|
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 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
|
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 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 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 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 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 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 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
|
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 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 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
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0757T
|
| Hospital Charge Code |
31200015
|
|
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 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
|
|
|
HC DGTZ GLS MCRSCP SL SPC HCHEM
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0758T
|
| Hospital Charge Code |
31200016
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$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 HCHEM
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0758T
|
| Hospital Charge Code |
31200016
|
|
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 SP GRPIII
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
CPT 0759T
|
| Hospital Charge Code |
31200017
|
|
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 SP GRPIII
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
CPT 0759T
|
| Hospital Charge Code |
31200017
|
|
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 DHEA
|
Facility
|
OP
|
$50.98
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
30100187
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna Medicare |
$13.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.93
|
| Rate for Payer: BCBS Complete |
$19.18
|
| Rate for Payer: BCBS MAPPO |
$12.74
|
| Rate for Payer: BCBS Trust/PPO |
$41.91
|
| Rate for Payer: BCN Commercial |
$39.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.74
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.23
|
| Rate for Payer: Mclaren Medicaid |
$18.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.38
|
| Rate for Payer: Meridian Medicaid |
$19.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: Nomi Health Commercial |
$41.80
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.74
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: PHP Medicare Advantage |
$12.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health HMO/PPO |
$44.35
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.16
|
| Rate for Payer: Railroad Medicare Medicare |
$12.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.86
|
| Rate for Payer: UHC Core |
$42.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.74
|
| Rate for Payer: UHC Exchange |
$12.74
|
| Rate for Payer: UHC Medicare Advantage |
$12.74
|
| Rate for Payer: UHCCP Medicaid |
$18.27
|
| Rate for Payer: VA VA |
$12.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.23
|
|
|
HC DHEA
|
Facility
|
IP
|
$50.98
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
30100187
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: BCBS Trust/PPO |
$41.61
|
| Rate for Payer: BCN Commercial |
$39.40
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: Nomi Health Commercial |
$41.80
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health HMO/PPO |
$44.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.86
|
| Rate for Payer: UHC Core |
$42.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.23
|
|
|
HC DHEA-SULFATE
|
Facility
|
OP
|
$56.18
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
30100188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.34 |
| Max. Negotiated Rate |
$50.56 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$14.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.56
|
| Rate for Payer: BCBS Complete |
$16.88
|
| Rate for Payer: BCBS MAPPO |
$14.04
|
| Rate for Payer: BCBS Trust/PPO |
$46.19
|
| Rate for Payer: BCN Commercial |
$43.68
|
| Rate for Payer: BCN Medicare Advantage |
$14.04
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.04
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.13
|
| Rate for Payer: Mclaren Medicaid |
$16.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.75
|
| Rate for Payer: Meridian Medicaid |
$16.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: Nomi Health Commercial |
$46.07
|
| Rate for Payer: PACE Senior Care Partners |
$13.34
|
| Rate for Payer: PACE SWMI |
$14.04
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: PHP Medicare Advantage |
$14.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.52
|
| Rate for Payer: Priority Health HMO/PPO |
$48.88
|
| Rate for Payer: Priority Health Medicare |
$14.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.64
|
| Rate for Payer: Railroad Medicare Medicare |
$14.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.44
|
| Rate for Payer: UHC Core |
$46.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.04
|
| Rate for Payer: UHC Exchange |
$14.04
|
| Rate for Payer: UHC Medicare Advantage |
$14.04
|
| Rate for Payer: UHCCP Medicaid |
$16.07
|
| Rate for Payer: VA VA |
$14.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.13
|
|
|
HC DHEA-SULFATE
|
Facility
|
IP
|
$56.18
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
30100188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$50.56 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: BCBS Trust/PPO |
$45.86
|
| Rate for Payer: BCN Commercial |
$43.42
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: Nomi Health Commercial |
$46.07
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.52
|
| Rate for Payer: Priority Health HMO/PPO |
$48.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.44
|
| Rate for Payer: UHC Core |
$46.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.13
|
|
