.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,725.53
|
| Rate for Payer: Healthscope Commercial |
$2,156.91
|
| Rate for Payer: Healthscope Whirlpool |
$2,092.20
|
| Rate for Payer: Mclaren Commercial |
$1,941.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,833.37
|
| Rate for Payer: Nomi Health Commercial |
$1,768.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,401.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,898.08
|
|
|
HC PSORALEN
|
Facility
|
OP
|
$2,156.91
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$308.42 |
| Max. Negotiated Rate |
$2,156.91 |
| Rate for Payer: Aetna Commercial |
$1,941.22
|
| Rate for Payer: Aetna Medicare |
$575.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$719.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$719.26
|
| Rate for Payer: ASR ASR |
$2,092.20
|
| Rate for Payer: ASR Commercial |
$2,092.20
|
| Rate for Payer: BCBS Complete |
$323.84
|
| Rate for Payer: BCBS MAPPO |
$575.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,766.29
|
| Rate for Payer: BCN Commercial |
$1,672.25
|
| Rate for Payer: BCN Medicare Advantage |
$575.41
|
| Rate for Payer: Cash Price |
$1,725.53
|
| Rate for Payer: Cash Price |
$1,725.53
|
| Rate for Payer: Cofinity Commercial |
$2,027.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,725.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$575.41
|
| Rate for Payer: Healthscope Commercial |
$2,156.91
|
| Rate for Payer: Healthscope Whirlpool |
$2,092.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$575.41
|
| Rate for Payer: Mclaren Commercial |
$1,941.22
|
| Rate for Payer: Mclaren Medicaid |
$308.42
|
| Rate for Payer: Mclaren Medicare |
$575.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$604.18
|
| Rate for Payer: Meridian Medicaid |
$323.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$661.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,833.37
|
| Rate for Payer: Nomi Health Commercial |
$1,768.67
|
| Rate for Payer: PACE Medicare |
$546.64
|
| Rate for Payer: PACE SWMI |
$575.41
|
| Rate for Payer: PHP Commercial |
$632.95
|
| Rate for Payer: PHP Medicaid |
$308.42
|
| Rate for Payer: PHP Medicare Advantage |
$575.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$308.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,401.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$715.11
|
| Rate for Payer: Priority Health Medicare |
$575.41
|
| Rate for Payer: Priority Health Narrow Network |
$572.09
|
| Rate for Payer: Railroad Medicare Medicare |
$575.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,898.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$575.41
|
| Rate for Payer: UHC Exchange |
$891.89
|
| Rate for Payer: UHC Medicare Advantage |
$575.41
|
| Rate for Payer: UHCCP DNSP |
$575.41
|
| Rate for Payer: UHCCP Medicaid |
$308.42
|
| Rate for Payer: VA VA |
$575.41
|
|
|
HC PSORALEN TREATED WASHED PLATELETS
|
Facility
|
IP
|
$2,238.51
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000086
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,455.03 |
| Max. Negotiated Rate |
$2,238.51 |
| Rate for Payer: Aetna Commercial |
$2,014.66
|
| Rate for Payer: ASR ASR |
$2,171.35
|
| Rate for Payer: ASR Commercial |
$2,171.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,824.16
|
| Rate for Payer: BCN Commercial |
$1,735.52
|
| Rate for Payer: Cash Price |
$1,790.81
|
| Rate for Payer: Cofinity Commercial |
$2,104.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,790.81
|
| Rate for Payer: Healthscope Commercial |
$2,238.51
|
| Rate for Payer: Healthscope Whirlpool |
$2,171.35
|
| Rate for Payer: Mclaren Commercial |
$2,014.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,902.73
|
| Rate for Payer: Nomi Health Commercial |
$1,835.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,455.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,969.89
|
|
|
HC PSORALEN TREATED WASHED PLATELETS
|
Facility
|
OP
|
$2,238.51
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000086
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$308.42 |
| Max. Negotiated Rate |
$2,238.51 |
| Rate for Payer: Aetna Commercial |
$2,014.66
|
| Rate for Payer: Aetna Medicare |
$575.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$719.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$719.26
|
| Rate for Payer: ASR ASR |
$2,171.35
|
| Rate for Payer: ASR Commercial |
$2,171.35
|
| Rate for Payer: BCBS Complete |
$323.84
|
| Rate for Payer: BCBS MAPPO |
$575.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,833.12
|
| Rate for Payer: BCN Commercial |
$1,735.52
|
| Rate for Payer: BCN Medicare Advantage |
$575.41
|
| Rate for Payer: Cash Price |
$1,790.81
|
| Rate for Payer: Cash Price |
$1,790.81
|
| Rate for Payer: Cofinity Commercial |
$2,104.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,790.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$575.41
|
| Rate for Payer: Healthscope Commercial |
$2,238.51
|
| Rate for Payer: Healthscope Whirlpool |
$2,171.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$575.41
|
| Rate for Payer: Mclaren Commercial |
$2,014.66
|
| Rate for Payer: Mclaren Medicaid |
$308.42
|
| Rate for Payer: Mclaren Medicare |
$575.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$604.18
|
| Rate for Payer: Meridian Medicaid |
$323.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$661.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,902.73
|
| Rate for Payer: Nomi Health Commercial |
$1,835.58
|
| Rate for Payer: PACE Medicare |
$546.64
|
| Rate for Payer: PACE SWMI |
$575.41
|
| Rate for Payer: PHP Commercial |
$632.95
|
| Rate for Payer: PHP Medicaid |
$308.42
|
| Rate for Payer: PHP Medicare Advantage |
$575.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$308.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,455.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$715.11
|
| Rate for Payer: Priority Health Medicare |
$575.41
|
| Rate for Payer: Priority Health Narrow Network |
$572.09
|
| Rate for Payer: Railroad Medicare Medicare |
$575.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,969.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$575.41
|
| Rate for Payer: UHC Exchange |
$891.89
|
| Rate for Payer: UHC Medicare Advantage |
$575.41
|
| Rate for Payer: UHCCP DNSP |
$575.41
|
| Rate for Payer: UHCCP Medicaid |
$308.42
|
| Rate for Payer: VA VA |
$575.41
|
|
|
HC PSYCH COLLAB CARE MGMT EA ADD 30 MIN
|
Facility
|
OP
|
$89.47
|
|
|
Service Code
|
CPT 99494
|
| Hospital Charge Code |
51000094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.79 |
| Max. Negotiated Rate |
$89.47 |
| Rate for Payer: Aetna Commercial |
$80.52
|
| Rate for Payer: Aetna Medicare |
$44.74
|
| Rate for Payer: ASR ASR |
$86.79
|
| Rate for Payer: ASR Commercial |
$86.79
|
| Rate for Payer: BCBS Complete |
$35.79
|
| Rate for Payer: BCBS Trust/PPO |
$73.27
|
| Rate for Payer: BCN Commercial |
$69.37
|
| Rate for Payer: Cash Price |
$71.58
|
| Rate for Payer: Cofinity Commercial |
$84.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.58
|
| Rate for Payer: Healthscope Commercial |
$89.47
|
| Rate for Payer: Healthscope Whirlpool |
$86.79
|
| Rate for Payer: Mclaren Commercial |
$80.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.05
|
| Rate for Payer: Nomi Health Commercial |
$73.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.39
|
| Rate for Payer: Priority Health Narrow Network |
$62.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.73
|
|
|
HC PSYCH COLLAB CARE MGMT EA ADD 30 MIN
|
Facility
|
IP
|
$89.47
|
|
|
Service Code
|
CPT 99494
|
| Hospital Charge Code |
51000094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.16 |
| Max. Negotiated Rate |
$89.47 |
| Rate for Payer: Aetna Commercial |
$80.52
|
| Rate for Payer: ASR ASR |
$86.79
|
| Rate for Payer: ASR Commercial |
$86.79
|
| Rate for Payer: BCBS Trust/PPO |
$72.91
|
| Rate for Payer: BCN Commercial |
$69.37
|
| Rate for Payer: Cash Price |
$71.58
|
| Rate for Payer: Cofinity Commercial |
$84.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.58
|
| Rate for Payer: Healthscope Commercial |
$89.47
|
| Rate for Payer: Healthscope Whirlpool |
$86.79
|
| Rate for Payer: Mclaren Commercial |
$80.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.05
|
| Rate for Payer: Nomi Health Commercial |
$73.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.73
|
|
|
HC PSYCH COLLAB CARE MGMT INIT 70 MIN
|
Facility
|
OP
|
$95.72
|
|
|
Service Code
|
CPT 99492
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.58 |
| Max. Negotiated Rate |
$140.48 |
| Rate for Payer: Aetna Commercial |
$86.15
|
| Rate for Payer: Aetna Medicare |
$90.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.29
|
| Rate for Payer: ASR ASR |
$92.85
|
| Rate for Payer: ASR Commercial |
$92.85
|
| Rate for Payer: BCBS Complete |
$51.01
|
| Rate for Payer: BCBS MAPPO |
$90.63
|
| Rate for Payer: BCBS Trust/PPO |
$78.39
|
| Rate for Payer: BCN Commercial |
$74.21
|
| Rate for Payer: BCN Medicare Advantage |
$90.63
|
| Rate for Payer: Cash Price |
$76.58
|
| Rate for Payer: Cash Price |
$76.58
|
| Rate for Payer: Cofinity Commercial |
$89.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.63
|
| Rate for Payer: Healthscope Commercial |
$95.72
|
| Rate for Payer: Healthscope Whirlpool |
$92.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$90.63
|
| Rate for Payer: Mclaren Commercial |
$86.15
|
| Rate for Payer: Mclaren Medicaid |
$48.58
|
| Rate for Payer: Mclaren Medicare |
$90.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.16
|
| Rate for Payer: Meridian Medicaid |
$51.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.36
|
| Rate for Payer: Nomi Health Commercial |
$78.49
|
| Rate for Payer: PACE Medicare |
$86.10
|
| Rate for Payer: PACE SWMI |
$90.63
|
| Rate for Payer: PHP Commercial |
$99.69
|
| Rate for Payer: PHP Medicaid |
$48.58
|
| Rate for Payer: PHP Medicare Advantage |
$90.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.37
|
| Rate for Payer: Priority Health Medicare |
$90.63
|
| Rate for Payer: Priority Health Narrow Network |
$65.90
|
| Rate for Payer: Railroad Medicare Medicare |
$90.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.63
|
| Rate for Payer: UHC Exchange |
$140.48
|
| Rate for Payer: UHC Medicare Advantage |
$90.63
|
| Rate for Payer: UHCCP DNSP |
$90.63
|
| Rate for Payer: UHCCP Medicaid |
$48.58
|
| Rate for Payer: VA VA |
$90.63
|
|
|
HC PSYCH COLLAB CARE MGMT INIT 70 MIN
|
Facility
|
IP
|
$95.72
|
|
|
Service Code
|
CPT 99492
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.22 |
| Max. Negotiated Rate |
$95.72 |
| Rate for Payer: Aetna Commercial |
$86.15
|
| Rate for Payer: ASR ASR |
$92.85
|
| Rate for Payer: ASR Commercial |
$92.85
|
| Rate for Payer: BCBS Trust/PPO |
$78.00
|
| Rate for Payer: BCN Commercial |
$74.21
|
| Rate for Payer: Cash Price |
$76.58
|
| Rate for Payer: Cofinity Commercial |
$89.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.58
|
| Rate for Payer: Healthscope Commercial |
$95.72
|
| Rate for Payer: Healthscope Whirlpool |
$92.85
|
| Rate for Payer: Mclaren Commercial |
$86.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.36
|
| Rate for Payer: Nomi Health Commercial |
$78.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.23
|
|
|
HC PSYCH COLLAB CARE MGMT SUBSEQ 60 MIN
|
Facility
|
IP
|
$105.28
|
|
|
Service Code
|
CPT 99493
|
| Hospital Charge Code |
51000093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.43 |
| Max. Negotiated Rate |
$105.28 |
| Rate for Payer: Aetna Commercial |
$94.75
|
| Rate for Payer: ASR ASR |
$102.12
|
| Rate for Payer: ASR Commercial |
$102.12
|
| Rate for Payer: BCBS Trust/PPO |
$85.79
|
| Rate for Payer: BCN Commercial |
$81.62
|
| Rate for Payer: Cash Price |
$84.22
|
| Rate for Payer: Cofinity Commercial |
$98.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.22
|
| Rate for Payer: Healthscope Commercial |
$105.28
|
| Rate for Payer: Healthscope Whirlpool |
$102.12
|
| Rate for Payer: Mclaren Commercial |
$94.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.49
|
| Rate for Payer: Nomi Health Commercial |
$86.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.65
|
|
|
HC PSYCH COLLAB CARE MGMT SUBSEQ 60 MIN
|
Facility
|
OP
|
$105.28
|
|
|
Service Code
|
CPT 99493
|
| Hospital Charge Code |
51000093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.58 |
| Max. Negotiated Rate |
$140.48 |
| Rate for Payer: Aetna Commercial |
$94.75
|
| Rate for Payer: Aetna Medicare |
$90.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.29
|
| Rate for Payer: ASR ASR |
$102.12
|
| Rate for Payer: ASR Commercial |
$102.12
|
| Rate for Payer: BCBS Complete |
$51.01
|
| Rate for Payer: BCBS MAPPO |
$90.63
|
| Rate for Payer: BCBS Trust/PPO |
$86.21
|
| Rate for Payer: BCN Commercial |
$81.62
|
| Rate for Payer: BCN Medicare Advantage |
$90.63
|
| Rate for Payer: Cash Price |
$84.22
|
| Rate for Payer: Cash Price |
$84.22
|
| Rate for Payer: Cofinity Commercial |
$98.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.63
|
| Rate for Payer: Healthscope Commercial |
$105.28
|
| Rate for Payer: Healthscope Whirlpool |
$102.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$90.63
|
| Rate for Payer: Mclaren Commercial |
$94.75
|
| Rate for Payer: Mclaren Medicaid |
$48.58
|
| Rate for Payer: Mclaren Medicare |
$90.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.16
|
| Rate for Payer: Meridian Medicaid |
$51.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.49
|
| Rate for Payer: Nomi Health Commercial |
$86.33
|
| Rate for Payer: PACE Medicare |
$86.10
|
| Rate for Payer: PACE SWMI |
$90.63
|
| Rate for Payer: PHP Commercial |
$99.69
|
| Rate for Payer: PHP Medicaid |
$48.58
|
| Rate for Payer: PHP Medicare Advantage |
$90.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.37
|
| Rate for Payer: Priority Health Medicare |
$90.63
|
| Rate for Payer: Priority Health Narrow Network |
$65.90
|
| Rate for Payer: Railroad Medicare Medicare |
$90.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.63
|
| Rate for Payer: UHC Exchange |
$140.48
|
| Rate for Payer: UHC Medicare Advantage |
$90.63
|
| Rate for Payer: UHCCP DNSP |
$90.63
|
| Rate for Payer: UHCCP Medicaid |
$48.58
|
| Rate for Payer: VA VA |
$90.63
|
|
|
HC PSYCH DIAGNOSTIC EVAL W/MED SVCS
|
Facility
|
IP
|
$198.72
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
91400008
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$129.17 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$178.85
|
| Rate for Payer: ASR ASR |
$192.76
|
| Rate for Payer: ASR Commercial |
$192.76
|
| Rate for Payer: BCBS Trust/PPO |
$161.94
|
| Rate for Payer: BCN Commercial |
$154.07
|
| Rate for Payer: Cash Price |
$158.98
|
| Rate for Payer: Cofinity Commercial |
$186.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.98
|
| Rate for Payer: Healthscope Commercial |
$198.72
|
| Rate for Payer: Healthscope Whirlpool |
$192.76
|
| Rate for Payer: Mclaren Commercial |
$178.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.91
|
| Rate for Payer: Nomi Health Commercial |
$162.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.87
|
|
|
HC PSYCH DIAGNOSTIC EVAL W/MED SVCS
|
Facility
|
OP
|
$198.72
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
91400008
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$84.38 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$178.85
|
| Rate for Payer: Aetna Medicare |
$157.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$196.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$196.78
|
| Rate for Payer: ASR ASR |
$192.76
|
| Rate for Payer: ASR Commercial |
$192.76
|
| Rate for Payer: BCBS Complete |
$88.60
|
| Rate for Payer: BCBS MAPPO |
$157.42
|
| Rate for Payer: BCBS Trust/PPO |
$162.73
|
| Rate for Payer: BCN Commercial |
$154.07
|
| Rate for Payer: BCN Medicare Advantage |
$157.42
|
| Rate for Payer: Cash Price |
$158.98
|
| Rate for Payer: Cash Price |
$158.98
|
| Rate for Payer: Cofinity Commercial |
$186.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.42
|
| Rate for Payer: Healthscope Commercial |
$198.72
|
| Rate for Payer: Healthscope Whirlpool |
$192.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$157.42
|
| Rate for Payer: Mclaren Commercial |
$178.85
|
| Rate for Payer: Mclaren Medicaid |
$84.38
|
| Rate for Payer: Mclaren Medicare |
$157.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$165.29
|
| Rate for Payer: Meridian Medicaid |
$88.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.91
|
| Rate for Payer: Nomi Health Commercial |
$162.95
|
| Rate for Payer: PACE Medicare |
$149.55
|
| Rate for Payer: PACE SWMI |
$157.42
|
| Rate for Payer: PHP Commercial |
$173.16
|
| Rate for Payer: PHP Medicaid |
$84.38
|
| Rate for Payer: PHP Medicare Advantage |
$157.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.12
|
| Rate for Payer: Priority Health Medicare |
$157.42
|
| Rate for Payer: Priority Health Narrow Network |
$100.90
|
| Rate for Payer: Railroad Medicare Medicare |
$157.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.42
|
| Rate for Payer: UHC Exchange |
$244.00
|
| Rate for Payer: UHC Medicare Advantage |
$157.42
|
| Rate for Payer: UHCCP DNSP |
$157.42
|
| Rate for Payer: UHCCP Medicaid |
$84.38
|
| Rate for Payer: VA VA |
$157.42
|
|
|
HC PSYCHIATRIC DIAG EVAL
|
Facility
|
OP
|
$198.72
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
91400004
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$84.38 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$178.85
|
| Rate for Payer: Aetna Medicare |
$157.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$196.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$196.78
|
| Rate for Payer: ASR ASR |
$192.76
|
| Rate for Payer: ASR Commercial |
$192.76
|
| Rate for Payer: BCBS Complete |
$88.60
|
| Rate for Payer: BCBS MAPPO |
$157.42
|
| Rate for Payer: BCBS Trust/PPO |
$162.73
|
| Rate for Payer: BCN Commercial |
$154.07
|
| Rate for Payer: BCN Medicare Advantage |
$157.42
|
| Rate for Payer: Cash Price |
$158.98
|
| Rate for Payer: Cash Price |
$158.98
|
| Rate for Payer: Cofinity Commercial |
$186.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.42
|
| Rate for Payer: Healthscope Commercial |
$198.72
|
| Rate for Payer: Healthscope Whirlpool |
$192.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$157.42
|
| Rate for Payer: Mclaren Commercial |
$178.85
|
| Rate for Payer: Mclaren Medicaid |
$84.38
|
| Rate for Payer: Mclaren Medicare |
$157.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$165.29
|
| Rate for Payer: Meridian Medicaid |
$88.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.91
|
| Rate for Payer: Nomi Health Commercial |
$162.95
|
| Rate for Payer: PACE Medicare |
$149.55
|
| Rate for Payer: PACE SWMI |
$157.42
|
| Rate for Payer: PHP Commercial |
$173.16
|
| Rate for Payer: PHP Medicaid |
$84.38
|
| Rate for Payer: PHP Medicare Advantage |
$157.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.12
|
| Rate for Payer: Priority Health Medicare |
$157.42
|
| Rate for Payer: Priority Health Narrow Network |
$100.90
|
| Rate for Payer: Railroad Medicare Medicare |
$157.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.42
|
| Rate for Payer: UHC Exchange |
$244.00
|
| Rate for Payer: UHC Medicare Advantage |
$157.42
|
| Rate for Payer: UHCCP DNSP |
$157.42
|
| Rate for Payer: UHCCP Medicaid |
$84.38
|
| Rate for Payer: VA VA |
$157.42
|
|
|
HC PSYCHIATRIC DIAG EVAL
|
Facility
|
IP
|
$198.72
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
91400004
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$129.17 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$178.85
|
| Rate for Payer: ASR ASR |
$192.76
|
| Rate for Payer: ASR Commercial |
$192.76
|
| Rate for Payer: BCBS Trust/PPO |
$161.94
|
| Rate for Payer: BCN Commercial |
$154.07
|
| Rate for Payer: Cash Price |
$158.98
|
| Rate for Payer: Cofinity Commercial |
$186.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.98
|
| Rate for Payer: Healthscope Commercial |
$198.72
|
| Rate for Payer: Healthscope Whirlpool |
$192.76
|
| Rate for Payer: Mclaren Commercial |
$178.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.91
|
| Rate for Payer: Nomi Health Commercial |
$162.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.87
|
|
|
HC PSYCH/NEUROPSYCH TEST BY PHYS 30 MIN
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 96136
|
| Hospital Charge Code |
91800009
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
|
HC PSYCH/NEUROPSYCH TEST BY PHYS 30 MIN
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 96136
|
| Hospital Charge Code |
91800009
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$195.75 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$126.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$126.29
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$138.92
|
| Rate for Payer: PHP Medicaid |
$67.69
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.66
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$15.73
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$195.75
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP DNSP |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: VA VA |
$126.29
|
|
|
HC PSYCH/NEUROPSYCH TEST BY TECH 30 MIN
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 96138
|
| Hospital Charge Code |
91800011
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
