|
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
|
|
|
HC DGTZ GLS MCRSCP SL IMM EA 1
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0761T
|
| Hospital Charge Code |
31200019
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$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 EA 1
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0761T
|
| Hospital Charge Code |
31200019
|
|
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 SL IMM EA M
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0762T
|
| Hospital Charge Code |
31200020
|
|
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 EA M
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0762T
|
| Hospital Charge Code |
31200020
|
|
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 SL SPC GRPII
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0757T
|
| Hospital Charge Code |
31200015
|
|
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 SL SPC GRPII
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0757T
|
| Hospital Charge Code |
31200015
|
|
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 SPC HCHEM
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0758T
|
| Hospital Charge Code |
31200016
|
|
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 SPC HCHEM
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0758T
|
| Hospital Charge Code |
31200016
|
|
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 SL SP GRPIII
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0759T
|
| Hospital Charge Code |
31200017
|
|
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 SP GRPIII
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0759T
|
| Hospital Charge Code |
31200017
|
|
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 DHEA
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
30100187
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna Commercial |
$44.20
|
| Rate for Payer: Aetna Medicare |
$13.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.25
|
| Rate for Payer: BCBS Complete |
$9.63
|
| Rate for Payer: BCBS MAPPO |
$13.00
|
| Rate for Payer: BCBS Trust/PPO |
$42.75
|
| Rate for Payer: BCN Commercial |
$42.75
|
| Rate for Payer: BCN Medicare Advantage |
$13.00
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$44.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.00
|
| Rate for Payer: Healthscope Commercial |
$46.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.00
|
| Rate for Payer: Mclaren Medicaid |
$9.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.65
|
| Rate for Payer: Meridian Medicaid |
$9.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.20
|
| Rate for Payer: Nomi Health Commercial |
$42.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: PACE Senior Care Partners |
$12.35
|
| Rate for Payer: PACE SWMI |
$13.00
|
| Rate for Payer: PHP Commercial |
$44.20
|
| Rate for Payer: PHP Medicare Advantage |
$13.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.24
|
| Rate for Payer: Priority Health Medicare |
$13.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.19
|
| Rate for Payer: Railroad Medicare Medicare |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.76
|
| Rate for Payer: UHC Core |
$43.42
|
| Rate for Payer: UHC Exchange |
$13.00
|
| Rate for Payer: UHC Medicaid |
$9.17
|
| Rate for Payer: UHC Medicare Advantage |
$13.00
|
| Rate for Payer: UHCCP Medicaid |
$9.17
|
| Rate for Payer: VA VA |
$13.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.00
|
|
|
HC DHEA
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
30100187
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.19 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna Commercial |
$44.20
|
| Rate for Payer: BCBS Trust/PPO |
$42.95
|
| Rate for Payer: BCN Commercial |
$42.95
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$44.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.60
|
| Rate for Payer: Healthscope Commercial |
$46.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.20
|
| Rate for Payer: Nomi Health Commercial |
$42.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: PHP Commercial |
$44.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.76
|
| Rate for Payer: UHC Core |
$43.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.00
|
|
|
HC DHEA-SULFATE
|
Facility
|
OP
|
$57.30
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
30100188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$51.57 |
| Rate for Payer: Aetna Commercial |
$48.70
|
| Rate for Payer: Aetna Medicare |
$14.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.91
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: BCBS MAPPO |
$14.32
|
| Rate for Payer: BCBS Trust/PPO |
$47.11
|
| Rate for Payer: BCN Commercial |
$47.11
|
| Rate for Payer: BCN Medicare Advantage |
$14.32
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cofinity Commercial |
$49.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.32
|
| Rate for Payer: Healthscope Commercial |
$51.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.98
|
| Rate for Payer: Mclaren Medicaid |
$10.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.04
|
| Rate for Payer: Meridian Medicaid |
$10.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.70
|
| Rate for Payer: Nomi Health Commercial |
$46.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.98
|
| Rate for Payer: PACE Senior Care Partners |
$13.61
|
| Rate for Payer: PACE SWMI |
$14.32
|
| Rate for Payer: PHP Commercial |
$48.70
|
| Rate for Payer: PHP Medicare Advantage |
$14.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$49.85
|
| Rate for Payer: Priority Health Medicare |
$14.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.88
|
| Rate for Payer: Railroad Medicare Medicare |
$14.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.42
|
| Rate for Payer: UHC Core |
$47.85
|
| Rate for Payer: UHC Exchange |
$14.32
|
| Rate for Payer: UHC Medicaid |
$10.10
|
| Rate for Payer: UHC Medicare Advantage |
$14.32
|
| Rate for Payer: UHCCP Medicaid |
$10.10
|
| Rate for Payer: VA VA |
$14.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.98
|
|
|
HC DHEA-SULFATE
|
Facility
|
IP
|
$57.30
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
30100188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.88 |
| Max. Negotiated Rate |
$51.57 |
| Rate for Payer: Aetna Commercial |
$48.70
|
| Rate for Payer: BCBS Trust/PPO |
$47.32
|
| Rate for Payer: BCN Commercial |
$47.32
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cofinity Commercial |
$49.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.84
|
| Rate for Payer: Healthscope Commercial |
$51.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.70
|
| Rate for Payer: Nomi Health Commercial |
$46.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.98
|
| Rate for Payer: PHP Commercial |
$48.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$49.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.42
|
| Rate for Payer: UHC Core |
$47.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.98
|
|
|
HC DIABETES GROUP SESSION PER 30"
|
Facility
|
IP
|
$64.35
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200006
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$44.79 |
| Max. Negotiated Rate |
$57.91 |
| Rate for Payer: Aetna Commercial |
$54.70
|
| Rate for Payer: BCBS Trust/PPO |
$53.15
|
| Rate for Payer: BCN Commercial |
$53.15
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cofinity Commercial |
$55.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.48
|
| Rate for Payer: Healthscope Commercial |
$57.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.70
|
| Rate for Payer: Nomi Health Commercial |
$52.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.26
|
| Rate for Payer: PHP Commercial |
$54.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.63
|
| Rate for Payer: UHC Core |
$53.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.26
|
|
|
HC DIABETES GROUP SESSION PER 30"
|
Facility
|
OP
|
$64.35
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200006
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$11.34 |
| Max. Negotiated Rate |
$57.91 |
| Rate for Payer: Aetna Commercial |
$54.70
|
| Rate for Payer: Aetna Medicare |
$16.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.11
|
| Rate for Payer: BCBS Complete |
$11.91
|
| Rate for Payer: BCBS MAPPO |
$16.09
|
| Rate for Payer: BCBS Trust/PPO |
$52.90
|
| Rate for Payer: BCN Commercial |
$52.90
|
| Rate for Payer: BCN Medicare Advantage |
$16.09
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cofinity Commercial |
$55.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.09
|
| Rate for Payer: Healthscope Commercial |
$57.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.26
|
| Rate for Payer: Mclaren Medicaid |
$11.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.89
|
| Rate for Payer: Meridian Medicaid |
$11.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.70
|
| Rate for Payer: Nomi Health Commercial |
$52.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.26
|
| Rate for Payer: PACE Senior Care Partners |
$15.28
|
| Rate for Payer: PACE SWMI |
$16.09
|
| Rate for Payer: PHP Commercial |
$54.70
|
| Rate for Payer: PHP Medicare Advantage |
$16.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.98
|
| Rate for Payer: Priority Health Medicare |
$16.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.79
|
| Rate for Payer: Railroad Medicare Medicare |
$16.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.63
|
| Rate for Payer: UHC Core |
$53.73
|
| Rate for Payer: UHC Exchange |
$16.09
|
| Rate for Payer: UHC Medicaid |
$11.34
|
| Rate for Payer: UHC Medicare Advantage |
$16.09
|
| Rate for Payer: UHCCP Medicaid |
$11.34
|
| Rate for Payer: VA VA |
$16.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.26
|
|
|
HC DIABETES MELLITUS TYPE 1 EVAL
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna Medicare |
$16.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.31
|
| Rate for Payer: BCBS Complete |
$12.03
|
| Rate for Payer: BCBS MAPPO |
$16.25
|
| Rate for Payer: BCBS Trust/PPO |
$53.44
|
| Rate for Payer: BCN Commercial |
$53.44
|
| Rate for Payer: BCN Medicare Advantage |
$16.25
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.25
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.75
|
| Rate for Payer: Mclaren Medicaid |
$11.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.06
|
| Rate for Payer: Meridian Medicaid |
$12.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: Nomi Health Commercial |
$53.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: PACE Senior Care Partners |
$15.44
|
| Rate for Payer: PACE SWMI |
$16.25
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: PHP Medicare Advantage |
$16.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.55
|
| Rate for Payer: Priority Health Medicare |
$16.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.24
|
| Rate for Payer: Railroad Medicare Medicare |
$16.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.20
|
| Rate for Payer: UHC Core |
$54.27
|
| Rate for Payer: UHC Exchange |
$16.25
|
| Rate for Payer: UHC Medicaid |
$11.46
|
| Rate for Payer: UHC Medicare Advantage |
$16.25
|
| Rate for Payer: UHCCP Medicaid |
$11.46
|
| Rate for Payer: VA VA |
$16.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.75
|
|
|
HC DIABETES MELLITUS TYPE 1 EVAL
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.24 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: BCBS Trust/PPO |
$53.68
|
| Rate for Payer: BCN Commercial |
$53.68
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: Nomi Health Commercial |
$53.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.20
|
| Rate for Payer: UHC Core |
$54.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.75
|
|
|
HC DIABETES TRAINING PER 30 MIN
|
Facility
|
OP
|
$152.77
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200007
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$137.49 |
| Rate for Payer: Aetna Commercial |
$129.85
|
| Rate for Payer: Aetna Medicare |
$39.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.74
|
| Rate for Payer: BCBS Complete |
$28.28
|
| Rate for Payer: BCBS MAPPO |
$38.19
|
| Rate for Payer: BCBS Trust/PPO |
$125.59
|
| Rate for Payer: BCN Commercial |
$125.59
|
| Rate for Payer: BCN Medicare Advantage |
$38.19
|
| Rate for Payer: Cash Price |
$122.22
|
| Rate for Payer: Cofinity Commercial |
$131.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.19
|
| Rate for Payer: Healthscope Commercial |
$137.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.58
|
| Rate for Payer: Mclaren Medicaid |
$26.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.10
|
| Rate for Payer: Meridian Medicaid |
$28.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.85
|
| Rate for Payer: Nomi Health Commercial |
$125.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.58
|
| Rate for Payer: PACE Senior Care Partners |
$36.28
|
| Rate for Payer: PACE SWMI |
$38.19
|
| Rate for Payer: PHP Commercial |
$129.85
|
| Rate for Payer: PHP Medicare Advantage |
$38.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$132.91
|
| Rate for Payer: Priority Health Medicare |
$38.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.33
|
| Rate for Payer: Railroad Medicare Medicare |
$38.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.44
|
| Rate for Payer: UHC Core |
$127.56
|
| Rate for Payer: UHC Exchange |
$38.19
|
| Rate for Payer: UHC Medicaid |
$26.93
|
| Rate for Payer: UHC Medicare Advantage |
$38.19
|
| Rate for Payer: UHCCP Medicaid |
$26.93
|
| Rate for Payer: VA VA |
$38.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.58
|
|
|
HC DIABETES TRAINING PER 30 MIN
|
Facility
|
IP
|
$152.77
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200007
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$106.33 |
| Max. Negotiated Rate |
$137.49 |
| Rate for Payer: Aetna Commercial |
$129.85
|
| Rate for Payer: BCBS Trust/PPO |
$126.17
|
| Rate for Payer: BCN Commercial |
$126.17
|
| Rate for Payer: Cash Price |
$122.22
|
| Rate for Payer: Cofinity Commercial |
$131.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.22
|
| Rate for Payer: Healthscope Commercial |
$137.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.85
|
| Rate for Payer: Nomi Health Commercial |
$125.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.58
|
| Rate for Payer: PHP Commercial |
$129.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$132.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.44
|
| Rate for Payer: UHC Core |
$127.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.58
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W ANGIOPLASTY AND IMAGING
|
Facility
|
IP
|
$11,229.50
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
36100526
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,815.73 |
| Max. Negotiated Rate |
$10,106.55 |
| Rate for Payer: Aetna Commercial |
$9,545.08
|
| Rate for Payer: BCBS Trust/PPO |
$9,274.44
|
| Rate for Payer: BCN Commercial |
$9,274.44
|
| Rate for Payer: Cash Price |
$8,983.60
|
| Rate for Payer: Cofinity Commercial |
$9,657.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,983.60
|
| Rate for Payer: Healthscope Commercial |
$10,106.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,422.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,545.08
|
| Rate for Payer: Nomi Health Commercial |
$9,208.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,422.12
|
| Rate for Payer: PHP Commercial |
$9,545.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9,769.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,815.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,881.96
|
| Rate for Payer: UHC Core |
$9,376.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,422.12
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W ANGIOPLASTY AND IMAGING
|
Facility
|
OP
|
$11,229.50
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
36100526
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,979.76 |
| Max. Negotiated Rate |
$10,106.55 |
| Rate for Payer: Aetna Commercial |
$9,545.08
|
| Rate for Payer: Aetna Medicare |
$2,919.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,509.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,509.22
|
| Rate for Payer: BCBS Complete |
$2,078.58
|
| Rate for Payer: BCBS MAPPO |
$2,807.38
|
| Rate for Payer: BCBS Trust/PPO |
$9,231.77
|
| Rate for Payer: BCN Commercial |
$9,231.77
|
| Rate for Payer: BCN Medicare Advantage |
$2,807.38
|
| Rate for Payer: Cash Price |
$8,983.60
|
| Rate for Payer: Cofinity Commercial |
$9,657.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,983.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,807.38
|
| Rate for Payer: Healthscope Commercial |
$10,106.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,422.12
|
| Rate for Payer: Mclaren Medicaid |
$1,979.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,947.74
|
| Rate for Payer: Meridian Medicaid |
$2,078.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,228.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,088.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,545.08
|
| Rate for Payer: Nomi Health Commercial |
$9,208.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,422.12
|
| Rate for Payer: PACE Senior Care Partners |
$2,667.01
|
| Rate for Payer: PACE SWMI |
$2,807.38
|
| Rate for Payer: PHP Commercial |
$9,545.08
|
| Rate for Payer: PHP Medicare Advantage |
$2,807.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,979.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9,769.67
|
| Rate for Payer: Priority Health Medicare |
$2,835.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,815.73
|
| Rate for Payer: Railroad Medicare Medicare |
$2,807.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,881.96
|
| Rate for Payer: UHC Core |
$9,376.63
|
| Rate for Payer: UHC Exchange |
$2,807.38
|
| Rate for Payer: UHC Medicaid |
$1,979.76
|
| Rate for Payer: UHC Medicare Advantage |
$2,807.38
|
| Rate for Payer: UHCCP Medicaid |
$1,979.76
|
| Rate for Payer: VA VA |
$2,807.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,422.12
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W IMAGING
|
Facility
|
IP
|
$2,189.04
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
36100525
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,523.57 |
| Max. Negotiated Rate |
$1,970.14 |
| Rate for Payer: Aetna Commercial |
$1,860.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,807.93
|
| Rate for Payer: BCN Commercial |
$1,807.93
|
| Rate for Payer: Cash Price |
$1,751.23
|
| Rate for Payer: Cofinity Commercial |
$1,882.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.23
|
| Rate for Payer: Healthscope Commercial |
$1,970.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,641.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,860.68
|
| Rate for Payer: Nomi Health Commercial |
$1,795.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,641.78
|
| Rate for Payer: PHP Commercial |
$1,860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,904.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,523.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,926.36
|
| Rate for Payer: UHC Core |
$1,827.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,641.78
|
|
|
HC DIAG ANGIO OF DIALYSIS CIRCUIT W IMAGING
|
Facility
|
OP
|
$2,189.04
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
36100525
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$385.93 |
| Max. Negotiated Rate |
$1,970.14 |
| Rate for Payer: Aetna Commercial |
$1,860.68
|
| Rate for Payer: Aetna Medicare |
$569.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$684.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$684.08
|
| Rate for Payer: BCBS Complete |
$405.19
|
| Rate for Payer: BCBS MAPPO |
$547.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,799.61
|
| Rate for Payer: BCN Commercial |
$1,799.61
|
| Rate for Payer: BCN Medicare Advantage |
$547.26
|
| Rate for Payer: Cash Price |
$1,751.23
|
| Rate for Payer: Cofinity Commercial |
$1,882.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$547.26
|
| Rate for Payer: Healthscope Commercial |
$1,970.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,641.78
|
| Rate for Payer: Mclaren Medicaid |
$385.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$574.62
|
| Rate for Payer: Meridian Medicaid |
$405.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$629.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$601.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,860.68
|
| Rate for Payer: Nomi Health Commercial |
$1,795.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,641.78
|
| Rate for Payer: PACE Senior Care Partners |
$519.90
|
| Rate for Payer: PACE SWMI |
$547.26
|
| Rate for Payer: PHP Commercial |
$1,860.68
|
| Rate for Payer: PHP Medicare Advantage |
$547.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,904.46
|
| Rate for Payer: Priority Health Medicare |
$552.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,523.57
|
| Rate for Payer: Railroad Medicare Medicare |
$547.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,926.36
|
| Rate for Payer: UHC Core |
$1,827.85
|
| Rate for Payer: UHC Exchange |
$547.26
|
| Rate for Payer: UHC Medicaid |
$385.93
|
| Rate for Payer: UHC Medicare Advantage |
$547.26
|
| Rate for Payer: UHCCP Medicaid |
$385.93
|
| Rate for Payer: VA VA |
$547.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,641.78
|
|
