|
HC HEPARIN ANTI-XA
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
30500083
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$13.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| 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 |
$7.37
|
| Rate for Payer: BCBS MAPPO |
$13.09
|
| Rate for Payer: BCN Medicare Advantage |
$13.09
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.09
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$7.02
|
| Rate for Payer: Mclaren Medicare |
$13.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.74
|
| Rate for Payer: Meridian Medicaid |
$7.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PACE Medicare |
$12.44
|
| Rate for Payer: PACE SWMI |
$13.09
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$13.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health Medicare |
$13.09
|
| Rate for Payer: Priority Health SBD |
$49.16
|
| Rate for Payer: Railroad Medicare Medicare |
$13.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.09
|
| Rate for Payer: UHC Medicare Advantage |
$13.09
|
| Rate for Payer: UHCCP Medicaid |
$7.37
|
| Rate for Payer: VA VA |
$13.09
|
|
|
HC HEPARIN NEUTRALIZATION
|
Facility
|
OP
|
$46.31
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
30500050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$41.68 |
| Rate for Payer: Aetna Commercial |
$39.36
|
| Rate for Payer: Aetna Medicare |
$12.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.10
|
| 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 |
$6.66
|
| Rate for Payer: BCBS MAPPO |
$11.84
|
| Rate for Payer: BCN Medicare Advantage |
$11.84
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cofinity Commercial |
$39.83
|
| Rate for Payer: Cofinity Commercial |
$32.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$41.68
|
| Rate for Payer: Mclaren Medicaid |
$6.35
|
| Rate for Payer: Mclaren Medicare |
$11.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.43
|
| Rate for Payer: Meridian Medicaid |
$6.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.36
|
| Rate for Payer: PACE Medicare |
$11.25
|
| Rate for Payer: PACE SWMI |
$11.84
|
| Rate for Payer: PHP Commercial |
$39.36
|
| Rate for Payer: PHP Medicare Advantage |
$11.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health Medicare |
$11.84
|
| Rate for Payer: Priority Health SBD |
$29.18
|
| Rate for Payer: Railroad Medicare Medicare |
$11.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.84
|
| Rate for Payer: UHC Medicare Advantage |
$11.84
|
| Rate for Payer: UHCCP Medicaid |
$6.67
|
| Rate for Payer: VA VA |
$11.84
|
|
|
HC HEPARIN NEUTRALIZATION
|
Facility
|
IP
|
$46.31
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
30500050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$41.68 |
| Rate for Payer: Aetna Commercial |
$39.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.10
|
| Rate for Payer: Cash Price |
$37.05
|
| Rate for Payer: Cofinity Commercial |
$32.42
|
| Rate for Payer: Cofinity Commercial |
$39.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.05
|
| Rate for Payer: Healthscope Commercial |
$41.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.36
|
| Rate for Payer: PHP Commercial |
$39.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health SBD |
$29.18
|
|
|
HC HEPARIN PF4 AB HIT
|
Facility
|
OP
|
$244.49
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$220.04 |
| Rate for Payer: Aetna Commercial |
$207.82
|
| Rate for Payer: Aetna Medicare |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.92
|
| 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 |
$10.34
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$195.59
|
| Rate for Payer: Cash Price |
$195.59
|
| Rate for Payer: Cofinity Commercial |
$210.26
|
| Rate for Payer: Cofinity Commercial |
$171.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$220.04
|
| Rate for Payer: Mclaren Medicaid |
$9.85
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: Meridian Medicaid |
$10.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.82
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$207.82
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.92
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health SBD |
$154.03
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.37
|
| Rate for Payer: UHC Medicare Advantage |
$18.37
|
| Rate for Payer: UHCCP Medicaid |
$10.34
|
| Rate for Payer: VA VA |
$18.37
|
|
|
HC HEPARIN PF4 AB HIT
|
Facility
|
IP
|
$244.49
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$154.03 |
| Max. Negotiated Rate |
$220.04 |
| Rate for Payer: Aetna Commercial |
$207.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.92
|
| Rate for Payer: Cash Price |
$195.59
|
| Rate for Payer: Cofinity Commercial |
$171.14
|
| Rate for Payer: Cofinity Commercial |
$210.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.59
|
| Rate for Payer: Healthscope Commercial |
$220.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.82
|
| Rate for Payer: PHP Commercial |
$207.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.92
|
| Rate for Payer: Priority Health SBD |
$154.03
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
30100018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health SBD |
$26.22
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
30100018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| 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 |
$4.60
|
| Rate for Payer: BCBS MAPPO |
$8.17
|
| Rate for Payer: BCN Medicare Advantage |
$8.17
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.17
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$4.38
|
| Rate for Payer: Mclaren Medicare |
$8.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.58
|
| Rate for Payer: Meridian Medicaid |
$4.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: PACE Medicare |
$7.76
|
| Rate for Payer: PACE SWMI |
$8.17
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$8.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health Medicare |
$8.17
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: Railroad Medicare Medicare |
$8.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.17
|
| Rate for Payer: UHC Medicare Advantage |
$8.17
|
| Rate for Payer: UHCCP Medicaid |
$4.60
|
| Rate for Payer: VA VA |
$8.17
|
|
|
HC HEPATIC VENOGRAPHY WO HEMODYNAMIC EVAL
|
Facility
|
IP
|
$3,551.24
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
32000323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,237.28 |
| Max. Negotiated Rate |
$3,196.12 |
| Rate for Payer: Aetna Commercial |
$3,018.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,308.31
|
| Rate for Payer: Cash Price |
$2,840.99
|
| Rate for Payer: Cofinity Commercial |
$2,485.87
|
| Rate for Payer: Cofinity Commercial |
$3,054.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,485.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,840.99
|
| Rate for Payer: Healthscope Commercial |
$3,196.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,018.55
|
| Rate for Payer: PHP Commercial |
$3,018.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,308.31
|
| Rate for Payer: Priority Health SBD |
$2,237.28
|
|
|
HC HEPATIC VENOGRAPHY WO HEMODYNAMIC EVAL
|
Facility
|
OP
|
$3,551.24
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
32000323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Commercial |
$3,018.55
|
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,308.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$2,840.99
|
| Rate for Payer: Cash Price |
$2,840.99
|
| Rate for Payer: Cofinity Commercial |
$3,054.07
|
| Rate for Payer: Cofinity Commercial |
$2,485.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,485.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,840.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$3,196.12
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,018.55
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,018.55
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,308.31
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health SBD |
$2,237.28
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Core |
$2,627.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$2,627.92
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,728.24
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC HEPATITIS A ANTIBODY IGM
|
Facility
|
OP
|
$130.76
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
30200299
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$117.68 |
| Rate for Payer: Aetna Commercial |
$111.15
|
| Rate for Payer: Aetna Medicare |
$11.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.07
|
| Rate for Payer: BCBS Complete |
$6.34
|
| Rate for Payer: BCBS MAPPO |
$11.26
|
| Rate for Payer: BCN Medicare Advantage |
$11.26
|
| Rate for Payer: Cash Price |
$104.61
|
| Rate for Payer: Cash Price |
$104.61
|
| Rate for Payer: Cofinity Commercial |
$91.53
|
| Rate for Payer: Cofinity Commercial |
$112.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$117.68
|
| Rate for Payer: Mclaren Medicaid |
$6.04
|
| Rate for Payer: Mclaren Medicare |
$11.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.82
|
| Rate for Payer: Meridian Medicaid |
$6.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.15
|
| Rate for Payer: PACE Medicare |
$10.70
|
| Rate for Payer: PACE SWMI |
$11.26
|
| Rate for Payer: PHP Commercial |
$111.15
|
| Rate for Payer: PHP Medicare Advantage |
$11.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.99
|
| Rate for Payer: Priority Health Medicare |
$11.26
|
| Rate for Payer: Priority Health SBD |
$82.38
|
| Rate for Payer: Railroad Medicare Medicare |
$11.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.26
|
| Rate for Payer: UHC Medicare Advantage |
$11.26
|
| Rate for Payer: UHCCP Medicaid |
$6.34
|
| Rate for Payer: VA VA |
$11.26
|
|
|
HC HEPATITIS A ANTIBODY IGM
|
Facility
|
IP
|
$130.76
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
30200299
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$82.38 |
| Max. Negotiated Rate |
$117.68 |
| Rate for Payer: Aetna Commercial |
$111.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.99
|
| Rate for Payer: Cash Price |
$104.61
|
| Rate for Payer: Cofinity Commercial |
$112.45
|
| Rate for Payer: Cofinity Commercial |
$91.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.61
|
| Rate for Payer: Healthscope Commercial |
$117.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.15
|
| Rate for Payer: PHP Commercial |
$111.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.99
|
| Rate for Payer: Priority Health SBD |
$82.38
|
|
|
HC HEPATITIS ABC PANEL
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
30100017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.53 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Aetna Medicare |
$49.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.90
|
| 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 |
$26.81
|
| Rate for Payer: BCBS MAPPO |
$47.63
|
| Rate for Payer: BCN Medicare Advantage |
$47.63
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$263.16
|
| Rate for Payer: Cofinity Commercial |
$214.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.63
|
| Rate for Payer: Healthscope Commercial |
$275.40
|
| Rate for Payer: Mclaren Medicaid |
$25.53
|
| Rate for Payer: Mclaren Medicare |
$47.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.01
|
| Rate for Payer: Meridian Medicaid |
$26.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.10
|
| Rate for Payer: PACE Medicare |
$45.25
|
| Rate for Payer: PACE SWMI |
$47.63
|
| Rate for Payer: PHP Commercial |
$260.10
|
| Rate for Payer: PHP Medicare Advantage |
$47.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health Medicare |
$47.63
|
| Rate for Payer: Priority Health SBD |
$192.78
|
| Rate for Payer: Railroad Medicare Medicare |
$47.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.63
|
| Rate for Payer: UHC Medicare Advantage |
$47.63
|
| Rate for Payer: UHCCP Medicaid |
$26.82
|
| Rate for Payer: VA VA |
$47.63
|
|
|
HC HEPATITIS ABC PANEL
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
30100017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$192.78 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.90
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$214.20
|
| Rate for Payer: Cofinity Commercial |
$263.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Healthscope Commercial |
$275.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.10
|
| Rate for Payer: PHP Commercial |
$260.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health SBD |
$192.78
|
|
|
HC HEPATITIS A IGG
|
Facility
|
IP
|
$43.70
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.53 |
| Max. Negotiated Rate |
$39.33 |
| Rate for Payer: Aetna Commercial |
$37.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.41
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$30.59
|
| Rate for Payer: Cofinity Commercial |
$37.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$39.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: PHP Commercial |
$37.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.41
|
| Rate for Payer: Priority Health SBD |
$27.53
|
|
|
HC HEPATITIS A IGG
|
Facility
|
OP
|
$43.70
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$39.33 |
| Rate for Payer: Aetna Commercial |
$37.15
|
| Rate for Payer: Aetna Medicare |
$12.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.41
|
| 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 |
$6.97
|
| Rate for Payer: BCBS MAPPO |
$12.39
|
| Rate for Payer: BCN Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$37.58
|
| Rate for Payer: Cofinity Commercial |
$30.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.39
|
| Rate for Payer: Healthscope Commercial |
$39.33
|
| Rate for Payer: Mclaren Medicaid |
$6.64
|
| Rate for Payer: Mclaren Medicare |
$12.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.01
|
| Rate for Payer: Meridian Medicaid |
$6.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: PACE Medicare |
$11.77
|
| Rate for Payer: PACE SWMI |
$12.39
|
| Rate for Payer: PHP Commercial |
$37.15
|
| Rate for Payer: PHP Medicare Advantage |
$12.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.41
|
| Rate for Payer: Priority Health Medicare |
$12.39
|
| Rate for Payer: Priority Health SBD |
$27.53
|
| Rate for Payer: Railroad Medicare Medicare |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.39
|
| Rate for Payer: UHC Medicare Advantage |
$12.39
|
| Rate for Payer: UHCCP Medicaid |
$6.98
|
| Rate for Payer: VA VA |
$12.39
|
|
|
HC HEPATITIS A TOTAL ANTIBODY
|
Facility
|
IP
|
$47.86
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200298
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.15 |
| Max. Negotiated Rate |
$43.07 |
| Rate for Payer: Aetna Commercial |
$40.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.11
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.29
|
| Rate for Payer: Healthscope Commercial |
$43.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.68
|
| Rate for Payer: PHP Commercial |
$40.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.11
|
| Rate for Payer: Priority Health SBD |
$30.15
|
|
|
HC HEPATITIS A TOTAL ANTIBODY
|
Facility
|
OP
|
$47.86
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200298
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$43.07 |
| Rate for Payer: Aetna Commercial |
$40.68
|
| Rate for Payer: Aetna Medicare |
$12.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.11
|
| 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 |
$6.97
|
| Rate for Payer: BCBS MAPPO |
$12.39
|
| Rate for Payer: BCN Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cofinity Commercial |
$41.16
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.39
|
| Rate for Payer: Healthscope Commercial |
$43.07
|
| Rate for Payer: Mclaren Medicaid |
$6.64
|
| Rate for Payer: Mclaren Medicare |
$12.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.01
|
| Rate for Payer: Meridian Medicaid |
$6.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.68
|
| Rate for Payer: PACE Medicare |
$11.77
|
| Rate for Payer: PACE SWMI |
$12.39
|
| Rate for Payer: PHP Commercial |
$40.68
|
| Rate for Payer: PHP Medicare Advantage |
$12.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.11
|
| Rate for Payer: Priority Health Medicare |
$12.39
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: Railroad Medicare Medicare |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.39
|
| Rate for Payer: UHC Medicare Advantage |
$12.39
|
| Rate for Payer: UHCCP Medicaid |
$6.98
|
| Rate for Payer: VA VA |
$12.39
|
|
|
HC HEPATITIS A VACCINE (HEPA) ADULT IM
|
Facility
|
OP
|
$91.56
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
63600067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$82.40 |
| Rate for Payer: Aetna Commercial |
$77.83
|
| Rate for Payer: Aetna Medicare |
$45.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.51
|
| Rate for Payer: BCBS Complete |
$36.62
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$78.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$82.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: PHP Commercial |
$77.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health SBD |
$57.68
|
|
|
HC HEPATITIS A VACCINE (HEPA) ADULT IM
|
Facility
|
IP
|
$91.56
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
63600067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.68 |
| Max. Negotiated Rate |
$82.40 |
| Rate for Payer: Aetna Commercial |
$77.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.51
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$78.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$82.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: PHP Commercial |
$77.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health SBD |
$57.68
|
|
|
HC HEPATITIS A VAC (HEPA) PEDI/ADOLESCENT DOSAGE-2 DOSE SCHEDULE IM
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
63600068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC HEPATITIS A VAC (HEPA) PEDI/ADOLESCENT DOSAGE-2 DOSE SCHEDULE IM
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
63600068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
OP
|
$99.96
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
30200295
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Medicare |
$12.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.71
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.77
|
| Rate for Payer: BCN Medicare Advantage |
$11.77
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Cofinity Commercial |
$69.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.77
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.36
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.97
|
| Rate for Payer: PACE Medicare |
$11.18
|
| Rate for Payer: PACE SWMI |
$11.77
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: PHP Medicare Advantage |
$11.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: Priority Health Medicare |
$11.77
|
| Rate for Payer: Priority Health SBD |
$62.97
|
| Rate for Payer: Railroad Medicare Medicare |
$11.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.77
|
| Rate for Payer: UHC Medicare Advantage |
$11.77
|
| Rate for Payer: UHCCP Medicaid |
$6.63
|
| Rate for Payer: VA VA |
$11.77
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
IP
|
$99.96
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
30200295
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.97 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.97
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$69.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.97
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: Priority Health SBD |
$62.97
|
|
|
HC HEPATITIS B CORE AB TOTAL.
|
Facility
|
OP
|
$48.80
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200294
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$43.92 |
| Rate for Payer: Aetna Commercial |
$41.48
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$39.04
|
| Rate for Payer: Cash Price |
$39.04
|
| Rate for Payer: Cofinity Commercial |
$41.97
|
| Rate for Payer: Cofinity Commercial |
$34.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$43.92
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.48
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$41.48
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.72
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$30.74
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC HEPATITIS B CORE AB TOTAL.
|
Facility
|
IP
|
$48.80
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200294
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$43.92 |
| Rate for Payer: Aetna Commercial |
$41.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.72
|
| Rate for Payer: Cash Price |
$39.04
|
| Rate for Payer: Cofinity Commercial |
$34.16
|
| Rate for Payer: Cofinity Commercial |
$41.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.04
|
| Rate for Payer: Healthscope Commercial |
$43.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.48
|
| Rate for Payer: PHP Commercial |
$41.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.72
|
| Rate for Payer: Priority Health SBD |
$30.74
|
|
