|
HC PSYCH/NEUROPSYCH TEST BY TECH 30 MIN
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 96138
|
| Hospital Charge Code |
91800011
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$606.00 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$390.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$488.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$488.71
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$220.04
|
| Rate for Payer: BCBS MAPPO |
$390.97
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: BCN Medicare Advantage |
$390.97
|
| 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 |
$390.97
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$390.97
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$209.56
|
| Rate for Payer: Mclaren Medicare |
$390.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.52
|
| Rate for Payer: Meridian Medicaid |
$220.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Medicare |
$371.42
|
| Rate for Payer: PACE SWMI |
$390.97
|
| Rate for Payer: PHP Commercial |
$430.07
|
| Rate for Payer: PHP Medicaid |
$209.56
|
| Rate for Payer: PHP Medicare Advantage |
$390.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.56
|
| 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 |
$390.97
|
| Rate for Payer: Priority Health Narrow Network |
$15.73
|
| Rate for Payer: Railroad Medicare Medicare |
$390.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.97
|
| Rate for Payer: UHC Exchange |
$606.00
|
| Rate for Payer: UHC Medicare Advantage |
$390.97
|
| Rate for Payer: UHCCP DNSP |
$390.97
|
| Rate for Payer: UHCCP Medicaid |
$209.56
|
| Rate for Payer: VA VA |
$390.97
|
|
|
HC PSYCH/NEUROPSYCH TEST BY TECH EA ADDL 30 MIN
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 96139
|
| Hospital Charge Code |
91800012
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: ASR ASR |
$15.14
|
| Rate for Payer: ASR Commercial |
$15.14
|
| Rate for Payer: BCBS Trust/PPO |
$12.72
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$15.61
|
| Rate for Payer: Healthscope Whirlpool |
$15.14
|
| Rate for Payer: Mclaren Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
|
|
HC PSYCH/NEUROPSYCH TEST BY TECH EA ADDL 30 MIN
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT 96139
|
| Hospital Charge Code |
91800012
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: Aetna Medicare |
$7.80
|
| Rate for Payer: ASR ASR |
$15.14
|
| Rate for Payer: ASR Commercial |
$15.14
|
| Rate for Payer: BCBS Complete |
$6.24
|
| Rate for Payer: BCBS Trust/PPO |
$12.78
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$15.61
|
| Rate for Payer: Healthscope Whirlpool |
$15.14
|
| Rate for Payer: Mclaren Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.68
|
| Rate for Payer: Priority Health Narrow Network |
$10.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
|
|
HC PSYCH/NEUROPSYCH TEST PHYS EA ADDL 30 MIN
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 96137
|
| Hospital Charge Code |
91800010
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: ASR ASR |
$15.14
|
| Rate for Payer: ASR Commercial |
$15.14
|
| Rate for Payer: BCBS Trust/PPO |
$12.72
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$15.61
|
| Rate for Payer: Healthscope Whirlpool |
$15.14
|
| Rate for Payer: Mclaren Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
|
|
HC PSYCH/NEUROPSYCH TEST PHYS EA ADDL 30 MIN
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT 96137
|
| Hospital Charge Code |
91800010
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: Aetna Medicare |
$7.80
|
| Rate for Payer: ASR ASR |
$15.14
|
| Rate for Payer: ASR Commercial |
$15.14
|
| Rate for Payer: BCBS Complete |
$6.24
|
| Rate for Payer: BCBS Trust/PPO |
$12.78
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$15.61
|
| Rate for Payer: Healthscope Whirlpool |
$15.14
|
| Rate for Payer: Mclaren Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.68
|
| Rate for Payer: Priority Health Narrow Network |
$10.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
|
|
HC PSYCH/NEUROPSYCH TEST SINGLE AUTOMATED
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 96146
|
| Hospital Charge Code |
91800013
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$37.18 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$23.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.99
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$13.50
|
| Rate for Payer: BCBS MAPPO |
$23.99
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: BCN Medicare Advantage |
$23.99
|
| 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 |
$23.99
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$23.99
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$12.86
|
| Rate for Payer: Mclaren Medicare |
$23.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.19
|
| Rate for Payer: Meridian Medicaid |
$13.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Medicare |
$22.79
|
| Rate for Payer: PACE SWMI |
$23.99
|
| Rate for Payer: PHP Commercial |
$26.39
|
| Rate for Payer: PHP Medicaid |
$12.86
|
| Rate for Payer: PHP Medicare Advantage |
$23.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.86
|
| 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 |
$23.99
|
| Rate for Payer: Priority Health Narrow Network |
$15.73
|
| Rate for Payer: Railroad Medicare Medicare |
$23.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.99
|
| Rate for Payer: UHC Exchange |
$37.18
|
| Rate for Payer: UHC Medicare Advantage |
$23.99
|
| Rate for Payer: UHCCP DNSP |
$23.99
|
| Rate for Payer: UHCCP Medicaid |
$12.86
|
| Rate for Payer: VA VA |
$23.99
|
|
|
HC PSYCH/NEUROPSYCH TEST SINGLE AUTOMATED
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 96146
|
| Hospital Charge Code |
91800013
|
|
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 PSYCHOLOGICAL TEST EVAL PHYS/QHP 1ST HOUR
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 96130
|
| Hospital Charge Code |
91800450
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$464.10 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: ASR ASR |
$692.58
|
| Rate for Payer: ASR Commercial |
$692.58
|
| Rate for Payer: BCBS Trust/PPO |
$581.84
|
| Rate for Payer: BCN Commercial |
$553.56
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$671.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.20
|
| Rate for Payer: Healthscope Commercial |
$714.00
|
| Rate for Payer: Healthscope Whirlpool |
$692.58
|
| Rate for Payer: Mclaren Commercial |
$642.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$606.90
|
| Rate for Payer: Nomi Health Commercial |
$585.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$628.32
|
|
|
HC PSYCHOLOGICAL TEST EVAL PHYS/QHP 1ST HOUR
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT 96130
|
| Hospital Charge Code |
91800450
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$124.52 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Medicare |
$305.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: ASR ASR |
$692.58
|
| Rate for Payer: ASR Commercial |
$692.58
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$584.69
|
| Rate for Payer: BCN Commercial |
$553.56
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$671.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$714.00
|
| Rate for Payer: Healthscope Whirlpool |
$692.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.10
|
| Rate for Payer: Mclaren Commercial |
$642.60
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$606.90
|
| Rate for Payer: Nomi Health Commercial |
$585.48
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$335.61
|
| Rate for Payer: PHP Medicaid |
$163.53
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.65
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$124.52
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$628.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$472.90
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP DNSP |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC PSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HOUR
|
Facility
|
OP
|
$542.64
|
|
|
Service Code
|
CPT 96131
|
| Hospital Charge Code |
91800449
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$217.06 |
| Max. Negotiated Rate |
$542.64 |
| Rate for Payer: Aetna Commercial |
$488.38
|
| Rate for Payer: Aetna Medicare |
$271.32
|
| Rate for Payer: ASR ASR |
$526.36
|
| Rate for Payer: ASR Commercial |
$526.36
|
| Rate for Payer: BCBS Complete |
$217.06
|
| Rate for Payer: BCBS Trust/PPO |
$444.37
|
| Rate for Payer: BCN Commercial |
$420.71
|
| Rate for Payer: Cash Price |
$434.11
|
| Rate for Payer: Cofinity Commercial |
$510.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.11
|
| Rate for Payer: Healthscope Commercial |
$542.64
|
| Rate for Payer: Healthscope Whirlpool |
$526.36
|
| Rate for Payer: Mclaren Commercial |
$488.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.24
|
| Rate for Payer: Nomi Health Commercial |
$444.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$475.46
|
| Rate for Payer: Priority Health Narrow Network |
$380.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$477.52
|
|
|
HC PSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HOUR
|
Facility
|
IP
|
$542.64
|
|
|
Service Code
|
CPT 96131
|
| Hospital Charge Code |
91800449
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$352.72 |
| Max. Negotiated Rate |
$542.64 |
| Rate for Payer: Aetna Commercial |
$488.38
|
| Rate for Payer: ASR ASR |
$526.36
|
| Rate for Payer: ASR Commercial |
$526.36
|
| Rate for Payer: BCBS Trust/PPO |
$442.20
|
| Rate for Payer: BCN Commercial |
$420.71
|
| Rate for Payer: Cash Price |
$434.11
|
| Rate for Payer: Cofinity Commercial |
$510.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.11
|
| Rate for Payer: Healthscope Commercial |
$542.64
|
| Rate for Payer: Healthscope Whirlpool |
$526.36
|
| Rate for Payer: Mclaren Commercial |
$488.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.24
|
| Rate for Payer: Nomi Health Commercial |
$444.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$477.52
|
|
|
HC PSYCHOTHERAPY 30 MIN W/PATIENT
|
Facility
|
OP
|
$86.96
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
91400001
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$56.52 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$78.26
|
| 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 |
$84.35
|
| Rate for Payer: ASR Commercial |
$84.35
|
| Rate for Payer: BCBS Complete |
$88.60
|
| Rate for Payer: BCBS MAPPO |
$157.42
|
| Rate for Payer: BCBS Trust/PPO |
$71.21
|
| Rate for Payer: BCN Commercial |
$67.42
|
| Rate for Payer: BCN Medicare Advantage |
$157.42
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Cofinity Commercial |
$81.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.42
|
| Rate for Payer: Healthscope Commercial |
$86.96
|
| Rate for Payer: Healthscope Whirlpool |
$84.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$157.42
|
| Rate for Payer: Mclaren Commercial |
$78.26
|
| 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 |
$73.92
|
| Rate for Payer: Nomi Health Commercial |
$71.31
|
| 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 |
$56.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.87
|
| Rate for Payer: Priority Health Medicare |
$157.42
|
| Rate for Payer: Priority Health Narrow Network |
$75.90
|
| Rate for Payer: Railroad Medicare Medicare |
$157.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.52
|
| 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 PSYCHOTHERAPY 30 MIN W/PATIENT
|
Facility
|
IP
|
$86.96
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
91400001
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$56.52 |
| Max. Negotiated Rate |
$86.96 |
| Rate for Payer: Aetna Commercial |
$78.26
|
| Rate for Payer: ASR ASR |
$84.35
|
| Rate for Payer: ASR Commercial |
$84.35
|
| Rate for Payer: BCBS Trust/PPO |
$70.86
|
| Rate for Payer: BCN Commercial |
$67.42
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Cofinity Commercial |
$81.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.57
|
| Rate for Payer: Healthscope Commercial |
$86.96
|
| Rate for Payer: Healthscope Whirlpool |
$84.35
|
| Rate for Payer: Mclaren Commercial |
$78.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.92
|
| Rate for Payer: Nomi Health Commercial |
$71.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.52
|
|
|
HC PSYCHOTHERAPY 45 MIN W/PATIENT
|
Facility
|
OP
|
$156.11
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
91400002
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$84.38 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$140.50
|
| 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 |
$151.43
|
| Rate for Payer: ASR Commercial |
$151.43
|
| Rate for Payer: BCBS Complete |
$88.60
|
| Rate for Payer: BCBS MAPPO |
$157.42
|
| Rate for Payer: BCBS Trust/PPO |
$127.84
|
| Rate for Payer: BCN Commercial |
$121.03
|
| Rate for Payer: BCN Medicare Advantage |
$157.42
|
| Rate for Payer: Cash Price |
$124.89
|
| Rate for Payer: Cash Price |
$124.89
|
| Rate for Payer: Cofinity Commercial |
$146.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.42
|
| Rate for Payer: Healthscope Commercial |
$156.11
|
| Rate for Payer: Healthscope Whirlpool |
$151.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$157.42
|
| Rate for Payer: Mclaren Commercial |
$140.50
|
| 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 |
$132.69
|
| Rate for Payer: Nomi Health Commercial |
$128.01
|
| 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 |
$101.47
|
| 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 |
$137.38
|
| 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 PSYCHOTHERAPY 45 MIN W/PATIENT
|
Facility
|
IP
|
$156.11
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
91400002
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$101.47 |
| Max. Negotiated Rate |
$156.11 |
| Rate for Payer: Aetna Commercial |
$140.50
|
| Rate for Payer: ASR ASR |
$151.43
|
| Rate for Payer: ASR Commercial |
$151.43
|
| Rate for Payer: BCBS Trust/PPO |
$127.21
|
| Rate for Payer: BCN Commercial |
$121.03
|
| Rate for Payer: Cash Price |
$124.89
|
| Rate for Payer: Cofinity Commercial |
$146.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.89
|
| Rate for Payer: Healthscope Commercial |
$156.11
|
| Rate for Payer: Healthscope Whirlpool |
$151.43
|
| Rate for Payer: Mclaren Commercial |
$140.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.69
|
| Rate for Payer: Nomi Health Commercial |
$128.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.38
|
|
|
HC PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
IP
|
$131.09
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
91400005
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$85.21 |
| Max. Negotiated Rate |
$131.09 |
| Rate for Payer: Aetna Commercial |
$117.98
|
| Rate for Payer: ASR ASR |
$127.16
|
| Rate for Payer: ASR Commercial |
$127.16
|
| Rate for Payer: BCBS Trust/PPO |
$106.83
|
| Rate for Payer: BCN Commercial |
$101.63
|
| Rate for Payer: Cash Price |
$104.87
|
| Rate for Payer: Cofinity Commercial |
$123.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.87
|
| Rate for Payer: Healthscope Commercial |
$131.09
|
| Rate for Payer: Healthscope Whirlpool |
$127.16
|
| Rate for Payer: Mclaren Commercial |
$117.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.43
|
| Rate for Payer: Nomi Health Commercial |
$107.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.36
|
|
|
HC PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
OP
|
$131.09
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
91400005
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$84.38 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$117.98
|
| 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 |
$127.16
|
| Rate for Payer: ASR Commercial |
$127.16
|
| Rate for Payer: BCBS Complete |
$88.60
|
| Rate for Payer: BCBS MAPPO |
$157.42
|
| Rate for Payer: BCBS Trust/PPO |
$107.35
|
| Rate for Payer: BCN Commercial |
$101.63
|
| Rate for Payer: BCN Medicare Advantage |
$157.42
|
| Rate for Payer: Cash Price |
$104.87
|
| Rate for Payer: Cash Price |
$104.87
|
| Rate for Payer: Cofinity Commercial |
$123.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.42
|
| Rate for Payer: Healthscope Commercial |
$131.09
|
| Rate for Payer: Healthscope Whirlpool |
$127.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$157.42
|
| Rate for Payer: Mclaren Commercial |
$117.98
|
| 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 |
$111.43
|
| Rate for Payer: Nomi Health Commercial |
$107.49
|
| 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 |
$85.21
|
| 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 |
$115.36
|
| 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 PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
91400012
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$41.31
|
| Rate for Payer: Aetna Medicare |
$22.95
|
| Rate for Payer: ASR ASR |
$44.52
|
| Rate for Payer: ASR Commercial |
$44.52
|
| Rate for Payer: BCBS Complete |
$18.36
|
| Rate for Payer: BCBS Trust/PPO |
$37.59
|
| Rate for Payer: BCN Commercial |
$35.59
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$43.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Healthscope Whirlpool |
$44.52
|
| Rate for Payer: Mclaren Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Nomi Health Commercial |
$37.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.39
|
|
|
HC PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
91400012
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$41.31
|
| Rate for Payer: ASR ASR |
$44.52
|
| Rate for Payer: ASR Commercial |
$44.52
|
| Rate for Payer: BCBS Trust/PPO |
$37.40
|
| Rate for Payer: BCN Commercial |
$35.59
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$43.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Healthscope Whirlpool |
$44.52
|
| Rate for Payer: Mclaren Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Nomi Health Commercial |
$37.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.39
|
|
|
HC PSYCHOTHERAPY FOR CRISIS EA ADDL 15 MIN
|
Facility
|
OP
|
$118.32
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
91400014
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$118.32 |
| Rate for Payer: Aetna Commercial |
$106.49
|
| Rate for Payer: Aetna Medicare |
$59.16
|
| Rate for Payer: ASR ASR |
$114.77
|
| Rate for Payer: ASR Commercial |
$114.77
|
| Rate for Payer: BCBS Complete |
$47.33
|
| Rate for Payer: BCBS Trust/PPO |
$96.89
|
| Rate for Payer: BCN Commercial |
$91.73
|
| Rate for Payer: Cash Price |
$94.66
|
| Rate for Payer: Cash Price |
$94.66
|
| Rate for Payer: Cofinity Commercial |
$111.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.66
|
| Rate for Payer: Healthscope Commercial |
$118.32
|
| Rate for Payer: Healthscope Whirlpool |
$114.77
|
| Rate for Payer: Mclaren Commercial |
$106.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.57
|
| Rate for Payer: Nomi Health Commercial |
$97.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.12
|
|
|
HC PSYCHOTHERAPY FOR CRISIS EA ADDL 15 MIN
|
Facility
|
IP
|
$118.32
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
91400014
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$76.91 |
| Max. Negotiated Rate |
$118.32 |
| Rate for Payer: Aetna Commercial |
$106.49
|
| Rate for Payer: ASR ASR |
$114.77
|
| Rate for Payer: ASR Commercial |
$114.77
|
| Rate for Payer: BCBS Trust/PPO |
$96.42
|
| Rate for Payer: BCN Commercial |
$91.73
|
| Rate for Payer: Cash Price |
$94.66
|
| Rate for Payer: Cofinity Commercial |
$111.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.66
|
| Rate for Payer: Healthscope Commercial |
$118.32
|
| Rate for Payer: Healthscope Whirlpool |
$114.77
|
| Rate for Payer: Mclaren Commercial |
$106.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.57
|
| Rate for Payer: Nomi Health Commercial |
$97.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.12
|
|
|
HC PSYCHOTHERAPY FOR CRISIS FIRST 60 MIN
|
Facility
|
OP
|
$229.50
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
91400003
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$84.38 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$206.55
|
| 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 |
$222.62
|
| Rate for Payer: ASR Commercial |
$222.62
|
| Rate for Payer: BCBS Complete |
$88.60
|
| Rate for Payer: BCBS MAPPO |
$157.42
|
| Rate for Payer: BCBS Trust/PPO |
$187.94
|
| Rate for Payer: BCN Commercial |
$177.93
|
| Rate for Payer: BCN Medicare Advantage |
$157.42
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$215.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.42
|
| Rate for Payer: Healthscope Commercial |
$229.50
|
| Rate for Payer: Healthscope Whirlpool |
$222.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$157.42
|
| Rate for Payer: Mclaren Commercial |
$206.55
|
| 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 |
$195.08
|
| Rate for Payer: Nomi Health Commercial |
$188.19
|
| 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 |
$149.18
|
| 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 |
$201.96
|
| 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 PSYCHOTHERAPY FOR CRISIS FIRST 60 MIN
|
Facility
|
IP
|
$229.50
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
91400003
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$149.18 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna Commercial |
$206.55
|
| Rate for Payer: ASR ASR |
$222.62
|
| Rate for Payer: ASR Commercial |
$222.62
|
| Rate for Payer: BCBS Trust/PPO |
$187.02
|
| Rate for Payer: BCN Commercial |
$177.93
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$215.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.60
|
| Rate for Payer: Healthscope Commercial |
$229.50
|
| Rate for Payer: Healthscope Whirlpool |
$222.62
|
| Rate for Payer: Mclaren Commercial |
$206.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.08
|
| Rate for Payer: Nomi Health Commercial |
$188.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.96
|
|
|
HC PTCA ADD/BRANCH
|
Facility
|
OP
|
$7,290.61
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
48100099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,916.24 |
| Max. Negotiated Rate |
$7,290.61 |
| Rate for Payer: Aetna Commercial |
$6,561.55
|
| Rate for Payer: Aetna Medicare |
$3,645.30
|
| Rate for Payer: ASR ASR |
$7,071.89
|
| Rate for Payer: ASR Commercial |
$7,071.89
|
| Rate for Payer: BCBS Complete |
$2,916.24
|
| Rate for Payer: BCBS Trust/PPO |
$5,970.28
|
| Rate for Payer: BCN Commercial |
$5,652.41
|
| Rate for Payer: Cash Price |
$5,832.49
|
| Rate for Payer: Cash Price |
$5,832.49
|
| Rate for Payer: Cofinity Commercial |
$6,853.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,832.49
|
| Rate for Payer: Healthscope Commercial |
$7,290.61
|
| Rate for Payer: Healthscope Whirlpool |
$7,071.89
|
| Rate for Payer: Mclaren Commercial |
$6,561.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,197.02
|
| Rate for Payer: Nomi Health Commercial |
$5,978.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,738.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,605.99
|
| Rate for Payer: Priority Health Narrow Network |
$3,684.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,415.74
|
|
|
HC PTCA ADD/BRANCH
|
Facility
|
IP
|
$7,290.61
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
48100099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,738.90 |
| Max. Negotiated Rate |
$7,290.61 |
| Rate for Payer: Aetna Commercial |
$6,561.55
|
| Rate for Payer: ASR ASR |
$7,071.89
|
| Rate for Payer: ASR Commercial |
$7,071.89
|
| Rate for Payer: BCBS Trust/PPO |
$5,941.12
|
| Rate for Payer: BCN Commercial |
$5,652.41
|
| Rate for Payer: Cash Price |
$5,832.49
|
| Rate for Payer: Cofinity Commercial |
$6,853.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,832.49
|
| Rate for Payer: Healthscope Commercial |
$7,290.61
|
| Rate for Payer: Healthscope Whirlpool |
$7,071.89
|
| Rate for Payer: Mclaren Commercial |
$6,561.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,197.02
|
| Rate for Payer: Nomi Health Commercial |
$5,978.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,738.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,415.74
|
|
