|
HC HOME SLEEP TEST TYPE 3 PORTA
|
Facility
|
OP
|
$216.41
|
|
|
Service Code
|
HCPCS G0399
|
| Hospital Charge Code |
92000027
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$38.15 |
| Max. Negotiated Rate |
$194.77 |
| Rate for Payer: Aetna Commercial |
$183.95
|
| Rate for Payer: Aetna Medicare |
$56.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.63
|
| Rate for Payer: BCBS Complete |
$40.06
|
| Rate for Payer: BCBS MAPPO |
$54.10
|
| Rate for Payer: BCBS Trust/PPO |
$177.91
|
| Rate for Payer: BCN Commercial |
$177.91
|
| Rate for Payer: BCN Medicare Advantage |
$54.10
|
| Rate for Payer: Cash Price |
$173.13
|
| Rate for Payer: Cofinity Commercial |
$186.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$194.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.31
|
| Rate for Payer: Mclaren Medicaid |
$38.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.81
|
| Rate for Payer: Meridian Medicaid |
$40.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.95
|
| Rate for Payer: Nomi Health Commercial |
$177.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.31
|
| Rate for Payer: PACE Senior Care Partners |
$51.40
|
| Rate for Payer: PACE SWMI |
$54.10
|
| Rate for Payer: PHP Commercial |
$183.95
|
| Rate for Payer: PHP Medicare Advantage |
$54.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$188.28
|
| Rate for Payer: Priority Health Medicare |
$54.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.62
|
| Rate for Payer: Railroad Medicare Medicare |
$54.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.44
|
| Rate for Payer: UHC Core |
$180.70
|
| Rate for Payer: UHC Exchange |
$54.10
|
| Rate for Payer: UHC Medicaid |
$38.15
|
| Rate for Payer: UHC Medicare Advantage |
$54.10
|
| Rate for Payer: UHCCP Medicaid |
$38.15
|
| Rate for Payer: VA VA |
$54.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.31
|
|
|
HC HOME SLEEP TEST TYPE 3 PORTA
|
Facility
|
IP
|
$216.41
|
|
|
Service Code
|
HCPCS G0399
|
| Hospital Charge Code |
92000027
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$150.62 |
| Max. Negotiated Rate |
$194.77 |
| Rate for Payer: Aetna Commercial |
$183.95
|
| Rate for Payer: BCBS Trust/PPO |
$178.73
|
| Rate for Payer: BCN Commercial |
$178.73
|
| Rate for Payer: Cash Price |
$173.13
|
| Rate for Payer: Cofinity Commercial |
$186.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.13
|
| Rate for Payer: Healthscope Commercial |
$194.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.95
|
| Rate for Payer: Nomi Health Commercial |
$177.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.31
|
| Rate for Payer: PHP Commercial |
$183.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$188.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.44
|
| Rate for Payer: UHC Core |
$180.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.31
|
|
|
HC HOME SLEEP TEST/TYPE 4 PORTA
|
Facility
|
OP
|
$216.41
|
|
|
Service Code
|
HCPCS G0400
|
| Hospital Charge Code |
92000028
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$38.15 |
| Max. Negotiated Rate |
$194.77 |
| Rate for Payer: Aetna Commercial |
$183.95
|
| Rate for Payer: Aetna Medicare |
$56.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.63
|
| Rate for Payer: BCBS Complete |
$40.06
|
| Rate for Payer: BCBS MAPPO |
$54.10
|
| Rate for Payer: BCBS Trust/PPO |
$177.91
|
| Rate for Payer: BCN Commercial |
$177.91
|
| Rate for Payer: BCN Medicare Advantage |
$54.10
|
| Rate for Payer: Cash Price |
$173.13
|
| Rate for Payer: Cofinity Commercial |
$186.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$194.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.31
|
| Rate for Payer: Mclaren Medicaid |
$38.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.81
|
| Rate for Payer: Meridian Medicaid |
$40.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.95
|
| Rate for Payer: Nomi Health Commercial |
$177.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.31
|
| Rate for Payer: PACE Senior Care Partners |
$51.40
|
| Rate for Payer: PACE SWMI |
$54.10
|
| Rate for Payer: PHP Commercial |
$183.95
|
| Rate for Payer: PHP Medicare Advantage |
$54.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$188.28
|
| Rate for Payer: Priority Health Medicare |
$54.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.62
|
| Rate for Payer: Railroad Medicare Medicare |
$54.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.44
|
| Rate for Payer: UHC Core |
$180.70
|
| Rate for Payer: UHC Exchange |
$54.10
|
| Rate for Payer: UHC Medicaid |
$38.15
|
| Rate for Payer: UHC Medicare Advantage |
$54.10
|
| Rate for Payer: UHCCP Medicaid |
$38.15
|
| Rate for Payer: VA VA |
$54.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.31
|
|
|
HC HOME SLEEP TEST/TYPE 4 PORTA
|
Facility
|
IP
|
$216.41
|
|
|
Service Code
|
HCPCS G0400
|
| Hospital Charge Code |
92000028
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$150.62 |
| Max. Negotiated Rate |
$194.77 |
| Rate for Payer: Aetna Commercial |
$183.95
|
| Rate for Payer: BCBS Trust/PPO |
$178.73
|
| Rate for Payer: BCN Commercial |
$178.73
|
| Rate for Payer: Cash Price |
$173.13
|
| Rate for Payer: Cofinity Commercial |
$186.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.13
|
| Rate for Payer: Healthscope Commercial |
$194.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.95
|
| Rate for Payer: Nomi Health Commercial |
$177.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.31
|
| Rate for Payer: PHP Commercial |
$183.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$188.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.44
|
| Rate for Payer: UHC Core |
$180.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.31
|
|
|
HC HOMOCYSTEINE SERUM
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
30100243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.93 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: BCBS Trust/PPO |
$43.82
|
| Rate for Payer: BCN Commercial |
$43.82
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.69
|
| Rate for Payer: UHC Core |
$44.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC HOMOCYSTEINE SERUM
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
30100243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$13.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.58
|
| Rate for Payer: BCBS Complete |
$9.82
|
| Rate for Payer: BCBS MAPPO |
$13.27
|
| Rate for Payer: BCBS Trust/PPO |
$43.62
|
| Rate for Payer: BCN Commercial |
$43.62
|
| Rate for Payer: BCN Medicare Advantage |
$13.27
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.27
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Mclaren Medicaid |
$9.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.93
|
| Rate for Payer: Meridian Medicaid |
$9.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Senior Care Partners |
$12.60
|
| Rate for Payer: PACE SWMI |
$13.27
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.16
|
| Rate for Payer: Priority Health Medicare |
$13.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.93
|
| Rate for Payer: Railroad Medicare Medicare |
$13.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.69
|
| Rate for Payer: UHC Core |
$44.31
|
| Rate for Payer: UHC Exchange |
$13.27
|
| Rate for Payer: UHC Medicaid |
$9.35
|
| Rate for Payer: UHC Medicare Advantage |
$13.27
|
| Rate for Payer: UHCCP Medicaid |
$9.35
|
| Rate for Payer: VA VA |
$13.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC HOMOVANILLIC ACID RANDOM URINE
|
Facility
|
OP
|
$64.73
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
30100474
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$58.26 |
| Rate for Payer: Aetna Commercial |
$55.02
|
| Rate for Payer: Aetna Medicare |
$16.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.23
|
| Rate for Payer: BCBS Complete |
$11.98
|
| Rate for Payer: BCBS MAPPO |
$16.18
|
| Rate for Payer: BCBS Trust/PPO |
$53.21
|
| Rate for Payer: BCN Commercial |
$53.21
|
| Rate for Payer: BCN Medicare Advantage |
$16.18
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cofinity Commercial |
$55.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$58.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.55
|
| Rate for Payer: Mclaren Medicaid |
$11.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.99
|
| Rate for Payer: Meridian Medicaid |
$11.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.02
|
| Rate for Payer: Nomi Health Commercial |
$53.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.55
|
| Rate for Payer: PACE Senior Care Partners |
$15.37
|
| Rate for Payer: PACE SWMI |
$16.18
|
| Rate for Payer: PHP Commercial |
$55.02
|
| Rate for Payer: PHP Medicare Advantage |
$16.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.32
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.05
|
| Rate for Payer: Railroad Medicare Medicare |
$16.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.96
|
| Rate for Payer: UHC Core |
$54.05
|
| Rate for Payer: UHC Exchange |
$16.18
|
| Rate for Payer: UHC Medicaid |
$11.41
|
| Rate for Payer: UHC Medicare Advantage |
$16.18
|
| Rate for Payer: UHCCP Medicaid |
$11.41
|
| Rate for Payer: VA VA |
$16.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.55
|
|
|
HC HOMOVANILLIC ACID RANDOM URINE
|
Facility
|
IP
|
$64.73
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
30100474
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$58.26 |
| Rate for Payer: Aetna Commercial |
$55.02
|
| Rate for Payer: BCBS Trust/PPO |
$53.46
|
| Rate for Payer: BCN Commercial |
$53.46
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cofinity Commercial |
$55.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.78
|
| Rate for Payer: Healthscope Commercial |
$58.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.02
|
| Rate for Payer: Nomi Health Commercial |
$53.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.55
|
| Rate for Payer: PHP Commercial |
$55.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.96
|
| Rate for Payer: UHC Core |
$54.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.55
|
|
|
HC HOMOVANILLIC ACID URINE
|
Facility
|
OP
|
$64.73
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
30100244
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$58.26 |
| Rate for Payer: Aetna Commercial |
$55.02
|
| Rate for Payer: Aetna Medicare |
$16.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.23
|
| Rate for Payer: BCBS Complete |
$11.98
|
| Rate for Payer: BCBS MAPPO |
$16.18
|
| Rate for Payer: BCBS Trust/PPO |
$53.21
|
| Rate for Payer: BCN Commercial |
$53.21
|
| Rate for Payer: BCN Medicare Advantage |
$16.18
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cofinity Commercial |
$55.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$58.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.55
|
| Rate for Payer: Mclaren Medicaid |
$11.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.99
|
| Rate for Payer: Meridian Medicaid |
$11.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.02
|
| Rate for Payer: Nomi Health Commercial |
$53.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.55
|
| Rate for Payer: PACE Senior Care Partners |
$15.37
|
| Rate for Payer: PACE SWMI |
$16.18
|
| Rate for Payer: PHP Commercial |
$55.02
|
| Rate for Payer: PHP Medicare Advantage |
$16.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.32
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.05
|
| Rate for Payer: Railroad Medicare Medicare |
$16.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.96
|
| Rate for Payer: UHC Core |
$54.05
|
| Rate for Payer: UHC Exchange |
$16.18
|
| Rate for Payer: UHC Medicaid |
$11.41
|
| Rate for Payer: UHC Medicare Advantage |
$16.18
|
| Rate for Payer: UHCCP Medicaid |
$11.41
|
| Rate for Payer: VA VA |
$16.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.55
|
|
|
HC HOMOVANILLIC ACID URINE
|
Facility
|
IP
|
$64.73
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
30100244
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$58.26 |
| Rate for Payer: Aetna Commercial |
$55.02
|
| Rate for Payer: BCBS Trust/PPO |
$53.46
|
| Rate for Payer: BCN Commercial |
$53.46
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cofinity Commercial |
$55.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.78
|
| Rate for Payer: Healthscope Commercial |
$58.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.02
|
| Rate for Payer: Nomi Health Commercial |
$53.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.55
|
| Rate for Payer: PHP Commercial |
$55.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.96
|
| Rate for Payer: UHC Core |
$54.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.55
|
|
|
HC HONEY BEE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200089
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC HONEY BEE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200089
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC HOSP OUTPT CONSULT LVL 2
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000125
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$71.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.25
|
| Rate for Payer: BCBS Complete |
$51.09
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$226.90
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| 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 |
$69.00
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Mclaren Medicaid |
$48.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$51.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PACE Senior Care Partners |
$65.55
|
| Rate for Payer: PACE SWMI |
$69.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$69.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.10
|
| Rate for Payer: Railroad Medicare Medicare |
$69.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicaid |
$48.66
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$48.66
|
| Rate for Payer: VA VA |
$69.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOSP OUTPT CONSULT LVL 2
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000125
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.10 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$227.95
|
| Rate for Payer: BCN Commercial |
$227.95
|
| Rate for Payer: Cash Price |
$220.80
|
| 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: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOSP OUTPT CONSULT LVL 3
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000126
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.10 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$227.95
|
| Rate for Payer: BCN Commercial |
$227.95
|
| Rate for Payer: Cash Price |
$220.80
|
| 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: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOSP OUTPT CONSULT LVL 3
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000126
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$71.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.25
|
| Rate for Payer: BCBS Complete |
$51.09
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$226.90
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| 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 |
$69.00
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Mclaren Medicaid |
$48.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$51.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PACE Senior Care Partners |
$65.55
|
| Rate for Payer: PACE SWMI |
$69.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$69.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.10
|
| Rate for Payer: Railroad Medicare Medicare |
$69.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicaid |
$48.66
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$48.66
|
| Rate for Payer: VA VA |
$69.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOSP OUTPT CONSULT LVL 4
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000127
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.10 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$227.95
|
| Rate for Payer: BCN Commercial |
$227.95
|
| Rate for Payer: Cash Price |
$220.80
|
| 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: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOSP OUTPT CONSULT LVL 4
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000127
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$71.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.25
|
| Rate for Payer: BCBS Complete |
$51.09
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$226.90
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| 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 |
$69.00
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Mclaren Medicaid |
$48.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$51.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PACE Senior Care Partners |
$65.55
|
| Rate for Payer: PACE SWMI |
$69.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$69.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.10
|
| Rate for Payer: Railroad Medicare Medicare |
$69.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicaid |
$48.66
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$48.66
|
| Rate for Payer: VA VA |
$69.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOSP OUTPT CONSULT LVL 5
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000128
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.10 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$227.95
|
| Rate for Payer: BCN Commercial |
$227.95
|
| Rate for Payer: Cash Price |
$220.80
|
| 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: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOSP OUTPT CONSULT LVL 5
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000128
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$71.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.25
|
| Rate for Payer: BCBS Complete |
$51.09
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$226.90
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| 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 |
$69.00
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Mclaren Medicaid |
$48.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$51.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PACE Senior Care Partners |
$65.55
|
| Rate for Payer: PACE SWMI |
$69.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$69.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.10
|
| Rate for Payer: Railroad Medicare Medicare |
$69.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicaid |
$48.66
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$48.66
|
| Rate for Payer: VA VA |
$69.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOSP OUTPT VISIT EST LVL 1
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000116
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$71.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.25
|
| Rate for Payer: BCBS Complete |
$51.09
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$226.90
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| 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 |
$69.00
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Mclaren Medicaid |
$48.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$51.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PACE Senior Care Partners |
$65.55
|
| Rate for Payer: PACE SWMI |
$69.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$69.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.10
|
| Rate for Payer: Railroad Medicare Medicare |
$69.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicaid |
$48.66
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$48.66
|
| Rate for Payer: VA VA |
$69.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOSP OUTPT VISIT EST LVL 1
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000116
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.10 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$227.95
|
| Rate for Payer: BCN Commercial |
$227.95
|
| Rate for Payer: Cash Price |
$220.80
|
| 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: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOSP OUTPT VISIT EST LVL 2
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000117
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.10 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$227.95
|
| Rate for Payer: BCN Commercial |
$227.95
|
| Rate for Payer: Cash Price |
$220.80
|
| 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: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOSP OUTPT VISIT EST LVL 2
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000117
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$71.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.25
|
| Rate for Payer: BCBS Complete |
$51.09
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$226.90
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| 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 |
$69.00
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Mclaren Medicaid |
$48.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$51.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PACE Senior Care Partners |
$65.55
|
| Rate for Payer: PACE SWMI |
$69.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$69.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.10
|
| Rate for Payer: Railroad Medicare Medicare |
$69.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicaid |
$48.66
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$48.66
|
| Rate for Payer: VA VA |
$69.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
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 |
$48.66 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$71.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.25
|
| Rate for Payer: BCBS Complete |
$51.09
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$226.90
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| 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 |
$69.00
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Mclaren Medicaid |
$48.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$51.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.00
|
| Rate for Payer: PACE Senior Care Partners |
$65.55
|
| Rate for Payer: PACE SWMI |
$69.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$69.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.10
|
| Rate for Payer: Railroad Medicare Medicare |
$69.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicaid |
$48.66
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$48.66
|
| Rate for Payer: VA VA |
$69.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
