|
HC IGH IN BCLL
|
Facility
|
OP
|
$481.76
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
31000146
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$157.86 |
| Max. Negotiated Rate |
$829.04 |
| Rate for Payer: Aetna Commercial |
$409.50
|
| Rate for Payer: Aetna Medicare |
$306.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$368.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$368.15
|
| Rate for Payer: BCBS Complete |
$165.76
|
| Rate for Payer: BCBS MAPPO |
$294.52
|
| Rate for Payer: BCN Medicare Advantage |
$294.52
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cofinity Commercial |
$414.31
|
| Rate for Payer: Cofinity Commercial |
$337.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.52
|
| Rate for Payer: Healthscope Commercial |
$433.58
|
| Rate for Payer: Mclaren Medicaid |
$157.86
|
| Rate for Payer: Mclaren Medicare |
$294.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.25
|
| Rate for Payer: Meridian Medicaid |
$165.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: PACE Medicare |
$279.79
|
| Rate for Payer: PACE SWMI |
$294.52
|
| Rate for Payer: PHP Commercial |
$409.50
|
| Rate for Payer: PHP Medicare Advantage |
$294.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: Priority Health Medicare |
$294.52
|
| Rate for Payer: Priority Health SBD |
$303.51
|
| Rate for Payer: Railroad Medicare Medicare |
$294.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$829.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.52
|
| Rate for Payer: UHC Medicare Advantage |
$294.52
|
| Rate for Payer: UHCCP Medicaid |
$165.81
|
| Rate for Payer: VA VA |
$294.52
|
|
|
HC ILEOSCOPY
|
Facility
|
IP
|
$2,308.81
|
|
| Hospital Charge Code |
36000055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,454.55 |
| Max. Negotiated Rate |
$2,077.93 |
| Rate for Payer: Aetna Commercial |
$1,962.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,500.73
|
| Rate for Payer: Cash Price |
$1,847.05
|
| Rate for Payer: Cofinity Commercial |
$1,616.17
|
| Rate for Payer: Cofinity Commercial |
$1,985.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,616.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,847.05
|
| Rate for Payer: Healthscope Commercial |
$2,077.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,962.49
|
| Rate for Payer: PHP Commercial |
$1,962.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,500.73
|
| Rate for Payer: Priority Health SBD |
$1,454.55
|
|
|
HC ILEOSCOPY
|
Facility
|
OP
|
$2,308.81
|
|
| Hospital Charge Code |
36000055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$923.52 |
| Max. Negotiated Rate |
$2,077.93 |
| Rate for Payer: Aetna Commercial |
$1,962.49
|
| Rate for Payer: Aetna Medicare |
$1,154.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,500.73
|
| Rate for Payer: BCBS Complete |
$923.52
|
| Rate for Payer: Cash Price |
$1,847.05
|
| Rate for Payer: Cofinity Commercial |
$1,616.17
|
| Rate for Payer: Cofinity Commercial |
$1,985.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,616.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,847.05
|
| Rate for Payer: Healthscope Commercial |
$2,077.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,962.49
|
| Rate for Payer: PHP Commercial |
$1,962.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,500.73
|
| Rate for Payer: Priority Health SBD |
$1,454.55
|
|
|
HC ILIAC ANGIOGRAPHY W/HEART CATH
|
Facility
|
IP
|
$2,755.73
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,736.11 |
| Max. Negotiated Rate |
$2,480.16 |
| Rate for Payer: Aetna Commercial |
$2,342.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,791.22
|
| Rate for Payer: Cash Price |
$2,204.58
|
| Rate for Payer: Cofinity Commercial |
$1,929.01
|
| Rate for Payer: Cofinity Commercial |
$2,369.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,929.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,204.58
|
| Rate for Payer: Healthscope Commercial |
$2,480.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,342.37
|
| Rate for Payer: PHP Commercial |
$2,342.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,791.22
|
| Rate for Payer: Priority Health SBD |
$1,736.11
|
|
|
HC ILIAC ANGIOGRAPHY W/HEART CATH
|
Facility
|
OP
|
$2,755.73
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,102.29 |
| Max. Negotiated Rate |
$2,480.16 |
| Rate for Payer: Aetna Commercial |
$2,342.37
|
| Rate for Payer: Aetna Medicare |
$1,377.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,791.22
|
| Rate for Payer: BCBS Complete |
$1,102.29
|
| Rate for Payer: Cash Price |
$2,204.58
|
| Rate for Payer: Cofinity Commercial |
$1,929.01
|
| Rate for Payer: Cofinity Commercial |
$2,369.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,929.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,204.58
|
| Rate for Payer: Healthscope Commercial |
$2,480.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,342.37
|
| Rate for Payer: PHP Commercial |
$2,342.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,791.22
|
| Rate for Payer: Priority Health SBD |
$1,736.11
|
|
|
HC IMFLUOR 1ST AB STAIN (BILL ONLY)
|
Facility
|
OP
|
$139.38
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
31000086
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$87.81 |
| Max. Negotiated Rate |
$470.43 |
| Rate for Payer: Aetna Commercial |
$118.47
|
| Rate for Payer: Aetna Medicare |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$208.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$208.90
|
| Rate for Payer: BCBS Complete |
$94.06
|
| Rate for Payer: BCBS MAPPO |
$167.12
|
| Rate for Payer: BCN Medicare Advantage |
$167.12
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Cofinity Commercial |
$119.87
|
| Rate for Payer: Cofinity Commercial |
$97.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.12
|
| Rate for Payer: Healthscope Commercial |
$125.44
|
| Rate for Payer: Mclaren Medicaid |
$89.58
|
| Rate for Payer: Mclaren Medicare |
$167.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.48
|
| Rate for Payer: Meridian Medicaid |
$94.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.47
|
| Rate for Payer: PACE Medicare |
$158.76
|
| Rate for Payer: PACE SWMI |
$167.12
|
| Rate for Payer: PHP Commercial |
$118.47
|
| Rate for Payer: PHP Medicare Advantage |
$167.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.60
|
| Rate for Payer: Priority Health Medicare |
$167.12
|
| Rate for Payer: Priority Health SBD |
$87.81
|
| Rate for Payer: Railroad Medicare Medicare |
$167.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.12
|
| Rate for Payer: UHC Medicare Advantage |
$167.12
|
| Rate for Payer: UHCCP Medicaid |
$94.09
|
| Rate for Payer: VA VA |
$167.12
|
|
|
HC IMFLUOR 1ST AB STAIN (BILL ONLY)
|
Facility
|
IP
|
$139.38
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
31000086
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$87.81 |
| Max. Negotiated Rate |
$125.44 |
| Rate for Payer: Aetna Commercial |
$118.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.60
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Cofinity Commercial |
$119.87
|
| Rate for Payer: Cofinity Commercial |
$97.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.50
|
| Rate for Payer: Healthscope Commercial |
$125.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.47
|
| Rate for Payer: PHP Commercial |
$118.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.60
|
| Rate for Payer: Priority Health SBD |
$87.81
|
|
|
HC IMFLUOR EACH ADDL AB STAIN (BILL ONLY)
|
Facility
|
OP
|
$105.99
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
31000085
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$95.39 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Aetna Medicare |
$52.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.89
|
| Rate for Payer: BCBS Complete |
$42.40
|
| Rate for Payer: Cash Price |
$84.79
|
| Rate for Payer: Cofinity Commercial |
$74.19
|
| Rate for Payer: Cofinity Commercial |
$91.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.79
|
| Rate for Payer: Healthscope Commercial |
$95.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.09
|
| Rate for Payer: PHP Commercial |
$90.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.89
|
| Rate for Payer: Priority Health SBD |
$66.77
|
|
|
HC IMFLUOR EACH ADDL AB STAIN (BILL ONLY)
|
Facility
|
IP
|
$105.99
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
31000085
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.77 |
| Max. Negotiated Rate |
$95.39 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.89
|
| Rate for Payer: Cash Price |
$84.79
|
| Rate for Payer: Cofinity Commercial |
$74.19
|
| Rate for Payer: Cofinity Commercial |
$91.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.79
|
| Rate for Payer: Healthscope Commercial |
$95.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.09
|
| Rate for Payer: PHP Commercial |
$90.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.89
|
| Rate for Payer: Priority Health SBD |
$66.77
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
IP
|
$61.07
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
30500013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$38.47 |
| Max. Negotiated Rate |
$54.96 |
| Rate for Payer: Aetna Commercial |
$51.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.70
|
| Rate for Payer: Cash Price |
$48.86
|
| Rate for Payer: Cofinity Commercial |
$42.75
|
| Rate for Payer: Cofinity Commercial |
$52.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.86
|
| Rate for Payer: Healthscope Commercial |
$54.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.91
|
| Rate for Payer: PHP Commercial |
$51.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.70
|
| Rate for Payer: Priority Health SBD |
$38.47
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
OP
|
$61.07
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
30500013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.16 |
| Max. Negotiated Rate |
$100.60 |
| Rate for Payer: Aetna Commercial |
$51.91
|
| Rate for Payer: Aetna Medicare |
$37.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.67
|
| Rate for Payer: BCBS Complete |
$20.11
|
| Rate for Payer: BCBS MAPPO |
$35.74
|
| Rate for Payer: BCN Medicare Advantage |
$35.74
|
| Rate for Payer: Cash Price |
$48.86
|
| Rate for Payer: Cash Price |
$48.86
|
| Rate for Payer: Cofinity Commercial |
$52.52
|
| Rate for Payer: Cofinity Commercial |
$42.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.74
|
| Rate for Payer: Healthscope Commercial |
$54.96
|
| Rate for Payer: Mclaren Medicaid |
$19.16
|
| Rate for Payer: Mclaren Medicare |
$35.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.53
|
| Rate for Payer: Meridian Medicaid |
$20.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.91
|
| Rate for Payer: PACE Medicare |
$33.95
|
| Rate for Payer: PACE SWMI |
$35.74
|
| Rate for Payer: PHP Commercial |
$51.91
|
| Rate for Payer: PHP Medicare Advantage |
$35.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.70
|
| Rate for Payer: Priority Health Medicare |
$35.74
|
| Rate for Payer: Priority Health SBD |
$38.47
|
| Rate for Payer: Railroad Medicare Medicare |
$35.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.74
|
| Rate for Payer: UHC Medicare Advantage |
$35.74
|
| Rate for Payer: UHCCP Medicaid |
$20.12
|
| Rate for Payer: VA VA |
$35.74
|
|
|
HC IMMUNIZATION 18YEARS OR YOUNGER
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
77100001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$15.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: BCBS Complete |
$12.24
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health SBD |
$19.28
|
|
|
HC IMMUNIZATION 18YEARS OR YOUNGER
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
77100001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health SBD |
$19.28
|
|
|
HC IMMUNIZATION 1ST VACCINE
|
Facility
|
IP
|
$33.66
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
77100003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$30.29 |
| Rate for Payer: Aetna Commercial |
$28.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.88
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cofinity Commercial |
$23.56
|
| Rate for Payer: Cofinity Commercial |
$28.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.93
|
| Rate for Payer: Healthscope Commercial |
$30.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.61
|
| Rate for Payer: PHP Commercial |
$28.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.88
|
| Rate for Payer: Priority Health SBD |
$21.21
|
|
|
HC IMMUNIZATION 1ST VACCINE
|
Facility
|
OP
|
$33.66
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
77100003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$195.38 |
| Rate for Payer: Aetna Commercial |
$28.61
|
| Rate for Payer: Aetna Medicare |
$72.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.76
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: BCBS MAPPO |
$69.41
|
| Rate for Payer: BCN Medicare Advantage |
$69.41
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cofinity Commercial |
$28.95
|
| Rate for Payer: Cofinity Commercial |
$23.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.41
|
| Rate for Payer: Healthscope Commercial |
$30.29
|
| Rate for Payer: Mclaren Medicaid |
$37.20
|
| Rate for Payer: Mclaren Medicare |
$69.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.88
|
| Rate for Payer: Meridian Medicaid |
$39.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.61
|
| Rate for Payer: PACE Medicare |
$65.94
|
| Rate for Payer: PACE SWMI |
$69.41
|
| Rate for Payer: PHP Commercial |
$28.61
|
| Rate for Payer: PHP Medicare Advantage |
$69.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.88
|
| Rate for Payer: Priority Health Medicare |
$69.41
|
| Rate for Payer: Priority Health SBD |
$21.21
|
| Rate for Payer: Railroad Medicare Medicare |
$69.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.41
|
| Rate for Payer: UHC Medicare Advantage |
$69.41
|
| Rate for Payer: UHCCP Medicaid |
$39.08
|
| Rate for Payer: VA VA |
$69.41
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE
|
Facility
|
IP
|
$34.12
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
77100004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$30.71 |
| Rate for Payer: Aetna Commercial |
$29.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.18
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cofinity Commercial |
$23.88
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.30
|
| Rate for Payer: Healthscope Commercial |
$30.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.00
|
| Rate for Payer: PHP Commercial |
$29.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.18
|
| Rate for Payer: Priority Health SBD |
$21.50
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE
|
Facility
|
OP
|
$34.12
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
77100004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$30.71 |
| Rate for Payer: Aetna Commercial |
$29.00
|
| Rate for Payer: Aetna Medicare |
$17.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.18
|
| Rate for Payer: BCBS Complete |
$13.65
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cofinity Commercial |
$23.88
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.30
|
| Rate for Payer: Healthscope Commercial |
$30.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.00
|
| Rate for Payer: PHP Commercial |
$29.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.18
|
| Rate for Payer: Priority Health SBD |
$21.50
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE 18 YEARS OR YOUNGER
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
77100002
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health SBD |
$16.07
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE 18 YEARS OR YOUNGER
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
77100002
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$12.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health SBD |
$16.07
|
|
|
HC IMMUNIZATION NASAL ORAL 1ST
|
Facility
|
OP
|
$37.54
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
77100005
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.65 |
| Max. Negotiated Rate |
$195.38 |
| Rate for Payer: Aetna Commercial |
$31.91
|
| Rate for Payer: Aetna Medicare |
$72.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.76
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: BCBS MAPPO |
$69.41
|
| Rate for Payer: BCN Medicare Advantage |
$69.41
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cofinity Commercial |
$26.28
|
| Rate for Payer: Cofinity Commercial |
$32.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.41
|
| Rate for Payer: Healthscope Commercial |
$33.79
|
| Rate for Payer: Mclaren Medicaid |
$37.20
|
| Rate for Payer: Mclaren Medicare |
$69.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.88
|
| Rate for Payer: Meridian Medicaid |
$39.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.91
|
| Rate for Payer: PACE Medicare |
$65.94
|
| Rate for Payer: PACE SWMI |
$69.41
|
| Rate for Payer: PHP Commercial |
$31.91
|
| Rate for Payer: PHP Medicare Advantage |
$69.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.40
|
| Rate for Payer: Priority Health Medicare |
$69.41
|
| Rate for Payer: Priority Health SBD |
$23.65
|
| Rate for Payer: Railroad Medicare Medicare |
$69.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.41
|
| Rate for Payer: UHC Medicare Advantage |
$69.41
|
| Rate for Payer: UHCCP Medicaid |
$39.08
|
| Rate for Payer: VA VA |
$69.41
|
|
|
HC IMMUNIZATION NASAL ORAL 1ST
|
Facility
|
IP
|
$37.54
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
77100005
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.65 |
| Max. Negotiated Rate |
$33.79 |
| Rate for Payer: Aetna Commercial |
$31.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.40
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cofinity Commercial |
$26.28
|
| Rate for Payer: Cofinity Commercial |
$32.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.03
|
| Rate for Payer: Healthscope Commercial |
$33.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.91
|
| Rate for Payer: PHP Commercial |
$31.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.40
|
| Rate for Payer: Priority Health SBD |
$23.65
|
|
|
HC IMMUNIZATION ORAL/NASL EA ADD
|
Facility
|
IP
|
$27.54
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
77100006
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.90
|
| Rate for Payer: Cash Price |
$22.03
|
| Rate for Payer: Cofinity Commercial |
$19.28
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.03
|
| Rate for Payer: Healthscope Commercial |
$24.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.41
|
| Rate for Payer: PHP Commercial |
$23.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.90
|
| Rate for Payer: Priority Health SBD |
$17.35
|
|
|
HC IMMUNIZATION ORAL/NASL EA ADD
|
Facility
|
OP
|
$27.54
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
77100006
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.90
|
| Rate for Payer: BCBS Complete |
$11.02
|
| Rate for Payer: Cash Price |
$22.03
|
| Rate for Payer: Cofinity Commercial |
$19.28
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.03
|
| Rate for Payer: Healthscope Commercial |
$24.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.41
|
| Rate for Payer: PHP Commercial |
$23.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.90
|
| Rate for Payer: Priority Health SBD |
$17.35
|
|
|
HC IMMUNOASSAY MULTI STEP
|
Facility
|
IP
|
$24.97
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100659
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.23
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health SBD |
$15.73
|
|
|
HC IMMUNOASSAY MULTI STEP
|
Facility
|
OP
|
$24.97
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100659
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$32.46 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Cofinity Commercial |
$17.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$15.73
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.49
|
| Rate for Payer: VA VA |
$11.53
|
|
