|
HC DEVICE NOT RETURNED TYPE III HOME STUDY W/EFFORT & FLOW
|
Professional
|
Both
|
$1,626.00
|
|
| Hospital Charge Code |
27000603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$650.40 |
| Max. Negotiated Rate |
$1,219.50 |
| Rate for Payer: Aetna Medicare |
$813.00
|
| Rate for Payer: BCBS Complete |
$650.40
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,056.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,219.50
|
|
|
HC DEXA BONE DENSITY
|
Facility
|
IP
|
$552.45
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
32000260
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$348.04 |
| Max. Negotiated Rate |
$497.20 |
| Rate for Payer: Aetna Commercial |
$469.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.09
|
| Rate for Payer: Cash Price |
$441.96
|
| Rate for Payer: Cofinity Advantage |
$386.71
|
| Rate for Payer: Cofinity Commercial |
$475.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.96
|
| Rate for Payer: Healthscope Commercial |
$497.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.34
|
| Rate for Payer: PHP Commercial |
$469.58
|
| Rate for Payer: Priority Health SBD |
$348.04
|
|
|
HC DEXA BONE DENSITY
|
Facility
|
OP
|
$552.45
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
32000260
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$497.20 |
| Rate for Payer: Aetna Commercial |
$469.58
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$68.14
|
| Rate for Payer: BCN Commercial |
$68.14
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$441.96
|
| Rate for Payer: Cash Price |
$441.96
|
| Rate for Payer: Cofinity Advantage |
$386.71
|
| Rate for Payer: Cofinity Commercial |
$475.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$497.20
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.58
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.34
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$469.58
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$348.04
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.09
|
| Rate for Payer: UHC Core |
$287.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$217.11
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC DEXA BONE DENSITY APPENDICULAR
|
Facility
|
IP
|
$208.31
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
32000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$131.24 |
| Max. Negotiated Rate |
$187.48 |
| Rate for Payer: Aetna Commercial |
$177.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.40
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cofinity Advantage |
$145.82
|
| Rate for Payer: Cofinity Commercial |
$179.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.65
|
| Rate for Payer: Healthscope Commercial |
$187.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.23
|
| Rate for Payer: PHP Commercial |
$177.06
|
| Rate for Payer: Priority Health SBD |
$131.24
|
|
|
HC DEXA BONE DENSITY APPENDICULAR
|
Facility
|
OP
|
$208.31
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
32000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$280.42 |
| Rate for Payer: Aetna Commercial |
$177.06
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$51.49
|
| Rate for Payer: BCN Commercial |
$51.49
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cofinity Advantage |
$145.82
|
| Rate for Payer: Cofinity Commercial |
$179.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$187.48
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.06
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.23
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$177.06
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$131.24
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.40
|
| Rate for Payer: UHC Core |
$108.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$81.87
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC DEXAMETHASONE DEXA
|
Facility
|
IP
|
$153.44
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100751
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.67 |
| Max. Negotiated Rate |
$138.10 |
| Rate for Payer: Aetna Commercial |
$130.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.74
|
| Rate for Payer: Cash Price |
$122.75
|
| Rate for Payer: Cofinity Advantage |
$107.41
|
| Rate for Payer: Cofinity Commercial |
$131.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.75
|
| Rate for Payer: Healthscope Commercial |
$138.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.08
|
| Rate for Payer: PHP Commercial |
$130.42
|
| Rate for Payer: Priority Health SBD |
$96.67
|
|
|
HC DEXAMETHASONE DEXA
|
Facility
|
OP
|
$153.44
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100751
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$138.10 |
| Rate for Payer: Aetna Commercial |
$130.42
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.87
|
| Rate for Payer: BCN Commercial |
$19.87
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$122.75
|
| Rate for Payer: Cash Price |
$122.75
|
| Rate for Payer: Cofinity Advantage |
$107.41
|
| Rate for Payer: Cofinity Commercial |
$131.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$138.10
|
| Rate for Payer: Mclaren Medicaid |
$9.75
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.42
|
| Rate for Payer: Nomi Health Commercial |
$27.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.08
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$130.42
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$96.67
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.96
|
| Rate for Payer: UHC Core |
$27.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$27.96
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC DEXAMETHASONE SODIUM PHOS, PER 1 MG
|
Facility
|
OP
|
$10.61
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.90
|
| Rate for Payer: BCBS Complete |
$4.24
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cofinity Advantage |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$9.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$9.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: PHP Commercial |
$9.02
|
| Rate for Payer: Priority Health SBD |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
|
|
HC DEXAMETHASONE SODIUM PHOS, PER 1 MG
|
Facility
|
IP
|
$10.61
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.90
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cofinity Advantage |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$9.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$9.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: PHP Commercial |
$9.02
|
| Rate for Payer: Priority Health SBD |
$6.68
|
|
|
HC DGTZ GLS MCRSCP MPHMTRC ALYS
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0763T
|
| Hospital Charge Code |
31200021
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Healthscope Commercial |
$17.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.54
|
| Rate for Payer: UHC Core |
$9.54
|
| Rate for Payer: UHC Exchange |
$9.54
|
|
|
HC DGTZ GLS MCRSCP MPHMTRC ALYS
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0763T
|
| Hospital Charge Code |
31200021
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Healthscope Commercial |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL II
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0751T
|
| Hospital Charge Code |
31200009
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Healthscope Commercial |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL II
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0751T
|
| Hospital Charge Code |
31200009
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Healthscope Commercial |
$17.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.54
|
| Rate for Payer: UHC Core |
$9.54
|
| Rate for Payer: UHC Exchange |
$9.54
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL IV
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0753T
|
| Hospital Charge Code |
31200011
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.54
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Healthscope Commercial |
$17.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UHC Core |
$9.54
|
| Rate for Payer: UHC Exchange |
$9.54
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL IV
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0753T
|
| Hospital Charge Code |
31200011
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Healthscope Commercial |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL V
|
Facility
|
OP
|
$38.16
|
|
|
Service Code
|
CPT 0754T
|
| Hospital Charge Code |
31200012
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$15.26 |
| Max. Negotiated Rate |
$34.34 |
| Rate for Payer: Aetna Commercial |
$32.44
|
| Rate for Payer: Aetna Medicare |
$19.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.80
|
| Rate for Payer: BCBS Complete |
$15.26
|
| Rate for Payer: Cash Price |
$30.53
|
| Rate for Payer: Cofinity Advantage |
$26.71
|
| Rate for Payer: Cofinity Commercial |
$32.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.53
|
| Rate for Payer: Healthscope Commercial |
$34.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.62
|
| Rate for Payer: PHP Commercial |
$32.44
|
| Rate for Payer: Priority Health SBD |
$24.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.08
|
| Rate for Payer: UHC Core |
$19.08
|
| Rate for Payer: UHC Exchange |
$19.08
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL V
|
Facility
|
IP
|
$38.16
|
|
|
Service Code
|
CPT 0754T
|
| Hospital Charge Code |
31200012
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$24.04 |
| Max. Negotiated Rate |
$34.34 |
| Rate for Payer: Aetna Commercial |
$32.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.80
|
| Rate for Payer: Cash Price |
$30.53
|
| Rate for Payer: Cofinity Advantage |
$26.71
|
| Rate for Payer: Cofinity Commercial |
$32.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.53
|
| Rate for Payer: Healthscope Commercial |
$34.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.62
|
| Rate for Payer: PHP Commercial |
$32.44
|
| Rate for Payer: Priority Health SBD |
$24.04
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL VI
|
Facility
|
OP
|
$38.16
|
|
|
Service Code
|
CPT 0755T
|
| Hospital Charge Code |
31200013
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$15.26 |
| Max. Negotiated Rate |
$34.34 |
| Rate for Payer: Aetna Commercial |
$32.44
|
| Rate for Payer: Aetna Medicare |
$19.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.80
|
| Rate for Payer: BCBS Complete |
$15.26
|
| Rate for Payer: Cash Price |
$30.53
|
| Rate for Payer: Cofinity Advantage |
$26.71
|
| Rate for Payer: Cofinity Commercial |
$32.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.53
|
| Rate for Payer: Healthscope Commercial |
$34.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.62
|
| Rate for Payer: PHP Commercial |
$32.44
|
| Rate for Payer: Priority Health SBD |
$24.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.08
|
| Rate for Payer: UHC Core |
$19.08
|
| Rate for Payer: UHC Exchange |
$19.08
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL VI
|
Facility
|
IP
|
$38.16
|
|
|
Service Code
|
CPT 0755T
|
| Hospital Charge Code |
31200013
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$24.04 |
| Max. Negotiated Rate |
$34.34 |
| Rate for Payer: Aetna Commercial |
$32.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.80
|
| Rate for Payer: Cash Price |
$30.53
|
| Rate for Payer: Cofinity Advantage |
$26.71
|
| Rate for Payer: Cofinity Commercial |
$32.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.53
|
| Rate for Payer: Healthscope Commercial |
$34.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.62
|
| Rate for Payer: PHP Commercial |
$32.44
|
| Rate for Payer: Priority Health SBD |
$24.04
|
|
|
HC DGTZ GLS MCRSCP SLD LVL III
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0752T
|
| Hospital Charge Code |
31200010
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Healthscope Commercial |
$17.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.54
|
| Rate for Payer: UHC Core |
$9.54
|
| Rate for Payer: UHC Exchange |
$9.54
|
|
|
HC DGTZ GLS MCRSCP SLD LVL III
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0752T
|
| Hospital Charge Code |
31200010
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Healthscope Commercial |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
|
|
HC DGTZ GLS MCRSCP SLD SPC GRPI
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0756T
|
| Hospital Charge Code |
31200014
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Healthscope Commercial |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
|
|
HC DGTZ GLS MCRSCP SLD SPC GRPI
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0756T
|
| Hospital Charge Code |
31200014
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Healthscope Commercial |
$17.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.54
|
| Rate for Payer: UHC Core |
$9.54
|
| Rate for Payer: UHC Exchange |
$9.54
|
|
|
HC DGTZ GLS MCRSCP SL IMM 1ST
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0760T
|
| Hospital Charge Code |
31200018
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Healthscope Commercial |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
|
|
HC DGTZ GLS MCRSCP SL IMM 1ST
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0760T
|
| Hospital Charge Code |
31200018
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Healthscope Commercial |
$17.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.54
|
| Rate for Payer: UHC Core |
$9.54
|
| Rate for Payer: UHC Exchange |
$9.54
|
|
