|
HC INDWELLING PORT
|
Facility
|
IP
|
$1,388.73
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$874.90 |
| Max. Negotiated Rate |
$1,249.86 |
| Rate for Payer: Aetna Commercial |
$1,180.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$902.67
|
| Rate for Payer: Cash Price |
$1,110.98
|
| Rate for Payer: Cofinity Advantage |
$972.11
|
| Rate for Payer: Cofinity Commercial |
$1,194.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,110.98
|
| Rate for Payer: Healthscope Commercial |
$1,249.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,180.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,041.55
|
| Rate for Payer: PHP Commercial |
$1,180.42
|
| Rate for Payer: Priority Health SBD |
$874.90
|
|
|
HC INFANT COOLING SYSTEM
|
Facility
|
IP
|
$684.33
|
|
| Hospital Charge Code |
27000644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$431.13 |
| Max. Negotiated Rate |
$615.90 |
| Rate for Payer: Aetna Commercial |
$581.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.81
|
| Rate for Payer: Cash Price |
$547.46
|
| Rate for Payer: Cofinity Advantage |
$479.03
|
| Rate for Payer: Cofinity Commercial |
$588.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.46
|
| Rate for Payer: Healthscope Commercial |
$615.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.25
|
| Rate for Payer: PHP Commercial |
$581.68
|
| Rate for Payer: Priority Health SBD |
$431.13
|
|
|
HC INFANT COOLING SYSTEM
|
Facility
|
OP
|
$684.33
|
|
| Hospital Charge Code |
27000644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$268.94 |
| Max. Negotiated Rate |
$615.90 |
| Rate for Payer: Aetna Commercial |
$581.68
|
| Rate for Payer: Aetna Medicare |
$342.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.81
|
| Rate for Payer: BCBS Complete |
$273.73
|
| Rate for Payer: Cash Price |
$547.46
|
| Rate for Payer: Cofinity Advantage |
$479.03
|
| Rate for Payer: Cofinity Commercial |
$588.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.46
|
| Rate for Payer: Healthscope Commercial |
$615.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.25
|
| Rate for Payer: PHP Commercial |
$581.68
|
| Rate for Payer: Priority Health SBD |
$431.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$444.81
|
| Rate for Payer: UHC Core |
$356.54
|
| Rate for Payer: UHC Exchange |
$268.94
|
|
|
HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
OP
|
$159.18
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.10 |
| Max. Negotiated Rate |
$143.70 |
| Rate for Payer: Aetna Commercial |
$135.30
|
| Rate for Payer: Aetna Medicare |
$99.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.75
|
| Rate for Payer: BCBS Complete |
$52.61
|
| Rate for Payer: BCBS MAPPO |
$95.80
|
| Rate for Payer: BCBS Trust/PPO |
$102.14
|
| Rate for Payer: BCN Commercial |
$102.14
|
| Rate for Payer: BCN Medicare Advantage |
$95.80
|
| Rate for Payer: Cash Price |
$127.34
|
| Rate for Payer: Cash Price |
$127.34
|
| Rate for Payer: Cofinity Advantage |
$111.43
|
| Rate for Payer: Cofinity Commercial |
$136.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.80
|
| Rate for Payer: Healthscope Commercial |
$143.26
|
| Rate for Payer: Mclaren Medicaid |
$50.10
|
| Rate for Payer: Mclaren Medicare |
$95.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.59
|
| Rate for Payer: Meridian Medicaid |
$100.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$105.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.30
|
| Rate for Payer: Nomi Health Commercial |
$143.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.39
|
| Rate for Payer: PACE Medicare |
$91.01
|
| Rate for Payer: PACE SWMI |
$95.80
|
| Rate for Payer: PHP Commercial |
$135.30
|
| Rate for Payer: PHP Medicare Advantage |
$95.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$95.80
|
| Rate for Payer: Priority Health Medicare |
$95.80
|
| Rate for Payer: Priority Health SBD |
$100.28
|
| Rate for Payer: Priority Health Tiered Network |
$76.64
|
| Rate for Payer: Railroad Medicare Medicare |
$95.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.70
|
| Rate for Payer: UHC Core |
$143.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.80
|
| Rate for Payer: UHC Exchange |
$143.70
|
| Rate for Payer: UHC Medicaid |
$50.10
|
| Rate for Payer: UHCCP Medicaid |
$50.10
|
| Rate for Payer: VA VA |
$95.80
|
|
|
HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
IP
|
$159.18
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.28 |
| Max. Negotiated Rate |
$143.26 |
| Rate for Payer: Aetna Commercial |
$135.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.47
|
| Rate for Payer: Cash Price |
$127.34
|
| Rate for Payer: Cofinity Advantage |
$111.43
|
| Rate for Payer: Cofinity Commercial |
$136.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.34
|
| Rate for Payer: Healthscope Commercial |
$143.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.39
|
| Rate for Payer: PHP Commercial |
$135.30
|
| Rate for Payer: Priority Health SBD |
$100.28
|
|
|
HC INFLIXIMAB AB
|
Facility
|
IP
|
$192.47
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$121.26 |
| Max. Negotiated Rate |
$173.22 |
| Rate for Payer: Aetna Commercial |
$163.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.11
|
| Rate for Payer: Cash Price |
$153.98
|
| Rate for Payer: Cofinity Advantage |
$134.73
|
| Rate for Payer: Cofinity Commercial |
$165.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.98
|
| Rate for Payer: Healthscope Commercial |
$173.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.35
|
| Rate for Payer: PHP Commercial |
$163.60
|
| Rate for Payer: Priority Health SBD |
$121.26
|
|
|
HC INFLIXIMAB AB
|
Facility
|
OP
|
$192.47
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$173.22 |
| Rate for Payer: Aetna Commercial |
$163.60
|
| Rate for Payer: Aetna Medicare |
$14.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.65
|
| Rate for Payer: BCBS Complete |
$7.75
|
| Rate for Payer: BCBS MAPPO |
$14.12
|
| Rate for Payer: BCBS Trust/PPO |
$15.05
|
| Rate for Payer: BCN Commercial |
$15.05
|
| Rate for Payer: BCN Medicare Advantage |
$14.12
|
| Rate for Payer: Cash Price |
$153.98
|
| Rate for Payer: Cash Price |
$153.98
|
| Rate for Payer: Cofinity Advantage |
$134.73
|
| Rate for Payer: Cofinity Commercial |
$165.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.12
|
| Rate for Payer: Healthscope Commercial |
$173.22
|
| Rate for Payer: Mclaren Medicaid |
$7.38
|
| Rate for Payer: Mclaren Medicare |
$14.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.83
|
| Rate for Payer: Meridian Medicaid |
$14.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.60
|
| Rate for Payer: Nomi Health Commercial |
$21.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.35
|
| Rate for Payer: PACE Medicare |
$13.41
|
| Rate for Payer: PACE SWMI |
$14.12
|
| Rate for Payer: PHP Commercial |
$163.60
|
| Rate for Payer: PHP Medicare Advantage |
$14.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.12
|
| Rate for Payer: Priority Health Medicare |
$14.12
|
| Rate for Payer: Priority Health SBD |
$121.26
|
| Rate for Payer: Priority Health Tiered Network |
$11.30
|
| Rate for Payer: Railroad Medicare Medicare |
$14.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.18
|
| Rate for Payer: UHC Core |
$21.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.12
|
| Rate for Payer: UHC Exchange |
$21.18
|
| Rate for Payer: UHC Medicaid |
$7.38
|
| Rate for Payer: UHCCP Medicaid |
$7.38
|
| Rate for Payer: VA VA |
$14.12
|
|
|
HC INFLIXIMAB, S
|
Facility
|
OP
|
$254.90
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.17 |
| Max. Negotiated Rate |
$229.41 |
| Rate for Payer: Aetna Commercial |
$216.66
|
| Rate for Payer: Aetna Medicare |
$40.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.21
|
| Rate for Payer: BCBS Complete |
$21.18
|
| Rate for Payer: BCBS MAPPO |
$38.57
|
| Rate for Payer: BCBS Trust/PPO |
$41.13
|
| Rate for Payer: BCN Commercial |
$41.13
|
| Rate for Payer: BCN Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cofinity Advantage |
$178.43
|
| Rate for Payer: Cofinity Commercial |
$219.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.57
|
| Rate for Payer: Healthscope Commercial |
$229.41
|
| Rate for Payer: Mclaren Medicaid |
$20.17
|
| Rate for Payer: Mclaren Medicare |
$38.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.50
|
| Rate for Payer: Meridian Medicaid |
$40.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.66
|
| Rate for Payer: Nomi Health Commercial |
$57.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.18
|
| Rate for Payer: PACE Medicare |
$36.64
|
| Rate for Payer: PACE SWMI |
$38.57
|
| Rate for Payer: PHP Commercial |
$216.66
|
| Rate for Payer: PHP Medicare Advantage |
$38.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38.57
|
| Rate for Payer: Priority Health Medicare |
$38.57
|
| Rate for Payer: Priority Health SBD |
$160.59
|
| Rate for Payer: Priority Health Tiered Network |
$30.86
|
| Rate for Payer: Railroad Medicare Medicare |
$38.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.86
|
| Rate for Payer: UHC Core |
$57.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.57
|
| Rate for Payer: UHC Exchange |
$57.86
|
| Rate for Payer: UHC Medicaid |
$20.17
|
| Rate for Payer: UHCCP Medicaid |
$20.17
|
| Rate for Payer: VA VA |
$38.57
|
|
|
HC INFLIXIMAB, S
|
Facility
|
IP
|
$254.90
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$160.59 |
| Max. Negotiated Rate |
$229.41 |
| Rate for Payer: Aetna Commercial |
$216.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.69
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cofinity Advantage |
$178.43
|
| Rate for Payer: Cofinity Commercial |
$219.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.92
|
| Rate for Payer: Healthscope Commercial |
$229.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.18
|
| Rate for Payer: PHP Commercial |
$216.66
|
| Rate for Payer: Priority Health SBD |
$160.59
|
|
|
HC INFLUENZA A AND B PCR
|
Facility
|
OP
|
$221.29
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600207
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$213.95 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Aetna Medicare |
$148.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: BCBS Complete |
$78.33
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$152.07
|
| Rate for Payer: BCN Commercial |
$152.07
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$177.03
|
| Rate for Payer: Cash Price |
$177.03
|
| Rate for Payer: Cofinity Advantage |
$154.90
|
| Rate for Payer: Cofinity Commercial |
$190.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$199.16
|
| Rate for Payer: Mclaren Medicaid |
$74.60
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: Meridian Medicaid |
$149.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$156.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.10
|
| Rate for Payer: Nomi Health Commercial |
$213.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.97
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$188.10
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$142.63
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health SBD |
$139.41
|
| Rate for Payer: Priority Health Tiered Network |
$114.10
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.95
|
| Rate for Payer: UHC Core |
$213.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$142.63
|
| Rate for Payer: UHC Exchange |
$213.95
|
| Rate for Payer: UHC Medicaid |
$74.60
|
| Rate for Payer: UHCCP Medicaid |
$74.60
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC INFLUENZA A AND B PCR
|
Facility
|
IP
|
$221.29
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600207
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$139.41 |
| Max. Negotiated Rate |
$199.16 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.84
|
| Rate for Payer: Cash Price |
$177.03
|
| Rate for Payer: Cofinity Advantage |
$154.90
|
| Rate for Payer: Cofinity Commercial |
$190.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.03
|
| Rate for Payer: Healthscope Commercial |
$199.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.97
|
| Rate for Payer: PHP Commercial |
$188.10
|
| Rate for Payer: Priority Health SBD |
$139.41
|
|
|
HC INFLUENZA A/B DNA AMP PROBE
|
Facility
|
IP
|
$148.64
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30600314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$93.64 |
| Max. Negotiated Rate |
$133.78 |
| Rate for Payer: Aetna Commercial |
$126.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.62
|
| Rate for Payer: Cash Price |
$118.91
|
| Rate for Payer: Cofinity Advantage |
$104.05
|
| Rate for Payer: Cofinity Commercial |
$127.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.91
|
| Rate for Payer: Healthscope Commercial |
$133.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.48
|
| Rate for Payer: PHP Commercial |
$126.34
|
| Rate for Payer: Priority Health SBD |
$93.64
|
|
|
HC INFLUENZA A/B DNA AMP PROBE
|
Facility
|
OP
|
$148.64
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30600314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.10 |
| Max. Negotiated Rate |
$143.70 |
| Rate for Payer: Aetna Commercial |
$126.34
|
| Rate for Payer: Aetna Medicare |
$99.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.75
|
| Rate for Payer: BCBS Complete |
$52.61
|
| Rate for Payer: BCBS MAPPO |
$95.80
|
| Rate for Payer: BCBS Trust/PPO |
$102.14
|
| Rate for Payer: BCN Commercial |
$102.14
|
| Rate for Payer: BCN Medicare Advantage |
$95.80
|
| Rate for Payer: Cash Price |
$118.91
|
| Rate for Payer: Cash Price |
$118.91
|
| Rate for Payer: Cofinity Advantage |
$104.05
|
| Rate for Payer: Cofinity Commercial |
$127.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.80
|
| Rate for Payer: Healthscope Commercial |
$133.78
|
| Rate for Payer: Mclaren Medicaid |
$50.10
|
| Rate for Payer: Mclaren Medicare |
$95.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.59
|
| Rate for Payer: Meridian Medicaid |
$100.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$105.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.34
|
| Rate for Payer: Nomi Health Commercial |
$143.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.48
|
| Rate for Payer: PACE Medicare |
$91.01
|
| Rate for Payer: PACE SWMI |
$95.80
|
| Rate for Payer: PHP Commercial |
$126.34
|
| Rate for Payer: PHP Medicare Advantage |
$95.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$95.80
|
| Rate for Payer: Priority Health Medicare |
$95.80
|
| Rate for Payer: Priority Health SBD |
$93.64
|
| Rate for Payer: Priority Health Tiered Network |
$76.64
|
| Rate for Payer: Railroad Medicare Medicare |
$95.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.70
|
| Rate for Payer: UHC Core |
$143.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.80
|
| Rate for Payer: UHC Exchange |
$143.70
|
| Rate for Payer: UHC Medicaid |
$50.10
|
| Rate for Payer: UHCCP Medicaid |
$50.10
|
| Rate for Payer: VA VA |
$95.80
|
|
|
HC INFLUENZA AND RSV BY PCR
|
Facility
|
OP
|
$227.81
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600213
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$213.95 |
| Rate for Payer: Aetna Commercial |
$193.64
|
| Rate for Payer: Aetna Medicare |
$148.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: BCBS Complete |
$78.33
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$152.07
|
| Rate for Payer: BCN Commercial |
$152.07
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cofinity Advantage |
$159.47
|
| Rate for Payer: Cofinity Commercial |
$195.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$205.03
|
| Rate for Payer: Mclaren Medicaid |
$74.60
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: Meridian Medicaid |
$149.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$156.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.64
|
| Rate for Payer: Nomi Health Commercial |
$213.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.86
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$193.64
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$142.63
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health SBD |
$143.52
|
| Rate for Payer: Priority Health Tiered Network |
$114.10
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.95
|
| Rate for Payer: UHC Core |
$213.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$142.63
|
| Rate for Payer: UHC Exchange |
$213.95
|
| Rate for Payer: UHC Medicaid |
$74.60
|
| Rate for Payer: UHCCP Medicaid |
$74.60
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC INFLUENZA AND RSV BY PCR
|
Facility
|
IP
|
$227.81
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600213
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$143.52 |
| Max. Negotiated Rate |
$205.03 |
| Rate for Payer: Aetna Commercial |
$193.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.08
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cofinity Advantage |
$159.47
|
| Rate for Payer: Cofinity Commercial |
$195.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.25
|
| Rate for Payer: Healthscope Commercial |
$205.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.86
|
| Rate for Payer: PHP Commercial |
$193.64
|
| Rate for Payer: Priority Health SBD |
$143.52
|
|
|
HC INFLUENZA INJECTION
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
77100009
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$12.27 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$48.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.33
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS MAPPO |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$58.24
|
| Rate for Payer: BCN Commercial |
$58.24
|
| Rate for Payer: BCN Medicare Advantage |
$46.66
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Advantage |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.66
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$24.40
|
| Rate for Payer: Mclaren Medicare |
$46.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.99
|
| Rate for Payer: Meridian Medicaid |
$48.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$139.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PACE Medicare |
$44.33
|
| Rate for Payer: PACE SWMI |
$46.66
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: PHP Medicare Advantage |
$46.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$150.88
|
| Rate for Payer: Priority Health Medicare |
$46.66
|
| Rate for Payer: Priority Health SBD |
$19.66
|
| Rate for Payer: Priority Health Tiered Network |
$120.70
|
| Rate for Payer: Railroad Medicare Medicare |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.29
|
| Rate for Payer: UHC Core |
$16.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.66
|
| Rate for Payer: UHC Exchange |
$12.27
|
| Rate for Payer: UHC Medicaid |
$24.40
|
| Rate for Payer: UHCCP Medicaid |
$24.40
|
| Rate for Payer: VA VA |
$46.66
|
|
|
HC INFLUENZA INJECTION
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
77100009
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Advantage |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health SBD |
$19.66
|
|
|
HC INFLUENZA VAC, INACTIV ADJUVANT IM
|
Facility
|
OP
|
$170.34
|
|
|
Service Code
|
CPT 90653
|
| Hospital Charge Code |
63600251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.14 |
| Max. Negotiated Rate |
$212.33 |
| Rate for Payer: Aetna Commercial |
$144.79
|
| Rate for Payer: Aetna Medicare |
$85.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.72
|
| Rate for Payer: BCBS Complete |
$68.14
|
| Rate for Payer: BCBS Trust/PPO |
$212.33
|
| Rate for Payer: BCN Commercial |
$212.33
|
| Rate for Payer: Cash Price |
$136.27
|
| Rate for Payer: Cash Price |
$136.27
|
| Rate for Payer: Cofinity Advantage |
$119.24
|
| Rate for Payer: Cofinity Commercial |
$146.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.27
|
| Rate for Payer: Healthscope Commercial |
$153.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.75
|
| Rate for Payer: PHP Commercial |
$144.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$98.16
|
| Rate for Payer: Priority Health SBD |
$107.31
|
| Rate for Payer: Priority Health Tiered Network |
$78.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.96
|
| Rate for Payer: UHC Core |
$161.96
|
| Rate for Payer: UHC Exchange |
$161.96
|
|
|
HC INFLUENZA VAC, INACTIV ADJUVANT IM
|
Facility
|
IP
|
$170.34
|
|
|
Service Code
|
CPT 90653
|
| Hospital Charge Code |
63600251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.31 |
| Max. Negotiated Rate |
$153.31 |
| Rate for Payer: Aetna Commercial |
$144.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.72
|
| Rate for Payer: Cash Price |
$136.27
|
| Rate for Payer: Cofinity Advantage |
$119.24
|
| Rate for Payer: Cofinity Commercial |
$146.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.27
|
| Rate for Payer: Healthscope Commercial |
$153.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.75
|
| Rate for Payer: PHP Commercial |
$144.79
|
| Rate for Payer: Priority Health SBD |
$107.31
|
|
|
HC INFLUENZA VIRUS VACCINE (IIV), SPLIT VIRUS, PRESERVATIVE FREE IM
|
Facility
|
OP
|
$111.18
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
63600073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.47 |
| Max. Negotiated Rate |
$212.33 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Medicare |
$55.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.27
|
| Rate for Payer: BCBS Complete |
$44.47
|
| Rate for Payer: BCBS Trust/PPO |
$212.33
|
| Rate for Payer: BCN Commercial |
$212.33
|
| Rate for Payer: Cash Price |
$88.94
|
| Rate for Payer: Cash Price |
$88.94
|
| Rate for Payer: Cofinity Advantage |
$77.83
|
| Rate for Payer: Cofinity Commercial |
$95.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.94
|
| Rate for Payer: Healthscope Commercial |
$100.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.39
|
| Rate for Payer: PHP Commercial |
$94.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$98.16
|
| Rate for Payer: Priority Health SBD |
$70.04
|
| Rate for Payer: Priority Health Tiered Network |
$78.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.96
|
| Rate for Payer: UHC Core |
$161.96
|
| Rate for Payer: UHC Exchange |
$161.96
|
|
|
HC INFLUENZA VIRUS VACCINE (IIV), SPLIT VIRUS, PRESERVATIVE FREE IM
|
Facility
|
IP
|
$111.18
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
63600073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.04 |
| Max. Negotiated Rate |
$100.06 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.27
|
| Rate for Payer: Cash Price |
$88.94
|
| Rate for Payer: Cofinity Advantage |
$77.83
|
| Rate for Payer: Cofinity Commercial |
$95.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.94
|
| Rate for Payer: Healthscope Commercial |
$100.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.39
|
| Rate for Payer: PHP Commercial |
$94.50
|
| Rate for Payer: Priority Health SBD |
$70.04
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
63600079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$45.41 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$45.41
|
| Rate for Payer: BCN Commercial |
$45.41
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20.88
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$16.70
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
63600079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT, LIVE (LAIV4) INTRANASAL
|
Facility
|
IP
|
$32.90
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
63600075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$29.61 |
| Rate for Payer: Aetna Commercial |
$27.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.39
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cofinity Advantage |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$28.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$29.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.68
|
| Rate for Payer: PHP Commercial |
$27.96
|
| Rate for Payer: Priority Health SBD |
$20.73
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT, LIVE (LAIV4) INTRANASAL
|
Facility
|
OP
|
$32.90
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
63600075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$60.33 |
| Rate for Payer: Aetna Commercial |
$27.96
|
| Rate for Payer: Aetna Medicare |
$16.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.39
|
| Rate for Payer: BCBS Complete |
$13.16
|
| Rate for Payer: BCBS Trust/PPO |
$60.33
|
| Rate for Payer: BCN Commercial |
$60.33
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cofinity Advantage |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$28.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$29.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.68
|
| Rate for Payer: PHP Commercial |
$27.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27.79
|
| Rate for Payer: Priority Health SBD |
$20.73
|
| Rate for Payer: Priority Health Tiered Network |
$22.23
|
|
