|
HC DGTZ GLS MCRSCP SL IMM EA 1
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0761T
|
| Hospital Charge Code |
31200019
|
|
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 EA 1
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0761T
|
| Hospital Charge Code |
31200019
|
|
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 EA M
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0762T
|
| Hospital Charge Code |
31200020
|
|
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 EA M
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0762T
|
| Hospital Charge Code |
31200020
|
|
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 SPC GRPII
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0757T
|
| Hospital Charge Code |
31200015
|
|
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 SPC GRPII
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0757T
|
| Hospital Charge Code |
31200015
|
|
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 SPC HCHEM
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0758T
|
| Hospital Charge Code |
31200016
|
|
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 SPC HCHEM
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0758T
|
| Hospital Charge Code |
31200016
|
|
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 SP GRPIII
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0759T
|
| Hospital Charge Code |
31200017
|
|
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 SP GRPIII
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0759T
|
| Hospital Charge Code |
31200017
|
|
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 DHEA
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
30100187
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.22 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna Commercial |
$44.20
|
| Rate for Payer: Aetna Medicare |
$26.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.59
|
| Rate for Payer: BCBS Complete |
$13.88
|
| Rate for Payer: BCBS MAPPO |
$25.27
|
| Rate for Payer: BCBS Trust/PPO |
$26.94
|
| Rate for Payer: BCN Commercial |
$26.94
|
| Rate for Payer: BCN Medicare Advantage |
$25.27
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Advantage |
$36.40
|
| Rate for Payer: Cofinity Commercial |
$44.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.27
|
| Rate for Payer: Healthscope Commercial |
$46.80
|
| Rate for Payer: Mclaren Medicaid |
$13.22
|
| Rate for Payer: Mclaren Medicare |
$25.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.53
|
| Rate for Payer: Meridian Medicaid |
$26.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.20
|
| Rate for Payer: Nomi Health Commercial |
$37.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: PACE Medicare |
$24.01
|
| Rate for Payer: PACE SWMI |
$25.27
|
| Rate for Payer: PHP Commercial |
$44.20
|
| Rate for Payer: PHP Medicare Advantage |
$25.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25.27
|
| Rate for Payer: Priority Health Medicare |
$25.27
|
| Rate for Payer: Priority Health SBD |
$32.76
|
| Rate for Payer: Priority Health Tiered Network |
$20.22
|
| Rate for Payer: Railroad Medicare Medicare |
$25.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.91
|
| Rate for Payer: UHC Core |
$37.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.27
|
| Rate for Payer: UHC Exchange |
$37.91
|
| Rate for Payer: UHC Medicaid |
$13.22
|
| Rate for Payer: UHCCP Medicaid |
$13.22
|
| Rate for Payer: VA VA |
$25.27
|
|
|
HC DHEA
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
30100187
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Aetna Commercial |
$44.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.80
|
| Rate for Payer: Cofinity Advantage |
$36.40
|
| Rate for Payer: Cofinity Commercial |
$44.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.60
|
| Rate for Payer: Healthscope Commercial |
$46.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: PHP Commercial |
$44.20
|
| Rate for Payer: Priority Health SBD |
$32.76
|
|
|
HC DHEA-SULFATE
|
Facility
|
OP
|
$57.30
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
30100188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$51.57 |
| Rate for Payer: Aetna Commercial |
$48.70
|
| Rate for Payer: Aetna Medicare |
$23.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.79
|
| Rate for Payer: BCBS Complete |
$12.21
|
| Rate for Payer: BCBS MAPPO |
$22.23
|
| Rate for Payer: BCBS Trust/PPO |
$23.70
|
| Rate for Payer: BCN Commercial |
$23.70
|
| Rate for Payer: BCN Medicare Advantage |
$22.23
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cofinity Advantage |
$40.11
|
| Rate for Payer: Cofinity Commercial |
$49.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.23
|
| Rate for Payer: Healthscope Commercial |
$51.57
|
| Rate for Payer: Mclaren Medicaid |
$11.63
|
| Rate for Payer: Mclaren Medicare |
$22.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.34
|
| Rate for Payer: Meridian Medicaid |
$23.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.70
|
| Rate for Payer: Nomi Health Commercial |
$33.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.98
|
| Rate for Payer: PACE Medicare |
$21.12
|
| Rate for Payer: PACE SWMI |
$22.23
|
| Rate for Payer: PHP Commercial |
$48.70
|
| Rate for Payer: PHP Medicare Advantage |
$22.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.23
|
| Rate for Payer: Priority Health Medicare |
$22.23
|
| Rate for Payer: Priority Health SBD |
$36.10
|
| Rate for Payer: Priority Health Tiered Network |
$17.78
|
| Rate for Payer: Railroad Medicare Medicare |
$22.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.35
|
| Rate for Payer: UHC Core |
$33.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.23
|
| Rate for Payer: UHC Exchange |
$33.35
|
| Rate for Payer: UHC Medicaid |
$11.63
|
| Rate for Payer: UHCCP Medicaid |
$11.63
|
| Rate for Payer: VA VA |
$22.23
|
|
|
HC DHEA-SULFATE
|
Facility
|
IP
|
$57.30
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
30100188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.10 |
| Max. Negotiated Rate |
$51.57 |
| Rate for Payer: Aetna Commercial |
$48.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.24
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cofinity Advantage |
$40.11
|
| Rate for Payer: Cofinity Commercial |
$49.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.84
|
| Rate for Payer: Healthscope Commercial |
$51.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.98
|
| Rate for Payer: PHP Commercial |
$48.70
|
| Rate for Payer: Priority Health SBD |
$36.10
|
|
|
HC DIABETES GROUP SESSION PER 30"
|
Facility
|
OP
|
$64.35
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200006
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$57.91 |
| Rate for Payer: Aetna Commercial |
$54.70
|
| Rate for Payer: Aetna Medicare |
$32.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.83
|
| Rate for Payer: BCBS Complete |
$25.74
|
| Rate for Payer: BCBS Trust/PPO |
$31.08
|
| Rate for Payer: BCN Commercial |
$31.08
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cofinity Advantage |
$45.05
|
| Rate for Payer: Cofinity Commercial |
$55.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.48
|
| Rate for Payer: Healthscope Commercial |
$57.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.26
|
| Rate for Payer: PHP Commercial |
$54.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.00
|
| Rate for Payer: Priority Health SBD |
$40.54
|
| Rate for Payer: Priority Health Tiered Network |
$12.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.83
|
| Rate for Payer: UHC Core |
$33.53
|
| Rate for Payer: UHC Exchange |
$25.29
|
|
|
HC DIABETES GROUP SESSION PER 30"
|
Facility
|
IP
|
$64.35
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200006
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$40.54 |
| Max. Negotiated Rate |
$57.91 |
| Rate for Payer: Aetna Commercial |
$54.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.83
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cofinity Advantage |
$45.05
|
| Rate for Payer: Cofinity Commercial |
$55.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.48
|
| Rate for Payer: Healthscope Commercial |
$57.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.26
|
| Rate for Payer: PHP Commercial |
$54.70
|
| Rate for Payer: Priority Health SBD |
$40.54
|
|
|
HC DIABETES MELLITUS TYPE 1 EVAL
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna Medicare |
$22.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.76
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: BCBS MAPPO |
$21.41
|
| Rate for Payer: BCBS Trust/PPO |
$22.83
|
| Rate for Payer: BCN Commercial |
$22.83
|
| Rate for Payer: BCN Medicare Advantage |
$21.41
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Advantage |
$45.50
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Mclaren Medicaid |
$11.20
|
| Rate for Payer: Mclaren Medicare |
$21.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.48
|
| Rate for Payer: Meridian Medicaid |
$22.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: Nomi Health Commercial |
$32.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: PACE Medicare |
$20.34
|
| Rate for Payer: PACE SWMI |
$21.41
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: PHP Medicare Advantage |
$21.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.41
|
| Rate for Payer: Priority Health Medicare |
$21.41
|
| Rate for Payer: Priority Health SBD |
$40.95
|
| Rate for Payer: Priority Health Tiered Network |
$17.13
|
| Rate for Payer: Railroad Medicare Medicare |
$21.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.12
|
| Rate for Payer: UHC Core |
$32.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.41
|
| Rate for Payer: UHC Exchange |
$32.12
|
| Rate for Payer: UHC Medicaid |
$11.20
|
| Rate for Payer: UHCCP Medicaid |
$11.20
|
| Rate for Payer: VA VA |
$21.41
|
|
|
HC DIABETES MELLITUS TYPE 1 EVAL
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Advantage |
$45.50
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: Priority Health SBD |
$40.95
|
|
|
HC DIABETES TRAINING PER 30 MIN
|
Facility
|
IP
|
$152.77
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200007
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$137.49 |
| Rate for Payer: Aetna Commercial |
$129.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.30
|
| Rate for Payer: Cash Price |
$122.22
|
| Rate for Payer: Cofinity Advantage |
$106.94
|
| Rate for Payer: Cofinity Commercial |
$131.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.22
|
| Rate for Payer: Healthscope Commercial |
$137.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.58
|
| Rate for Payer: PHP Commercial |
$129.85
|
| Rate for Payer: Priority Health SBD |
$96.25
|
|
|
HC DIABETES TRAINING PER 30 MIN
|
Facility
|
OP
|
$152.77
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200007
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$137.49 |
| Rate for Payer: Aetna Commercial |
$129.85
|
| Rate for Payer: Aetna Medicare |
$76.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.30
|
| Rate for Payer: BCBS Complete |
$61.11
|
| Rate for Payer: BCBS Trust/PPO |
$103.63
|
| Rate for Payer: BCN Commercial |
$103.63
|
| Rate for Payer: Cash Price |
$122.22
|
| Rate for Payer: Cash Price |
$122.22
|
| Rate for Payer: Cofinity Advantage |
$106.94
|
| Rate for Payer: Cofinity Commercial |
$131.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.22
|
| Rate for Payer: Healthscope Commercial |
$137.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.58
|
| Rate for Payer: PHP Commercial |
$129.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.00
|
| Rate for Payer: Priority Health SBD |
$96.25
|
| Rate for Payer: Priority Health Tiered Network |
$27.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.30
|
| Rate for Payer: UHC Core |
$79.59
|
| Rate for Payer: UHC Exchange |
$60.04
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W ANGIOPLASTY AND IMAGING
|
Facility
|
OP
|
$11,229.50
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
36100526
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,728.58 |
| Max. Negotiated Rate |
$18,339.80 |
| Rate for Payer: Aetna Commercial |
$9,545.08
|
| Rate for Payer: Aetna Medicare |
$5,897.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,299.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,088.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,088.88
|
| Rate for Payer: BCBS Complete |
$3,114.57
|
| Rate for Payer: BCBS MAPPO |
$5,671.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,728.58
|
| Rate for Payer: BCN Commercial |
$2,728.58
|
| Rate for Payer: BCN Medicare Advantage |
$5,671.10
|
| Rate for Payer: Cash Price |
$8,983.60
|
| Rate for Payer: Cash Price |
$8,983.60
|
| Rate for Payer: Cash Price |
$8,983.60
|
| Rate for Payer: Cofinity Advantage |
$7,860.65
|
| Rate for Payer: Cofinity Commercial |
$9,657.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,983.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,671.10
|
| Rate for Payer: Healthscope Commercial |
$10,106.55
|
| Rate for Payer: Mclaren Medicaid |
$2,965.99
|
| Rate for Payer: Mclaren Medicare |
$5,671.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,954.65
|
| Rate for Payer: Meridian Medicaid |
$5,954.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,521.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,238.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,545.08
|
| Rate for Payer: Nomi Health Commercial |
$17,013.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,422.12
|
| Rate for Payer: PACE Medicare |
$5,387.55
|
| Rate for Payer: PACE SWMI |
$5,671.10
|
| Rate for Payer: PHP Commercial |
$9,545.08
|
| Rate for Payer: PHP Medicare Advantage |
$5,671.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,965.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,339.80
|
| Rate for Payer: Priority Health Medicare |
$5,671.10
|
| Rate for Payer: Priority Health SBD |
$7,074.59
|
| Rate for Payer: Priority Health Tiered Network |
$14,671.84
|
| Rate for Payer: Railroad Medicare Medicare |
$5,671.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,671.10
|
| Rate for Payer: UHC Medicaid |
$2,965.99
|
| Rate for Payer: UHCCP Medicaid |
$2,965.99
|
| Rate for Payer: VA VA |
$5,671.10
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W ANGIOPLASTY AND IMAGING
|
Facility
|
IP
|
$11,229.50
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
36100526
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,074.59 |
| Max. Negotiated Rate |
$10,106.55 |
| Rate for Payer: Aetna Commercial |
$9,545.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,299.18
|
| Rate for Payer: Cash Price |
$8,983.60
|
| Rate for Payer: Cofinity Advantage |
$7,860.65
|
| Rate for Payer: Cofinity Commercial |
$9,657.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,983.60
|
| Rate for Payer: Healthscope Commercial |
$10,106.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,545.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,422.12
|
| Rate for Payer: PHP Commercial |
$9,545.08
|
| Rate for Payer: Priority Health SBD |
$7,074.59
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W IMAGING
|
Facility
|
OP
|
$2,189.04
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
36100525
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$820.32 |
| Max. Negotiated Rate |
$5,072.36 |
| Rate for Payer: Aetna Commercial |
$1,860.68
|
| Rate for Payer: Aetna Medicare |
$1,631.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,422.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.61
|
| Rate for Payer: BCBS Complete |
$861.41
|
| Rate for Payer: BCBS MAPPO |
$1,568.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,226.73
|
| Rate for Payer: BCN Commercial |
$1,226.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.49
|
| Rate for Payer: Cash Price |
$1,751.23
|
| Rate for Payer: Cash Price |
$1,751.23
|
| Rate for Payer: Cash Price |
$1,751.23
|
| Rate for Payer: Cofinity Advantage |
$1,532.33
|
| Rate for Payer: Cofinity Commercial |
$1,882.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.49
|
| Rate for Payer: Healthscope Commercial |
$1,970.14
|
| Rate for Payer: Mclaren Medicaid |
$820.32
|
| Rate for Payer: Mclaren Medicare |
$1,568.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.91
|
| Rate for Payer: Meridian Medicaid |
$1,646.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,725.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,860.68
|
| Rate for Payer: Nomi Health Commercial |
$4,705.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,641.78
|
| Rate for Payer: PACE Medicare |
$1,490.07
|
| Rate for Payer: PACE SWMI |
$1,568.49
|
| Rate for Payer: PHP Commercial |
$1,860.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$820.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,072.36
|
| Rate for Payer: Priority Health Medicare |
$1,568.49
|
| Rate for Payer: Priority Health SBD |
$1,379.10
|
| Rate for Payer: Priority Health Tiered Network |
$4,057.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,568.49
|
| Rate for Payer: UHC Medicaid |
$820.32
|
| Rate for Payer: UHCCP Medicaid |
$820.32
|
| Rate for Payer: VA VA |
$1,568.49
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W IMAGING
|
Facility
|
IP
|
$2,189.04
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
36100525
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,379.10 |
| Max. Negotiated Rate |
$1,970.14 |
| Rate for Payer: Aetna Commercial |
$1,860.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,422.88
|
| Rate for Payer: Cash Price |
$1,751.23
|
| Rate for Payer: Cofinity Advantage |
$1,532.33
|
| Rate for Payer: Cofinity Commercial |
$1,882.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.23
|
| Rate for Payer: Healthscope Commercial |
$1,970.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,860.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,641.78
|
| Rate for Payer: PHP Commercial |
$1,860.68
|
| Rate for Payer: Priority Health SBD |
$1,379.10
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W STENT AND IMAGING
|
Facility
|
OP
|
$18,905.74
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
36100527
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna Commercial |
$16,069.88
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,288.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$7,546.95
|
| Rate for Payer: BCN Commercial |
$7,546.95
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$15,124.59
|
| Rate for Payer: Cash Price |
$15,124.59
|
| Rate for Payer: Cash Price |
$15,124.59
|
| Rate for Payer: Cofinity Advantage |
$13,234.02
|
| Rate for Payer: Cofinity Commercial |
$16,258.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,124.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$17,015.17
|
| Rate for Payer: Mclaren Medicaid |
$6,015.90
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,069.88
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,179.31
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$16,069.88
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health SBD |
$11,910.62
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
