|
HC HEP A & HEP B VACC ADULT IM
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$390.90 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$390.90
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health SBD |
$96.39
|
|
|
HC HEP A & HEP B VACC ADULT IM
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.39 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health SBD |
$96.39
|
|
|
HC HEPARIN ANTI-XA
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
30500083
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health SBD |
$48.20
|
|
|
HC HEPARIN ANTI-XA
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
30500083
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$13.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.36
|
| Rate for Payer: BCBS Complete |
$7.52
|
| Rate for Payer: BCBS MAPPO |
$13.09
|
| Rate for Payer: BCBS Trust/PPO |
$10.25
|
| Rate for Payer: BCN Medicare Advantage |
$13.09
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.09
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$7.16
|
| Rate for Payer: Mclaren Medicare |
$13.09
|
| Rate for Payer: Meridian Medicaid |
$7.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$12.44
|
| Rate for Payer: PACE SWMI |
$13.09
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$13.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health Medicare |
$13.09
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: Railroad Medicare Medicare |
$13.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.71
|
| Rate for Payer: UHC Core |
$22.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.09
|
| Rate for Payer: UHC Exchange |
$13.09
|
| Rate for Payer: UHC Medicare Advantage |
$13.48
|
| Rate for Payer: VA VA |
$13.09
|
|
|
HC HEPARIN NEUTRALIZATION
|
Facility
|
IP
|
$45.40
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
30500050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$40.86 |
| Rate for Payer: Aetna Commercial |
$38.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.51
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cofinity Commercial |
$39.04
|
| Rate for Payer: Cofinity Commercial |
$31.78
|
| Rate for Payer: Healthscope Commercial |
$40.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.59
|
| Rate for Payer: PHP Commercial |
$38.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: Priority Health SBD |
$28.60
|
|
|
HC HEPARIN NEUTRALIZATION
|
Facility
|
OP
|
$45.40
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
30500050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$40.86 |
| Rate for Payer: Aetna Commercial |
$38.59
|
| Rate for Payer: Aetna Medicare |
$12.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.80
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$11.84
|
| Rate for Payer: BCBS Trust/PPO |
$9.27
|
| Rate for Payer: BCN Medicare Advantage |
$11.84
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cofinity Commercial |
$39.04
|
| Rate for Payer: Cofinity Commercial |
$31.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$40.86
|
| Rate for Payer: Mclaren Medicaid |
$6.48
|
| Rate for Payer: Mclaren Medicare |
$11.84
|
| Rate for Payer: Meridian Medicaid |
$6.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.59
|
| Rate for Payer: PACE Medicare |
$11.25
|
| Rate for Payer: PACE SWMI |
$11.84
|
| Rate for Payer: PHP Commercial |
$38.59
|
| Rate for Payer: PHP Medicare Advantage |
$11.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: Priority Health Medicare |
$11.84
|
| Rate for Payer: Priority Health SBD |
$28.60
|
| Rate for Payer: Railroad Medicare Medicare |
$11.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.21
|
| Rate for Payer: UHC Core |
$20.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.84
|
| Rate for Payer: UHC Exchange |
$11.84
|
| Rate for Payer: UHC Medicare Advantage |
$12.20
|
| Rate for Payer: VA VA |
$11.84
|
|
|
HC HEPARIN PF4 AB HIT
|
Facility
|
OP
|
$239.70
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna Commercial |
$203.74
|
| Rate for Payer: Aetna Medicare |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$14.39
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Cofinity Commercial |
$167.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Mclaren Medicaid |
$10.05
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Medicaid |
$10.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$203.74
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$203.74
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.79
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health SBD |
$151.01
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.04
|
| Rate for Payer: UHC Core |
$31.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.37
|
| Rate for Payer: UHC Exchange |
$18.37
|
| Rate for Payer: UHC Medicare Advantage |
$18.92
|
| Rate for Payer: VA VA |
$18.37
|
|
|
HC HEPARIN PF4 AB HIT
|
Facility
|
IP
|
$239.70
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$151.01 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna Commercial |
$203.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.80
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Cofinity Commercial |
$167.79
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$203.74
|
| Rate for Payer: PHP Commercial |
$203.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.79
|
| Rate for Payer: Priority Health SBD |
$151.01
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
30100018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health SBD |
$25.70
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
30100018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.21
|
| Rate for Payer: BCBS Complete |
$4.69
|
| Rate for Payer: BCBS MAPPO |
$8.17
|
| Rate for Payer: BCBS Trust/PPO |
$7.92
|
| Rate for Payer: BCN Medicare Advantage |
$8.17
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.17
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$4.47
|
| Rate for Payer: Mclaren Medicare |
$8.17
|
| Rate for Payer: Meridian Medicaid |
$4.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$7.76
|
| Rate for Payer: PACE SWMI |
$8.17
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$8.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health Medicare |
$8.17
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: Railroad Medicare Medicare |
$8.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.80
|
| Rate for Payer: UHC Core |
$13.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.17
|
| Rate for Payer: UHC Exchange |
$8.17
|
| Rate for Payer: UHC Medicare Advantage |
$8.42
|
| Rate for Payer: VA VA |
$8.17
|
|
|
HC HEPATIC VENOGRAPHY WO HEMODYNAMIC EVAL
|
Facility
|
OP
|
$3,481.61
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
32000323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$2,959.37
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,263.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$120.80
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$2,785.29
|
| Rate for Payer: Cash Price |
$2,785.29
|
| Rate for Payer: Cofinity Commercial |
$2,994.18
|
| Rate for Payer: Cofinity Commercial |
$2,437.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$3,133.45
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,959.37
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$2,959.37
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,437.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Priority Health SBD |
$2,193.41
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$121.81
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC HEPATIC VENOGRAPHY WO HEMODYNAMIC EVAL
|
Facility
|
IP
|
$3,481.61
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
32000323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,193.41 |
| Max. Negotiated Rate |
$3,133.45 |
| Rate for Payer: Aetna Commercial |
$2,959.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,263.05
|
| Rate for Payer: Cash Price |
$2,785.29
|
| Rate for Payer: Cofinity Commercial |
$2,437.13
|
| Rate for Payer: Cofinity Commercial |
$2,994.18
|
| Rate for Payer: Healthscope Commercial |
$3,133.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,959.37
|
| Rate for Payer: PHP Commercial |
$2,959.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,437.13
|
| Rate for Payer: Priority Health SBD |
$2,193.41
|
|
|
HC HEPATITIS A ANTIBODY IGM
|
Facility
|
IP
|
$128.20
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
30200299
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$80.77 |
| Max. Negotiated Rate |
$115.38 |
| Rate for Payer: Aetna Commercial |
$108.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.33
|
| Rate for Payer: Cash Price |
$102.56
|
| Rate for Payer: Cofinity Commercial |
$110.25
|
| Rate for Payer: Cofinity Commercial |
$89.74
|
| Rate for Payer: Healthscope Commercial |
$115.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.97
|
| Rate for Payer: PHP Commercial |
$108.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.74
|
| Rate for Payer: Priority Health SBD |
$80.77
|
|
|
HC HEPATITIS A ANTIBODY IGM
|
Facility
|
OP
|
$128.20
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
30200299
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$115.38 |
| Rate for Payer: Aetna Commercial |
$108.97
|
| Rate for Payer: Aetna Medicare |
$11.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.08
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: BCBS MAPPO |
$11.26
|
| Rate for Payer: BCBS Trust/PPO |
$8.82
|
| Rate for Payer: BCN Medicare Advantage |
$11.26
|
| Rate for Payer: Cash Price |
$102.56
|
| Rate for Payer: Cash Price |
$102.56
|
| Rate for Payer: Cofinity Commercial |
$89.74
|
| Rate for Payer: Cofinity Commercial |
$110.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$115.38
|
| Rate for Payer: Mclaren Medicaid |
$6.16
|
| Rate for Payer: Mclaren Medicare |
$11.26
|
| Rate for Payer: Meridian Medicaid |
$6.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.97
|
| Rate for Payer: PACE Medicare |
$10.70
|
| Rate for Payer: PACE SWMI |
$11.26
|
| Rate for Payer: PHP Commercial |
$108.97
|
| Rate for Payer: PHP Medicare Advantage |
$11.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.74
|
| Rate for Payer: Priority Health Medicare |
$11.26
|
| Rate for Payer: Priority Health SBD |
$80.77
|
| Rate for Payer: Railroad Medicare Medicare |
$11.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.51
|
| Rate for Payer: UHC Core |
$19.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.26
|
| Rate for Payer: UHC Exchange |
$11.26
|
| Rate for Payer: UHC Medicare Advantage |
$11.60
|
| Rate for Payer: VA VA |
$11.26
|
|
|
HC HEPATITIS ABC PANEL
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
30100017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.05 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Medicare |
$49.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.54
|
| Rate for Payer: BCBS Complete |
$27.36
|
| Rate for Payer: BCBS MAPPO |
$47.63
|
| Rate for Payer: BCBS Trust/PPO |
$43.89
|
| Rate for Payer: BCN Medicare Advantage |
$47.63
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.63
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Mclaren Medicaid |
$26.05
|
| Rate for Payer: Mclaren Medicare |
$47.63
|
| Rate for Payer: Meridian Medicaid |
$27.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PACE Medicare |
$45.25
|
| Rate for Payer: PACE SWMI |
$47.63
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: PHP Medicare Advantage |
$47.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health Medicare |
$47.63
|
| Rate for Payer: Priority Health SBD |
$189.00
|
| Rate for Payer: Railroad Medicare Medicare |
$47.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.16
|
| Rate for Payer: UHC Core |
$80.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.63
|
| Rate for Payer: UHC Exchange |
$47.63
|
| Rate for Payer: UHC Medicare Advantage |
$49.06
|
| Rate for Payer: VA VA |
$47.63
|
|
|
HC HEPATITIS ABC PANEL
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
30100017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
|
|
HC HEPATITIS A IGG
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$12.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.49
|
| Rate for Payer: BCBS Complete |
$7.12
|
| Rate for Payer: BCBS MAPPO |
$12.39
|
| Rate for Payer: BCBS Trust/PPO |
$9.70
|
| Rate for Payer: BCN Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.39
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Mclaren Medicaid |
$6.78
|
| Rate for Payer: Mclaren Medicare |
$12.39
|
| Rate for Payer: Meridian Medicaid |
$7.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.41
|
| Rate for Payer: PACE Medicare |
$11.77
|
| Rate for Payer: PACE SWMI |
$12.39
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: PHP Medicare Advantage |
$12.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.99
|
| Rate for Payer: Priority Health Medicare |
$12.39
|
| Rate for Payer: Priority Health SBD |
$26.99
|
| Rate for Payer: Railroad Medicare Medicare |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.87
|
| Rate for Payer: UHC Core |
$21.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.39
|
| Rate for Payer: UHC Exchange |
$12.39
|
| Rate for Payer: UHC Medicare Advantage |
$12.76
|
| Rate for Payer: VA VA |
$12.39
|
|
|
HC HEPATITIS A IGG
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.41
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.99
|
| Rate for Payer: Priority Health SBD |
$26.99
|
|
|
HC HEPATITIS A TOTAL ANTIBODY
|
Facility
|
OP
|
$46.92
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200298
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$42.23 |
| Rate for Payer: Aetna Commercial |
$39.88
|
| Rate for Payer: Aetna Medicare |
$12.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.49
|
| Rate for Payer: BCBS Complete |
$7.12
|
| Rate for Payer: BCBS MAPPO |
$12.39
|
| Rate for Payer: BCBS Trust/PPO |
$9.70
|
| Rate for Payer: BCN Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$32.84
|
| Rate for Payer: Cofinity Commercial |
$40.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.39
|
| Rate for Payer: Healthscope Commercial |
$42.23
|
| Rate for Payer: Mclaren Medicaid |
$6.78
|
| Rate for Payer: Mclaren Medicare |
$12.39
|
| Rate for Payer: Meridian Medicaid |
$7.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.88
|
| Rate for Payer: PACE Medicare |
$11.77
|
| Rate for Payer: PACE SWMI |
$12.39
|
| Rate for Payer: PHP Commercial |
$39.88
|
| Rate for Payer: PHP Medicare Advantage |
$12.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.84
|
| Rate for Payer: Priority Health Medicare |
$12.39
|
| Rate for Payer: Priority Health SBD |
$29.56
|
| Rate for Payer: Railroad Medicare Medicare |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.87
|
| Rate for Payer: UHC Core |
$21.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.39
|
| Rate for Payer: UHC Exchange |
$12.39
|
| Rate for Payer: UHC Medicare Advantage |
$12.76
|
| Rate for Payer: VA VA |
$12.39
|
|
|
HC HEPATITIS A TOTAL ANTIBODY
|
Facility
|
IP
|
$46.92
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200298
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$42.23 |
| Rate for Payer: Aetna Commercial |
$39.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.50
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$32.84
|
| Rate for Payer: Cofinity Commercial |
$40.35
|
| Rate for Payer: Healthscope Commercial |
$42.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.88
|
| Rate for Payer: PHP Commercial |
$39.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.84
|
| Rate for Payer: Priority Health SBD |
$29.56
|
|
|
HC HEPATITIS A VACCINE (HEPA) ADULT IM
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
63600067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$210.20 |
| Rate for Payer: Aetna Commercial |
$76.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.34
|
| Rate for Payer: BCBS Complete |
$35.90
|
| Rate for Payer: BCBS Trust/PPO |
$210.20
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$62.83
|
| Rate for Payer: Cofinity Commercial |
$77.19
|
| Rate for Payer: Healthscope Commercial |
$80.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: PHP Commercial |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: Priority Health SBD |
$56.55
|
|
|
HC HEPATITIS A VACCINE (HEPA) ADULT IM
|
Facility
|
IP
|
$89.76
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
63600067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.55 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$76.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.34
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$62.83
|
| Rate for Payer: Cofinity Commercial |
$77.19
|
| Rate for Payer: Healthscope Commercial |
$80.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: PHP Commercial |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: Priority Health SBD |
$56.55
|
|
|
HC HEPATITIS A VAC (HEPA) PEDI/ADOLESCENT DOSAGE-2 DOSE SCHEDULE IM
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
63600068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$91.01 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$91.01
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC HEPATITIS A VAC (HEPA) PEDI/ADOLESCENT DOSAGE-2 DOSE SCHEDULE IM
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
63600068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
30200295
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$61.74 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.70
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$84.28
|
| Rate for Payer: Cofinity Commercial |
$68.60
|
| Rate for Payer: Healthscope Commercial |
$88.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: PHP Commercial |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health SBD |
$61.74
|
|
