|
HC DEVICE NOT RETURNED TYPE III HOME STUDY W/EFFORT & FLOW
|
Facility
|
OP
|
$1,548.00
|
|
| Hospital Charge Code |
27000603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$272.91 |
| Max. Negotiated Rate |
$1,393.20 |
| Rate for Payer: Aetna Commercial |
$1,315.80
|
| Rate for Payer: Aetna Medicare |
$402.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$483.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$483.75
|
| Rate for Payer: BCBS Complete |
$286.53
|
| Rate for Payer: BCBS MAPPO |
$387.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,272.61
|
| Rate for Payer: BCN Commercial |
$1,272.61
|
| Rate for Payer: BCN Medicare Advantage |
$387.00
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cofinity Commercial |
$1,331.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.00
|
| Rate for Payer: Healthscope Commercial |
$1,393.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,161.00
|
| Rate for Payer: Mclaren Medicaid |
$272.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$406.35
|
| Rate for Payer: Meridian Medicaid |
$286.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$445.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$425.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,315.80
|
| Rate for Payer: Nomi Health Commercial |
$1,269.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,161.00
|
| Rate for Payer: PACE Senior Care Partners |
$367.65
|
| Rate for Payer: PACE SWMI |
$387.00
|
| Rate for Payer: PHP Commercial |
$1,315.80
|
| Rate for Payer: PHP Medicare Advantage |
$387.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$272.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,346.76
|
| Rate for Payer: Priority Health Medicare |
$390.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,077.41
|
| Rate for Payer: Railroad Medicare Medicare |
$387.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,362.24
|
| Rate for Payer: UHC Core |
$1,292.58
|
| Rate for Payer: UHC Exchange |
$387.00
|
| Rate for Payer: UHC Medicaid |
$272.91
|
| Rate for Payer: UHC Medicare Advantage |
$387.00
|
| Rate for Payer: UHCCP Medicaid |
$272.91
|
| Rate for Payer: VA VA |
$387.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,161.00
|
|
|
HC DEVICE NOT RETURNED TYPE III HOME STUDY W/EFFORT & FLOW
|
Facility
|
IP
|
$1,548.00
|
|
| Hospital Charge Code |
27000603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,077.41 |
| Max. Negotiated Rate |
$1,393.20 |
| Rate for Payer: Aetna Commercial |
$1,315.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,278.49
|
| Rate for Payer: BCN Commercial |
$1,278.49
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cofinity Commercial |
$1,331.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.40
|
| Rate for Payer: Healthscope Commercial |
$1,393.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,161.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,315.80
|
| Rate for Payer: Nomi Health Commercial |
$1,269.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,161.00
|
| Rate for Payer: PHP Commercial |
$1,315.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,346.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,077.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,362.24
|
| Rate for Payer: UHC Core |
$1,292.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,161.00
|
|
|
HC DEXA BONE DENSITY
|
Facility
|
OP
|
$552.45
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
32000260
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.40 |
| Max. Negotiated Rate |
$497.20 |
| Rate for Payer: Aetna Commercial |
$469.58
|
| Rate for Payer: Aetna Medicare |
$143.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$172.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$172.64
|
| Rate for Payer: BCBS Complete |
$102.26
|
| Rate for Payer: BCBS MAPPO |
$138.11
|
| Rate for Payer: BCBS Trust/PPO |
$454.17
|
| Rate for Payer: BCN Commercial |
$454.17
|
| Rate for Payer: BCN Medicare Advantage |
$138.11
|
| Rate for Payer: Cash Price |
$441.96
|
| Rate for Payer: Cofinity Commercial |
$475.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.11
|
| Rate for Payer: Healthscope Commercial |
$497.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$414.34
|
| Rate for Payer: Mclaren Medicaid |
$97.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.02
|
| Rate for Payer: Meridian Medicaid |
$102.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$151.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.58
|
| Rate for Payer: Nomi Health Commercial |
$453.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.34
|
| Rate for Payer: PACE Senior Care Partners |
$131.21
|
| Rate for Payer: PACE SWMI |
$138.11
|
| Rate for Payer: PHP Commercial |
$469.58
|
| Rate for Payer: PHP Medicare Advantage |
$138.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$480.63
|
| Rate for Payer: Priority Health Medicare |
$139.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$384.51
|
| Rate for Payer: Railroad Medicare Medicare |
$138.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.16
|
| Rate for Payer: UHC Core |
$461.30
|
| Rate for Payer: UHC Exchange |
$138.11
|
| Rate for Payer: UHC Medicaid |
$97.40
|
| Rate for Payer: UHC Medicare Advantage |
$138.11
|
| Rate for Payer: UHCCP Medicaid |
$97.40
|
| Rate for Payer: VA VA |
$138.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$414.34
|
|
|
HC DEXA BONE DENSITY
|
Facility
|
IP
|
$552.45
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
32000260
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$384.51 |
| Max. Negotiated Rate |
$497.20 |
| Rate for Payer: Aetna Commercial |
$469.58
|
| Rate for Payer: BCBS Trust/PPO |
$456.27
|
| Rate for Payer: BCN Commercial |
$456.27
|
| Rate for Payer: Cash Price |
$441.96
|
| Rate for Payer: Cofinity Commercial |
$475.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.96
|
| Rate for Payer: Healthscope Commercial |
$497.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$414.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.58
|
| Rate for Payer: Nomi Health Commercial |
$453.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.34
|
| Rate for Payer: PHP Commercial |
$469.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$480.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$384.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.16
|
| Rate for Payer: UHC Core |
$461.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$414.34
|
|
|
HC DEXA BONE DENSITY APPENDICULAR
|
Facility
|
IP
|
$208.31
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
32000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$144.98 |
| Max. Negotiated Rate |
$187.48 |
| Rate for Payer: Aetna Commercial |
$177.06
|
| Rate for Payer: BCBS Trust/PPO |
$172.04
|
| Rate for Payer: BCN Commercial |
$172.04
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cofinity Commercial |
$179.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.65
|
| Rate for Payer: Healthscope Commercial |
$187.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.06
|
| Rate for Payer: Nomi Health Commercial |
$170.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.23
|
| Rate for Payer: PHP Commercial |
$177.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$181.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.31
|
| Rate for Payer: UHC Core |
$173.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.23
|
|
|
HC DEXA BONE DENSITY APPENDICULAR
|
Facility
|
OP
|
$208.31
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
32000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.73 |
| Max. Negotiated Rate |
$187.48 |
| Rate for Payer: Aetna Commercial |
$177.06
|
| Rate for Payer: Aetna Medicare |
$54.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.10
|
| Rate for Payer: BCBS Complete |
$38.56
|
| Rate for Payer: BCBS MAPPO |
$52.08
|
| Rate for Payer: BCBS Trust/PPO |
$171.25
|
| Rate for Payer: BCN Commercial |
$171.25
|
| Rate for Payer: BCN Medicare Advantage |
$52.08
|
| Rate for Payer: Cash Price |
$166.65
|
| Rate for Payer: Cofinity Commercial |
$179.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.08
|
| Rate for Payer: Healthscope Commercial |
$187.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.23
|
| Rate for Payer: Mclaren Medicaid |
$36.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.68
|
| Rate for Payer: Meridian Medicaid |
$38.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.06
|
| Rate for Payer: Nomi Health Commercial |
$170.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.23
|
| Rate for Payer: PACE Senior Care Partners |
$49.47
|
| Rate for Payer: PACE SWMI |
$52.08
|
| Rate for Payer: PHP Commercial |
$177.06
|
| Rate for Payer: PHP Medicare Advantage |
$52.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$181.23
|
| Rate for Payer: Priority Health Medicare |
$52.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.98
|
| Rate for Payer: Railroad Medicare Medicare |
$52.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.31
|
| Rate for Payer: UHC Core |
$173.94
|
| Rate for Payer: UHC Exchange |
$52.08
|
| Rate for Payer: UHC Medicaid |
$36.73
|
| Rate for Payer: UHC Medicare Advantage |
$52.08
|
| Rate for Payer: UHCCP Medicaid |
$36.73
|
| Rate for Payer: VA VA |
$52.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.23
|
|
|
HC DEXAMETHASONE DEXA
|
Facility
|
IP
|
$153.44
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100751
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.79 |
| Max. Negotiated Rate |
$138.10 |
| Rate for Payer: Aetna Commercial |
$130.42
|
| Rate for Payer: BCBS Trust/PPO |
$126.73
|
| Rate for Payer: BCN Commercial |
$126.73
|
| Rate for Payer: Cash Price |
$122.75
|
| Rate for Payer: Cofinity Commercial |
$131.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.75
|
| Rate for Payer: Healthscope Commercial |
$138.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.42
|
| Rate for Payer: Nomi Health Commercial |
$125.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.08
|
| Rate for Payer: PHP Commercial |
$130.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$133.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.03
|
| Rate for Payer: UHC Core |
$128.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.08
|
|
|
HC DEXAMETHASONE DEXA
|
Facility
|
OP
|
$153.44
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100751
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$138.10 |
| Rate for Payer: Aetna Commercial |
$130.42
|
| Rate for Payer: Aetna Medicare |
$39.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.95
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: BCBS MAPPO |
$38.36
|
| Rate for Payer: BCBS Trust/PPO |
$126.14
|
| Rate for Payer: BCN Commercial |
$126.14
|
| Rate for Payer: BCN Medicare Advantage |
$38.36
|
| Rate for Payer: Cash Price |
$122.75
|
| Rate for Payer: Cofinity Commercial |
$131.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.36
|
| Rate for Payer: Healthscope Commercial |
$138.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.08
|
| Rate for Payer: Mclaren Medicaid |
$27.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.28
|
| Rate for Payer: Meridian Medicaid |
$28.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.42
|
| Rate for Payer: Nomi Health Commercial |
$125.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.08
|
| Rate for Payer: PACE Senior Care Partners |
$36.44
|
| Rate for Payer: PACE SWMI |
$38.36
|
| Rate for Payer: PHP Commercial |
$130.42
|
| Rate for Payer: PHP Medicare Advantage |
$38.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$133.49
|
| Rate for Payer: Priority Health Medicare |
$38.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.79
|
| Rate for Payer: Railroad Medicare Medicare |
$38.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.03
|
| Rate for Payer: UHC Core |
$128.12
|
| Rate for Payer: UHC Exchange |
$38.36
|
| Rate for Payer: UHC Medicaid |
$27.05
|
| Rate for Payer: UHC Medicare Advantage |
$38.36
|
| Rate for Payer: UHCCP Medicaid |
$27.05
|
| Rate for Payer: VA VA |
$38.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.08
|
|
|
HC DEXAMETHASONE SODIUM PHOS, PER 1 MG
|
Facility
|
IP
|
$10.61
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: BCBS Trust/PPO |
$8.76
|
| Rate for Payer: BCN Commercial |
$8.76
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cofinity Commercial |
$9.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$9.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.02
|
| Rate for Payer: Nomi Health Commercial |
$8.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: PHP Commercial |
$9.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.34
|
| Rate for Payer: UHC Core |
$8.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.96
|
|
|
HC DEXAMETHASONE SODIUM PHOS, PER 1 MG
|
Facility
|
OP
|
$10.61
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Aetna Medicare |
$2.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.32
|
| Rate for Payer: BCBS Complete |
$1.96
|
| Rate for Payer: BCBS MAPPO |
$2.65
|
| Rate for Payer: BCBS Trust/PPO |
$8.72
|
| Rate for Payer: BCN Commercial |
$8.72
|
| Rate for Payer: BCN Medicare Advantage |
$2.65
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cofinity Commercial |
$9.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.65
|
| Rate for Payer: Healthscope Commercial |
$9.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.96
|
| Rate for Payer: Mclaren Medicaid |
$1.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.79
|
| Rate for Payer: Meridian Medicaid |
$1.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.02
|
| Rate for Payer: Nomi Health Commercial |
$8.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: PACE Senior Care Partners |
$2.52
|
| Rate for Payer: PACE SWMI |
$2.65
|
| Rate for Payer: PHP Commercial |
$9.02
|
| Rate for Payer: PHP Medicare Advantage |
$2.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$2.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.34
|
| Rate for Payer: UHC Core |
$8.86
|
| Rate for Payer: UHC Exchange |
$2.65
|
| Rate for Payer: UHC Medicaid |
$1.87
|
| Rate for Payer: UHC Medicare Advantage |
$2.65
|
| Rate for Payer: UHCCP Medicaid |
$1.87
|
| Rate for Payer: VA VA |
$2.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.96
|
|
|
HC DGTZ GLS MCRSCP MPHMTRC ALYS
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0763T
|
| Hospital Charge Code |
31200021
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$15.27
|
| 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: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.80
|
| Rate for Payer: UHC Core |
$15.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
HC DGTZ GLS MCRSCP MPHMTRC ALYS
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0763T
|
| Hospital Charge Code |
31200021
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$4.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.97
|
| Rate for Payer: BCBS Complete |
$3.53
|
| Rate for Payer: BCBS MAPPO |
$4.77
|
| Rate for Payer: BCBS Trust/PPO |
$15.69
|
| Rate for Payer: BCN Commercial |
$15.69
|
| Rate for Payer: BCN Medicare Advantage |
$4.77
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.77
|
| Rate for Payer: Healthscope Commercial |
$17.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Mclaren Medicaid |
$3.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.01
|
| Rate for Payer: Meridian Medicaid |
$3.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PACE Senior Care Partners |
$4.53
|
| Rate for Payer: PACE SWMI |
$4.77
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: PHP Medicare Advantage |
$4.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.61
|
| Rate for Payer: Priority Health Medicare |
$4.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.29
|
| Rate for Payer: Railroad Medicare Medicare |
$4.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.80
|
| Rate for Payer: UHC Core |
$15.94
|
| Rate for Payer: UHC Exchange |
$4.77
|
| Rate for Payer: UHC Medicaid |
$3.37
|
| Rate for Payer: UHC Medicare Advantage |
$4.77
|
| Rate for Payer: UHCCP Medicaid |
$3.37
|
| Rate for Payer: VA VA |
$4.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL II
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0751T
|
| Hospital Charge Code |
31200009
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$4.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.97
|
| Rate for Payer: BCBS Complete |
$3.53
|
| Rate for Payer: BCBS MAPPO |
$4.77
|
| Rate for Payer: BCBS Trust/PPO |
$15.69
|
| Rate for Payer: BCN Commercial |
$15.69
|
| Rate for Payer: BCN Medicare Advantage |
$4.77
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.77
|
| Rate for Payer: Healthscope Commercial |
$17.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Mclaren Medicaid |
$3.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.01
|
| Rate for Payer: Meridian Medicaid |
$3.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PACE Senior Care Partners |
$4.53
|
| Rate for Payer: PACE SWMI |
$4.77
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: PHP Medicare Advantage |
$4.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.61
|
| Rate for Payer: Priority Health Medicare |
$4.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.29
|
| Rate for Payer: Railroad Medicare Medicare |
$4.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.80
|
| Rate for Payer: UHC Core |
$15.94
|
| Rate for Payer: UHC Exchange |
$4.77
|
| Rate for Payer: UHC Medicaid |
$3.37
|
| Rate for Payer: UHC Medicare Advantage |
$4.77
|
| Rate for Payer: UHCCP Medicaid |
$3.37
|
| Rate for Payer: VA VA |
$4.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL II
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0751T
|
| Hospital Charge Code |
31200009
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$15.27
|
| 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: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.80
|
| Rate for Payer: UHC Core |
$15.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL IV
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0753T
|
| Hospital Charge Code |
31200011
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$4.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.97
|
| Rate for Payer: BCBS Complete |
$3.53
|
| Rate for Payer: BCBS MAPPO |
$4.77
|
| Rate for Payer: BCBS Trust/PPO |
$15.69
|
| Rate for Payer: BCN Commercial |
$15.69
|
| Rate for Payer: BCN Medicare Advantage |
$4.77
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.77
|
| Rate for Payer: Healthscope Commercial |
$17.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Mclaren Medicaid |
$3.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.01
|
| Rate for Payer: Meridian Medicaid |
$3.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PACE Senior Care Partners |
$4.53
|
| Rate for Payer: PACE SWMI |
$4.77
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: PHP Medicare Advantage |
$4.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.61
|
| Rate for Payer: Priority Health Medicare |
$4.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.29
|
| Rate for Payer: Railroad Medicare Medicare |
$4.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.80
|
| Rate for Payer: UHC Core |
$15.94
|
| Rate for Payer: UHC Exchange |
$4.77
|
| Rate for Payer: UHC Medicaid |
$3.37
|
| Rate for Payer: UHC Medicare Advantage |
$4.77
|
| Rate for Payer: UHCCP Medicaid |
$3.37
|
| Rate for Payer: VA VA |
$4.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL IV
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0753T
|
| Hospital Charge Code |
31200011
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$15.27
|
| 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: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.80
|
| Rate for Payer: UHC Core |
$15.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL V
|
Facility
|
OP
|
$38.16
|
|
|
Service Code
|
CPT 0754T
|
| Hospital Charge Code |
31200012
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$34.34 |
| Rate for Payer: Aetna Commercial |
$32.44
|
| Rate for Payer: Aetna Medicare |
$9.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.93
|
| Rate for Payer: BCBS Complete |
$7.06
|
| Rate for Payer: BCBS MAPPO |
$9.54
|
| Rate for Payer: BCBS Trust/PPO |
$31.37
|
| Rate for Payer: BCN Commercial |
$31.37
|
| Rate for Payer: BCN Medicare Advantage |
$9.54
|
| Rate for Payer: Cash Price |
$30.53
|
| Rate for Payer: Cofinity Commercial |
$32.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.54
|
| Rate for Payer: Healthscope Commercial |
$34.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.62
|
| Rate for Payer: Mclaren Medicaid |
$6.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.02
|
| Rate for Payer: Meridian Medicaid |
$7.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.44
|
| Rate for Payer: Nomi Health Commercial |
$31.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.62
|
| Rate for Payer: PACE Senior Care Partners |
$9.06
|
| Rate for Payer: PACE SWMI |
$9.54
|
| Rate for Payer: PHP Commercial |
$32.44
|
| Rate for Payer: PHP Medicare Advantage |
$9.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.20
|
| Rate for Payer: Priority Health Medicare |
$9.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.56
|
| Rate for Payer: Railroad Medicare Medicare |
$9.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.58
|
| Rate for Payer: UHC Core |
$31.86
|
| Rate for Payer: UHC Exchange |
$9.54
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHC Medicare Advantage |
$9.54
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: VA VA |
$9.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.62
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL V
|
Facility
|
IP
|
$38.16
|
|
|
Service Code
|
CPT 0754T
|
| Hospital Charge Code |
31200012
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$26.56 |
| Max. Negotiated Rate |
$34.34 |
| Rate for Payer: Aetna Commercial |
$32.44
|
| Rate for Payer: BCBS Trust/PPO |
$31.52
|
| Rate for Payer: BCN Commercial |
$31.52
|
| Rate for Payer: Cash Price |
$30.53
|
| Rate for Payer: Cofinity Commercial |
$32.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.53
|
| Rate for Payer: Healthscope Commercial |
$34.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.44
|
| Rate for Payer: Nomi Health Commercial |
$31.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.62
|
| Rate for Payer: PHP Commercial |
$32.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.58
|
| Rate for Payer: UHC Core |
$31.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.62
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL VI
|
Facility
|
OP
|
$38.16
|
|
|
Service Code
|
CPT 0755T
|
| Hospital Charge Code |
31200013
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$34.34 |
| Rate for Payer: Aetna Commercial |
$32.44
|
| Rate for Payer: Aetna Medicare |
$9.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.93
|
| Rate for Payer: BCBS Complete |
$7.06
|
| Rate for Payer: BCBS MAPPO |
$9.54
|
| Rate for Payer: BCBS Trust/PPO |
$31.37
|
| Rate for Payer: BCN Commercial |
$31.37
|
| Rate for Payer: BCN Medicare Advantage |
$9.54
|
| Rate for Payer: Cash Price |
$30.53
|
| Rate for Payer: Cofinity Commercial |
$32.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.54
|
| Rate for Payer: Healthscope Commercial |
$34.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.62
|
| Rate for Payer: Mclaren Medicaid |
$6.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.02
|
| Rate for Payer: Meridian Medicaid |
$7.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.44
|
| Rate for Payer: Nomi Health Commercial |
$31.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.62
|
| Rate for Payer: PACE Senior Care Partners |
$9.06
|
| Rate for Payer: PACE SWMI |
$9.54
|
| Rate for Payer: PHP Commercial |
$32.44
|
| Rate for Payer: PHP Medicare Advantage |
$9.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.20
|
| Rate for Payer: Priority Health Medicare |
$9.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.56
|
| Rate for Payer: Railroad Medicare Medicare |
$9.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.58
|
| Rate for Payer: UHC Core |
$31.86
|
| Rate for Payer: UHC Exchange |
$9.54
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHC Medicare Advantage |
$9.54
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: VA VA |
$9.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.62
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL VI
|
Facility
|
IP
|
$38.16
|
|
|
Service Code
|
CPT 0755T
|
| Hospital Charge Code |
31200013
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$26.56 |
| Max. Negotiated Rate |
$34.34 |
| Rate for Payer: Aetna Commercial |
$32.44
|
| Rate for Payer: BCBS Trust/PPO |
$31.52
|
| Rate for Payer: BCN Commercial |
$31.52
|
| Rate for Payer: Cash Price |
$30.53
|
| Rate for Payer: Cofinity Commercial |
$32.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.53
|
| Rate for Payer: Healthscope Commercial |
$34.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.44
|
| Rate for Payer: Nomi Health Commercial |
$31.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.62
|
| Rate for Payer: PHP Commercial |
$32.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.58
|
| Rate for Payer: UHC Core |
$31.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.62
|
|
|
HC DGTZ GLS MCRSCP SLD LVL III
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0752T
|
| Hospital Charge Code |
31200010
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$4.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.97
|
| Rate for Payer: BCBS Complete |
$3.53
|
| Rate for Payer: BCBS MAPPO |
$4.77
|
| Rate for Payer: BCBS Trust/PPO |
$15.69
|
| Rate for Payer: BCN Commercial |
$15.69
|
| Rate for Payer: BCN Medicare Advantage |
$4.77
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.77
|
| Rate for Payer: Healthscope Commercial |
$17.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Mclaren Medicaid |
$3.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.01
|
| Rate for Payer: Meridian Medicaid |
$3.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PACE Senior Care Partners |
$4.53
|
| Rate for Payer: PACE SWMI |
$4.77
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: PHP Medicare Advantage |
$4.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.61
|
| Rate for Payer: Priority Health Medicare |
$4.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.29
|
| Rate for Payer: Railroad Medicare Medicare |
$4.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.80
|
| Rate for Payer: UHC Core |
$15.94
|
| Rate for Payer: UHC Exchange |
$4.77
|
| Rate for Payer: UHC Medicaid |
$3.37
|
| Rate for Payer: UHC Medicare Advantage |
$4.77
|
| Rate for Payer: UHCCP Medicaid |
$3.37
|
| Rate for Payer: VA VA |
$4.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
HC DGTZ GLS MCRSCP SLD LVL III
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0752T
|
| Hospital Charge Code |
31200010
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$15.27
|
| 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: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.80
|
| Rate for Payer: UHC Core |
$15.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
HC DGTZ GLS MCRSCP SLD SPC GRPI
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0756T
|
| Hospital Charge Code |
31200014
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$15.27
|
| 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: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.80
|
| Rate for Payer: UHC Core |
$15.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
HC DGTZ GLS MCRSCP SLD SPC GRPI
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0756T
|
| Hospital Charge Code |
31200014
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$4.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.97
|
| Rate for Payer: BCBS Complete |
$3.53
|
| Rate for Payer: BCBS MAPPO |
$4.77
|
| Rate for Payer: BCBS Trust/PPO |
$15.69
|
| Rate for Payer: BCN Commercial |
$15.69
|
| Rate for Payer: BCN Medicare Advantage |
$4.77
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.77
|
| Rate for Payer: Healthscope Commercial |
$17.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Mclaren Medicaid |
$3.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.01
|
| Rate for Payer: Meridian Medicaid |
$3.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PACE Senior Care Partners |
$4.53
|
| Rate for Payer: PACE SWMI |
$4.77
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: PHP Medicare Advantage |
$4.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.61
|
| Rate for Payer: Priority Health Medicare |
$4.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.29
|
| Rate for Payer: Railroad Medicare Medicare |
$4.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.80
|
| Rate for Payer: UHC Core |
$15.94
|
| Rate for Payer: UHC Exchange |
$4.77
|
| Rate for Payer: UHC Medicaid |
$3.37
|
| Rate for Payer: UHC Medicare Advantage |
$4.77
|
| Rate for Payer: UHCCP Medicaid |
$3.37
|
| Rate for Payer: VA VA |
$4.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
HC DGTZ GLS MCRSCP SL IMM 1ST
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0760T
|
| Hospital Charge Code |
31200018
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$15.27
|
| 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: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.80
|
| Rate for Payer: UHC Core |
$15.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
