|
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 |
$42.91 |
| 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: 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
|
| Rate for Payer: UHC Core |
$42.91
|
| Rate for Payer: UHC Exchange |
$42.91
|
|
|
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 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 |
$35.36 |
| 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: 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
|
| Rate for Payer: UHC Core |
$35.36
|
| Rate for Payer: UHC Exchange |
$35.36
|
|
|
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 |
$45.88 |
| 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: BCBS Trust/PPO |
$22.37
|
| Rate for Payer: BCN Commercial |
$22.37
|
| 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: Nomi Health Commercial |
$37.90
|
| 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 HMO/PPO/Tiered Network |
$26.00
|
| Rate for Payer: Priority Health Medicare |
$25.27
|
| Rate for Payer: Priority Health Narrow Network |
$20.80
|
| Rate for Payer: Priority Health SBD |
$32.12
|
| Rate for Payer: Railroad Medicare Medicare |
$25.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.32
|
| 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 |
$50.56 |
| 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: BCBS Trust/PPO |
$19.68
|
| Rate for Payer: BCN Commercial |
$19.68
|
| 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: Nomi Health Commercial |
$33.34
|
| 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 HMO/PPO/Tiered Network |
$22.88
|
| Rate for Payer: Priority Health Medicare |
$22.23
|
| Rate for Payer: Priority Health Narrow Network |
$18.30
|
| Rate for Payer: Priority Health SBD |
$35.39
|
| Rate for Payer: Railroad Medicare Medicare |
$22.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.68
|
| 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 |
$12.80 |
| Max. Negotiated Rate |
$56.78 |
| Rate for Payer: Aetna Commercial |
$53.63
|
| Rate for Payer: Aetna Medicare |
$31.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.01
|
| Rate for Payer: BCBS Complete |
$25.24
|
| Rate for Payer: BCBS Trust/PPO |
$31.00
|
| Rate for Payer: BCN Commercial |
$31.00
|
| Rate for Payer: Cash Price |
$50.47
|
| Rate for Payer: Cash Price |
$50.47
|
| Rate for Payer: Cofinity Commercial |
$54.26
|
| Rate for Payer: Cofinity Commercial |
$44.16
|
| 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 HMO/PPO/Tiered Network |
$16.00
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: Priority Health SBD |
$39.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.31
|
| Rate for Payer: UHC Exchange |
$46.69
|
|
|
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 |
$43.81 |
| 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: BCBS Trust/PPO |
$18.96
|
| Rate for Payer: BCN Commercial |
$18.96
|
| 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: Nomi Health Commercial |
$32.12
|
| 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 HMO/PPO/Tiered Network |
$22.03
|
| Rate for Payer: Priority Health Medicare |
$21.41
|
| Rate for Payer: Priority Health Narrow Network |
$17.62
|
| Rate for Payer: Priority Health SBD |
$30.67
|
| Rate for Payer: Railroad Medicare Medicare |
$21.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.69
|
| 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 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 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 DIABETES TRAINING PER 30 MIN
|
Facility
|
OP
|
$149.77
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200007
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$134.79 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Medicare |
$74.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.35
|
| Rate for Payer: BCBS Complete |
$59.91
|
| Rate for Payer: BCBS Trust/PPO |
$101.89
|
| Rate for Payer: BCN Commercial |
$101.89
|
| Rate for Payer: Cash Price |
$119.82
|
| Rate for Payer: Cash Price |
$119.82
|
| Rate for Payer: Cofinity Commercial |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$104.84
|
| 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 HMO/PPO/Tiered Network |
$34.00
|
| Rate for Payer: Priority Health Narrow Network |
$27.20
|
| Rate for Payer: Priority Health SBD |
$94.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.75
|
| Rate for Payer: UHC Exchange |
$110.83
|
|
|
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 |
$251.64 |
| Max. Negotiated Rate |
$17,557.45 |
| Rate for Payer: Aetna Commercial |
$9,357.91
|
| Rate for Payer: Aetna Medicare |
$5,809.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,156.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,982.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,982.80
|
| Rate for Payer: BCBS Complete |
$3,143.94
|
| Rate for Payer: BCBS MAPPO |
$5,586.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,130.25
|
| Rate for Payer: BCN Commercial |
$2,130.25
|
| Rate for Payer: BCN Medicare Advantage |
$5,586.24
|
| Rate for Payer: Cash Price |
$8,807.45
|
| Rate for Payer: Cash Price |
$8,807.45
|
| 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: Health Alliance Plan Medicare Advantage |
$5,586.24
|
| Rate for Payer: Healthscope Commercial |
$9,908.38
|
| Rate for Payer: Mclaren Medicaid |
$2,994.22
|
| Rate for Payer: Mclaren Medicare |
$5,586.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,865.55
|
| Rate for Payer: Meridian Medicaid |
$3,143.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,424.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,357.91
|
| Rate for Payer: Nomi Health Commercial |
$11,731.10
|
| Rate for Payer: PACE Medicare |
$5,306.93
|
| Rate for Payer: PACE SWMI |
$5,586.24
|
| Rate for Payer: PHP Commercial |
$9,357.91
|
| Rate for Payer: PHP Medicare Advantage |
$5,586.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,994.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,156.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,557.45
|
| Rate for Payer: Priority Health Medicare |
$5,586.24
|
| Rate for Payer: Priority Health Narrow Network |
$14,045.96
|
| Rate for Payer: Priority Health SBD |
$6,935.87
|
| Rate for Payer: Railroad Medicare Medicare |
$5,586.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.64
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,586.24
|
| Rate for Payer: UHC Exchange |
$8,174.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,586.24
|
| Rate for Payer: UHCCP Medicaid |
$3,145.05
|
| Rate for Payer: VA VA |
$5,586.24
|
|
|
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 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
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W IMAGING
|
Facility
|
OP
|
$2,146.12
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
36100525
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$176.36 |
| Max. Negotiated Rate |
$4,783.71 |
| Rate for Payer: Aetna Commercial |
$1,824.20
|
| Rate for Payer: Aetna Medicare |
$1,582.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,394.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,902.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,902.54
|
| Rate for Payer: BCBS Complete |
$856.60
|
| Rate for Payer: BCBS MAPPO |
$1,522.03
|
| Rate for Payer: BCBS Trust/PPO |
$957.73
|
| Rate for Payer: BCN Commercial |
$957.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,522.03
|
| Rate for Payer: Cash Price |
$1,716.90
|
| Rate for Payer: Cash Price |
$1,716.90
|
| 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: Health Alliance Plan Medicare Advantage |
$1,522.03
|
| Rate for Payer: Healthscope Commercial |
$1,931.51
|
| Rate for Payer: Mclaren Medicaid |
$815.81
|
| Rate for Payer: Mclaren Medicare |
$1,522.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,598.13
|
| Rate for Payer: Meridian Medicaid |
$856.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,750.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.20
|
| Rate for Payer: Nomi Health Commercial |
$3,196.26
|
| Rate for Payer: PACE Medicare |
$1,445.93
|
| Rate for Payer: PACE SWMI |
$1,522.03
|
| Rate for Payer: PHP Commercial |
$1,824.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,522.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$815.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,783.71
|
| Rate for Payer: Priority Health Medicare |
$1,522.03
|
| Rate for Payer: Priority Health Narrow Network |
$3,826.97
|
| Rate for Payer: Priority Health SBD |
$1,352.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1,522.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.36
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,522.03
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,522.03
|
| Rate for Payer: UHCCP Medicaid |
$856.90
|
| Rate for Payer: VA VA |
$1,522.03
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W STENT AND IMAGING
|
Facility
|
OP
|
$18,535.04
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
36100527
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$331.76 |
| Max. Negotiated Rate |
$34,922.52 |
| Rate for Payer: Aetna Commercial |
$15,754.78
|
| Rate for Payer: Aetna Medicare |
$11,555.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,047.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,889.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,889.08
|
| Rate for Payer: BCBS Complete |
$6,253.42
|
| Rate for Payer: BCBS MAPPO |
$11,111.26
|
| Rate for Payer: BCBS Trust/PPO |
$5,892.02
|
| Rate for Payer: BCN Commercial |
$5,892.02
|
| Rate for Payer: BCN Medicare Advantage |
$11,111.26
|
| Rate for Payer: Cash Price |
$14,828.03
|
| Rate for Payer: Cash Price |
$14,828.03
|
| Rate for Payer: Cash Price |
$14,828.03
|
| Rate for Payer: Cofinity Commercial |
$12,974.53
|
| Rate for Payer: Cofinity Commercial |
$15,940.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,974.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,828.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,111.26
|
| Rate for Payer: Healthscope Commercial |
$16,681.54
|
| Rate for Payer: Mclaren Medicaid |
$5,955.64
|
| Rate for Payer: Mclaren Medicare |
$11,111.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,666.82
|
| Rate for Payer: Meridian Medicaid |
$6,253.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,777.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,754.78
|
| Rate for Payer: Nomi Health Commercial |
$23,333.65
|
| Rate for Payer: PACE Medicare |
$10,555.70
|
| Rate for Payer: PACE SWMI |
$11,111.26
|
| Rate for Payer: PHP Commercial |
$15,754.78
|
| Rate for Payer: PHP Medicare Advantage |
$11,111.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,955.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,047.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,922.52
|
| Rate for Payer: Priority Health Medicare |
$11,111.26
|
| Rate for Payer: Priority Health Narrow Network |
$27,938.02
|
| Rate for Payer: Priority Health SBD |
$11,677.08
|
| Rate for Payer: Railroad Medicare Medicare |
$11,111.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$331.76
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,111.26
|
| Rate for Payer: UHC Exchange |
$9,445.00
|
| Rate for Payer: UHC Medicare Advantage |
$11,111.26
|
| Rate for Payer: UHCCP Medicaid |
$6,255.64
|
| Rate for Payer: VA VA |
$11,111.26
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W STENT AND IMAGING
|
Facility
|
IP
|
$18,535.04
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
36100527
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,677.08 |
| Max. Negotiated Rate |
$16,681.54 |
| Rate for Payer: Aetna Commercial |
$15,754.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,047.78
|
| Rate for Payer: Cash Price |
$14,828.03
|
| Rate for Payer: Cofinity Commercial |
$12,974.53
|
| Rate for Payer: Cofinity Commercial |
$15,940.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,974.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,828.03
|
| Rate for Payer: Healthscope Commercial |
$16,681.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,754.78
|
| Rate for Payer: PHP Commercial |
$15,754.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,047.78
|
| Rate for Payer: Priority Health SBD |
$11,677.08
|
|
|
HC DIALYSIS CATH LVL 10 LONG TERM
|
Facility
|
OP
|
$1,047.44
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$418.98 |
| Max. Negotiated Rate |
$942.70 |
| Rate for Payer: Aetna Commercial |
$890.32
|
| Rate for Payer: Aetna Medicare |
$523.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$680.84
|
| Rate for Payer: BCBS Complete |
$418.98
|
| Rate for Payer: Cash Price |
$837.95
|
| Rate for Payer: Cofinity Commercial |
$733.21
|
| Rate for Payer: Cofinity Commercial |
$900.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$733.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$837.95
|
| Rate for Payer: Healthscope Commercial |
$942.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.32
|
| Rate for Payer: PHP Commercial |
$890.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.84
|
| Rate for Payer: Priority Health SBD |
$659.89
|
|
|
HC DIALYSIS CATH LVL 10 LONG TERM
|
Facility
|
IP
|
$1,047.44
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.89 |
| Max. Negotiated Rate |
$942.70 |
| Rate for Payer: Aetna Commercial |
$890.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$680.84
|
| Rate for Payer: Cash Price |
$837.95
|
| Rate for Payer: Cofinity Commercial |
$733.21
|
| Rate for Payer: Cofinity Commercial |
$900.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$733.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$837.95
|
| Rate for Payer: Healthscope Commercial |
$942.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.32
|
| Rate for Payer: PHP Commercial |
$890.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.84
|
| Rate for Payer: Priority Health SBD |
$659.89
|
|
|
HC DIALYSIS CATH LVL 11 LONG TERM
|
Facility
|
IP
|
$1,171.97
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$738.34 |
| Max. Negotiated Rate |
$1,054.77 |
| Rate for Payer: Aetna Commercial |
$996.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.78
|
| Rate for Payer: Cash Price |
$937.58
|
| Rate for Payer: Cofinity Commercial |
$1,007.89
|
| Rate for Payer: Cofinity Commercial |
$820.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$820.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$937.58
|
| Rate for Payer: Healthscope Commercial |
$1,054.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$996.17
|
| Rate for Payer: PHP Commercial |
$996.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.78
|
| Rate for Payer: Priority Health SBD |
$738.34
|
|
|
HC DIALYSIS CATH LVL 11 LONG TERM
|
Facility
|
OP
|
$1,171.97
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.79 |
| Max. Negotiated Rate |
$1,054.77 |
| Rate for Payer: Aetna Commercial |
$996.17
|
| Rate for Payer: Aetna Medicare |
$585.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.78
|
| Rate for Payer: BCBS Complete |
$468.79
|
| Rate for Payer: Cash Price |
$937.58
|
| Rate for Payer: Cofinity Commercial |
$1,007.89
|
| Rate for Payer: Cofinity Commercial |
$820.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$820.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$937.58
|
| Rate for Payer: Healthscope Commercial |
$1,054.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$996.17
|
| Rate for Payer: PHP Commercial |
$996.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.78
|
| Rate for Payer: Priority Health SBD |
$738.34
|
|
|
HC DIALYSIS CATH LVL 13 LONG TERM
|
Facility
|
OP
|
$1,380.06
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$552.02 |
| Max. Negotiated Rate |
$1,242.05 |
| Rate for Payer: Aetna Commercial |
$1,173.05
|
| Rate for Payer: Aetna Medicare |
$690.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.04
|
| Rate for Payer: BCBS Complete |
$552.02
|
| Rate for Payer: Cash Price |
$1,104.05
|
| Rate for Payer: Cofinity Commercial |
$1,186.85
|
| Rate for Payer: Cofinity Commercial |
$966.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$966.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.05
|
| Rate for Payer: Healthscope Commercial |
$1,242.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.05
|
| Rate for Payer: PHP Commercial |
$1,173.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.04
|
| Rate for Payer: Priority Health SBD |
$869.44
|
|
|
HC DIALYSIS CATH LVL 13 LONG TERM
|
Facility
|
IP
|
$1,380.06
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$869.44 |
| Max. Negotiated Rate |
$1,242.05 |
| Rate for Payer: Aetna Commercial |
$1,173.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.04
|
| Rate for Payer: Cash Price |
$1,104.05
|
| Rate for Payer: Cofinity Commercial |
$1,186.85
|
| Rate for Payer: Cofinity Commercial |
$966.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$966.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.05
|
| Rate for Payer: Healthscope Commercial |
$1,242.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.05
|
| Rate for Payer: PHP Commercial |
$1,173.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.04
|
| Rate for Payer: Priority Health SBD |
$869.44
|
|
