|
HC DGTZ GLS MCRSCP SL IMM 1ST
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0760T
|
| Hospital Charge Code |
31200018
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health SBD |
$11.79
|
|
|
HC DGTZ GLS MCRSCP SL IMM 1ST
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0760T
|
| Hospital Charge Code |
31200018
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health SBD |
$11.79
|
|
|
HC DGTZ GLS MCRSCP SL IMM EA 1
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0761T
|
| Hospital Charge Code |
31200019
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health SBD |
$11.79
|
|
|
HC DGTZ GLS MCRSCP SL IMM EA 1
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0761T
|
| Hospital Charge Code |
31200019
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health SBD |
$11.79
|
|
|
HC DGTZ GLS MCRSCP SL IMM EA M
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0762T
|
| Hospital Charge Code |
31200020
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health SBD |
$11.79
|
|
|
HC DGTZ GLS MCRSCP SL IMM EA M
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0762T
|
| Hospital Charge Code |
31200020
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health SBD |
$11.79
|
|
|
HC DGTZ GLS MCRSCP SL SPC GRPII
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0757T
|
| Hospital Charge Code |
31200015
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health SBD |
$11.79
|
|
|
HC DGTZ GLS MCRSCP SL SPC GRPII
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0757T
|
| Hospital Charge Code |
31200015
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health SBD |
$11.79
|
|
|
HC DGTZ GLS MCRSCP SL SPC HCHEM
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0758T
|
| Hospital Charge Code |
31200016
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health SBD |
$11.79
|
|
|
HC DGTZ GLS MCRSCP SL SPC HCHEM
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0758T
|
| Hospital Charge Code |
31200016
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health SBD |
$11.79
|
|
|
HC DGTZ GLS MCRSCP SL SP GRPIII
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0759T
|
| Hospital Charge Code |
31200017
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health SBD |
$11.79
|
|
|
HC DGTZ GLS MCRSCP SL SP GRPIII
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0759T
|
| Hospital Charge Code |
31200017
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health SBD |
$11.79
|
|
|
HC DHEA
|
Facility
|
OP
|
$50.98
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
30100187
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$71.13 |
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna Medicare |
$26.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| 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 |
$14.22
|
| Rate for Payer: BCBS MAPPO |
$25.27
|
| Rate for Payer: BCN Medicare Advantage |
$25.27
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.27
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Mclaren Medicaid |
$13.54
|
| 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 |
$14.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: PACE Medicare |
$24.01
|
| Rate for Payer: PACE SWMI |
$25.27
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: PHP Medicare Advantage |
$25.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health Medicare |
$25.27
|
| Rate for Payer: Priority Health SBD |
$32.12
|
| Rate for Payer: Railroad Medicare Medicare |
$25.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.27
|
| Rate for Payer: UHC Medicare Advantage |
$25.27
|
| Rate for Payer: UHCCP Medicaid |
$14.23
|
| Rate for Payer: VA VA |
$25.27
|
|
|
HC DHEA
|
Facility
|
IP
|
$50.98
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
30100187
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health SBD |
$32.12
|
|
|
HC DHEA-SULFATE
|
Facility
|
OP
|
$56.18
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
30100188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$62.58 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$23.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.52
|
| 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 |
$12.51
|
| Rate for Payer: BCBS MAPPO |
$22.23
|
| Rate for Payer: BCN Medicare Advantage |
$22.23
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Cofinity Commercial |
$39.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.23
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: Mclaren Medicaid |
$11.92
|
| 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 |
$12.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: PACE Medicare |
$21.12
|
| Rate for Payer: PACE SWMI |
$22.23
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: PHP Medicare Advantage |
$22.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.52
|
| Rate for Payer: Priority Health Medicare |
$22.23
|
| Rate for Payer: Priority Health SBD |
$35.39
|
| Rate for Payer: Railroad Medicare Medicare |
$22.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.23
|
| Rate for Payer: UHC Medicare Advantage |
$22.23
|
| Rate for Payer: UHCCP Medicaid |
$12.52
|
| Rate for Payer: VA VA |
$22.23
|
|
|
HC DHEA-SULFATE
|
Facility
|
IP
|
$56.18
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
30100188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.39 |
| Max. Negotiated Rate |
$50.56 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.52
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$39.33
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.52
|
| Rate for Payer: Priority Health SBD |
$35.39
|
|
|
HC DIABETES GROUP SESSION PER 30"
|
Facility
|
IP
|
$63.09
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200006
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$56.78 |
| Rate for Payer: Aetna Commercial |
$53.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.01
|
| Rate for Payer: Cash Price |
$50.47
|
| Rate for Payer: Cofinity Commercial |
$44.16
|
| Rate for Payer: Cofinity Commercial |
$54.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.47
|
| Rate for Payer: Healthscope Commercial |
$56.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.63
|
| Rate for Payer: PHP Commercial |
$53.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.01
|
| Rate for Payer: Priority Health SBD |
$39.75
|
|
|
HC DIABETES GROUP SESSION PER 30"
|
Facility
|
OP
|
$63.09
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200006
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$25.24 |
| Max. Negotiated Rate |
$56.78 |
| Rate for Payer: Aetna Commercial |
$53.63
|
| Rate for Payer: Aetna Medicare |
$31.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.01
|
| Rate for Payer: BCBS Complete |
$25.24
|
| Rate for Payer: Cash Price |
$50.47
|
| Rate for Payer: Cofinity Commercial |
$44.16
|
| Rate for Payer: Cofinity Commercial |
$54.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.47
|
| Rate for Payer: Healthscope Commercial |
$56.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.63
|
| Rate for Payer: PHP Commercial |
$53.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.01
|
| Rate for Payer: Priority Health SBD |
$39.75
|
| Rate for Payer: UHC Core |
$46.69
|
| Rate for Payer: UHC Exchange |
$46.69
|
|
|
HC DIABETES MELLITUS TYPE 1 EVAL
|
Facility
|
IP
|
$48.68
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$43.81 |
| Rate for Payer: Aetna Commercial |
$41.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.64
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cofinity Commercial |
$34.08
|
| Rate for Payer: Cofinity Commercial |
$41.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.94
|
| Rate for Payer: Healthscope Commercial |
$43.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.38
|
| Rate for Payer: PHP Commercial |
$41.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.64
|
| Rate for Payer: Priority Health SBD |
$30.67
|
|
|
HC DIABETES MELLITUS TYPE 1 EVAL
|
Facility
|
OP
|
$48.68
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$60.27 |
| Rate for Payer: Aetna Commercial |
$41.38
|
| Rate for Payer: Aetna Medicare |
$22.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.64
|
| 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 |
$12.05
|
| Rate for Payer: BCBS MAPPO |
$21.41
|
| Rate for Payer: BCN Medicare Advantage |
$21.41
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cofinity Commercial |
$41.86
|
| Rate for Payer: Cofinity Commercial |
$34.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$43.81
|
| Rate for Payer: Mclaren Medicaid |
$11.48
|
| 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 |
$12.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.38
|
| Rate for Payer: PACE Medicare |
$20.34
|
| Rate for Payer: PACE SWMI |
$21.41
|
| Rate for Payer: PHP Commercial |
$41.38
|
| Rate for Payer: PHP Medicare Advantage |
$21.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.64
|
| Rate for Payer: Priority Health Medicare |
$21.41
|
| Rate for Payer: Priority Health SBD |
$30.67
|
| Rate for Payer: Railroad Medicare Medicare |
$21.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.41
|
| Rate for Payer: UHC Medicare Advantage |
$21.41
|
| Rate for Payer: UHCCP Medicaid |
$12.05
|
| Rate for Payer: VA VA |
$21.41
|
|
|
HC DIABETES TRAINING PER 30 MIN
|
Facility
|
OP
|
$149.77
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200007
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$134.79 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Medicare |
$74.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.35
|
| Rate for Payer: BCBS Complete |
$59.91
|
| Rate for Payer: Cash Price |
$119.82
|
| Rate for Payer: Cofinity Commercial |
$104.84
|
| Rate for Payer: Cofinity Commercial |
$128.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.82
|
| Rate for Payer: Healthscope Commercial |
$134.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.30
|
| Rate for Payer: PHP Commercial |
$127.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.35
|
| Rate for Payer: Priority Health SBD |
$94.36
|
| Rate for Payer: UHC Core |
$110.83
|
| Rate for Payer: UHC Exchange |
$110.83
|
|
|
HC DIABETES TRAINING PER 30 MIN
|
Facility
|
IP
|
$149.77
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200007
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$94.36 |
| Max. Negotiated Rate |
$134.79 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.35
|
| Rate for Payer: Cash Price |
$119.82
|
| Rate for Payer: Cofinity Commercial |
$104.84
|
| Rate for Payer: Cofinity Commercial |
$128.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.82
|
| Rate for Payer: Healthscope Commercial |
$134.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.30
|
| Rate for Payer: PHP Commercial |
$127.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.35
|
| Rate for Payer: Priority Health SBD |
$94.36
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W ANGIOPLASTY AND IMAGING
|
Facility
|
IP
|
$11,009.31
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
36100526
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,935.87 |
| Max. Negotiated Rate |
$9,908.38 |
| Rate for Payer: Aetna Commercial |
$9,357.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,156.05
|
| Rate for Payer: Cash Price |
$8,807.45
|
| Rate for Payer: Cofinity Commercial |
$7,706.52
|
| Rate for Payer: Cofinity Commercial |
$9,468.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,706.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,807.45
|
| Rate for Payer: Healthscope Commercial |
$9,908.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,357.91
|
| Rate for Payer: PHP Commercial |
$9,357.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,156.05
|
| Rate for Payer: Priority Health SBD |
$6,935.87
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W ANGIOPLASTY AND IMAGING
|
Facility
|
OP
|
$11,009.31
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
36100526
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,980.47 |
| Max. Negotiated Rate |
$15,652.48 |
| Rate for Payer: Aetna Commercial |
$9,357.91
|
| Rate for Payer: Aetna Medicare |
$5,783.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,156.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,950.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,950.73
|
| Rate for Payer: BCBS Complete |
$3,129.49
|
| Rate for Payer: BCBS MAPPO |
$5,560.58
|
| Rate for Payer: BCN Medicare Advantage |
$5,560.58
|
| Rate for Payer: Cash Price |
$8,807.45
|
| Rate for Payer: Cash Price |
$8,807.45
|
| Rate for Payer: Cofinity Commercial |
$9,468.01
|
| Rate for Payer: Cofinity Commercial |
$7,706.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,706.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,807.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,560.58
|
| Rate for Payer: Healthscope Commercial |
$9,908.38
|
| Rate for Payer: Mclaren Medicaid |
$2,980.47
|
| Rate for Payer: Mclaren Medicare |
$5,560.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,838.61
|
| Rate for Payer: Meridian Medicaid |
$3,129.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,394.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,357.91
|
| Rate for Payer: PACE Medicare |
$5,282.55
|
| Rate for Payer: PACE SWMI |
$5,560.58
|
| Rate for Payer: PHP Commercial |
$9,357.91
|
| Rate for Payer: PHP Medicare Advantage |
$5,560.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,980.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,156.05
|
| Rate for Payer: Priority Health Medicare |
$5,560.58
|
| Rate for Payer: Priority Health SBD |
$6,935.87
|
| Rate for Payer: Railroad Medicare Medicare |
$5,560.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,652.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,560.58
|
| Rate for Payer: UHC Medicare Advantage |
$5,560.58
|
| Rate for Payer: UHCCP Medicaid |
$3,130.61
|
| Rate for Payer: VA VA |
$5,560.58
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W IMAGING
|
Facility
|
IP
|
$2,146.12
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
36100525
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,352.06 |
| Max. Negotiated Rate |
$1,931.51 |
| Rate for Payer: Aetna Commercial |
$1,824.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,394.98
|
| Rate for Payer: Cash Price |
$1,716.90
|
| Rate for Payer: Cofinity Commercial |
$1,502.28
|
| Rate for Payer: Cofinity Commercial |
$1,845.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,502.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,716.90
|
| Rate for Payer: Healthscope Commercial |
$1,931.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.20
|
| Rate for Payer: PHP Commercial |
$1,824.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.98
|
| Rate for Payer: Priority Health SBD |
$1,352.06
|
|
