|
HC PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13) IM
|
Facility
|
IP
|
$289.68
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
63600074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$182.50 |
| Max. Negotiated Rate |
$260.71 |
| Rate for Payer: Aetna Commercial |
$246.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.29
|
| Rate for Payer: Cash Price |
$231.74
|
| Rate for Payer: Cofinity Commercial |
$202.78
|
| Rate for Payer: Cofinity Commercial |
$249.12
|
| Rate for Payer: Healthscope Commercial |
$260.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.23
|
| Rate for Payer: PHP Commercial |
$246.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.78
|
| Rate for Payer: Priority Health SBD |
$182.50
|
|
|
HC PNEUMOCOCCAL IGG AB CMPTS
|
Facility
|
IP
|
$23.67
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200190
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$21.30 |
| Rate for Payer: Aetna Commercial |
$20.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.39
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$16.57
|
| Rate for Payer: Healthscope Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.12
|
| Rate for Payer: PHP Commercial |
$20.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health SBD |
$14.91
|
|
|
HC PNEUMOCOCCAL IGG AB CMPTS
|
Facility
|
OP
|
$23.67
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200190
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$25.49 |
| Rate for Payer: Aetna Commercial |
$20.12
|
| Rate for Payer: Aetna Medicare |
$15.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.74
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS MAPPO |
$14.99
|
| Rate for Payer: BCBS Trust/PPO |
$11.74
|
| Rate for Payer: BCN Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$16.57
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$21.30
|
| Rate for Payer: Mclaren Medicaid |
$8.20
|
| Rate for Payer: Mclaren Medicare |
$14.99
|
| Rate for Payer: Meridian Medicaid |
$8.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.12
|
| Rate for Payer: PACE Medicare |
$14.24
|
| Rate for Payer: PACE SWMI |
$14.99
|
| Rate for Payer: PHP Commercial |
$20.12
|
| Rate for Payer: PHP Medicare Advantage |
$14.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health Medicare |
$14.99
|
| Rate for Payer: Priority Health SBD |
$14.91
|
| Rate for Payer: Railroad Medicare Medicare |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.99
|
| Rate for Payer: UHC Core |
$25.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.99
|
| Rate for Payer: UHC Exchange |
$14.99
|
| Rate for Payer: UHC Medicare Advantage |
$15.44
|
| Rate for Payer: VA VA |
$14.99
|
|
|
HC PNEUMOCOCCAL IGG ABS 23 SEROTYPE
|
Facility
|
IP
|
$23.67
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200189
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$21.30 |
| Rate for Payer: Aetna Commercial |
$20.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.39
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$16.57
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Healthscope Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.12
|
| Rate for Payer: PHP Commercial |
$20.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health SBD |
$14.91
|
|
|
HC PNEUMOCOCCAL IGG ABS 23 SEROTYPE
|
Facility
|
OP
|
$23.67
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200189
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$25.49 |
| Rate for Payer: Aetna Commercial |
$20.12
|
| Rate for Payer: Aetna Medicare |
$15.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.74
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS MAPPO |
$14.99
|
| Rate for Payer: BCBS Trust/PPO |
$11.74
|
| Rate for Payer: BCN Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$16.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$21.30
|
| Rate for Payer: Mclaren Medicaid |
$8.20
|
| Rate for Payer: Mclaren Medicare |
$14.99
|
| Rate for Payer: Meridian Medicaid |
$8.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.12
|
| Rate for Payer: PACE Medicare |
$14.24
|
| Rate for Payer: PACE SWMI |
$14.99
|
| Rate for Payer: PHP Commercial |
$20.12
|
| Rate for Payer: PHP Medicare Advantage |
$14.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health Medicare |
$14.99
|
| Rate for Payer: Priority Health SBD |
$14.91
|
| Rate for Payer: Railroad Medicare Medicare |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.99
|
| Rate for Payer: UHC Core |
$25.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.99
|
| Rate for Payer: UHC Exchange |
$14.99
|
| Rate for Payer: UHC Medicare Advantage |
$15.44
|
| Rate for Payer: VA VA |
$14.99
|
|
|
HC PNEUMOCOCCAL IGG ABS PRE & POST
|
Facility
|
OP
|
$8.16
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
30200226
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$21.90 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Aetna Medicare |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$10.09
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cofinity Commercial |
$7.02
|
| Rate for Payer: Cofinity Commercial |
$5.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$7.34
|
| Rate for Payer: Mclaren Medicaid |
$7.05
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Medicaid |
$7.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.94
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$6.94
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.71
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health SBD |
$5.14
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.46
|
| Rate for Payer: UHC Core |
$21.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.88
|
| Rate for Payer: UHC Exchange |
$12.88
|
| Rate for Payer: UHC Medicare Advantage |
$13.27
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC PNEUMOCOCCAL IGG ABS PRE & POST
|
Facility
|
IP
|
$8.16
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
30200226
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.30
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cofinity Commercial |
$5.71
|
| Rate for Payer: Cofinity Commercial |
$7.02
|
| Rate for Payer: Healthscope Commercial |
$7.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.94
|
| Rate for Payer: PHP Commercial |
$6.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.71
|
| Rate for Payer: Priority Health SBD |
$5.14
|
|
|
HC PNEUMOCOCCAL INJECTION
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
77100010
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$127.06 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna Medicare |
$43.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.84
|
| Rate for Payer: BCBS Complete |
$24.28
|
| Rate for Payer: BCBS MAPPO |
$42.27
|
| Rate for Payer: BCBS Trust/PPO |
$61.17
|
| Rate for Payer: BCN Medicare Advantage |
$42.27
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.27
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Mclaren Medicaid |
$23.12
|
| Rate for Payer: Mclaren Medicare |
$42.27
|
| Rate for Payer: Meridian Medicaid |
$24.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PACE Medicare |
$40.16
|
| Rate for Payer: PACE SWMI |
$42.27
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: PHP Medicare Advantage |
$42.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.06
|
| Rate for Payer: Priority Health Medicare |
$42.27
|
| Rate for Payer: Priority Health Narrow Network |
$101.65
|
| Rate for Payer: Priority Health SBD |
$18.90
|
| Rate for Payer: Railroad Medicare Medicare |
$42.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.27
|
| Rate for Payer: UHC Medicare Advantage |
$43.54
|
| Rate for Payer: VA VA |
$42.27
|
|
|
HC PNEUMOCOCCAL INJECTION
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
77100010
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health SBD |
$18.90
|
|
|
HC PNEUMOCOCCAL VACCINE
|
Facility
|
IP
|
$145.86
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
63600029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.89 |
| Max. Negotiated Rate |
$131.27 |
| Rate for Payer: Aetna Commercial |
$123.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.81
|
| Rate for Payer: Cash Price |
$116.69
|
| Rate for Payer: Cofinity Commercial |
$102.10
|
| Rate for Payer: Cofinity Commercial |
$125.44
|
| Rate for Payer: Healthscope Commercial |
$131.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.98
|
| Rate for Payer: PHP Commercial |
$123.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.10
|
| Rate for Payer: Priority Health SBD |
$91.89
|
|
|
HC PNEUMOCOCCAL VACCINE
|
Facility
|
OP
|
$145.86
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
63600029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$402.61 |
| Rate for Payer: Aetna Commercial |
$123.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.81
|
| Rate for Payer: BCBS Complete |
$58.34
|
| Rate for Payer: BCBS Trust/PPO |
$402.61
|
| Rate for Payer: Cash Price |
$116.69
|
| Rate for Payer: Cash Price |
$116.69
|
| Rate for Payer: Cofinity Commercial |
$102.10
|
| Rate for Payer: Cofinity Commercial |
$125.44
|
| Rate for Payer: Healthscope Commercial |
$131.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.98
|
| Rate for Payer: PHP Commercial |
$123.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.10
|
| Rate for Payer: Priority Health SBD |
$91.89
|
|
|
HC PNEUMOCYSTIS BY RAPID PCR
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600170
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.50
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health SBD |
$94.50
|
|
|
HC PNEUMOCYSTIS BY RAPID PCR
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600170
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$94.50
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC PNEUMONIAE AB IGM BY IFA
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200309
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$91.98 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna Commercial |
$124.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.90
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$102.20
|
| Rate for Payer: Cofinity Commercial |
$125.56
|
| Rate for Payer: Healthscope Commercial |
$131.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.10
|
| Rate for Payer: PHP Commercial |
$124.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: Priority Health SBD |
$91.98
|
|
|
HC PNEUMONIAE AB IGM BY IFA
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200309
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna Commercial |
$124.10
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.55
|
| Rate for Payer: BCBS Complete |
$7.61
|
| Rate for Payer: BCBS MAPPO |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$10.37
|
| Rate for Payer: BCN Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$102.20
|
| Rate for Payer: Cofinity Commercial |
$125.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.24
|
| Rate for Payer: Healthscope Commercial |
$131.40
|
| Rate for Payer: Mclaren Medicaid |
$7.24
|
| Rate for Payer: Mclaren Medicare |
$13.24
|
| Rate for Payer: Meridian Medicaid |
$7.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.10
|
| Rate for Payer: PACE Medicare |
$12.58
|
| Rate for Payer: PACE SWMI |
$13.24
|
| Rate for Payer: PHP Commercial |
$124.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: Priority Health Medicare |
$13.24
|
| Rate for Payer: Priority Health SBD |
$91.98
|
| Rate for Payer: Railroad Medicare Medicare |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.89
|
| Rate for Payer: UHC Core |
$22.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.24
|
| Rate for Payer: UHC Exchange |
$13.24
|
| Rate for Payer: UHC Medicare Advantage |
$13.64
|
| Rate for Payer: VA VA |
$13.24
|
|
|
HC POC BASIC METABOLIC PANEL W/ICAL
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
30100696
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$14.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.16
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: BCBS MAPPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$8.00
|
| Rate for Payer: BCN Medicare Advantage |
$13.73
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.73
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$7.51
|
| Rate for Payer: Mclaren Medicare |
$13.73
|
| Rate for Payer: Meridian Medicaid |
$7.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$13.04
|
| Rate for Payer: PACE SWMI |
$13.73
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$13.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$13.73
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$13.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.48
|
| Rate for Payer: UHC Core |
$14.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.73
|
| Rate for Payer: UHC Exchange |
$13.73
|
| Rate for Payer: UHC Medicare Advantage |
$14.14
|
| Rate for Payer: VA VA |
$13.73
|
|
|
HC POC BASIC METABOLIC PANEL W/ICAL
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
30100696
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC POC BLOOD GAS
|
Facility
|
OP
|
$161.98
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
30100499
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.09 |
| Max. Negotiated Rate |
$145.78 |
| Rate for Payer: Aetna Commercial |
$137.68
|
| Rate for Payer: Aetna Medicare |
$81.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.46
|
| Rate for Payer: BCBS Complete |
$45.25
|
| Rate for Payer: BCBS MAPPO |
$78.77
|
| Rate for Payer: BCBS Trust/PPO |
$61.69
|
| Rate for Payer: BCN Medicare Advantage |
$78.77
|
| Rate for Payer: Cash Price |
$129.58
|
| Rate for Payer: Cash Price |
$129.58
|
| Rate for Payer: Cofinity Commercial |
$113.39
|
| Rate for Payer: Cofinity Commercial |
$139.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.77
|
| Rate for Payer: Healthscope Commercial |
$145.78
|
| Rate for Payer: Mclaren Medicaid |
$43.09
|
| Rate for Payer: Mclaren Medicare |
$78.77
|
| Rate for Payer: Meridian Medicaid |
$45.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$82.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.68
|
| Rate for Payer: PACE Medicare |
$74.83
|
| Rate for Payer: PACE SWMI |
$78.77
|
| Rate for Payer: PHP Commercial |
$137.68
|
| Rate for Payer: PHP Medicare Advantage |
$78.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.39
|
| Rate for Payer: Priority Health Medicare |
$78.77
|
| Rate for Payer: Priority Health SBD |
$102.05
|
| Rate for Payer: Railroad Medicare Medicare |
$78.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.52
|
| Rate for Payer: UHC Core |
$48.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.77
|
| Rate for Payer: UHC Exchange |
$78.77
|
| Rate for Payer: UHC Medicare Advantage |
$81.13
|
| Rate for Payer: VA VA |
$78.77
|
|
|
HC POC BLOOD GAS
|
Facility
|
IP
|
$161.98
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
30100499
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.05 |
| Max. Negotiated Rate |
$145.78 |
| Rate for Payer: Aetna Commercial |
$137.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.29
|
| Rate for Payer: Cash Price |
$129.58
|
| Rate for Payer: Cofinity Commercial |
$113.39
|
| Rate for Payer: Cofinity Commercial |
$139.30
|
| Rate for Payer: Healthscope Commercial |
$145.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.68
|
| Rate for Payer: PHP Commercial |
$137.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.39
|
| Rate for Payer: Priority Health SBD |
$102.05
|
|
|
HC POC BLOOD GAS CALC O2 SAT
|
Facility
|
OP
|
$107.51
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
30100700
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna Commercial |
$91.38
|
| Rate for Payer: Aetna Medicare |
$27.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.59
|
| Rate for Payer: BCBS Complete |
$14.97
|
| Rate for Payer: BCBS MAPPO |
$26.07
|
| Rate for Payer: BCBS Trust/PPO |
$20.41
|
| Rate for Payer: BCN Medicare Advantage |
$26.07
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$75.26
|
| Rate for Payer: Cofinity Commercial |
$92.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.07
|
| Rate for Payer: Healthscope Commercial |
$96.76
|
| Rate for Payer: Mclaren Medicaid |
$14.26
|
| Rate for Payer: Mclaren Medicare |
$26.07
|
| Rate for Payer: Meridian Medicaid |
$14.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.38
|
| Rate for Payer: PACE Medicare |
$24.77
|
| Rate for Payer: PACE SWMI |
$26.07
|
| Rate for Payer: PHP Commercial |
$91.38
|
| Rate for Payer: PHP Medicare Advantage |
$26.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.26
|
| Rate for Payer: Priority Health Medicare |
$26.07
|
| Rate for Payer: Priority Health SBD |
$67.73
|
| Rate for Payer: Railroad Medicare Medicare |
$26.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.28
|
| Rate for Payer: UHC Core |
$32.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.07
|
| Rate for Payer: UHC Exchange |
$26.07
|
| Rate for Payer: UHC Medicare Advantage |
$26.85
|
| Rate for Payer: VA VA |
$26.07
|
|
|
HC POC BLOOD GAS CALC O2 SAT
|
Facility
|
IP
|
$107.51
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
30100700
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna Commercial |
$91.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.88
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$75.26
|
| Rate for Payer: Cofinity Commercial |
$92.46
|
| Rate for Payer: Healthscope Commercial |
$96.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.38
|
| Rate for Payer: PHP Commercial |
$91.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.26
|
| Rate for Payer: Priority Health SBD |
$67.73
|
|
|
HC POC CARBOXYHEMOGLOBIN QUANT
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
30100726
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC POC CARBOXYHEMOGLOBIN QUANT
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
30100726
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$20.95 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$12.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.40
|
| Rate for Payer: BCBS Complete |
$7.08
|
| Rate for Payer: BCBS MAPPO |
$12.32
|
| Rate for Payer: BCBS Trust/PPO |
$9.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$6.74
|
| Rate for Payer: Mclaren Medicare |
$12.32
|
| Rate for Payer: Meridian Medicaid |
$7.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$11.70
|
| Rate for Payer: PACE SWMI |
$12.32
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$12.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$12.32
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$12.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.78
|
| Rate for Payer: UHC Core |
$20.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.32
|
| Rate for Payer: UHC Exchange |
$12.32
|
| Rate for Payer: UHC Medicare Advantage |
$12.69
|
| Rate for Payer: VA VA |
$12.32
|
|
|
HC POC CHLORIDE
|
Facility
|
IP
|
$19.38
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
30100500
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$17.44 |
| Rate for Payer: Aetna Commercial |
$16.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.60
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cofinity Commercial |
$13.57
|
| Rate for Payer: Cofinity Commercial |
$16.67
|
| Rate for Payer: Healthscope Commercial |
$17.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.47
|
| Rate for Payer: PHP Commercial |
$16.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.57
|
| Rate for Payer: Priority Health SBD |
$12.21
|
|
|
HC POC CHLORIDE
|
Facility
|
OP
|
$19.38
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
30100500
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$17.44 |
| Rate for Payer: Aetna Commercial |
$16.47
|
| Rate for Payer: Aetna Medicare |
$4.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.75
|
| Rate for Payer: BCBS Complete |
$2.64
|
| Rate for Payer: BCBS MAPPO |
$4.60
|
| Rate for Payer: BCN Medicare Advantage |
$4.60
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cofinity Commercial |
$13.57
|
| Rate for Payer: Cofinity Commercial |
$16.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.60
|
| Rate for Payer: Healthscope Commercial |
$17.44
|
| Rate for Payer: Mclaren Medicaid |
$2.52
|
| Rate for Payer: Mclaren Medicare |
$4.60
|
| Rate for Payer: Meridian Medicaid |
$2.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.47
|
| Rate for Payer: PACE Medicare |
$4.37
|
| Rate for Payer: PACE SWMI |
$4.60
|
| Rate for Payer: PHP Commercial |
$16.47
|
| Rate for Payer: PHP Medicare Advantage |
$4.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.57
|
| Rate for Payer: Priority Health Medicare |
$4.60
|
| Rate for Payer: Priority Health SBD |
$12.21
|
| Rate for Payer: Railroad Medicare Medicare |
$4.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.52
|
| Rate for Payer: UHC Core |
$7.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.60
|
| Rate for Payer: UHC Exchange |
$4.60
|
| Rate for Payer: UHC Medicare Advantage |
$4.74
|
| Rate for Payer: VA VA |
$4.60
|
|
