|
HC HOSP OUTPT VISIT EST LVL 3
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000118
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.88 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.60
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health SBD |
$173.88
|
|
|
HC HOSP OUTPT VISIT EST LVL 3
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000118
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$369.96 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$122.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$147.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$147.02
|
| Rate for Payer: BCBS Complete |
$67.56
|
| Rate for Payer: BCBS MAPPO |
$117.62
|
| Rate for Payer: BCBS Trust/PPO |
$351.18
|
| Rate for Payer: BCN Medicare Advantage |
$117.62
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.62
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$64.34
|
| Rate for Payer: Mclaren Medicare |
$117.62
|
| Rate for Payer: Meridian Medicaid |
$67.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.60
|
| Rate for Payer: PACE Medicare |
$111.74
|
| Rate for Payer: PACE SWMI |
$117.62
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$117.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.96
|
| Rate for Payer: Priority Health Medicare |
$117.62
|
| Rate for Payer: Priority Health Narrow Network |
$295.97
|
| Rate for Payer: Priority Health SBD |
$173.88
|
| Rate for Payer: Railroad Medicare Medicare |
$117.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.62
|
| Rate for Payer: UHC Medicare Advantage |
$121.15
|
| Rate for Payer: VA VA |
$117.62
|
|
|
HC HOSP OUTPT VISIT EST LVL 4
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000119
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.88 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.60
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health SBD |
$173.88
|
|
|
HC HOSP OUTPT VISIT EST LVL 4
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000119
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$369.96 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$122.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$147.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$147.02
|
| Rate for Payer: BCBS Complete |
$67.56
|
| Rate for Payer: BCBS MAPPO |
$117.62
|
| Rate for Payer: BCBS Trust/PPO |
$351.18
|
| Rate for Payer: BCN Medicare Advantage |
$117.62
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.62
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$64.34
|
| Rate for Payer: Mclaren Medicare |
$117.62
|
| Rate for Payer: Meridian Medicaid |
$67.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.60
|
| Rate for Payer: PACE Medicare |
$111.74
|
| Rate for Payer: PACE SWMI |
$117.62
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$117.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.96
|
| Rate for Payer: Priority Health Medicare |
$117.62
|
| Rate for Payer: Priority Health Narrow Network |
$295.97
|
| Rate for Payer: Priority Health SBD |
$173.88
|
| Rate for Payer: Railroad Medicare Medicare |
$117.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.62
|
| Rate for Payer: UHC Medicare Advantage |
$121.15
|
| Rate for Payer: VA VA |
$117.62
|
|
|
HC HOSP OUTPT VISIT EST LVL 5
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.88 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.60
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health SBD |
$173.88
|
|
|
HC HOSP OUTPT VISIT EST LVL 5
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$369.96 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$122.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$147.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$147.02
|
| Rate for Payer: BCBS Complete |
$67.56
|
| Rate for Payer: BCBS MAPPO |
$117.62
|
| Rate for Payer: BCBS Trust/PPO |
$351.18
|
| Rate for Payer: BCN Medicare Advantage |
$117.62
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.62
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$64.34
|
| Rate for Payer: Mclaren Medicare |
$117.62
|
| Rate for Payer: Meridian Medicaid |
$67.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.60
|
| Rate for Payer: PACE Medicare |
$111.74
|
| Rate for Payer: PACE SWMI |
$117.62
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$117.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.96
|
| Rate for Payer: Priority Health Medicare |
$117.62
|
| Rate for Payer: Priority Health Narrow Network |
$295.97
|
| Rate for Payer: Priority Health SBD |
$173.88
|
| Rate for Payer: Railroad Medicare Medicare |
$117.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.62
|
| Rate for Payer: UHC Medicare Advantage |
$121.15
|
| Rate for Payer: VA VA |
$117.62
|
|
|
HC HOSP OUTPT VISIT NEW LVL 2
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000121
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$369.96 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$122.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$147.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$147.02
|
| Rate for Payer: BCBS Complete |
$67.56
|
| Rate for Payer: BCBS MAPPO |
$117.62
|
| Rate for Payer: BCBS Trust/PPO |
$351.18
|
| Rate for Payer: BCN Medicare Advantage |
$117.62
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.62
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$64.34
|
| Rate for Payer: Mclaren Medicare |
$117.62
|
| Rate for Payer: Meridian Medicaid |
$67.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.60
|
| Rate for Payer: PACE Medicare |
$111.74
|
| Rate for Payer: PACE SWMI |
$117.62
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$117.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.96
|
| Rate for Payer: Priority Health Medicare |
$117.62
|
| Rate for Payer: Priority Health Narrow Network |
$295.97
|
| Rate for Payer: Priority Health SBD |
$173.88
|
| Rate for Payer: Railroad Medicare Medicare |
$117.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.62
|
| Rate for Payer: UHC Medicare Advantage |
$121.15
|
| Rate for Payer: VA VA |
$117.62
|
|
|
HC HOSP OUTPT VISIT NEW LVL 2
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000121
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.88 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.60
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health SBD |
$173.88
|
|
|
HC HOSP OUTPT VISIT NEW LVL 3
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000122
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$369.96 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$122.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$147.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$147.02
|
| Rate for Payer: BCBS Complete |
$67.56
|
| Rate for Payer: BCBS MAPPO |
$117.62
|
| Rate for Payer: BCBS Trust/PPO |
$351.18
|
| Rate for Payer: BCN Medicare Advantage |
$117.62
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.62
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$64.34
|
| Rate for Payer: Mclaren Medicare |
$117.62
|
| Rate for Payer: Meridian Medicaid |
$67.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.60
|
| Rate for Payer: PACE Medicare |
$111.74
|
| Rate for Payer: PACE SWMI |
$117.62
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$117.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.96
|
| Rate for Payer: Priority Health Medicare |
$117.62
|
| Rate for Payer: Priority Health Narrow Network |
$295.97
|
| Rate for Payer: Priority Health SBD |
$173.88
|
| Rate for Payer: Railroad Medicare Medicare |
$117.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.62
|
| Rate for Payer: UHC Medicare Advantage |
$121.15
|
| Rate for Payer: VA VA |
$117.62
|
|
|
HC HOSP OUTPT VISIT NEW LVL 3
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000122
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.88 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.60
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health SBD |
$173.88
|
|
|
HC HOSP OUTPT VISIT NEW LVL 4
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000123
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.88 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.60
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health SBD |
$173.88
|
|
|
HC HOSP OUTPT VISIT NEW LVL 4
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000123
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$369.96 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$122.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$147.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$147.02
|
| Rate for Payer: BCBS Complete |
$67.56
|
| Rate for Payer: BCBS MAPPO |
$117.62
|
| Rate for Payer: BCBS Trust/PPO |
$351.18
|
| Rate for Payer: BCN Medicare Advantage |
$117.62
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.62
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$64.34
|
| Rate for Payer: Mclaren Medicare |
$117.62
|
| Rate for Payer: Meridian Medicaid |
$67.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.60
|
| Rate for Payer: PACE Medicare |
$111.74
|
| Rate for Payer: PACE SWMI |
$117.62
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$117.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.96
|
| Rate for Payer: Priority Health Medicare |
$117.62
|
| Rate for Payer: Priority Health Narrow Network |
$295.97
|
| Rate for Payer: Priority Health SBD |
$173.88
|
| Rate for Payer: Railroad Medicare Medicare |
$117.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.62
|
| Rate for Payer: UHC Medicare Advantage |
$121.15
|
| Rate for Payer: VA VA |
$117.62
|
|
|
HC HOSP OUTPT VISIT NEW LVL 5
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000124
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.88 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.60
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health SBD |
$173.88
|
|
|
HC HOSP OUTPT VISIT NEW LVL 5
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000124
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$369.96 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$122.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$147.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$147.02
|
| Rate for Payer: BCBS Complete |
$67.56
|
| Rate for Payer: BCBS MAPPO |
$117.62
|
| Rate for Payer: BCBS Trust/PPO |
$351.18
|
| Rate for Payer: BCN Medicare Advantage |
$117.62
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.62
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$64.34
|
| Rate for Payer: Mclaren Medicare |
$117.62
|
| Rate for Payer: Meridian Medicaid |
$67.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.60
|
| Rate for Payer: PACE Medicare |
$111.74
|
| Rate for Payer: PACE SWMI |
$117.62
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$117.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.96
|
| Rate for Payer: Priority Health Medicare |
$117.62
|
| Rate for Payer: Priority Health Narrow Network |
$295.97
|
| Rate for Payer: Priority Health SBD |
$173.88
|
| Rate for Payer: Railroad Medicare Medicare |
$117.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.62
|
| Rate for Payer: UHC Medicare Advantage |
$121.15
|
| Rate for Payer: VA VA |
$117.62
|
|
|
HC HOT BIOPSY
|
Facility
|
OP
|
$479.16
|
|
| Hospital Charge Code |
36000053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$191.66 |
| Max. Negotiated Rate |
$431.24 |
| Rate for Payer: Aetna Commercial |
$407.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.45
|
| Rate for Payer: BCBS Complete |
$191.66
|
| Rate for Payer: Cash Price |
$383.33
|
| Rate for Payer: Cofinity Commercial |
$335.41
|
| Rate for Payer: Cofinity Commercial |
$412.08
|
| Rate for Payer: Healthscope Commercial |
$431.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$407.29
|
| Rate for Payer: PHP Commercial |
$407.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.41
|
| Rate for Payer: Priority Health SBD |
$301.87
|
|
|
HC HOT BIOPSY
|
Facility
|
IP
|
$479.16
|
|
| Hospital Charge Code |
36000053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$301.87 |
| Max. Negotiated Rate |
$431.24 |
| Rate for Payer: Aetna Commercial |
$407.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.45
|
| Rate for Payer: Cash Price |
$383.33
|
| Rate for Payer: Cofinity Commercial |
$335.41
|
| Rate for Payer: Cofinity Commercial |
$412.08
|
| Rate for Payer: Healthscope Commercial |
$431.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$407.29
|
| Rate for Payer: PHP Commercial |
$407.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.41
|
| Rate for Payer: Priority Health SBD |
$301.87
|
|
|
HC HPV TYPES 6,11,16,18,31,33,45,53,58, NONVALENT (9VHPV), 3 DOSE IM
|
Facility
|
IP
|
$189.72
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
63600071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.52 |
| Max. Negotiated Rate |
$170.75 |
| Rate for Payer: Aetna Commercial |
$161.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.32
|
| Rate for Payer: Cash Price |
$151.78
|
| Rate for Payer: Cofinity Commercial |
$132.80
|
| Rate for Payer: Cofinity Commercial |
$163.16
|
| Rate for Payer: Healthscope Commercial |
$170.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.26
|
| Rate for Payer: PHP Commercial |
$161.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.80
|
| Rate for Payer: Priority Health SBD |
$119.52
|
|
|
HC HPV TYPES 6,11,16,18,31,33,45,53,58, NONVALENT (9VHPV), 3 DOSE IM
|
Facility
|
OP
|
$189.72
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
63600071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.89 |
| Max. Negotiated Rate |
$804.88 |
| Rate for Payer: Aetna Commercial |
$161.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.32
|
| Rate for Payer: BCBS Complete |
$75.89
|
| Rate for Payer: BCBS Trust/PPO |
$804.88
|
| Rate for Payer: Cash Price |
$151.78
|
| Rate for Payer: Cash Price |
$151.78
|
| Rate for Payer: Cofinity Commercial |
$132.80
|
| Rate for Payer: Cofinity Commercial |
$163.16
|
| Rate for Payer: Healthscope Commercial |
$170.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.26
|
| Rate for Payer: PHP Commercial |
$161.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.80
|
| Rate for Payer: Priority Health SBD |
$119.52
|
|
|
HC HPV TYPES 6, 11, 16, 18 QUADRIVALENT (4VHPV), 3 DOSE IM
|
Facility
|
IP
|
$208.69
|
|
|
Service Code
|
CPT 90649
|
| Hospital Charge Code |
63600070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.47 |
| Max. Negotiated Rate |
$187.82 |
| Rate for Payer: Aetna Commercial |
$177.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.65
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cofinity Commercial |
$146.08
|
| Rate for Payer: Cofinity Commercial |
$179.47
|
| Rate for Payer: Healthscope Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.39
|
| Rate for Payer: PHP Commercial |
$177.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.08
|
| Rate for Payer: Priority Health SBD |
$131.47
|
|
|
HC HPV TYPES 6, 11, 16, 18 QUADRIVALENT (4VHPV), 3 DOSE IM
|
Facility
|
OP
|
$208.69
|
|
|
Service Code
|
CPT 90649
|
| Hospital Charge Code |
63600070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.48 |
| Max. Negotiated Rate |
$465.41 |
| Rate for Payer: Aetna Commercial |
$177.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.65
|
| Rate for Payer: BCBS Complete |
$83.48
|
| Rate for Payer: BCBS Trust/PPO |
$465.41
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cofinity Commercial |
$146.08
|
| Rate for Payer: Cofinity Commercial |
$179.47
|
| Rate for Payer: Healthscope Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.39
|
| Rate for Payer: PHP Commercial |
$177.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.08
|
| Rate for Payer: Priority Health SBD |
$131.47
|
|
|
HC H PYLORI AG STOOL
|
Facility
|
OP
|
$117.90
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
30600138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$106.11 |
| Rate for Payer: Aetna Commercial |
$100.22
|
| Rate for Payer: Aetna Medicare |
$14.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.98
|
| Rate for Payer: BCBS Complete |
$8.26
|
| Rate for Payer: BCBS MAPPO |
$14.38
|
| Rate for Payer: BCBS Trust/PPO |
$11.27
|
| Rate for Payer: BCN Medicare Advantage |
$14.38
|
| Rate for Payer: Cash Price |
$94.32
|
| Rate for Payer: Cash Price |
$94.32
|
| Rate for Payer: Cofinity Commercial |
$82.53
|
| Rate for Payer: Cofinity Commercial |
$101.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.38
|
| Rate for Payer: Healthscope Commercial |
$106.11
|
| Rate for Payer: Mclaren Medicaid |
$7.87
|
| Rate for Payer: Mclaren Medicare |
$14.38
|
| Rate for Payer: Meridian Medicaid |
$8.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.22
|
| Rate for Payer: PACE Medicare |
$13.66
|
| Rate for Payer: PACE SWMI |
$14.38
|
| Rate for Payer: PHP Commercial |
$100.22
|
| Rate for Payer: PHP Medicare Advantage |
$14.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.53
|
| Rate for Payer: Priority Health Medicare |
$14.38
|
| Rate for Payer: Priority Health SBD |
$74.28
|
| Rate for Payer: Railroad Medicare Medicare |
$14.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.26
|
| Rate for Payer: UHC Core |
$24.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.38
|
| Rate for Payer: UHC Exchange |
$14.38
|
| Rate for Payer: UHC Medicare Advantage |
$14.81
|
| Rate for Payer: VA VA |
$14.38
|
|
|
HC H PYLORI AG STOOL
|
Facility
|
IP
|
$117.90
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
30600138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.28 |
| Max. Negotiated Rate |
$106.11 |
| Rate for Payer: Aetna Commercial |
$100.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.64
|
| Rate for Payer: Cash Price |
$94.32
|
| Rate for Payer: Cofinity Commercial |
$101.39
|
| Rate for Payer: Cofinity Commercial |
$82.53
|
| Rate for Payer: Healthscope Commercial |
$106.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.22
|
| Rate for Payer: PHP Commercial |
$100.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.53
|
| Rate for Payer: Priority Health SBD |
$74.28
|
|
|
HC H PYLORI CLARITHRO RESIST PCR CMPT
|
Facility
|
OP
|
$64.16
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600326
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna Commercial |
$54.54
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Cofinity Commercial |
$44.91
|
| Rate for Payer: Cofinity Commercial |
$55.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$57.74
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.54
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$54.54
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.91
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$40.42
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC H PYLORI CLARITHRO RESIST PCR CMPT
|
Facility
|
IP
|
$64.16
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600326
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.42 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Aetna Commercial |
$54.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.70
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Cofinity Commercial |
$44.91
|
| Rate for Payer: Cofinity Commercial |
$55.18
|
| Rate for Payer: Healthscope Commercial |
$57.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.54
|
| Rate for Payer: PHP Commercial |
$54.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.91
|
| Rate for Payer: Priority Health SBD |
$40.42
|
|
|
HC H PYLORI CLARITHRO RESIST PCR, FECES
|
Facility
|
OP
|
$64.16
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600325
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna Commercial |
$54.54
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Cofinity Commercial |
$44.91
|
| Rate for Payer: Cofinity Commercial |
$55.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$57.74
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.54
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$54.54
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.91
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$40.42
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
