|
HC DEXAMETHASONE DEXA
|
Facility
|
IP
|
$150.43
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100751
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.78 |
| Max. Negotiated Rate |
$135.39 |
| Rate for Payer: Aetna Commercial |
$127.87
|
| Rate for Payer: BCBS Trust/PPO |
$122.80
|
| Rate for Payer: BCN Commercial |
$116.25
|
| Rate for Payer: Cash Price |
$120.34
|
| Rate for Payer: Cofinity Commercial |
$129.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.34
|
| Rate for Payer: Healthscope Commercial |
$135.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.87
|
| Rate for Payer: Nomi Health Commercial |
$123.35
|
| Rate for Payer: PHP Commercial |
$127.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.78
|
| Rate for Payer: Priority Health HMO/PPO |
$130.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.38
|
| Rate for Payer: UHC Core |
$125.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.82
|
|
|
HC DEXAMETHASONE DEXA
|
Facility
|
OP
|
$150.43
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100751
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$135.39 |
| Rate for Payer: Aetna Commercial |
$127.87
|
| Rate for Payer: Aetna Medicare |
$39.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.01
|
| Rate for Payer: BCBS Complete |
$14.15
|
| Rate for Payer: BCBS MAPPO |
$37.61
|
| Rate for Payer: BCBS Trust/PPO |
$123.67
|
| Rate for Payer: BCN Commercial |
$116.96
|
| Rate for Payer: BCN Medicare Advantage |
$37.61
|
| Rate for Payer: Cash Price |
$120.34
|
| Rate for Payer: Cash Price |
$120.34
|
| Rate for Payer: Cofinity Commercial |
$129.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.61
|
| Rate for Payer: Healthscope Commercial |
$135.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.82
|
| Rate for Payer: Mclaren Medicaid |
$13.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.49
|
| Rate for Payer: Meridian Medicaid |
$14.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.87
|
| Rate for Payer: Nomi Health Commercial |
$123.35
|
| Rate for Payer: PACE Senior Care Partners |
$35.73
|
| Rate for Payer: PACE SWMI |
$37.61
|
| Rate for Payer: PHP Commercial |
$127.87
|
| Rate for Payer: PHP Medicare Advantage |
$37.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.78
|
| Rate for Payer: Priority Health HMO/PPO |
$130.87
|
| Rate for Payer: Priority Health Medicare |
$37.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.79
|
| Rate for Payer: Railroad Medicare Medicare |
$37.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.38
|
| Rate for Payer: UHC Core |
$125.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.61
|
| Rate for Payer: UHC Exchange |
$37.61
|
| Rate for Payer: UHC Medicare Advantage |
$37.61
|
| Rate for Payer: UHCCP Medicaid |
$13.48
|
| Rate for Payer: VA VA |
$37.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.82
|
|
|
HC DEXAMETHASONE SODIUM PHOS, PER 1 MG
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: BCBS Trust/PPO |
$8.49
|
| Rate for Payer: BCN Commercial |
$8.04
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health HMO/PPO |
$9.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.15
|
| Rate for Payer: UHC Core |
$8.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
|
HC DEXAMETHASONE SODIUM PHOS, PER 1 MG
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
63600138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna Medicare |
$2.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.25
|
| Rate for Payer: BCBS Complete |
$4.16
|
| Rate for Payer: BCBS MAPPO |
$2.60
|
| Rate for Payer: BCBS Trust/PPO |
$8.55
|
| Rate for Payer: BCN Commercial |
$8.09
|
| Rate for Payer: BCN Medicare Advantage |
$2.60
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: PACE Senior Care Partners |
$2.47
|
| Rate for Payer: PACE SWMI |
$2.60
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: PHP Medicare Advantage |
$2.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health HMO/PPO |
$9.05
|
| Rate for Payer: Priority Health Medicare |
$2.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.97
|
| Rate for Payer: Railroad Medicare Medicare |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.15
|
| Rate for Payer: UHC Core |
$8.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.60
|
| Rate for Payer: UHC Exchange |
$2.60
|
| Rate for Payer: UHC Medicare Advantage |
$2.60
|
| Rate for Payer: VA VA |
$2.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
|
HC DGTZ GLS MCRSCP MPHMTRC ALYS
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0763T
|
| Hospital Charge Code |
31200021
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Medicare |
$4.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.85
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS MAPPO |
$4.68
|
| Rate for Payer: BCBS Trust/PPO |
$15.39
|
| Rate for Payer: BCN Commercial |
$14.55
|
| Rate for Payer: BCN Medicare Advantage |
$4.68
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.68
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: PACE Senior Care Partners |
$4.45
|
| Rate for Payer: PACE SWMI |
$4.68
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: PHP Medicare Advantage |
$4.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: Railroad Medicare Medicare |
$4.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.68
|
| Rate for Payer: UHC Exchange |
$4.68
|
| Rate for Payer: UHC Medicare Advantage |
$4.68
|
| Rate for Payer: VA VA |
$4.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
HC DGTZ GLS MCRSCP MPHMTRC ALYS
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0763T
|
| Hospital Charge Code |
31200021
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$15.28
|
| Rate for Payer: BCN Commercial |
$14.47
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL II
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0751T
|
| Hospital Charge Code |
31200009
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Medicare |
$4.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.85
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS MAPPO |
$4.68
|
| Rate for Payer: BCBS Trust/PPO |
$15.39
|
| Rate for Payer: BCN Commercial |
$14.55
|
| Rate for Payer: BCN Medicare Advantage |
$4.68
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.68
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: PACE Senior Care Partners |
$4.45
|
| Rate for Payer: PACE SWMI |
$4.68
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: PHP Medicare Advantage |
$4.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: Railroad Medicare Medicare |
$4.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.68
|
| Rate for Payer: UHC Exchange |
$4.68
|
| Rate for Payer: UHC Medicare Advantage |
$4.68
|
| Rate for Payer: VA VA |
$4.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL II
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0751T
|
| Hospital Charge Code |
31200009
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$15.28
|
| Rate for Payer: BCN Commercial |
$14.47
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL IV
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0753T
|
| Hospital Charge Code |
31200011
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$15.28
|
| Rate for Payer: BCN Commercial |
$14.47
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL IV
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0753T
|
| Hospital Charge Code |
31200011
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Medicare |
$4.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.85
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS MAPPO |
$4.68
|
| Rate for Payer: BCBS Trust/PPO |
$15.39
|
| Rate for Payer: BCN Commercial |
$14.55
|
| Rate for Payer: BCN Medicare Advantage |
$4.68
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.68
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: PACE Senior Care Partners |
$4.45
|
| Rate for Payer: PACE SWMI |
$4.68
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: PHP Medicare Advantage |
$4.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: Railroad Medicare Medicare |
$4.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.68
|
| Rate for Payer: UHC Exchange |
$4.68
|
| Rate for Payer: UHC Medicare Advantage |
$4.68
|
| Rate for Payer: VA VA |
$4.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL V
|
Facility
|
IP
|
$37.41
|
|
|
Service Code
|
CPT 0754T
|
| Hospital Charge Code |
31200012
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$24.32 |
| Max. Negotiated Rate |
$33.67 |
| Rate for Payer: Aetna Commercial |
$31.80
|
| Rate for Payer: BCBS Trust/PPO |
$30.54
|
| Rate for Payer: BCN Commercial |
$28.91
|
| Rate for Payer: Cash Price |
$29.93
|
| Rate for Payer: Cofinity Commercial |
$32.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.93
|
| Rate for Payer: Healthscope Commercial |
$33.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.80
|
| Rate for Payer: Nomi Health Commercial |
$30.68
|
| Rate for Payer: PHP Commercial |
$31.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.32
|
| Rate for Payer: Priority Health HMO/PPO |
$32.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.92
|
| Rate for Payer: UHC Core |
$31.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.06
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL V
|
Facility
|
OP
|
$37.41
|
|
|
Service Code
|
CPT 0754T
|
| Hospital Charge Code |
31200012
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$33.67 |
| Rate for Payer: Aetna Commercial |
$31.80
|
| Rate for Payer: Aetna Medicare |
$9.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.69
|
| Rate for Payer: BCBS Complete |
$14.96
|
| Rate for Payer: BCBS MAPPO |
$9.35
|
| Rate for Payer: BCBS Trust/PPO |
$30.75
|
| Rate for Payer: BCN Commercial |
$29.09
|
| Rate for Payer: BCN Medicare Advantage |
$9.35
|
| Rate for Payer: Cash Price |
$29.93
|
| Rate for Payer: Cofinity Commercial |
$32.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.35
|
| Rate for Payer: Healthscope Commercial |
$33.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.80
|
| Rate for Payer: Nomi Health Commercial |
$30.68
|
| Rate for Payer: PACE Senior Care Partners |
$8.88
|
| Rate for Payer: PACE SWMI |
$9.35
|
| Rate for Payer: PHP Commercial |
$31.80
|
| Rate for Payer: PHP Medicare Advantage |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.32
|
| Rate for Payer: Priority Health HMO/PPO |
$32.55
|
| Rate for Payer: Priority Health Medicare |
$9.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.06
|
| Rate for Payer: Railroad Medicare Medicare |
$9.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.92
|
| Rate for Payer: UHC Core |
$31.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.35
|
| Rate for Payer: UHC Exchange |
$9.35
|
| Rate for Payer: UHC Medicare Advantage |
$9.35
|
| Rate for Payer: VA VA |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.06
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL VI
|
Facility
|
OP
|
$37.41
|
|
|
Service Code
|
CPT 0755T
|
| Hospital Charge Code |
31200013
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$33.67 |
| Rate for Payer: Aetna Commercial |
$31.80
|
| Rate for Payer: Aetna Medicare |
$9.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.69
|
| Rate for Payer: BCBS Complete |
$14.96
|
| Rate for Payer: BCBS MAPPO |
$9.35
|
| Rate for Payer: BCBS Trust/PPO |
$30.75
|
| Rate for Payer: BCN Commercial |
$29.09
|
| Rate for Payer: BCN Medicare Advantage |
$9.35
|
| Rate for Payer: Cash Price |
$29.93
|
| Rate for Payer: Cofinity Commercial |
$32.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.35
|
| Rate for Payer: Healthscope Commercial |
$33.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.80
|
| Rate for Payer: Nomi Health Commercial |
$30.68
|
| Rate for Payer: PACE Senior Care Partners |
$8.88
|
| Rate for Payer: PACE SWMI |
$9.35
|
| Rate for Payer: PHP Commercial |
$31.80
|
| Rate for Payer: PHP Medicare Advantage |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.32
|
| Rate for Payer: Priority Health HMO/PPO |
$32.55
|
| Rate for Payer: Priority Health Medicare |
$9.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.06
|
| Rate for Payer: Railroad Medicare Medicare |
$9.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.92
|
| Rate for Payer: UHC Core |
$31.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.35
|
| Rate for Payer: UHC Exchange |
$9.35
|
| Rate for Payer: UHC Medicare Advantage |
$9.35
|
| Rate for Payer: VA VA |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.06
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL VI
|
Facility
|
IP
|
$37.41
|
|
|
Service Code
|
CPT 0755T
|
| Hospital Charge Code |
31200013
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$24.32 |
| Max. Negotiated Rate |
$33.67 |
| Rate for Payer: Aetna Commercial |
$31.80
|
| Rate for Payer: BCBS Trust/PPO |
$30.54
|
| Rate for Payer: BCN Commercial |
$28.91
|
| Rate for Payer: Cash Price |
$29.93
|
| Rate for Payer: Cofinity Commercial |
$32.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.93
|
| Rate for Payer: Healthscope Commercial |
$33.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.80
|
| Rate for Payer: Nomi Health Commercial |
$30.68
|
| Rate for Payer: PHP Commercial |
$31.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.32
|
| Rate for Payer: Priority Health HMO/PPO |
$32.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.92
|
| Rate for Payer: UHC Core |
$31.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.06
|
|
|
HC DGTZ GLS MCRSCP SLD LVL III
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0752T
|
| Hospital Charge Code |
31200010
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$15.28
|
| Rate for Payer: BCN Commercial |
$14.47
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
HC DGTZ GLS MCRSCP SLD LVL III
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0752T
|
| Hospital Charge Code |
31200010
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Medicare |
$4.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.85
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS MAPPO |
$4.68
|
| Rate for Payer: BCBS Trust/PPO |
$15.39
|
| Rate for Payer: BCN Commercial |
$14.55
|
| Rate for Payer: BCN Medicare Advantage |
$4.68
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.68
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: PACE Senior Care Partners |
$4.45
|
| Rate for Payer: PACE SWMI |
$4.68
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: PHP Medicare Advantage |
$4.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: Railroad Medicare Medicare |
$4.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.68
|
| Rate for Payer: UHC Exchange |
$4.68
|
| Rate for Payer: UHC Medicare Advantage |
$4.68
|
| Rate for Payer: VA VA |
$4.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
HC DGTZ GLS MCRSCP SLD SPC GRPI
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0756T
|
| Hospital Charge Code |
31200014
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$15.28
|
| Rate for Payer: BCN Commercial |
$14.47
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
HC DGTZ GLS MCRSCP SLD SPC GRPI
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0756T
|
| Hospital Charge Code |
31200014
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Medicare |
$4.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.85
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS MAPPO |
$4.68
|
| Rate for Payer: BCBS Trust/PPO |
$15.39
|
| Rate for Payer: BCN Commercial |
$14.55
|
| Rate for Payer: BCN Medicare Advantage |
$4.68
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.68
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: PACE Senior Care Partners |
$4.45
|
| Rate for Payer: PACE SWMI |
$4.68
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: PHP Medicare Advantage |
$4.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: Railroad Medicare Medicare |
$4.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.68
|
| Rate for Payer: UHC Exchange |
$4.68
|
| Rate for Payer: UHC Medicare Advantage |
$4.68
|
| Rate for Payer: VA VA |
$4.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
HC DGTZ GLS MCRSCP SL IMM 1ST
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0760T
|
| Hospital Charge Code |
31200018
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Medicare |
$4.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.85
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS MAPPO |
$4.68
|
| Rate for Payer: BCBS Trust/PPO |
$15.39
|
| Rate for Payer: BCN Commercial |
$14.55
|
| Rate for Payer: BCN Medicare Advantage |
$4.68
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.68
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: PACE Senior Care Partners |
$4.45
|
| Rate for Payer: PACE SWMI |
$4.68
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: PHP Medicare Advantage |
$4.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: Railroad Medicare Medicare |
$4.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.68
|
| Rate for Payer: UHC Exchange |
$4.68
|
| Rate for Payer: UHC Medicare Advantage |
$4.68
|
| Rate for Payer: VA VA |
$4.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
HC DGTZ GLS MCRSCP SL IMM 1ST
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0760T
|
| Hospital Charge Code |
31200018
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$15.28
|
| Rate for Payer: BCN Commercial |
$14.47
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
HC DGTZ GLS MCRSCP SL IMM EA 1
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0761T
|
| Hospital Charge Code |
31200019
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$15.28
|
| Rate for Payer: BCN Commercial |
$14.47
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
HC DGTZ GLS MCRSCP SL IMM EA 1
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0761T
|
| Hospital Charge Code |
31200019
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Medicare |
$4.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.85
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS MAPPO |
$4.68
|
| Rate for Payer: BCBS Trust/PPO |
$15.39
|
| Rate for Payer: BCN Commercial |
$14.55
|
| Rate for Payer: BCN Medicare Advantage |
$4.68
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.68
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: PACE Senior Care Partners |
$4.45
|
| Rate for Payer: PACE SWMI |
$4.68
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: PHP Medicare Advantage |
$4.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: Railroad Medicare Medicare |
$4.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.68
|
| Rate for Payer: UHC Exchange |
$4.68
|
| Rate for Payer: UHC Medicare Advantage |
$4.68
|
| Rate for Payer: VA VA |
$4.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
HC DGTZ GLS MCRSCP SL IMM EA M
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0762T
|
| Hospital Charge Code |
31200020
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$15.28
|
| Rate for Payer: BCN Commercial |
$14.47
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
HC DGTZ GLS MCRSCP SL IMM EA M
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0762T
|
| Hospital Charge Code |
31200020
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Medicare |
$4.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.85
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS MAPPO |
$4.68
|
| Rate for Payer: BCBS Trust/PPO |
$15.39
|
| Rate for Payer: BCN Commercial |
$14.55
|
| Rate for Payer: BCN Medicare Advantage |
$4.68
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.68
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: PACE Senior Care Partners |
$4.45
|
| Rate for Payer: PACE SWMI |
$4.68
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: PHP Medicare Advantage |
$4.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: Railroad Medicare Medicare |
$4.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.68
|
| Rate for Payer: UHC Exchange |
$4.68
|
| Rate for Payer: UHC Medicare Advantage |
$4.68
|
| Rate for Payer: VA VA |
$4.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
HC DGTZ GLS MCRSCP SL SPC GRPII
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0757T
|
| Hospital Charge Code |
31200015
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Medicare |
$4.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.85
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS MAPPO |
$4.68
|
| Rate for Payer: BCBS Trust/PPO |
$15.39
|
| Rate for Payer: BCN Commercial |
$14.55
|
| Rate for Payer: BCN Medicare Advantage |
$4.68
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.68
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: PACE Senior Care Partners |
$4.45
|
| Rate for Payer: PACE SWMI |
$4.68
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: PHP Medicare Advantage |
$4.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: Railroad Medicare Medicare |
$4.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.68
|
| Rate for Payer: UHC Exchange |
$4.68
|
| Rate for Payer: UHC Medicare Advantage |
$4.68
|
| Rate for Payer: VA VA |
$4.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
