|
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 |
$69.38 |
| Max. Negotiated Rate |
$428.99 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$137.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.82
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: BCBS MAPPO |
$132.66
|
| Rate for Payer: BCBS Trust/PPO |
$106.25
|
| Rate for Payer: BCN Commercial |
$106.25
|
| Rate for Payer: BCN Medicare Advantage |
$132.66
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Advantage |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.66
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$69.38
|
| Rate for Payer: Mclaren Medicare |
$132.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.29
|
| Rate for Payer: Meridian Medicaid |
$139.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$397.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PACE Medicare |
$126.03
|
| Rate for Payer: PACE SWMI |
$132.66
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$132.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.99
|
| Rate for Payer: Priority Health Medicare |
$132.66
|
| Rate for Payer: Priority Health SBD |
$173.88
|
| Rate for Payer: Priority Health Tiered Network |
$343.19
|
| Rate for Payer: Railroad Medicare Medicare |
$132.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.40
|
| Rate for Payer: UHC Core |
$143.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.66
|
| Rate for Payer: UHC Exchange |
$108.47
|
| Rate for Payer: UHC Medicaid |
$69.38
|
| Rate for Payer: UHCCP Medicaid |
$69.38
|
| Rate for Payer: VA VA |
$132.66
|
|
|
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 Advantage |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| 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 |
$69.38 |
| Max. Negotiated Rate |
$428.99 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$137.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.82
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: BCBS MAPPO |
$132.66
|
| Rate for Payer: BCBS Trust/PPO |
$106.25
|
| Rate for Payer: BCN Commercial |
$106.25
|
| Rate for Payer: BCN Medicare Advantage |
$132.66
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Advantage |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.66
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$69.38
|
| Rate for Payer: Mclaren Medicare |
$132.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.29
|
| Rate for Payer: Meridian Medicaid |
$139.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$397.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PACE Medicare |
$126.03
|
| Rate for Payer: PACE SWMI |
$132.66
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$132.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.99
|
| Rate for Payer: Priority Health Medicare |
$132.66
|
| Rate for Payer: Priority Health SBD |
$173.88
|
| Rate for Payer: Priority Health Tiered Network |
$343.19
|
| Rate for Payer: Railroad Medicare Medicare |
$132.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.40
|
| Rate for Payer: UHC Core |
$143.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.66
|
| Rate for Payer: UHC Exchange |
$108.47
|
| Rate for Payer: UHC Medicaid |
$69.38
|
| Rate for Payer: UHCCP Medicaid |
$69.38
|
| Rate for Payer: VA VA |
$132.66
|
|
|
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 Advantage |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health SBD |
$173.88
|
|
|
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 |
$69.38 |
| Max. Negotiated Rate |
$428.99 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$137.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.82
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: BCBS MAPPO |
$132.66
|
| Rate for Payer: BCBS Trust/PPO |
$106.25
|
| Rate for Payer: BCN Commercial |
$106.25
|
| Rate for Payer: BCN Medicare Advantage |
$132.66
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Advantage |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.66
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$69.38
|
| Rate for Payer: Mclaren Medicare |
$132.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.29
|
| Rate for Payer: Meridian Medicaid |
$139.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$397.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PACE Medicare |
$126.03
|
| Rate for Payer: PACE SWMI |
$132.66
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$132.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.99
|
| Rate for Payer: Priority Health Medicare |
$132.66
|
| Rate for Payer: Priority Health SBD |
$173.88
|
| Rate for Payer: Priority Health Tiered Network |
$343.19
|
| Rate for Payer: Railroad Medicare Medicare |
$132.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.40
|
| Rate for Payer: UHC Core |
$143.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.66
|
| Rate for Payer: UHC Exchange |
$108.47
|
| Rate for Payer: UHC Medicaid |
$69.38
|
| Rate for Payer: UHCCP Medicaid |
$69.38
|
| Rate for Payer: VA VA |
$132.66
|
|
|
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: Encore Health Key Benefits Commercial |
$220.80
|
| 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 Advantage |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health SBD |
$173.88
|
|
|
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 Advantage |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| 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 |
$69.38 |
| Max. Negotiated Rate |
$428.99 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$137.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.82
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: BCBS MAPPO |
$132.66
|
| Rate for Payer: BCBS Trust/PPO |
$106.25
|
| Rate for Payer: BCN Commercial |
$106.25
|
| Rate for Payer: BCN Medicare Advantage |
$132.66
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Advantage |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.66
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$69.38
|
| Rate for Payer: Mclaren Medicare |
$132.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.29
|
| Rate for Payer: Meridian Medicaid |
$139.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$397.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PACE Medicare |
$126.03
|
| Rate for Payer: PACE SWMI |
$132.66
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$132.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.99
|
| Rate for Payer: Priority Health Medicare |
$132.66
|
| Rate for Payer: Priority Health SBD |
$173.88
|
| Rate for Payer: Priority Health Tiered Network |
$343.19
|
| Rate for Payer: Railroad Medicare Medicare |
$132.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.40
|
| Rate for Payer: UHC Core |
$143.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.66
|
| Rate for Payer: UHC Exchange |
$108.47
|
| Rate for Payer: UHC Medicaid |
$69.38
|
| Rate for Payer: UHCCP Medicaid |
$69.38
|
| Rate for Payer: VA VA |
$132.66
|
|
|
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 Advantage |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| 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 |
$69.38 |
| Max. Negotiated Rate |
$428.99 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$137.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.82
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: BCBS MAPPO |
$132.66
|
| Rate for Payer: BCBS Trust/PPO |
$106.25
|
| Rate for Payer: BCN Commercial |
$106.25
|
| Rate for Payer: BCN Medicare Advantage |
$132.66
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Advantage |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.66
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$69.38
|
| Rate for Payer: Mclaren Medicare |
$132.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.29
|
| Rate for Payer: Meridian Medicaid |
$139.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$397.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PACE Medicare |
$126.03
|
| Rate for Payer: PACE SWMI |
$132.66
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$132.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.99
|
| Rate for Payer: Priority Health Medicare |
$132.66
|
| Rate for Payer: Priority Health SBD |
$173.88
|
| Rate for Payer: Priority Health Tiered Network |
$343.19
|
| Rate for Payer: Railroad Medicare Medicare |
$132.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.40
|
| Rate for Payer: UHC Core |
$143.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.66
|
| Rate for Payer: UHC Exchange |
$108.47
|
| Rate for Payer: UHC Medicaid |
$69.38
|
| Rate for Payer: UHCCP Medicaid |
$69.38
|
| Rate for Payer: VA VA |
$132.66
|
|
|
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 Advantage |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| 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 |
$69.38 |
| Max. Negotiated Rate |
$428.99 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$137.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.82
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: BCBS MAPPO |
$132.66
|
| Rate for Payer: BCBS Trust/PPO |
$106.25
|
| Rate for Payer: BCN Commercial |
$106.25
|
| Rate for Payer: BCN Medicare Advantage |
$132.66
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Advantage |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.66
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$69.38
|
| Rate for Payer: Mclaren Medicare |
$132.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.29
|
| Rate for Payer: Meridian Medicaid |
$139.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$397.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PACE Medicare |
$126.03
|
| Rate for Payer: PACE SWMI |
$132.66
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$132.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.99
|
| Rate for Payer: Priority Health Medicare |
$132.66
|
| Rate for Payer: Priority Health SBD |
$173.88
|
| Rate for Payer: Priority Health Tiered Network |
$343.19
|
| Rate for Payer: Railroad Medicare Medicare |
$132.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.40
|
| Rate for Payer: UHC Core |
$143.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.66
|
| Rate for Payer: UHC Exchange |
$108.47
|
| Rate for Payer: UHC Medicaid |
$69.38
|
| Rate for Payer: UHCCP Medicaid |
$69.38
|
| Rate for Payer: VA VA |
$132.66
|
|
|
HC HOT BIOPSY
|
Facility
|
IP
|
$498.51
|
|
| Hospital Charge Code |
36000053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$314.06 |
| Max. Negotiated Rate |
$448.66 |
| Rate for Payer: Aetna Commercial |
$423.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.03
|
| Rate for Payer: Cash Price |
$398.81
|
| Rate for Payer: Cofinity Advantage |
$348.96
|
| Rate for Payer: Cofinity Commercial |
$428.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.81
|
| Rate for Payer: Healthscope Commercial |
$448.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.88
|
| Rate for Payer: PHP Commercial |
$423.73
|
| Rate for Payer: Priority Health SBD |
$314.06
|
|
|
HC HOT BIOPSY
|
Facility
|
OP
|
$498.51
|
|
| Hospital Charge Code |
36000053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$199.40 |
| Max. Negotiated Rate |
$448.66 |
| Rate for Payer: Aetna Commercial |
$423.73
|
| Rate for Payer: Aetna Medicare |
$249.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.03
|
| Rate for Payer: BCBS Complete |
$199.40
|
| Rate for Payer: Cash Price |
$398.81
|
| Rate for Payer: Cofinity Advantage |
$348.96
|
| Rate for Payer: Cofinity Commercial |
$428.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.81
|
| Rate for Payer: Healthscope Commercial |
$448.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$398.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.88
|
| Rate for Payer: PHP Commercial |
$423.73
|
| Rate for Payer: Priority Health SBD |
$314.06
|
|
|
HC HPV SEPARATELY REPORTABLE HR 16/18
|
Facility
|
IP
|
$99.07
|
|
|
Service Code
|
CPT 87626
|
| Hospital Charge Code |
30600346
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$62.41 |
| Max. Negotiated Rate |
$89.16 |
| Rate for Payer: Aetna Commercial |
$84.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.40
|
| Rate for Payer: Cash Price |
$79.26
|
| Rate for Payer: Cofinity Advantage |
$69.35
|
| Rate for Payer: Cofinity Commercial |
$85.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.26
|
| Rate for Payer: Healthscope Commercial |
$89.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.30
|
| Rate for Payer: PHP Commercial |
$84.21
|
| Rate for Payer: Priority Health SBD |
$62.41
|
|
|
HC HPV SEPARATELY REPORTABLE HR 16/18
|
Facility
|
OP
|
$99.07
|
|
|
Service Code
|
CPT 87626
|
| Hospital Charge Code |
30600346
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.71 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna Commercial |
$84.21
|
| Rate for Payer: Aetna Medicare |
$73.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.75
|
| Rate for Payer: BCBS Complete |
$38.55
|
| Rate for Payer: BCBS MAPPO |
$70.20
|
| Rate for Payer: BCBS Trust/PPO |
$74.85
|
| Rate for Payer: BCCCP Commercial |
$70.02
|
| Rate for Payer: BCN Commercial |
$74.85
|
| Rate for Payer: BCN Medicare Advantage |
$70.20
|
| Rate for Payer: Cash Price |
$79.26
|
| Rate for Payer: Cash Price |
$79.26
|
| Rate for Payer: Cofinity Advantage |
$69.35
|
| Rate for Payer: Cofinity Commercial |
$85.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$89.16
|
| Rate for Payer: Mclaren Medicaid |
$36.71
|
| Rate for Payer: Mclaren Medicare |
$70.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.71
|
| Rate for Payer: Meridian Medicaid |
$73.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.21
|
| Rate for Payer: Nomi Health Commercial |
$105.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.30
|
| Rate for Payer: PACE Medicare |
$66.69
|
| Rate for Payer: PACE SWMI |
$70.20
|
| Rate for Payer: PHP Commercial |
$84.21
|
| Rate for Payer: PHP Medicare Advantage |
$70.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$70.20
|
| Rate for Payer: Priority Health Medicare |
$70.20
|
| Rate for Payer: Priority Health SBD |
$62.41
|
| Rate for Payer: Priority Health Tiered Network |
$56.16
|
| Rate for Payer: Railroad Medicare Medicare |
$70.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.30
|
| Rate for Payer: UHC Core |
$105.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.20
|
| Rate for Payer: UHC Exchange |
$105.30
|
| Rate for Payer: UHC Medicaid |
$36.71
|
| Rate for Payer: UHCCP Medicaid |
$36.71
|
| Rate for Payer: VA VA |
$70.20
|
|
|
HC HPV TYPES 6,11,16,18,31,33,45,53,58, NONVALENT (9VHPV), 3 DOSE IM
|
Facility
|
IP
|
$197.38
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
63600071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$124.35 |
| Max. Negotiated Rate |
$177.64 |
| Rate for Payer: Aetna Commercial |
$167.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.30
|
| Rate for Payer: Cash Price |
$157.90
|
| Rate for Payer: Cofinity Advantage |
$138.17
|
| Rate for Payer: Cofinity Commercial |
$169.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.90
|
| Rate for Payer: Healthscope Commercial |
$177.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.03
|
| Rate for Payer: PHP Commercial |
$167.77
|
| Rate for Payer: Priority Health SBD |
$124.35
|
|
|
HC HPV TYPES 6,11,16,18,31,33,45,53,58, NONVALENT (9VHPV), 3 DOSE IM
|
Facility
|
OP
|
$197.38
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
63600071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.95 |
| Max. Negotiated Rate |
$810.35 |
| Rate for Payer: Aetna Commercial |
$167.77
|
| Rate for Payer: Aetna Medicare |
$98.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.30
|
| Rate for Payer: BCBS Complete |
$78.95
|
| Rate for Payer: BCBS Trust/PPO |
$810.35
|
| Rate for Payer: BCN Commercial |
$810.35
|
| Rate for Payer: Cash Price |
$157.90
|
| Rate for Payer: Cash Price |
$157.90
|
| Rate for Payer: Cofinity Advantage |
$138.17
|
| Rate for Payer: Cofinity Commercial |
$169.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.90
|
| Rate for Payer: Healthscope Commercial |
$177.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.03
|
| Rate for Payer: PHP Commercial |
$167.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$375.02
|
| Rate for Payer: Priority Health SBD |
$124.35
|
| Rate for Payer: Priority Health Tiered Network |
$300.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$651.35
|
| Rate for Payer: UHC Core |
$651.35
|
| Rate for Payer: UHC Exchange |
$651.35
|
|
|
HC HPV TYPES 6, 11, 16, 18 QUADRIVALENT (4VHPV), 3 DOSE IM
|
Facility
|
IP
|
$217.12
|
|
|
Service Code
|
CPT 90649
|
| Hospital Charge Code |
63600070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.79 |
| Max. Negotiated Rate |
$195.41 |
| Rate for Payer: Aetna Commercial |
$184.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.13
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cofinity Advantage |
$151.98
|
| Rate for Payer: Cofinity Commercial |
$186.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.70
|
| Rate for Payer: Healthscope Commercial |
$195.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.84
|
| Rate for Payer: PHP Commercial |
$184.55
|
| Rate for Payer: Priority Health SBD |
$136.79
|
|
|
HC HPV TYPES 6, 11, 16, 18 QUADRIVALENT (4VHPV), 3 DOSE IM
|
Facility
|
OP
|
$217.12
|
|
|
Service Code
|
CPT 90649
|
| Hospital Charge Code |
63600070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.85 |
| Max. Negotiated Rate |
$394.40 |
| Rate for Payer: Aetna Commercial |
$184.55
|
| Rate for Payer: Aetna Medicare |
$108.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.13
|
| Rate for Payer: BCBS Complete |
$86.85
|
| Rate for Payer: BCBS Trust/PPO |
$394.40
|
| Rate for Payer: BCN Commercial |
$394.40
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cofinity Advantage |
$151.98
|
| Rate for Payer: Cofinity Commercial |
$186.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.70
|
| Rate for Payer: Healthscope Commercial |
$195.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.84
|
| Rate for Payer: PHP Commercial |
$184.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$182.45
|
| Rate for Payer: Priority Health SBD |
$136.79
|
| Rate for Payer: Priority Health Tiered Network |
$145.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.83
|
| Rate for Payer: UHC Core |
$186.83
|
| Rate for Payer: UHC Exchange |
$186.83
|
|
|
HC H PYLORI AG STOOL
|
Facility
|
IP
|
$122.67
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
30600138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$77.28 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$104.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.74
|
| Rate for Payer: Cash Price |
$98.14
|
| Rate for Payer: Cofinity Advantage |
$85.87
|
| Rate for Payer: Cofinity Commercial |
$105.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.14
|
| Rate for Payer: Healthscope Commercial |
$110.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.00
|
| Rate for Payer: PHP Commercial |
$104.27
|
| Rate for Payer: Priority Health SBD |
$77.28
|
|
|
HC H PYLORI AG STOOL
|
Facility
|
OP
|
$122.67
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
30600138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$104.27
|
| Rate for Payer: Aetna Medicare |
$14.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.74
|
| 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 |
$7.90
|
| Rate for Payer: BCBS MAPPO |
$14.38
|
| Rate for Payer: BCBS Trust/PPO |
$15.34
|
| Rate for Payer: BCN Commercial |
$15.34
|
| Rate for Payer: BCN Medicare Advantage |
$14.38
|
| Rate for Payer: Cash Price |
$98.14
|
| Rate for Payer: Cash Price |
$98.14
|
| Rate for Payer: Cofinity Advantage |
$85.87
|
| Rate for Payer: Cofinity Commercial |
$105.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.38
|
| Rate for Payer: Healthscope Commercial |
$110.40
|
| Rate for Payer: Mclaren Medicaid |
$7.52
|
| Rate for Payer: Mclaren Medicare |
$14.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.10
|
| Rate for Payer: Meridian Medicaid |
$15.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.27
|
| Rate for Payer: Nomi Health Commercial |
$21.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.00
|
| Rate for Payer: PACE Medicare |
$13.66
|
| Rate for Payer: PACE SWMI |
$14.38
|
| Rate for Payer: PHP Commercial |
$104.27
|
| Rate for Payer: PHP Medicare Advantage |
$14.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.38
|
| Rate for Payer: Priority Health Medicare |
$14.38
|
| Rate for Payer: Priority Health SBD |
$77.28
|
| Rate for Payer: Priority Health Tiered Network |
$11.50
|
| Rate for Payer: Railroad Medicare Medicare |
$14.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.57
|
| Rate for Payer: UHC Core |
$21.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.38
|
| Rate for Payer: UHC Exchange |
$21.57
|
| Rate for Payer: UHC Medicaid |
$7.52
|
| Rate for Payer: UHCCP Medicaid |
$7.52
|
| Rate for Payer: VA VA |
$14.38
|
|
|
HC H PYLORI CLARITHRO RESIST PCR CMPT
|
Facility
|
IP
|
$66.75
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600326
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.05 |
| Max. Negotiated Rate |
$60.08 |
| Rate for Payer: Aetna Commercial |
$56.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.39
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cofinity Advantage |
$46.73
|
| Rate for Payer: Cofinity Commercial |
$57.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.40
|
| Rate for Payer: Healthscope Commercial |
$60.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.06
|
| Rate for Payer: PHP Commercial |
$56.74
|
| Rate for Payer: Priority Health SBD |
$42.05
|
|
|
HC H PYLORI CLARITHRO RESIST PCR CMPT
|
Facility
|
OP
|
$66.75
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600326
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$60.08 |
| Rate for Payer: Aetna Commercial |
$56.74
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.39
|
| 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 |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$37.42
|
| Rate for Payer: BCN Commercial |
$37.42
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cofinity Advantage |
$46.73
|
| Rate for Payer: Cofinity Commercial |
$57.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$60.08
|
| Rate for Payer: Mclaren Medicaid |
$18.35
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.74
|
| Rate for Payer: Nomi Health Commercial |
$52.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.06
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$56.74
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$42.05
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$52.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$52.64
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC H PYLORI CLARITHRO RESIST PCR, FECES
|
Facility
|
IP
|
$66.75
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600325
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.05 |
| Max. Negotiated Rate |
$60.08 |
| Rate for Payer: Aetna Commercial |
$56.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.39
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cofinity Advantage |
$46.73
|
| Rate for Payer: Cofinity Commercial |
$57.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.40
|
| Rate for Payer: Healthscope Commercial |
$60.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.06
|
| Rate for Payer: PHP Commercial |
$56.74
|
| Rate for Payer: Priority Health SBD |
$42.05
|
|
