|
HC IGH IN BCLL
|
Facility
|
IP
|
$527.22
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
31000146
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$332.15 |
| Max. Negotiated Rate |
$474.50 |
| Rate for Payer: Aetna Commercial |
$448.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.69
|
| Rate for Payer: Cash Price |
$421.78
|
| Rate for Payer: Cofinity Advantage |
$369.05
|
| Rate for Payer: Cofinity Commercial |
$453.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.78
|
| Rate for Payer: Healthscope Commercial |
$474.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$395.42
|
| Rate for Payer: PHP Commercial |
$448.14
|
| Rate for Payer: Priority Health SBD |
$332.15
|
|
|
HC IGH IN BCLL
|
Facility
|
OP
|
$527.22
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
31000146
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$154.03 |
| Max. Negotiated Rate |
$883.56 |
| Rate for Payer: Aetna Commercial |
$448.14
|
| Rate for Payer: Aetna Medicare |
$306.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$368.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$368.15
|
| Rate for Payer: BCBS Complete |
$161.75
|
| Rate for Payer: BCBS MAPPO |
$294.52
|
| Rate for Payer: BCBS Trust/PPO |
$314.02
|
| Rate for Payer: BCN Commercial |
$314.02
|
| Rate for Payer: BCN Medicare Advantage |
$294.52
|
| Rate for Payer: Cash Price |
$421.78
|
| Rate for Payer: Cash Price |
$421.78
|
| Rate for Payer: Cofinity Advantage |
$369.05
|
| Rate for Payer: Cofinity Commercial |
$453.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.52
|
| Rate for Payer: Healthscope Commercial |
$474.50
|
| Rate for Payer: Mclaren Medicaid |
$154.03
|
| Rate for Payer: Mclaren Medicare |
$294.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.25
|
| Rate for Payer: Meridian Medicaid |
$309.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$323.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.14
|
| Rate for Payer: Nomi Health Commercial |
$883.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$395.42
|
| Rate for Payer: PACE Medicare |
$279.79
|
| Rate for Payer: PACE SWMI |
$294.52
|
| Rate for Payer: PHP Commercial |
$448.14
|
| Rate for Payer: PHP Medicare Advantage |
$294.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$294.52
|
| Rate for Payer: Priority Health Medicare |
$294.52
|
| Rate for Payer: Priority Health SBD |
$332.15
|
| Rate for Payer: Priority Health Tiered Network |
$235.62
|
| Rate for Payer: Railroad Medicare Medicare |
$294.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.78
|
| Rate for Payer: UHC Core |
$441.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$294.52
|
| Rate for Payer: UHC Exchange |
$441.78
|
| Rate for Payer: UHC Medicaid |
$154.03
|
| Rate for Payer: UHCCP Medicaid |
$154.03
|
| Rate for Payer: VA VA |
$294.52
|
|
|
HC ILEOSCOPY
|
Facility
|
OP
|
$2,354.99
|
|
| Hospital Charge Code |
36000055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$942.00 |
| Max. Negotiated Rate |
$2,119.49 |
| Rate for Payer: Aetna Commercial |
$2,001.74
|
| Rate for Payer: Aetna Medicare |
$1,177.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,530.74
|
| Rate for Payer: BCBS Complete |
$942.00
|
| Rate for Payer: Cash Price |
$1,883.99
|
| Rate for Payer: Cofinity Advantage |
$1,648.49
|
| Rate for Payer: Cofinity Commercial |
$2,025.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.99
|
| Rate for Payer: Healthscope Commercial |
$2,119.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,883.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,001.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,766.24
|
| Rate for Payer: PHP Commercial |
$2,001.74
|
| Rate for Payer: Priority Health SBD |
$1,483.64
|
|
|
HC ILEOSCOPY
|
Facility
|
IP
|
$2,354.99
|
|
| Hospital Charge Code |
36000055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,483.64 |
| Max. Negotiated Rate |
$2,119.49 |
| Rate for Payer: Aetna Commercial |
$2,001.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,530.74
|
| Rate for Payer: Cash Price |
$1,883.99
|
| Rate for Payer: Cofinity Advantage |
$1,648.49
|
| Rate for Payer: Cofinity Commercial |
$2,025.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.99
|
| Rate for Payer: Healthscope Commercial |
$2,119.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,001.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,766.24
|
| Rate for Payer: PHP Commercial |
$2,001.74
|
| Rate for Payer: Priority Health SBD |
$1,483.64
|
|
|
HC ILIAC ANGIOGRAPHY W/HEART CATH
|
Facility
|
OP
|
$2,810.84
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$29.53 |
| Max. Negotiated Rate |
$2,529.76 |
| Rate for Payer: Aetna Commercial |
$2,389.21
|
| Rate for Payer: Aetna Medicare |
$1,405.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,827.05
|
| Rate for Payer: BCBS Complete |
$1,124.34
|
| Rate for Payer: BCBS Trust/PPO |
$29.53
|
| Rate for Payer: BCN Commercial |
$29.53
|
| Rate for Payer: Cash Price |
$2,248.67
|
| Rate for Payer: Cash Price |
$2,248.67
|
| Rate for Payer: Cofinity Advantage |
$1,967.59
|
| Rate for Payer: Cofinity Commercial |
$2,417.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,248.67
|
| Rate for Payer: Healthscope Commercial |
$2,529.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,248.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,389.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,108.13
|
| Rate for Payer: PHP Commercial |
$2,389.21
|
| Rate for Payer: Priority Health SBD |
$1,770.83
|
|
|
HC ILIAC ANGIOGRAPHY W/HEART CATH
|
Facility
|
IP
|
$2,810.84
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,770.83 |
| Max. Negotiated Rate |
$2,529.76 |
| Rate for Payer: Aetna Commercial |
$2,389.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,827.05
|
| Rate for Payer: Cash Price |
$2,248.67
|
| Rate for Payer: Cofinity Advantage |
$1,967.59
|
| Rate for Payer: Cofinity Commercial |
$2,417.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,248.67
|
| Rate for Payer: Healthscope Commercial |
$2,529.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,389.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,108.13
|
| Rate for Payer: PHP Commercial |
$2,389.21
|
| Rate for Payer: Priority Health SBD |
$1,770.83
|
|
|
HC IMFLUOR 1ST AB STAIN (BILL ONLY)
|
Facility
|
OP
|
$142.17
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
31000086
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.78 |
| Max. Negotiated Rate |
$548.99 |
| Rate for Payer: Aetna Commercial |
$120.84
|
| Rate for Payer: Aetna Medicare |
$176.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$186.83
|
| Rate for Payer: BCN Commercial |
$186.83
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$113.74
|
| Rate for Payer: Cash Price |
$113.74
|
| Rate for Payer: Cofinity Advantage |
$99.52
|
| Rate for Payer: Cofinity Commercial |
$122.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$127.95
|
| Rate for Payer: Mclaren Medicaid |
$88.78
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$178.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.84
|
| Rate for Payer: Nomi Health Commercial |
$509.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.63
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$120.84
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$548.99
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health SBD |
$89.57
|
| Rate for Payer: Priority Health Tiered Network |
$439.19
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.04
|
| Rate for Payer: UHC Core |
$257.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$257.04
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
|
HC IMFLUOR 1ST AB STAIN (BILL ONLY)
|
Facility
|
IP
|
$142.17
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
31000086
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$89.57 |
| Max. Negotiated Rate |
$127.95 |
| Rate for Payer: Aetna Commercial |
$120.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.41
|
| Rate for Payer: Cash Price |
$113.74
|
| Rate for Payer: Cofinity Advantage |
$99.52
|
| Rate for Payer: Cofinity Commercial |
$122.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.74
|
| Rate for Payer: Healthscope Commercial |
$127.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.63
|
| Rate for Payer: PHP Commercial |
$120.84
|
| Rate for Payer: Priority Health SBD |
$89.57
|
|
|
HC IMFLUOR EACH ADDL AB STAIN (BILL ONLY)
|
Facility
|
OP
|
$108.11
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
31000085
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.24 |
| Max. Negotiated Rate |
$140.26 |
| Rate for Payer: Aetna Commercial |
$91.89
|
| Rate for Payer: Aetna Medicare |
$54.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.27
|
| Rate for Payer: BCBS Complete |
$43.24
|
| Rate for Payer: BCBS Trust/PPO |
$140.26
|
| Rate for Payer: BCN Commercial |
$140.26
|
| Rate for Payer: Cash Price |
$86.49
|
| Rate for Payer: Cash Price |
$86.49
|
| Rate for Payer: Cofinity Advantage |
$75.68
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.49
|
| Rate for Payer: Healthscope Commercial |
$97.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.08
|
| Rate for Payer: PHP Commercial |
$91.89
|
| Rate for Payer: Priority Health SBD |
$68.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.85
|
| Rate for Payer: UHC Core |
$119.85
|
| Rate for Payer: UHC Exchange |
$119.85
|
|
|
HC IMFLUOR EACH ADDL AB STAIN (BILL ONLY)
|
Facility
|
IP
|
$108.11
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
31000085
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$68.11 |
| Max. Negotiated Rate |
$97.30 |
| Rate for Payer: Aetna Commercial |
$91.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.27
|
| Rate for Payer: Cash Price |
$86.49
|
| Rate for Payer: Cofinity Advantage |
$75.68
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.49
|
| Rate for Payer: Healthscope Commercial |
$97.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.08
|
| Rate for Payer: PHP Commercial |
$91.89
|
| Rate for Payer: Priority Health SBD |
$68.11
|
|
|
HC IMG RETINA DETCN/MNTR DS POC AUTON A/R UNI/BI
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 92229
|
| Hospital Charge Code |
92000034
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$198.39 |
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$198.39
|
| Rate for Payer: BCN Commercial |
$198.39
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Advantage |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Mclaren Medicaid |
$30.74
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.80
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.00
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health SBD |
$131.04
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.20
|
| Rate for Payer: UHC Core |
$108.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$81.74
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC IMG RETINA DETCN/MNTR DS POC AUTON A/R UNI/BI
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 92229
|
| Hospital Charge Code |
92000034
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.20
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Advantage |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.00
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health SBD |
$131.04
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
OP
|
$63.99
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
30500013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.69 |
| Max. Negotiated Rate |
$57.59 |
| Rate for Payer: Aetna Commercial |
$54.39
|
| Rate for Payer: Aetna Medicare |
$37.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.67
|
| Rate for Payer: BCBS Complete |
$19.63
|
| Rate for Payer: BCBS MAPPO |
$35.74
|
| Rate for Payer: BCBS Trust/PPO |
$38.11
|
| Rate for Payer: BCN Commercial |
$38.11
|
| Rate for Payer: BCN Medicare Advantage |
$35.74
|
| Rate for Payer: Cash Price |
$51.19
|
| Rate for Payer: Cash Price |
$51.19
|
| Rate for Payer: Cofinity Advantage |
$44.79
|
| Rate for Payer: Cofinity Commercial |
$55.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.74
|
| Rate for Payer: Healthscope Commercial |
$57.59
|
| Rate for Payer: Mclaren Medicaid |
$18.69
|
| Rate for Payer: Mclaren Medicare |
$35.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.53
|
| Rate for Payer: Meridian Medicaid |
$37.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.39
|
| Rate for Payer: Nomi Health Commercial |
$53.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.99
|
| Rate for Payer: PACE Medicare |
$33.95
|
| Rate for Payer: PACE SWMI |
$35.74
|
| Rate for Payer: PHP Commercial |
$54.39
|
| Rate for Payer: PHP Medicare Advantage |
$35.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35.74
|
| Rate for Payer: Priority Health Medicare |
$35.74
|
| Rate for Payer: Priority Health SBD |
$40.31
|
| Rate for Payer: Priority Health Tiered Network |
$28.59
|
| Rate for Payer: Railroad Medicare Medicare |
$35.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.61
|
| Rate for Payer: UHC Core |
$53.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.74
|
| Rate for Payer: UHC Exchange |
$53.61
|
| Rate for Payer: UHC Medicaid |
$18.69
|
| Rate for Payer: UHCCP Medicaid |
$18.69
|
| Rate for Payer: VA VA |
$35.74
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
IP
|
$63.99
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
30500013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$40.31 |
| Max. Negotiated Rate |
$57.59 |
| Rate for Payer: Aetna Commercial |
$54.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.59
|
| Rate for Payer: Cash Price |
$51.19
|
| Rate for Payer: Cofinity Advantage |
$44.79
|
| Rate for Payer: Cofinity Commercial |
$55.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$57.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.99
|
| Rate for Payer: PHP Commercial |
$54.39
|
| Rate for Payer: Priority Health SBD |
$40.31
|
|
|
HC IMM COUNSELING WO ADMIN, > 10 MIN UP TO 20 MIN
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 90483
|
| Hospital Charge Code |
77100069
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$15.72 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna Medicare |
$20.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Advantage |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.04
|
| Rate for Payer: Priority Health SBD |
$25.20
|
| Rate for Payer: Priority Health Tiered Network |
$17.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.00
|
| Rate for Payer: UHC Core |
$20.84
|
| Rate for Payer: UHC Exchange |
$15.72
|
|
|
HC IMM COUNSELING WO ADMIN, > 10 MIN UP TO 20 MIN
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 90483
|
| Hospital Charge Code |
77100069
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Advantage |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: Priority Health SBD |
$25.20
|
|
|
HC IMM COUNSELING WO ADMIN, > 20 MIN
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 90484
|
| Hospital Charge Code |
77100070
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.25
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Advantage |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.75
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33.07
|
| Rate for Payer: Priority Health SBD |
$28.35
|
| Rate for Payer: Priority Health Tiered Network |
$26.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.25
|
| Rate for Payer: UHC Core |
$23.45
|
| Rate for Payer: UHC Exchange |
$17.68
|
|
|
HC IMM COUNSELING WO ADMIN, > 20 MIN
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 90484
|
| Hospital Charge Code |
77100070
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$28.35 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.25
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Advantage |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.75
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health SBD |
$28.35
|
|
|
HC IMM COUNSELING WO ADMIN, 3 MIN UP TO 10 MIN
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 90482
|
| Hospital Charge Code |
77100068
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna Medicare |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.75
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Advantage |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10.69
|
| Rate for Payer: Priority Health SBD |
$22.05
|
| Rate for Payer: Priority Health Tiered Network |
$8.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.75
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: UHC Exchange |
$13.76
|
|
|
HC IMM COUNSELING WO ADMIN, 3 MIN UP TO 10 MIN
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 90482
|
| Hospital Charge Code |
77100068
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.75
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Advantage |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health SBD |
$22.05
|
|
|
HC IMMUNIZATION 18YEARS OR YOUNGER
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
77100001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Advantage |
$21.42
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.95
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health SBD |
$19.28
|
|
|
HC IMMUNIZATION 18YEARS OR YOUNGER
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
77100001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$15.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: BCBS Complete |
$12.24
|
| Rate for Payer: BCBS Trust/PPO |
$68.36
|
| Rate for Payer: BCN Commercial |
$68.36
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Advantage |
$21.42
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.95
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.99
|
| Rate for Payer: Priority Health SBD |
$19.28
|
| Rate for Payer: Priority Health Tiered Network |
$15.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.89
|
| Rate for Payer: UHC Core |
$15.94
|
| Rate for Payer: UHC Exchange |
$12.03
|
|
|
HC IMMUNIZATION 1ST VACCINE
|
Facility
|
OP
|
$33.66
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
77100003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$232.01 |
| Rate for Payer: Aetna Commercial |
$28.61
|
| Rate for Payer: Aetna Medicare |
$74.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.67
|
| Rate for Payer: BCBS Complete |
$39.40
|
| Rate for Payer: BCBS MAPPO |
$71.74
|
| Rate for Payer: BCBS Trust/PPO |
$71.29
|
| Rate for Payer: BCN Commercial |
$71.29
|
| Rate for Payer: BCN Medicare Advantage |
$71.74
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cofinity Advantage |
$23.56
|
| Rate for Payer: Cofinity Commercial |
$28.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.74
|
| Rate for Payer: Healthscope Commercial |
$30.29
|
| Rate for Payer: Mclaren Medicaid |
$37.52
|
| Rate for Payer: Mclaren Medicare |
$71.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.33
|
| Rate for Payer: Meridian Medicaid |
$75.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.61
|
| Rate for Payer: Nomi Health Commercial |
$215.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.25
|
| Rate for Payer: PACE Medicare |
$68.15
|
| Rate for Payer: PACE SWMI |
$71.74
|
| Rate for Payer: PHP Commercial |
$28.61
|
| Rate for Payer: PHP Medicare Advantage |
$71.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$232.01
|
| Rate for Payer: Priority Health Medicare |
$71.74
|
| Rate for Payer: Priority Health SBD |
$21.21
|
| Rate for Payer: Priority Health Tiered Network |
$185.61
|
| Rate for Payer: Railroad Medicare Medicare |
$71.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.88
|
| Rate for Payer: UHC Core |
$17.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.74
|
| Rate for Payer: UHC Exchange |
$13.23
|
| Rate for Payer: UHC Medicaid |
$37.52
|
| Rate for Payer: UHCCP Medicaid |
$37.52
|
| Rate for Payer: VA VA |
$71.74
|
|
|
HC IMMUNIZATION 1ST VACCINE
|
Facility
|
IP
|
$33.66
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
77100003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$30.29 |
| Rate for Payer: Aetna Commercial |
$28.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.88
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cofinity Advantage |
$23.56
|
| Rate for Payer: Cofinity Commercial |
$28.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.93
|
| Rate for Payer: Healthscope Commercial |
$30.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.25
|
| Rate for Payer: PHP Commercial |
$28.61
|
| Rate for Payer: Priority Health SBD |
$21.21
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE
|
Facility
|
IP
|
$34.12
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
77100004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$30.71 |
| Rate for Payer: Aetna Commercial |
$29.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.18
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cofinity Advantage |
$23.88
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.30
|
| Rate for Payer: Healthscope Commercial |
$30.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.59
|
| Rate for Payer: PHP Commercial |
$29.00
|
| Rate for Payer: Priority Health SBD |
$21.50
|
|
