|
HC HONEY BEE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200089
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
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 |
$67.36 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Medicare |
$125.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.10
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Complete |
$70.73
|
| Rate for Payer: BCBS MAPPO |
$125.68
|
| Rate for Payer: BCBS Trust/PPO |
$226.02
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: BCN Medicare Advantage |
$125.68
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.68
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$67.36
|
| Rate for Payer: Mclaren Medicare |
$125.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.96
|
| Rate for Payer: Meridian Medicaid |
$70.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: PACE Medicare |
$119.40
|
| Rate for Payer: PACE SWMI |
$125.68
|
| Rate for Payer: PHP Commercial |
$138.25
|
| Rate for Payer: PHP Medicaid |
$67.36
|
| Rate for Payer: PHP Medicare Advantage |
$125.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.83
|
| Rate for Payer: Priority Health Medicare |
$125.68
|
| Rate for Payer: Priority Health Narrow Network |
$193.48
|
| Rate for Payer: Railroad Medicare Medicare |
$125.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.68
|
| Rate for Payer: UHC Exchange |
$194.80
|
| Rate for Payer: UHC Medicare Advantage |
$125.68
|
| Rate for Payer: UHCCP DNSP |
$125.68
|
| Rate for Payer: UHCCP Medicaid |
$67.36
|
| Rate for Payer: VA VA |
$125.68
|
|
|
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 |
$179.40 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Trust/PPO |
$224.91
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
|
|
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 |
$179.40 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Trust/PPO |
$224.91
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
|
|
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 |
$67.36 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Medicare |
$125.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.10
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Complete |
$70.73
|
| Rate for Payer: BCBS MAPPO |
$125.68
|
| Rate for Payer: BCBS Trust/PPO |
$226.02
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: BCN Medicare Advantage |
$125.68
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.68
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$67.36
|
| Rate for Payer: Mclaren Medicare |
$125.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.96
|
| Rate for Payer: Meridian Medicaid |
$70.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: PACE Medicare |
$119.40
|
| Rate for Payer: PACE SWMI |
$125.68
|
| Rate for Payer: PHP Commercial |
$138.25
|
| Rate for Payer: PHP Medicaid |
$67.36
|
| Rate for Payer: PHP Medicare Advantage |
$125.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.83
|
| Rate for Payer: Priority Health Medicare |
$125.68
|
| Rate for Payer: Priority Health Narrow Network |
$193.48
|
| Rate for Payer: Railroad Medicare Medicare |
$125.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.68
|
| Rate for Payer: UHC Exchange |
$194.80
|
| Rate for Payer: UHC Medicare Advantage |
$125.68
|
| Rate for Payer: UHCCP DNSP |
$125.68
|
| Rate for Payer: UHCCP Medicaid |
$67.36
|
| Rate for Payer: VA VA |
$125.68
|
|
|
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 |
$67.36 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Medicare |
$125.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.10
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Complete |
$70.73
|
| Rate for Payer: BCBS MAPPO |
$125.68
|
| Rate for Payer: BCBS Trust/PPO |
$226.02
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: BCN Medicare Advantage |
$125.68
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.68
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$67.36
|
| Rate for Payer: Mclaren Medicare |
$125.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.96
|
| Rate for Payer: Meridian Medicaid |
$70.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: PACE Medicare |
$119.40
|
| Rate for Payer: PACE SWMI |
$125.68
|
| Rate for Payer: PHP Commercial |
$138.25
|
| Rate for Payer: PHP Medicaid |
$67.36
|
| Rate for Payer: PHP Medicare Advantage |
$125.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.83
|
| Rate for Payer: Priority Health Medicare |
$125.68
|
| Rate for Payer: Priority Health Narrow Network |
$193.48
|
| Rate for Payer: Railroad Medicare Medicare |
$125.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.68
|
| Rate for Payer: UHC Exchange |
$194.80
|
| Rate for Payer: UHC Medicare Advantage |
$125.68
|
| Rate for Payer: UHCCP DNSP |
$125.68
|
| Rate for Payer: UHCCP Medicaid |
$67.36
|
| Rate for Payer: VA VA |
$125.68
|
|
|
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 |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Trust/PPO |
$224.91
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
|
|
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 |
$67.36 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Medicare |
$125.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.10
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Complete |
$70.73
|
| Rate for Payer: BCBS MAPPO |
$125.68
|
| Rate for Payer: BCBS Trust/PPO |
$226.02
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: BCN Medicare Advantage |
$125.68
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.68
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$67.36
|
| Rate for Payer: Mclaren Medicare |
$125.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.96
|
| Rate for Payer: Meridian Medicaid |
$70.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: PACE Medicare |
$119.40
|
| Rate for Payer: PACE SWMI |
$125.68
|
| Rate for Payer: PHP Commercial |
$138.25
|
| Rate for Payer: PHP Medicaid |
$67.36
|
| Rate for Payer: PHP Medicare Advantage |
$125.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.83
|
| Rate for Payer: Priority Health Medicare |
$125.68
|
| Rate for Payer: Priority Health Narrow Network |
$193.48
|
| Rate for Payer: Railroad Medicare Medicare |
$125.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.68
|
| Rate for Payer: UHC Exchange |
$194.80
|
| Rate for Payer: UHC Medicare Advantage |
$125.68
|
| Rate for Payer: UHCCP DNSP |
$125.68
|
| Rate for Payer: UHCCP Medicaid |
$67.36
|
| Rate for Payer: VA VA |
$125.68
|
|
|
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 |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Trust/PPO |
$224.91
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
|
|
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 |
$67.36 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Medicare |
$125.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.10
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Complete |
$70.73
|
| Rate for Payer: BCBS MAPPO |
$125.68
|
| Rate for Payer: BCBS Trust/PPO |
$226.02
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: BCN Medicare Advantage |
$125.68
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.68
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$67.36
|
| Rate for Payer: Mclaren Medicare |
$125.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.96
|
| Rate for Payer: Meridian Medicaid |
$70.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: PACE Medicare |
$119.40
|
| Rate for Payer: PACE SWMI |
$125.68
|
| Rate for Payer: PHP Commercial |
$138.25
|
| Rate for Payer: PHP Medicaid |
$67.36
|
| Rate for Payer: PHP Medicare Advantage |
$125.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.83
|
| Rate for Payer: Priority Health Medicare |
$125.68
|
| Rate for Payer: Priority Health Narrow Network |
$193.48
|
| Rate for Payer: Railroad Medicare Medicare |
$125.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.68
|
| Rate for Payer: UHC Exchange |
$194.80
|
| Rate for Payer: UHC Medicare Advantage |
$125.68
|
| Rate for Payer: UHCCP DNSP |
$125.68
|
| Rate for Payer: UHCCP Medicaid |
$67.36
|
| Rate for Payer: VA VA |
$125.68
|
|
|
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 |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Trust/PPO |
$224.91
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
|
|
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 |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Trust/PPO |
$224.91
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
|
|
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 |
$67.36 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Medicare |
$125.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.10
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Complete |
$70.73
|
| Rate for Payer: BCBS MAPPO |
$125.68
|
| Rate for Payer: BCBS Trust/PPO |
$226.02
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: BCN Medicare Advantage |
$125.68
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.68
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$67.36
|
| Rate for Payer: Mclaren Medicare |
$125.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.96
|
| Rate for Payer: Meridian Medicaid |
$70.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: PACE Medicare |
$119.40
|
| Rate for Payer: PACE SWMI |
$125.68
|
| Rate for Payer: PHP Commercial |
$138.25
|
| Rate for Payer: PHP Medicaid |
$67.36
|
| Rate for Payer: PHP Medicare Advantage |
$125.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.83
|
| Rate for Payer: Priority Health Medicare |
$125.68
|
| Rate for Payer: Priority Health Narrow Network |
$193.48
|
| Rate for Payer: Railroad Medicare Medicare |
$125.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.68
|
| Rate for Payer: UHC Exchange |
$194.80
|
| Rate for Payer: UHC Medicare Advantage |
$125.68
|
| Rate for Payer: UHCCP DNSP |
$125.68
|
| Rate for Payer: UHCCP Medicaid |
$67.36
|
| Rate for Payer: VA VA |
$125.68
|
|
|
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 |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Trust/PPO |
$224.91
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
|
|
HC HOSP OUTPT VISIT EST LVL 3
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000118
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.36 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Medicare |
$125.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.10
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Complete |
$70.73
|
| Rate for Payer: BCBS MAPPO |
$125.68
|
| Rate for Payer: BCBS Trust/PPO |
$226.02
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: BCN Medicare Advantage |
$125.68
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.68
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$67.36
|
| Rate for Payer: Mclaren Medicare |
$125.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.96
|
| Rate for Payer: Meridian Medicaid |
$70.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: PACE Medicare |
$119.40
|
| Rate for Payer: PACE SWMI |
$125.68
|
| Rate for Payer: PHP Commercial |
$138.25
|
| Rate for Payer: PHP Medicaid |
$67.36
|
| Rate for Payer: PHP Medicare Advantage |
$125.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.83
|
| Rate for Payer: Priority Health Medicare |
$125.68
|
| Rate for Payer: Priority Health Narrow Network |
$193.48
|
| Rate for Payer: Railroad Medicare Medicare |
$125.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.68
|
| Rate for Payer: UHC Exchange |
$194.80
|
| Rate for Payer: UHC Medicare Advantage |
$125.68
|
| Rate for Payer: UHCCP DNSP |
$125.68
|
| Rate for Payer: UHCCP Medicaid |
$67.36
|
| Rate for Payer: VA VA |
$125.68
|
|
|
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 |
$67.36 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Medicare |
$125.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.10
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Complete |
$70.73
|
| Rate for Payer: BCBS MAPPO |
$125.68
|
| Rate for Payer: BCBS Trust/PPO |
$226.02
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: BCN Medicare Advantage |
$125.68
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.68
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$67.36
|
| Rate for Payer: Mclaren Medicare |
$125.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.96
|
| Rate for Payer: Meridian Medicaid |
$70.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: PACE Medicare |
$119.40
|
| Rate for Payer: PACE SWMI |
$125.68
|
| Rate for Payer: PHP Commercial |
$138.25
|
| Rate for Payer: PHP Medicaid |
$67.36
|
| Rate for Payer: PHP Medicare Advantage |
$125.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.83
|
| Rate for Payer: Priority Health Medicare |
$125.68
|
| Rate for Payer: Priority Health Narrow Network |
$193.48
|
| Rate for Payer: Railroad Medicare Medicare |
$125.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.68
|
| Rate for Payer: UHC Exchange |
$194.80
|
| Rate for Payer: UHC Medicare Advantage |
$125.68
|
| Rate for Payer: UHCCP DNSP |
$125.68
|
| Rate for Payer: UHCCP Medicaid |
$67.36
|
| Rate for Payer: VA VA |
$125.68
|
|
|
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 |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Trust/PPO |
$224.91
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
|
|
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 |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Trust/PPO |
$224.91
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
|
|
HC HOSP OUTPT VISIT EST LVL 5
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.36 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Medicare |
$125.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.10
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Complete |
$70.73
|
| Rate for Payer: BCBS MAPPO |
$125.68
|
| Rate for Payer: BCBS Trust/PPO |
$226.02
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: BCN Medicare Advantage |
$125.68
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.68
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$67.36
|
| Rate for Payer: Mclaren Medicare |
$125.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.96
|
| Rate for Payer: Meridian Medicaid |
$70.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: PACE Medicare |
$119.40
|
| Rate for Payer: PACE SWMI |
$125.68
|
| Rate for Payer: PHP Commercial |
$138.25
|
| Rate for Payer: PHP Medicaid |
$67.36
|
| Rate for Payer: PHP Medicare Advantage |
$125.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.83
|
| Rate for Payer: Priority Health Medicare |
$125.68
|
| Rate for Payer: Priority Health Narrow Network |
$193.48
|
| Rate for Payer: Railroad Medicare Medicare |
$125.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.68
|
| Rate for Payer: UHC Exchange |
$194.80
|
| Rate for Payer: UHC Medicare Advantage |
$125.68
|
| Rate for Payer: UHCCP DNSP |
$125.68
|
| Rate for Payer: UHCCP Medicaid |
$67.36
|
| Rate for Payer: VA VA |
$125.68
|
|
|
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 |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Trust/PPO |
$224.91
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
|
|
HC HOSP OUTPT VISIT NEW LVL 2
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000121
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.36 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Medicare |
$125.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.10
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Complete |
$70.73
|
| Rate for Payer: BCBS MAPPO |
$125.68
|
| Rate for Payer: BCBS Trust/PPO |
$226.02
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: BCN Medicare Advantage |
$125.68
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.68
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$67.36
|
| Rate for Payer: Mclaren Medicare |
$125.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.96
|
| Rate for Payer: Meridian Medicaid |
$70.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: PACE Medicare |
$119.40
|
| Rate for Payer: PACE SWMI |
$125.68
|
| Rate for Payer: PHP Commercial |
$138.25
|
| Rate for Payer: PHP Medicaid |
$67.36
|
| Rate for Payer: PHP Medicare Advantage |
$125.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.83
|
| Rate for Payer: Priority Health Medicare |
$125.68
|
| Rate for Payer: Priority Health Narrow Network |
$193.48
|
| Rate for Payer: Railroad Medicare Medicare |
$125.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.68
|
| Rate for Payer: UHC Exchange |
$194.80
|
| Rate for Payer: UHC Medicare Advantage |
$125.68
|
| Rate for Payer: UHCCP DNSP |
$125.68
|
| Rate for Payer: UHCCP Medicaid |
$67.36
|
| Rate for Payer: VA VA |
$125.68
|
|
|
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 |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Trust/PPO |
$224.91
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
|
|
HC HOSP OUTPT VISIT NEW LVL 3
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000122
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.36 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Medicare |
$125.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.10
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Complete |
$70.73
|
| Rate for Payer: BCBS MAPPO |
$125.68
|
| Rate for Payer: BCBS Trust/PPO |
$226.02
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: BCN Medicare Advantage |
$125.68
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.68
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$67.36
|
| Rate for Payer: Mclaren Medicare |
$125.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.96
|
| Rate for Payer: Meridian Medicaid |
$70.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: PACE Medicare |
$119.40
|
| Rate for Payer: PACE SWMI |
$125.68
|
| Rate for Payer: PHP Commercial |
$138.25
|
| Rate for Payer: PHP Medicaid |
$67.36
|
| Rate for Payer: PHP Medicare Advantage |
$125.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.83
|
| Rate for Payer: Priority Health Medicare |
$125.68
|
| Rate for Payer: Priority Health Narrow Network |
$193.48
|
| Rate for Payer: Railroad Medicare Medicare |
$125.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.68
|
| Rate for Payer: UHC Exchange |
$194.80
|
| Rate for Payer: UHC Medicare Advantage |
$125.68
|
| Rate for Payer: UHCCP DNSP |
$125.68
|
| Rate for Payer: UHCCP Medicaid |
$67.36
|
| Rate for Payer: VA VA |
$125.68
|
|
|
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 |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Trust/PPO |
$224.91
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
|
|
HC HOSP OUTPT VISIT NEW LVL 4
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000123
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.36 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Medicare |
$125.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.10
|
| Rate for Payer: ASR ASR |
$267.72
|
| Rate for Payer: ASR Commercial |
$267.72
|
| Rate for Payer: BCBS Complete |
$70.73
|
| Rate for Payer: BCBS MAPPO |
$125.68
|
| Rate for Payer: BCBS Trust/PPO |
$226.02
|
| Rate for Payer: BCN Commercial |
$213.98
|
| Rate for Payer: BCN Medicare Advantage |
$125.68
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$259.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.68
|
| Rate for Payer: Healthscope Commercial |
$276.00
|
| Rate for Payer: Healthscope Whirlpool |
$267.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$125.68
|
| Rate for Payer: Mclaren Commercial |
$248.40
|
| Rate for Payer: Mclaren Medicaid |
$67.36
|
| Rate for Payer: Mclaren Medicare |
$125.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.96
|
| Rate for Payer: Meridian Medicaid |
$70.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: PACE Medicare |
$119.40
|
| Rate for Payer: PACE SWMI |
$125.68
|
| Rate for Payer: PHP Commercial |
$138.25
|
| Rate for Payer: PHP Medicaid |
$67.36
|
| Rate for Payer: PHP Medicare Advantage |
$125.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.83
|
| Rate for Payer: Priority Health Medicare |
$125.68
|
| Rate for Payer: Priority Health Narrow Network |
$193.48
|
| Rate for Payer: Railroad Medicare Medicare |
$125.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.68
|
| Rate for Payer: UHC Exchange |
$194.80
|
| Rate for Payer: UHC Medicare Advantage |
$125.68
|
| Rate for Payer: UHCCP DNSP |
$125.68
|
| Rate for Payer: UHCCP Medicaid |
$67.36
|
| Rate for Payer: VA VA |
$125.68
|
|
