|
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 |
$179.40 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$225.30
|
| Rate for Payer: BCN Commercial |
$213.29
|
| 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: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 |
$65.55 |
| 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 |
$97.84
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$214.59
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| 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 |
$93.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| 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 |
$93.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 Dual Complete DSNP |
$69.00
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$93.17
|
| 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
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000128
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.55 |
| 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 |
$97.84
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$214.59
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| 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 |
$93.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| 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 |
$93.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 Dual Complete DSNP |
$69.00
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$93.17
|
| 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 |
$179.40 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$225.30
|
| Rate for Payer: BCN Commercial |
$213.29
|
| 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: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 1
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000116
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$225.30
|
| Rate for Payer: BCN Commercial |
$213.29
|
| 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: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 1
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000116
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.55 |
| 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 |
$97.84
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$214.59
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| 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 |
$93.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| 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 |
$93.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 Dual Complete DSNP |
$69.00
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$93.17
|
| Rate for Payer: VA VA |
$69.00
|
| 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 |
$179.40 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$225.30
|
| Rate for Payer: BCN Commercial |
$213.29
|
| 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: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 |
$65.55 |
| 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 |
$97.84
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$214.59
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| 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 |
$93.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| 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 |
$93.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 Dual Complete DSNP |
$69.00
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$93.17
|
| 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
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000118
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$225.30
|
| Rate for Payer: BCN Commercial |
$213.29
|
| 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: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 3
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000118
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.55 |
| 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 |
$97.84
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$214.59
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| 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 |
$93.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| 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 |
$93.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 Dual Complete DSNP |
$69.00
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$93.17
|
| 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 |
$179.40 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$225.30
|
| Rate for Payer: BCN Commercial |
$213.29
|
| 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: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 |
$65.55 |
| 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 |
$97.84
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$214.59
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| 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 |
$93.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| 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 |
$93.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 Dual Complete DSNP |
$69.00
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$93.17
|
| 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 |
$65.55 |
| 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 |
$97.84
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$214.59
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| 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 |
$93.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| 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 |
$93.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 Dual Complete DSNP |
$69.00
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$93.17
|
| 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 |
$179.40 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$225.30
|
| Rate for Payer: BCN Commercial |
$213.29
|
| 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: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 |
$65.55 |
| 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 |
$97.84
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$214.59
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| 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 |
$93.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| 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 |
$93.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 Dual Complete DSNP |
$69.00
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$93.17
|
| Rate for Payer: VA VA |
$69.00
|
| 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 |
$179.40 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$225.30
|
| Rate for Payer: BCN Commercial |
$213.29
|
| 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: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 |
$65.55 |
| 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 |
$97.84
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$214.59
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| 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 |
$93.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| 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 |
$93.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 Dual Complete DSNP |
$69.00
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$93.17
|
| 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 |
$179.40 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$225.30
|
| Rate for Payer: BCN Commercial |
$213.29
|
| 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: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 |
$65.55 |
| 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 |
$97.84
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$214.59
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| 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 |
$93.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| 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 |
$93.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 Dual Complete DSNP |
$69.00
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$93.17
|
| 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 |
$179.40 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$225.30
|
| Rate for Payer: BCN Commercial |
$213.29
|
| 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: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000124
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$225.30
|
| Rate for Payer: BCN Commercial |
$213.29
|
| 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: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 |
$65.55 |
| 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 |
$97.84
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$214.59
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| 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 |
$93.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$97.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| 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 |
$93.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| 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 Dual Complete DSNP |
$69.00
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$93.17
|
| Rate for Payer: VA VA |
$69.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOT BIOPSY
|
Facility
|
IP
|
$488.74
|
|
| Hospital Charge Code |
36000053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$317.68 |
| Max. Negotiated Rate |
$439.87 |
| Rate for Payer: Aetna Commercial |
$415.43
|
| Rate for Payer: BCBS Trust/PPO |
$398.96
|
| Rate for Payer: BCN Commercial |
$377.70
|
| Rate for Payer: Cash Price |
$390.99
|
| Rate for Payer: Cofinity Commercial |
$420.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.99
|
| Rate for Payer: Healthscope Commercial |
$439.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.43
|
| Rate for Payer: Nomi Health Commercial |
$400.77
|
| Rate for Payer: PHP Commercial |
$415.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.68
|
| Rate for Payer: Priority Health HMO/PPO |
$425.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$327.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$430.09
|
| Rate for Payer: UHC Core |
$408.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.56
|
|
|
HC HOT BIOPSY
|
Facility
|
OP
|
$488.74
|
|
| Hospital Charge Code |
36000053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$116.08 |
| Max. Negotiated Rate |
$439.87 |
| Rate for Payer: Aetna Commercial |
$415.43
|
| Rate for Payer: Aetna Medicare |
$127.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.73
|
| Rate for Payer: BCBS Complete |
$195.50
|
| Rate for Payer: BCBS MAPPO |
$122.19
|
| Rate for Payer: BCBS Trust/PPO |
$401.79
|
| Rate for Payer: BCN Commercial |
$380.00
|
| Rate for Payer: BCN Medicare Advantage |
$122.19
|
| Rate for Payer: Cash Price |
$390.99
|
| Rate for Payer: Cofinity Commercial |
$420.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.19
|
| Rate for Payer: Healthscope Commercial |
$439.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.43
|
| Rate for Payer: Nomi Health Commercial |
$400.77
|
| Rate for Payer: PACE Senior Care Partners |
$116.08
|
| Rate for Payer: PACE SWMI |
$122.19
|
| Rate for Payer: PHP Commercial |
$415.43
|
| Rate for Payer: PHP Medicare Advantage |
$122.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.68
|
| Rate for Payer: Priority Health HMO/PPO |
$425.20
|
| Rate for Payer: Priority Health Medicare |
$123.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$327.46
|
| Rate for Payer: Railroad Medicare Medicare |
$122.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$430.09
|
| Rate for Payer: UHC Core |
$408.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.19
|
| Rate for Payer: UHC Exchange |
$122.19
|
| Rate for Payer: UHC Medicare Advantage |
$122.19
|
| Rate for Payer: VA VA |
$122.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.56
|
|
|
HC HPV SEPARATELY REPORTABLE HR 16/18
|
Facility
|
OP
|
$97.13
|
|
|
Service Code
|
CPT 87626
|
| Hospital Charge Code |
30600346
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.07 |
| Max. Negotiated Rate |
$87.42 |
| Rate for Payer: Aetna Commercial |
$82.56
|
| Rate for Payer: Aetna Medicare |
$25.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.35
|
| Rate for Payer: BCBS Complete |
$53.30
|
| Rate for Payer: BCBS MAPPO |
$24.28
|
| Rate for Payer: BCBS Trust/PPO |
$79.85
|
| Rate for Payer: BCN Commercial |
$75.52
|
| Rate for Payer: BCN Medicare Advantage |
$24.28
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cofinity Commercial |
$83.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.28
|
| Rate for Payer: Healthscope Commercial |
$87.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.85
|
| Rate for Payer: Mclaren Medicaid |
$50.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.50
|
| Rate for Payer: Meridian Medicaid |
$53.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.56
|
| Rate for Payer: Nomi Health Commercial |
$79.65
|
| Rate for Payer: PACE Senior Care Partners |
$23.07
|
| Rate for Payer: PACE SWMI |
$24.28
|
| Rate for Payer: PHP Commercial |
$82.56
|
| Rate for Payer: PHP Medicare Advantage |
$24.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.13
|
| Rate for Payer: Priority Health HMO/PPO |
$84.50
|
| Rate for Payer: Priority Health Medicare |
$24.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.08
|
| Rate for Payer: Railroad Medicare Medicare |
$24.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.47
|
| Rate for Payer: UHC Core |
$81.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.28
|
| Rate for Payer: UHC Exchange |
$24.28
|
| Rate for Payer: UHC Medicare Advantage |
$24.28
|
| Rate for Payer: UHCCP Medicaid |
$50.75
|
| Rate for Payer: VA VA |
$24.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.85
|
|
