|
HC GLUCAGON LEVEL
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 82943
|
| Hospital Charge Code |
30100221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$14.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.86
|
| Rate for Payer: BCBS Complete |
$8.21
|
| Rate for Payer: BCBS MAPPO |
$14.29
|
| Rate for Payer: BCBS Trust/PPO |
$11.19
|
| Rate for Payer: BCN Medicare Advantage |
$14.29
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$56.70
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.29
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Mclaren Medicaid |
$7.82
|
| Rate for Payer: Mclaren Medicare |
$14.29
|
| Rate for Payer: Meridian Medicaid |
$8.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.85
|
| Rate for Payer: PACE Medicare |
$13.58
|
| Rate for Payer: PACE SWMI |
$14.29
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: PHP Medicare Advantage |
$14.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.70
|
| Rate for Payer: Priority Health Medicare |
$14.29
|
| Rate for Payer: Priority Health SBD |
$51.03
|
| Rate for Payer: Railroad Medicare Medicare |
$14.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.15
|
| Rate for Payer: UHC Core |
$24.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.29
|
| Rate for Payer: UHC Exchange |
$14.29
|
| Rate for Payer: UHC Medicare Advantage |
$14.72
|
| Rate for Payer: VA VA |
$14.29
|
|
|
HC GLUCEPTATE PER STUDY
|
Facility
|
IP
|
$133.31
|
|
|
Service Code
|
HCPCS A9550
|
| Hospital Charge Code |
34300008
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$83.99 |
| Max. Negotiated Rate |
$119.98 |
| Rate for Payer: Aetna Commercial |
$113.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.65
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Cofinity Commercial |
$114.65
|
| Rate for Payer: Cofinity Commercial |
$93.32
|
| Rate for Payer: Healthscope Commercial |
$119.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.31
|
| Rate for Payer: PHP Commercial |
$113.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.32
|
| Rate for Payer: Priority Health SBD |
$83.99
|
|
|
HC GLUCEPTATE PER STUDY
|
Facility
|
OP
|
$133.31
|
|
|
Service Code
|
HCPCS A9550
|
| Hospital Charge Code |
34300008
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$48.70 |
| Max. Negotiated Rate |
$119.98 |
| Rate for Payer: Aetna Commercial |
$113.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.65
|
| Rate for Payer: BCBS Complete |
$53.32
|
| Rate for Payer: BCBS Trust/PPO |
$48.70
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: Cofinity Commercial |
$93.32
|
| Rate for Payer: Cofinity Commercial |
$114.65
|
| Rate for Payer: Healthscope Commercial |
$119.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.31
|
| Rate for Payer: PHP Commercial |
$113.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.32
|
| Rate for Payer: Priority Health SBD |
$83.99
|
|
|
HC GLUCOSE (ADDITIONAL).
|
Facility
|
IP
|
$37.90
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
30100227
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.64
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$26.53
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Healthscope Commercial |
$34.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PHP Commercial |
$32.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health SBD |
$23.88
|
|
|
HC GLUCOSE (ADDITIONAL).
|
Facility
|
OP
|
$37.90
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
30100227
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna Medicare |
$4.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.90
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: BCBS MAPPO |
$3.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.07
|
| Rate for Payer: BCN Medicare Advantage |
$3.92
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Cofinity Commercial |
$26.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.92
|
| Rate for Payer: Healthscope Commercial |
$34.11
|
| Rate for Payer: Mclaren Medicaid |
$2.14
|
| Rate for Payer: Mclaren Medicare |
$3.92
|
| Rate for Payer: Meridian Medicaid |
$2.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PACE Medicare |
$3.72
|
| Rate for Payer: PACE SWMI |
$3.92
|
| Rate for Payer: PHP Commercial |
$32.22
|
| Rate for Payer: PHP Medicare Advantage |
$3.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health Medicare |
$3.92
|
| Rate for Payer: Priority Health SBD |
$23.88
|
| Rate for Payer: Railroad Medicare Medicare |
$3.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.70
|
| Rate for Payer: UHC Core |
$6.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.92
|
| Rate for Payer: UHC Exchange |
$3.92
|
| Rate for Payer: UHC Medicare Advantage |
$4.04
|
| Rate for Payer: VA VA |
$3.92
|
|
|
HC GLUCOSE BODY FLUID NOT BLOOD
|
Facility
|
IP
|
$37.90
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
30100222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.64
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Cofinity Commercial |
$26.53
|
| Rate for Payer: Healthscope Commercial |
$34.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PHP Commercial |
$32.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health SBD |
$23.88
|
|
|
HC GLUCOSE BODY FLUID NOT BLOOD
|
Facility
|
OP
|
$37.90
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
30100222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna Medicare |
$4.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.91
|
| Rate for Payer: BCBS Complete |
$2.26
|
| Rate for Payer: BCBS MAPPO |
$3.93
|
| Rate for Payer: BCBS Trust/PPO |
$3.08
|
| Rate for Payer: BCN Medicare Advantage |
$3.93
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$26.53
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.93
|
| Rate for Payer: Healthscope Commercial |
$34.11
|
| Rate for Payer: Mclaren Medicaid |
$2.15
|
| Rate for Payer: Mclaren Medicare |
$3.93
|
| Rate for Payer: Meridian Medicaid |
$2.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PACE Medicare |
$3.73
|
| Rate for Payer: PACE SWMI |
$3.93
|
| Rate for Payer: PHP Commercial |
$32.22
|
| Rate for Payer: PHP Medicare Advantage |
$3.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health Medicare |
$3.93
|
| Rate for Payer: Priority Health SBD |
$23.88
|
| Rate for Payer: Railroad Medicare Medicare |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.72
|
| Rate for Payer: UHC Core |
$6.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.93
|
| Rate for Payer: UHC Exchange |
$3.93
|
| Rate for Payer: UHC Medicare Advantage |
$4.05
|
| Rate for Payer: VA VA |
$3.93
|
|
|
HC GLUCOSE LEVEL
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
30100223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC GLUCOSE LEVEL
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
30100223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$4.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.91
|
| Rate for Payer: BCBS Complete |
$2.26
|
| Rate for Payer: BCBS MAPPO |
$3.93
|
| Rate for Payer: BCN Medicare Advantage |
$3.93
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.93
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$2.15
|
| Rate for Payer: Mclaren Medicare |
$3.93
|
| Rate for Payer: Meridian Medicaid |
$2.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$3.73
|
| Rate for Payer: PACE SWMI |
$3.93
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$3.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$3.93
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.72
|
| Rate for Payer: UHC Core |
$6.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.93
|
| Rate for Payer: UHC Exchange |
$3.93
|
| Rate for Payer: UHC Medicare Advantage |
$4.05
|
| Rate for Payer: VA VA |
$3.93
|
|
|
HC GLUCOSE POST DOSE
|
Facility
|
IP
|
$45.40
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
30100224
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$40.86 |
| Rate for Payer: Aetna Commercial |
$38.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.51
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cofinity Commercial |
$39.04
|
| Rate for Payer: Cofinity Commercial |
$31.78
|
| Rate for Payer: Healthscope Commercial |
$40.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.59
|
| Rate for Payer: PHP Commercial |
$38.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: Priority Health SBD |
$28.60
|
|
|
HC GLUCOSE POST DOSE
|
Facility
|
OP
|
$45.40
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
30100224
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$40.86 |
| Rate for Payer: Aetna Commercial |
$38.59
|
| Rate for Payer: Aetna Medicare |
$4.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.94
|
| Rate for Payer: BCBS Complete |
$2.73
|
| Rate for Payer: BCBS MAPPO |
$4.75
|
| Rate for Payer: BCBS Trust/PPO |
$3.72
|
| Rate for Payer: BCN Medicare Advantage |
$4.75
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cofinity Commercial |
$31.78
|
| Rate for Payer: Cofinity Commercial |
$39.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.75
|
| Rate for Payer: Healthscope Commercial |
$40.86
|
| Rate for Payer: Mclaren Medicaid |
$2.60
|
| Rate for Payer: Mclaren Medicare |
$4.75
|
| Rate for Payer: Meridian Medicaid |
$2.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.59
|
| Rate for Payer: PACE Medicare |
$4.51
|
| Rate for Payer: PACE SWMI |
$4.75
|
| Rate for Payer: PHP Commercial |
$38.59
|
| Rate for Payer: PHP Medicare Advantage |
$4.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: Priority Health Medicare |
$4.75
|
| Rate for Payer: Priority Health SBD |
$28.60
|
| Rate for Payer: Railroad Medicare Medicare |
$4.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.70
|
| Rate for Payer: UHC Core |
$8.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.75
|
| Rate for Payer: UHC Exchange |
$4.75
|
| Rate for Payer: UHC Medicare Advantage |
$4.89
|
| Rate for Payer: VA VA |
$4.75
|
|
|
HC GLUCOSE QUANT BLOOD EXCPT REAGENT STRIP
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
30100753
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC GLUCOSE QUANT BLOOD EXCPT REAGENT STRIP
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
30100753
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$4.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.91
|
| Rate for Payer: BCBS Complete |
$2.26
|
| Rate for Payer: BCBS MAPPO |
$3.93
|
| Rate for Payer: BCN Medicare Advantage |
$3.93
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.93
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$2.15
|
| Rate for Payer: Mclaren Medicare |
$3.93
|
| Rate for Payer: Meridian Medicaid |
$2.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$3.73
|
| Rate for Payer: PACE SWMI |
$3.93
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$3.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$3.93
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.72
|
| Rate for Payer: UHC Core |
$6.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.93
|
| Rate for Payer: UHC Exchange |
$3.93
|
| Rate for Payer: UHC Medicare Advantage |
$4.05
|
| Rate for Payer: VA VA |
$3.93
|
|
|
HC GLUCOSE STICK (ACCU-CHEK)
|
Facility
|
OP
|
$9.38
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
30000010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$8.44 |
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: Aetna Medicare |
$3.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.10
|
| Rate for Payer: BCBS Complete |
$1.88
|
| Rate for Payer: BCBS MAPPO |
$3.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.57
|
| Rate for Payer: BCN Medicare Advantage |
$3.28
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$8.07
|
| Rate for Payer: Cofinity Commercial |
$6.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.28
|
| Rate for Payer: Healthscope Commercial |
$8.44
|
| Rate for Payer: Mclaren Medicaid |
$1.79
|
| Rate for Payer: Mclaren Medicare |
$3.28
|
| Rate for Payer: Meridian Medicaid |
$1.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.97
|
| Rate for Payer: PACE Medicare |
$3.12
|
| Rate for Payer: PACE SWMI |
$3.28
|
| Rate for Payer: PHP Commercial |
$7.97
|
| Rate for Payer: PHP Medicare Advantage |
$3.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.57
|
| Rate for Payer: Priority Health Medicare |
$3.28
|
| Rate for Payer: Priority Health SBD |
$5.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.94
|
| Rate for Payer: UHC Core |
$3.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.28
|
| Rate for Payer: UHC Exchange |
$3.28
|
| Rate for Payer: UHC Medicare Advantage |
$3.38
|
| Rate for Payer: VA VA |
$3.28
|
|
|
HC GLUCOSE STICK (ACCU-CHEK)
|
Facility
|
IP
|
$9.38
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
30000010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$8.44 |
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.10
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$6.57
|
| Rate for Payer: Cofinity Commercial |
$8.07
|
| Rate for Payer: Healthscope Commercial |
$8.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.97
|
| Rate for Payer: PHP Commercial |
$7.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.57
|
| Rate for Payer: Priority Health SBD |
$5.91
|
|
|
HC GLUC TOLER 3 SPECIMENS
|
Facility
|
IP
|
$92.21
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Aetna Commercial |
$78.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.94
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Cofinity Commercial |
$79.30
|
| Rate for Payer: Healthscope Commercial |
$82.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.38
|
| Rate for Payer: PHP Commercial |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.55
|
| Rate for Payer: Priority Health SBD |
$58.09
|
|
|
HC GLUC TOLER 3 SPECIMENS
|
Facility
|
OP
|
$92.21
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Aetna Commercial |
$78.38
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.39
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$10.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Cofinity Commercial |
$79.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$82.99
|
| Rate for Payer: Mclaren Medicaid |
$7.04
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Medicaid |
$7.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.38
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$78.38
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.55
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$58.09
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$21.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Exchange |
$12.87
|
| Rate for Payer: UHC Medicare Advantage |
$13.26
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: Aetna Medicare |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: BCBS Complete |
$13.54
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$18.46
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$61.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$64.80
|
| Rate for Payer: Mclaren Medicaid |
$12.89
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Medicaid |
$13.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.20
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$61.20
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health SBD |
$45.36
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.28
|
| Rate for Payer: UHC Core |
$33.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.57
|
| Rate for Payer: UHC Exchange |
$23.57
|
| Rate for Payer: UHC Medicare Advantage |
$24.28
|
| Rate for Payer: VA VA |
$23.57
|
|
|
HC GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.36 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.80
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$61.92
|
| Rate for Payer: Healthscope Commercial |
$64.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.20
|
| Rate for Payer: PHP Commercial |
$61.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: Priority Health SBD |
$45.36
|
|
|
HC GLYCOHEMOGLOBIN (A1C)
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
30100238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.49 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health SBD |
$22.49
|
|
|
HC GLYCOHEMOGLOBIN (A1C)
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
30100238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$10.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.14
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS MAPPO |
$9.71
|
| Rate for Payer: BCBS Trust/PPO |
$7.60
|
| Rate for Payer: BCN Medicare Advantage |
$9.71
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$5.31
|
| Rate for Payer: Mclaren Medicare |
$9.71
|
| Rate for Payer: Meridian Medicaid |
$5.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PACE Medicare |
$9.22
|
| Rate for Payer: PACE SWMI |
$9.71
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$9.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health Medicare |
$9.71
|
| Rate for Payer: Priority Health SBD |
$22.49
|
| Rate for Payer: Railroad Medicare Medicare |
$9.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.65
|
| Rate for Payer: UHC Core |
$16.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.71
|
| Rate for Payer: UHC Exchange |
$9.71
|
| Rate for Payer: UHC Medicare Advantage |
$10.00
|
| Rate for Payer: VA VA |
$9.71
|
|
|
HC GMU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$108.91
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Cofinity Commercial |
$94.03
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health SBD |
$84.63
|
|
|
HC GMU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Cofinity Commercial |
$94.03
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health SBD |
$84.63
|
|
|
HC GOLDENROD IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC GOLDENROD IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
