|
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
|
|
|
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 |
$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 4
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000119
|
|
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 5
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000120
|
|
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 5
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000120
|
|
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 NEW LVL 2
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000121
|
|
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 NEW LVL 2
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000121
|
|
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 NEW LVL 3
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000122
|
|
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 NEW LVL 3
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000122
|
|
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 NEW LVL 4
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000123
|
|
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 NEW LVL 4
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000123
|
|
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 NEW LVL 5
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000124
|
|
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 NEW LVL 5
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000124
|
|
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 HOT BIOPSY
|
Facility
|
OP
|
$498.51
|
|
| Hospital Charge Code |
36000053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$87.89 |
| Max. Negotiated Rate |
$448.66 |
| Rate for Payer: Aetna Commercial |
$423.73
|
| Rate for Payer: Aetna Medicare |
$129.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.78
|
| Rate for Payer: BCBS Complete |
$92.27
|
| Rate for Payer: BCBS MAPPO |
$124.63
|
| Rate for Payer: BCBS Trust/PPO |
$409.83
|
| Rate for Payer: BCN Commercial |
$409.83
|
| Rate for Payer: BCN Medicare Advantage |
$124.63
|
| Rate for Payer: Cash Price |
$398.81
|
| Rate for Payer: Cofinity Commercial |
$428.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.63
|
| Rate for Payer: Healthscope Commercial |
$448.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.88
|
| Rate for Payer: Mclaren Medicaid |
$87.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.86
|
| Rate for Payer: Meridian Medicaid |
$92.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$137.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.73
|
| Rate for Payer: Nomi Health Commercial |
$408.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.88
|
| Rate for Payer: PACE Senior Care Partners |
$118.40
|
| Rate for Payer: PACE SWMI |
$124.63
|
| Rate for Payer: PHP Commercial |
$423.73
|
| Rate for Payer: PHP Medicare Advantage |
$124.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$433.70
|
| Rate for Payer: Priority Health Medicare |
$125.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$346.96
|
| Rate for Payer: Railroad Medicare Medicare |
$124.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$438.69
|
| Rate for Payer: UHC Core |
$416.26
|
| Rate for Payer: UHC Exchange |
$124.63
|
| Rate for Payer: UHC Medicaid |
$87.89
|
| Rate for Payer: UHC Medicare Advantage |
$124.63
|
| Rate for Payer: UHCCP Medicaid |
$87.89
|
| Rate for Payer: VA VA |
$124.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.88
|
|
|
HC HOT BIOPSY
|
Facility
|
IP
|
$498.51
|
|
| Hospital Charge Code |
36000053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$346.96 |
| Max. Negotiated Rate |
$448.66 |
| Rate for Payer: Aetna Commercial |
$423.73
|
| Rate for Payer: BCBS Trust/PPO |
$411.72
|
| Rate for Payer: BCN Commercial |
$411.72
|
| Rate for Payer: Cash Price |
$398.81
|
| 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: Lakeland Regional Health Systems Commercial |
$373.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.73
|
| Rate for Payer: Nomi Health Commercial |
$408.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.88
|
| Rate for Payer: PHP Commercial |
$423.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$433.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$346.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$438.69
|
| Rate for Payer: UHC Core |
$416.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.88
|
|
|
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 |
$17.47 |
| Max. Negotiated Rate |
$89.16 |
| Rate for Payer: Aetna Commercial |
$84.21
|
| Rate for Payer: Aetna Medicare |
$25.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.96
|
| Rate for Payer: BCBS Complete |
$18.34
|
| Rate for Payer: BCBS MAPPO |
$24.77
|
| Rate for Payer: BCBS Trust/PPO |
$81.45
|
| Rate for Payer: BCCCP Commercial |
$70.02
|
| Rate for Payer: BCN Commercial |
$81.45
|
| Rate for Payer: BCN Medicare Advantage |
$24.77
|
| Rate for Payer: Cash Price |
$79.26
|
| Rate for Payer: Cash Price |
$79.26
|
| 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 |
$24.77
|
| Rate for Payer: Healthscope Commercial |
$89.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.30
|
| Rate for Payer: Mclaren Medicaid |
$17.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.01
|
| Rate for Payer: Meridian Medicaid |
$18.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.21
|
| Rate for Payer: Nomi Health Commercial |
$81.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.30
|
| Rate for Payer: PACE Senior Care Partners |
$23.53
|
| Rate for Payer: PACE SWMI |
$24.77
|
| Rate for Payer: PHP Commercial |
$84.21
|
| Rate for Payer: PHP Medicare Advantage |
$24.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$86.19
|
| Rate for Payer: Priority Health Medicare |
$25.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.95
|
| Rate for Payer: Railroad Medicare Medicare |
$24.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.18
|
| Rate for Payer: UHC Core |
$82.72
|
| Rate for Payer: UHC Exchange |
$24.77
|
| Rate for Payer: UHC Medicaid |
$17.47
|
| Rate for Payer: UHC Medicare Advantage |
$24.77
|
| Rate for Payer: UHCCP Medicaid |
$17.47
|
| Rate for Payer: VA VA |
$24.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.30
|
|
|
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 |
$68.95 |
| Max. Negotiated Rate |
$89.16 |
| Rate for Payer: Aetna Commercial |
$84.21
|
| Rate for Payer: BCBS Trust/PPO |
$81.82
|
| Rate for Payer: BCN Commercial |
$81.82
|
| Rate for Payer: Cash Price |
$79.26
|
| 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: Lakeland Regional Health Systems Commercial |
$74.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.21
|
| Rate for Payer: Nomi Health Commercial |
$81.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.30
|
| Rate for Payer: PHP Commercial |
$84.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$86.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.18
|
| Rate for Payer: UHC Core |
$82.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.30
|
|
|
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 |
$137.38 |
| Max. Negotiated Rate |
$177.64 |
| Rate for Payer: Aetna Commercial |
$167.77
|
| Rate for Payer: BCBS Trust/PPO |
$163.02
|
| Rate for Payer: BCN Commercial |
$163.02
|
| Rate for Payer: Cash Price |
$157.90
|
| 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: Lakeland Regional Health Systems Commercial |
$148.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.77
|
| Rate for Payer: Nomi Health Commercial |
$161.85
|
| 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 |
$171.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.69
|
| Rate for Payer: UHC Core |
$164.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.03
|
|
|
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 |
$34.80 |
| Max. Negotiated Rate |
$177.64 |
| Rate for Payer: Aetna Commercial |
$167.77
|
| Rate for Payer: Aetna Medicare |
$51.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.68
|
| Rate for Payer: BCBS Complete |
$36.54
|
| Rate for Payer: BCBS MAPPO |
$49.34
|
| Rate for Payer: BCBS Trust/PPO |
$162.27
|
| Rate for Payer: BCN Commercial |
$162.27
|
| Rate for Payer: BCN Medicare Advantage |
$49.34
|
| Rate for Payer: Cash Price |
$157.90
|
| Rate for Payer: Cofinity Commercial |
$169.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.34
|
| Rate for Payer: Healthscope Commercial |
$177.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.03
|
| Rate for Payer: Mclaren Medicaid |
$34.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.81
|
| Rate for Payer: Meridian Medicaid |
$36.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.77
|
| Rate for Payer: Nomi Health Commercial |
$161.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.03
|
| Rate for Payer: PACE Senior Care Partners |
$46.88
|
| Rate for Payer: PACE SWMI |
$49.34
|
| Rate for Payer: PHP Commercial |
$167.77
|
| Rate for Payer: PHP Medicare Advantage |
$49.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$171.72
|
| Rate for Payer: Priority Health Medicare |
$49.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.38
|
| Rate for Payer: Railroad Medicare Medicare |
$49.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.69
|
| Rate for Payer: UHC Core |
$164.81
|
| Rate for Payer: UHC Exchange |
$49.34
|
| Rate for Payer: UHC Medicaid |
$34.80
|
| Rate for Payer: UHC Medicare Advantage |
$49.34
|
| Rate for Payer: UHCCP Medicaid |
$34.80
|
| Rate for Payer: VA VA |
$49.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.03
|
|
|
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 |
$38.28 |
| Max. Negotiated Rate |
$195.41 |
| Rate for Payer: Aetna Commercial |
$184.55
|
| Rate for Payer: Aetna Medicare |
$56.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.85
|
| Rate for Payer: BCBS Complete |
$40.19
|
| Rate for Payer: BCBS MAPPO |
$54.28
|
| Rate for Payer: BCBS Trust/PPO |
$178.49
|
| Rate for Payer: BCN Commercial |
$178.49
|
| Rate for Payer: BCN Medicare Advantage |
$54.28
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cofinity Commercial |
$186.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.28
|
| Rate for Payer: Healthscope Commercial |
$195.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.84
|
| Rate for Payer: Mclaren Medicaid |
$38.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.99
|
| Rate for Payer: Meridian Medicaid |
$40.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.55
|
| Rate for Payer: Nomi Health Commercial |
$178.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.84
|
| Rate for Payer: PACE Senior Care Partners |
$51.57
|
| Rate for Payer: PACE SWMI |
$54.28
|
| Rate for Payer: PHP Commercial |
$184.55
|
| Rate for Payer: PHP Medicare Advantage |
$54.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$188.89
|
| Rate for Payer: Priority Health Medicare |
$54.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.12
|
| Rate for Payer: Railroad Medicare Medicare |
$54.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.07
|
| Rate for Payer: UHC Core |
$181.30
|
| Rate for Payer: UHC Exchange |
$54.28
|
| Rate for Payer: UHC Medicaid |
$38.28
|
| Rate for Payer: UHC Medicare Advantage |
$54.28
|
| Rate for Payer: UHCCP Medicaid |
$38.28
|
| Rate for Payer: VA VA |
$54.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.84
|
|
|
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 |
$151.12 |
| Max. Negotiated Rate |
$195.41 |
| Rate for Payer: Aetna Commercial |
$184.55
|
| Rate for Payer: BCBS Trust/PPO |
$179.32
|
| Rate for Payer: BCN Commercial |
$179.32
|
| Rate for Payer: Cash Price |
$173.70
|
| 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: Lakeland Regional Health Systems Commercial |
$162.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.55
|
| Rate for Payer: Nomi Health Commercial |
$178.04
|
| 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 |
$188.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.07
|
| Rate for Payer: UHC Core |
$181.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.84
|
|
|
HC H PYLORI AG STOOL
|
Facility
|
OP
|
$122.67
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
30600138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.63 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$104.27
|
| Rate for Payer: Aetna Medicare |
$31.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.33
|
| Rate for Payer: BCBS Complete |
$22.71
|
| Rate for Payer: BCBS MAPPO |
$30.67
|
| Rate for Payer: BCBS Trust/PPO |
$100.85
|
| Rate for Payer: BCN Commercial |
$100.85
|
| Rate for Payer: BCN Medicare Advantage |
$30.67
|
| Rate for Payer: Cash Price |
$98.14
|
| 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 |
$30.67
|
| Rate for Payer: Healthscope Commercial |
$110.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.00
|
| Rate for Payer: Mclaren Medicaid |
$21.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.20
|
| Rate for Payer: Meridian Medicaid |
$22.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.27
|
| Rate for Payer: Nomi Health Commercial |
$100.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.00
|
| Rate for Payer: PACE Senior Care Partners |
$29.13
|
| Rate for Payer: PACE SWMI |
$30.67
|
| Rate for Payer: PHP Commercial |
$104.27
|
| Rate for Payer: PHP Medicare Advantage |
$30.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$106.72
|
| Rate for Payer: Priority Health Medicare |
$30.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.38
|
| Rate for Payer: Railroad Medicare Medicare |
$30.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.95
|
| Rate for Payer: UHC Core |
$102.43
|
| Rate for Payer: UHC Exchange |
$30.67
|
| Rate for Payer: UHC Medicaid |
$21.63
|
| Rate for Payer: UHC Medicare Advantage |
$30.67
|
| Rate for Payer: UHCCP Medicaid |
$21.63
|
| Rate for Payer: VA VA |
$30.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.00
|
|
|
HC H PYLORI AG STOOL
|
Facility
|
IP
|
$122.67
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
30600138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$85.38 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$104.27
|
| Rate for Payer: BCBS Trust/PPO |
$101.31
|
| Rate for Payer: BCN Commercial |
$101.31
|
| Rate for Payer: Cash Price |
$98.14
|
| 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: Lakeland Regional Health Systems Commercial |
$92.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.27
|
| Rate for Payer: Nomi Health Commercial |
$100.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.00
|
| Rate for Payer: PHP Commercial |
$104.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$106.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.95
|
| Rate for Payer: UHC Core |
$102.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.00
|
|
|
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 |
$46.46 |
| Max. Negotiated Rate |
$60.08 |
| Rate for Payer: Aetna Commercial |
$56.74
|
| Rate for Payer: BCBS Trust/PPO |
$55.13
|
| Rate for Payer: BCN Commercial |
$55.13
|
| Rate for Payer: Cash Price |
$53.40
|
| 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: Lakeland Regional Health Systems Commercial |
$50.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.74
|
| Rate for Payer: Nomi Health Commercial |
$54.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.06
|
| Rate for Payer: PHP Commercial |
$56.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.74
|
| Rate for Payer: UHC Core |
$55.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.06
|
|
|
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 |
$11.77 |
| Max. Negotiated Rate |
$60.08 |
| Rate for Payer: Aetna Commercial |
$56.74
|
| Rate for Payer: Aetna Medicare |
$17.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.86
|
| Rate for Payer: BCBS Complete |
$12.36
|
| Rate for Payer: BCBS MAPPO |
$16.69
|
| Rate for Payer: BCBS Trust/PPO |
$54.88
|
| Rate for Payer: BCN Commercial |
$54.88
|
| Rate for Payer: BCN Medicare Advantage |
$16.69
|
| Rate for Payer: Cash Price |
$53.40
|
| 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 |
$16.69
|
| Rate for Payer: Healthscope Commercial |
$60.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.06
|
| Rate for Payer: Mclaren Medicaid |
$11.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.52
|
| Rate for Payer: Meridian Medicaid |
$12.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.74
|
| Rate for Payer: Nomi Health Commercial |
$54.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.06
|
| Rate for Payer: PACE Senior Care Partners |
$15.85
|
| Rate for Payer: PACE SWMI |
$16.69
|
| Rate for Payer: PHP Commercial |
$56.74
|
| Rate for Payer: PHP Medicare Advantage |
$16.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.07
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.46
|
| Rate for Payer: Railroad Medicare Medicare |
$16.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.74
|
| Rate for Payer: UHC Core |
$55.74
|
| Rate for Payer: UHC Exchange |
$16.69
|
| Rate for Payer: UHC Medicaid |
$11.77
|
| Rate for Payer: UHC Medicare Advantage |
$16.69
|
| Rate for Payer: UHCCP Medicaid |
$11.77
|
| Rate for Payer: VA VA |
$16.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.06
|
|
