|
HC DGTZ GLS MCRSCP SLD LEVEL VI
|
Facility
|
OP
|
$38.16
|
|
|
Service Code
|
CPT 0755T
|
| Hospital Charge Code |
31200013
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$34.34 |
| Rate for Payer: Aetna American Axle |
$24.80
|
| Rate for Payer: Aetna Commercial |
$32.44
|
| Rate for Payer: Aetna Medicare |
$19.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.80
|
| Rate for Payer: BCBS Complete |
$15.26
|
| Rate for Payer: Cash Price |
$30.53
|
| Rate for Payer: Cofinity Advantage |
$26.71
|
| Rate for Payer: Cofinity Commercial |
$32.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.53
|
| Rate for Payer: Healthscope Commercial |
$34.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.62
|
| Rate for Payer: PHP Commercial |
$32.44
|
| Rate for Payer: Priority Health SBD |
$24.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.08
|
| Rate for Payer: UHC Core |
$19.08
|
| Rate for Payer: UHC Exchange |
$19.08
|
| Rate for Payer: UMR Bronson Commercial |
$14.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.62
|
|
|
HC DGTZ GLS MCRSCP SLD LEVEL VI
|
Facility
|
IP
|
$38.16
|
|
|
Service Code
|
CPT 0755T
|
| Hospital Charge Code |
31200013
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$34.34 |
| Rate for Payer: Aetna American Axle |
$24.80
|
| Rate for Payer: Aetna Commercial |
$32.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.80
|
| Rate for Payer: Cash Price |
$30.53
|
| Rate for Payer: Cofinity Advantage |
$26.71
|
| Rate for Payer: Cofinity Commercial |
$32.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.53
|
| Rate for Payer: Healthscope Commercial |
$34.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.62
|
| Rate for Payer: PHP Commercial |
$32.44
|
| Rate for Payer: Priority Health SBD |
$24.04
|
| Rate for Payer: UMR Bronson Commercial |
$16.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.62
|
|
|
HC DGTZ GLS MCRSCP SLD LVL III
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0752T
|
| Hospital Charge Code |
31200010
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UMR Bronson Commercial |
$8.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
HC DGTZ GLS MCRSCP SLD LVL III
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0752T
|
| Hospital Charge Code |
31200010
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.54
|
| Rate for Payer: UHC Core |
$9.54
|
| Rate for Payer: UHC Exchange |
$9.54
|
| Rate for Payer: UMR Bronson Commercial |
$7.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
HC DGTZ GLS MCRSCP SLD SPC GRPI
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0756T
|
| Hospital Charge Code |
31200014
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.54
|
| Rate for Payer: UHC Core |
$9.54
|
| Rate for Payer: UHC Exchange |
$9.54
|
| Rate for Payer: UMR Bronson Commercial |
$7.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
HC DGTZ GLS MCRSCP SLD SPC GRPI
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0756T
|
| Hospital Charge Code |
31200014
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UMR Bronson Commercial |
$8.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
HC DGTZ GLS MCRSCP SL IMM 1ST
|
Facility
|
OP
|
$19.09
|
|
|
Service Code
|
CPT 0760T
|
| Hospital Charge Code |
31200018
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.54
|
| Rate for Payer: UHC Core |
$9.54
|
| Rate for Payer: UHC Exchange |
$9.54
|
| Rate for Payer: UMR Bronson Commercial |
$7.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
HC DGTZ GLS MCRSCP SL IMM 1ST
|
Facility
|
IP
|
$19.09
|
|
|
Service Code
|
CPT 0760T
|
| Hospital Charge Code |
31200018
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UMR Bronson Commercial |
$8.40
|
| 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 |
$8.40 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UMR Bronson Commercial |
$8.40
|
| 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 |
$7.06 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.54
|
| Rate for Payer: UHC Core |
$9.54
|
| Rate for Payer: UHC Exchange |
$9.54
|
| Rate for Payer: UMR Bronson Commercial |
$7.06
|
| 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 |
$7.06 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.54
|
| Rate for Payer: UHC Core |
$9.54
|
| Rate for Payer: UHC Exchange |
$9.54
|
| Rate for Payer: UMR Bronson Commercial |
$7.06
|
| 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 |
$8.40 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UMR Bronson Commercial |
$8.40
|
| 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 |
$8.40 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UMR Bronson Commercial |
$8.40
|
| 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 |
$7.06 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.54
|
| Rate for Payer: UHC Core |
$9.54
|
| Rate for Payer: UHC Exchange |
$9.54
|
| Rate for Payer: UMR Bronson Commercial |
$7.06
|
| 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 |
$8.40 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UMR Bronson Commercial |
$8.40
|
| 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 |
$7.06 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.54
|
| Rate for Payer: UHC Core |
$9.54
|
| Rate for Payer: UHC Exchange |
$9.54
|
| Rate for Payer: UMR Bronson Commercial |
$7.06
|
| 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 |
$8.40 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UMR Bronson Commercial |
$8.40
|
| 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 |
$7.06 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: Cash Price |
$15.27
|
| Rate for Payer: Cofinity Advantage |
$13.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.54
|
| Rate for Payer: UHC Core |
$9.54
|
| Rate for Payer: UHC Exchange |
$9.54
|
| Rate for Payer: UMR Bronson Commercial |
$7.06
|
| 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 |
$13.22 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna American Axle |
$33.80
|
| Rate for Payer: Aetna Commercial |
$44.20
|
| Rate for Payer: Aetna Medicare |
$26.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.59
|
| Rate for Payer: BCBS Complete |
$13.88
|
| Rate for Payer: BCBS MAPPO |
$25.27
|
| Rate for Payer: BCBS Trust/PPO |
$29.21
|
| Rate for Payer: BCN Commercial |
$29.21
|
| Rate for Payer: BCN Medicare Advantage |
$25.27
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Advantage |
$36.40
|
| 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 |
$25.27
|
| Rate for Payer: Healthscope Commercial |
$46.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.00
|
| Rate for Payer: Mclaren Medicaid |
$25.27
|
| Rate for Payer: Mclaren Medicare |
$25.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.53
|
| Rate for Payer: Meridian Medicaid |
$26.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.20
|
| Rate for Payer: Nomi Health Commercial |
$37.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: PACE Medicare |
$24.01
|
| Rate for Payer: PACE SWMI |
$25.27
|
| Rate for Payer: PHP Commercial |
$44.20
|
| Rate for Payer: PHP Medicare Advantage |
$25.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25.27
|
| Rate for Payer: Priority Health Medicare |
$25.27
|
| Rate for Payer: Priority Health SBD |
$32.76
|
| Rate for Payer: Priority Health Tiered Network |
$20.22
|
| Rate for Payer: Railroad Medicare Medicare |
$25.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.91
|
| Rate for Payer: UHC Core |
$37.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.27
|
| Rate for Payer: UHC Exchange |
$37.91
|
| Rate for Payer: UHC Medicaid |
$13.22
|
| Rate for Payer: UHCCP Medicaid |
$13.22
|
| Rate for Payer: UMR Bronson Commercial |
$19.24
|
| Rate for Payer: VA VA |
$25.27
|
| 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 |
$22.88 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna American Axle |
$33.80
|
| Rate for Payer: Aetna Commercial |
$44.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Advantage |
$36.40
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$36.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: PHP Commercial |
$44.20
|
| Rate for Payer: Priority Health SBD |
$32.76
|
| Rate for Payer: UMR Bronson Commercial |
$22.88
|
| 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 |
$11.63 |
| Max. Negotiated Rate |
$51.57 |
| Rate for Payer: Aetna American Axle |
$37.24
|
| Rate for Payer: Aetna Commercial |
$48.70
|
| Rate for Payer: Aetna Medicare |
$23.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.79
|
| Rate for Payer: BCBS Complete |
$12.21
|
| Rate for Payer: BCBS MAPPO |
$22.23
|
| Rate for Payer: BCBS Trust/PPO |
$25.69
|
| Rate for Payer: BCN Commercial |
$25.69
|
| Rate for Payer: BCN Medicare Advantage |
$22.23
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cofinity Advantage |
$40.11
|
| 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 |
$22.23
|
| Rate for Payer: Healthscope Commercial |
$51.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.98
|
| Rate for Payer: Mclaren Medicaid |
$22.23
|
| Rate for Payer: Mclaren Medicare |
$22.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.34
|
| Rate for Payer: Meridian Medicaid |
$23.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.70
|
| Rate for Payer: Nomi Health Commercial |
$33.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.98
|
| Rate for Payer: PACE Medicare |
$21.12
|
| Rate for Payer: PACE SWMI |
$22.23
|
| Rate for Payer: PHP Commercial |
$48.70
|
| Rate for Payer: PHP Medicare Advantage |
$22.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.23
|
| Rate for Payer: Priority Health Medicare |
$22.23
|
| Rate for Payer: Priority Health SBD |
$36.10
|
| Rate for Payer: Priority Health Tiered Network |
$17.78
|
| Rate for Payer: Railroad Medicare Medicare |
$22.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.35
|
| Rate for Payer: UHC Core |
$33.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.23
|
| Rate for Payer: UHC Exchange |
$33.35
|
| Rate for Payer: UHC Medicaid |
$11.63
|
| Rate for Payer: UHCCP Medicaid |
$11.63
|
| Rate for Payer: UMR Bronson Commercial |
$21.20
|
| Rate for Payer: VA VA |
$22.23
|
| 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 |
$25.21 |
| Max. Negotiated Rate |
$51.57 |
| Rate for Payer: Aetna American Axle |
$37.24
|
| Rate for Payer: Aetna Commercial |
$48.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.24
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cofinity Advantage |
$40.11
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$40.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.98
|
| Rate for Payer: PHP Commercial |
$48.70
|
| Rate for Payer: Priority Health SBD |
$36.10
|
| Rate for Payer: UMR Bronson Commercial |
$25.21
|
| 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 |
$28.31 |
| Max. Negotiated Rate |
$57.91 |
| Rate for Payer: Aetna American Axle |
$41.83
|
| Rate for Payer: Aetna Commercial |
$54.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.83
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cofinity Advantage |
$45.05
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$45.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.26
|
| Rate for Payer: PHP Commercial |
$54.70
|
| Rate for Payer: Priority Health SBD |
$40.54
|
| Rate for Payer: UMR Bronson Commercial |
$28.31
|
| 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 |
$12.80 |
| Max. Negotiated Rate |
$57.91 |
| Rate for Payer: Aetna American Axle |
$41.83
|
| Rate for Payer: Aetna Commercial |
$54.70
|
| Rate for Payer: Aetna Medicare |
$32.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.83
|
| Rate for Payer: BCBS Complete |
$25.74
|
| Rate for Payer: BCBS Trust/PPO |
$29.57
|
| Rate for Payer: BCN Commercial |
$29.57
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cofinity Advantage |
$45.05
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$45.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.70
|
| 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/Narrow Network |
$16.00
|
| Rate for Payer: Priority Health SBD |
$40.54
|
| Rate for Payer: Priority Health Tiered Network |
$12.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.83
|
| Rate for Payer: UHC Core |
$33.53
|
| Rate for Payer: UHC Exchange |
$25.29
|
| Rate for Payer: UMR Bronson Commercial |
$23.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.26
|
|
|
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 |
$28.60 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna American Axle |
$42.25
|
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Advantage |
$45.50
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$45.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: Priority Health SBD |
$40.95
|
| Rate for Payer: UMR Bronson Commercial |
$28.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.75
|
|
