|
HC INDUCTION OF ARRHYTHMIA
|
Facility
|
OP
|
$3,753.24
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
48100036
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$637.54 |
| Max. Negotiated Rate |
$3,738.41 |
| Rate for Payer: Aetna Commercial |
$3,190.25
|
| Rate for Payer: Aetna Medicare |
$1,237.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,439.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,486.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,486.80
|
| Rate for Payer: BCBS Complete |
$669.42
|
| Rate for Payer: BCBS MAPPO |
$1,189.44
|
| Rate for Payer: BCBS Trust/PPO |
$3,143.88
|
| Rate for Payer: BCN Commercial |
$3,143.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,189.44
|
| Rate for Payer: Cash Price |
$3,002.59
|
| Rate for Payer: Cash Price |
$3,002.59
|
| Rate for Payer: Cash Price |
$3,002.59
|
| Rate for Payer: Cofinity Commercial |
$2,627.27
|
| Rate for Payer: Cofinity Commercial |
$3,227.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,627.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,002.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,189.44
|
| Rate for Payer: Healthscope Commercial |
$3,377.92
|
| Rate for Payer: Mclaren Medicaid |
$637.54
|
| Rate for Payer: Mclaren Medicare |
$1,189.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,248.91
|
| Rate for Payer: Meridian Medicaid |
$669.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,367.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,190.25
|
| Rate for Payer: Nomi Health Commercial |
$2,497.82
|
| Rate for Payer: PACE Medicare |
$1,129.97
|
| Rate for Payer: PACE SWMI |
$1,189.44
|
| Rate for Payer: PHP Commercial |
$3,190.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,189.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$637.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,439.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,738.41
|
| Rate for Payer: Priority Health Medicare |
$1,189.44
|
| Rate for Payer: Priority Health Narrow Network |
$2,990.73
|
| Rate for Payer: Priority Health SBD |
$2,364.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,189.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,348.15
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,189.44
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,189.44
|
| Rate for Payer: UHCCP Medicaid |
$669.65
|
| Rate for Payer: VA VA |
$1,189.44
|
|
|
HC INDUCTION OF ARRHYTHMIA
|
Facility
|
IP
|
$3,753.24
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
48100036
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,364.54 |
| Max. Negotiated Rate |
$3,377.92 |
| Rate for Payer: Aetna Commercial |
$3,190.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,439.61
|
| Rate for Payer: Cash Price |
$3,002.59
|
| Rate for Payer: Cofinity Commercial |
$2,627.27
|
| Rate for Payer: Cofinity Commercial |
$3,227.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,627.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,002.59
|
| Rate for Payer: Healthscope Commercial |
$3,377.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,190.25
|
| Rate for Payer: PHP Commercial |
$3,190.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,439.61
|
| Rate for Payer: Priority Health SBD |
$2,364.54
|
|
|
HC INDWELLING PORT
|
Facility
|
IP
|
$1,361.50
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.74 |
| Max. Negotiated Rate |
$1,225.35 |
| Rate for Payer: Aetna Commercial |
$1,157.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$884.98
|
| Rate for Payer: Cash Price |
$1,089.20
|
| Rate for Payer: Cofinity Commercial |
$1,170.89
|
| Rate for Payer: Cofinity Commercial |
$953.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$953.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.20
|
| Rate for Payer: Healthscope Commercial |
$1,225.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.28
|
| Rate for Payer: PHP Commercial |
$1,157.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.98
|
| Rate for Payer: Priority Health SBD |
$857.74
|
|
|
HC INDWELLING PORT
|
Facility
|
OP
|
$1,361.50
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.60 |
| Max. Negotiated Rate |
$1,225.35 |
| Rate for Payer: Aetna Commercial |
$1,157.28
|
| Rate for Payer: Aetna Medicare |
$680.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$884.98
|
| Rate for Payer: BCBS Complete |
$544.60
|
| Rate for Payer: Cash Price |
$1,089.20
|
| Rate for Payer: Cofinity Commercial |
$1,170.89
|
| Rate for Payer: Cofinity Commercial |
$953.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$953.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.20
|
| Rate for Payer: Healthscope Commercial |
$1,225.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.28
|
| Rate for Payer: PHP Commercial |
$1,157.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.98
|
| Rate for Payer: Priority Health SBD |
$857.74
|
|
|
HC INFANT COOLING SYSTEM
|
Facility
|
OP
|
$670.91
|
|
| Hospital Charge Code |
27000644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$268.36 |
| Max. Negotiated Rate |
$603.82 |
| Rate for Payer: Aetna Commercial |
$570.27
|
| Rate for Payer: Aetna Medicare |
$335.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.09
|
| Rate for Payer: BCBS Complete |
$268.36
|
| Rate for Payer: Cash Price |
$536.73
|
| Rate for Payer: Cofinity Commercial |
$469.64
|
| Rate for Payer: Cofinity Commercial |
$576.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$469.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.73
|
| Rate for Payer: Healthscope Commercial |
$603.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.27
|
| Rate for Payer: PHP Commercial |
$570.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.09
|
| Rate for Payer: Priority Health SBD |
$422.67
|
|
|
HC INFANT COOLING SYSTEM
|
Facility
|
IP
|
$670.91
|
|
| Hospital Charge Code |
27000644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$422.67 |
| Max. Negotiated Rate |
$603.82 |
| Rate for Payer: Aetna Commercial |
$570.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.09
|
| Rate for Payer: Cash Price |
$536.73
|
| Rate for Payer: Cofinity Commercial |
$469.64
|
| Rate for Payer: Cofinity Commercial |
$576.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$469.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.73
|
| Rate for Payer: Healthscope Commercial |
$603.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.27
|
| Rate for Payer: PHP Commercial |
$570.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.09
|
| Rate for Payer: Priority Health SBD |
$422.67
|
|
|
HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.32 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$109.24
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health SBD |
$98.32
|
|
|
HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$143.70 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna Medicare |
$99.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.75
|
| Rate for Payer: BCBS Complete |
$53.92
|
| Rate for Payer: BCBS MAPPO |
$95.80
|
| Rate for Payer: BCBS Trust/PPO |
$84.80
|
| Rate for Payer: BCN Commercial |
$84.80
|
| Rate for Payer: BCN Medicare Advantage |
$95.80
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Cofinity Commercial |
$109.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.80
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Mclaren Medicaid |
$51.35
|
| Rate for Payer: Mclaren Medicare |
$95.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.59
|
| Rate for Payer: Meridian Medicaid |
$53.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$143.70
|
| Rate for Payer: PACE Medicare |
$91.01
|
| Rate for Payer: PACE SWMI |
$95.80
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: PHP Medicare Advantage |
$95.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.80
|
| Rate for Payer: Priority Health Medicare |
$95.80
|
| Rate for Payer: Priority Health Narrow Network |
$76.64
|
| Rate for Payer: Priority Health SBD |
$98.32
|
| Rate for Payer: Railroad Medicare Medicare |
$95.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.80
|
| Rate for Payer: UHC Medicare Advantage |
$95.80
|
| Rate for Payer: UHCCP Medicaid |
$53.94
|
| Rate for Payer: VA VA |
$95.80
|
|
|
HC INFLIXIMAB AB
|
Facility
|
OP
|
$188.70
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$768.88 |
| Rate for Payer: Aetna Commercial |
$160.40
|
| Rate for Payer: Aetna Medicare |
$14.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.65
|
| Rate for Payer: BCBS Complete |
$7.95
|
| Rate for Payer: BCBS MAPPO |
$14.12
|
| Rate for Payer: BCBS Trust/PPO |
$12.50
|
| Rate for Payer: BCN Commercial |
$12.50
|
| Rate for Payer: BCN Medicare Advantage |
$14.12
|
| Rate for Payer: Cash Price |
$150.96
|
| Rate for Payer: Cash Price |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$132.09
|
| Rate for Payer: Cofinity Commercial |
$162.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.12
|
| Rate for Payer: Healthscope Commercial |
$169.83
|
| Rate for Payer: Mclaren Medicaid |
$7.57
|
| Rate for Payer: Mclaren Medicare |
$14.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.83
|
| Rate for Payer: Meridian Medicaid |
$7.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.40
|
| Rate for Payer: Nomi Health Commercial |
$21.18
|
| Rate for Payer: PACE Medicare |
$13.41
|
| Rate for Payer: PACE SWMI |
$14.12
|
| Rate for Payer: PHP Commercial |
$160.40
|
| Rate for Payer: PHP Medicare Advantage |
$14.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.12
|
| Rate for Payer: Priority Health Medicare |
$14.12
|
| Rate for Payer: Priority Health Narrow Network |
$11.30
|
| Rate for Payer: Priority Health SBD |
$118.88
|
| Rate for Payer: Railroad Medicare Medicare |
$14.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.94
|
| Rate for Payer: UHC Core |
$768.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.12
|
| Rate for Payer: UHC Exchange |
$768.88
|
| Rate for Payer: UHC Medicare Advantage |
$14.12
|
| Rate for Payer: UHCCP Medicaid |
$7.95
|
| Rate for Payer: VA VA |
$14.12
|
|
|
HC INFLIXIMAB AB
|
Facility
|
IP
|
$188.70
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$118.88 |
| Max. Negotiated Rate |
$169.83 |
| Rate for Payer: Aetna Commercial |
$160.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.66
|
| Rate for Payer: Cash Price |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$132.09
|
| Rate for Payer: Cofinity Commercial |
$162.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.96
|
| Rate for Payer: Healthscope Commercial |
$169.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.40
|
| Rate for Payer: PHP Commercial |
$160.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.66
|
| Rate for Payer: Priority Health SBD |
$118.88
|
|
|
HC INFLIXIMAB, S
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.44
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$174.93
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.42
|
| Rate for Payer: PHP Commercial |
$212.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health SBD |
$157.44
|
|
|
HC INFLIXIMAB, S
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.42
|
| Rate for Payer: Aetna Medicare |
$40.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.21
|
| Rate for Payer: BCBS Complete |
$21.71
|
| Rate for Payer: BCBS MAPPO |
$38.57
|
| Rate for Payer: BCBS Trust/PPO |
$34.15
|
| Rate for Payer: BCN Commercial |
$34.15
|
| Rate for Payer: BCN Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Cofinity Commercial |
$174.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.57
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Mclaren Medicaid |
$20.67
|
| Rate for Payer: Mclaren Medicare |
$38.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.50
|
| Rate for Payer: Meridian Medicaid |
$21.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.42
|
| Rate for Payer: Nomi Health Commercial |
$57.86
|
| Rate for Payer: PACE Medicare |
$36.64
|
| Rate for Payer: PACE SWMI |
$38.57
|
| Rate for Payer: PHP Commercial |
$212.42
|
| Rate for Payer: PHP Medicare Advantage |
$38.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.57
|
| Rate for Payer: Priority Health Medicare |
$38.57
|
| Rate for Payer: Priority Health Narrow Network |
$30.86
|
| Rate for Payer: Priority Health SBD |
$157.44
|
| Rate for Payer: Railroad Medicare Medicare |
$38.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.57
|
| Rate for Payer: UHC Medicare Advantage |
$38.57
|
| Rate for Payer: UHCCP Medicaid |
$21.71
|
| Rate for Payer: VA VA |
$38.57
|
|
|
HC INFLUENZA A AND B PCR
|
Facility
|
IP
|
$216.95
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600207
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$136.68 |
| Max. Negotiated Rate |
$195.26 |
| Rate for Payer: Aetna Commercial |
$184.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.02
|
| Rate for Payer: Cash Price |
$173.56
|
| Rate for Payer: Cofinity Commercial |
$151.86
|
| Rate for Payer: Cofinity Commercial |
$186.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.56
|
| Rate for Payer: Healthscope Commercial |
$195.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.41
|
| Rate for Payer: PHP Commercial |
$184.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.02
|
| Rate for Payer: Priority Health SBD |
$136.68
|
|
|
HC INFLUENZA A AND B PCR
|
Facility
|
OP
|
$216.95
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600207
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.45 |
| Max. Negotiated Rate |
$213.94 |
| Rate for Payer: Aetna Commercial |
$184.41
|
| Rate for Payer: Aetna Medicare |
$148.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: BCBS Complete |
$80.27
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$126.26
|
| Rate for Payer: BCN Commercial |
$126.26
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$173.56
|
| Rate for Payer: Cash Price |
$173.56
|
| Rate for Payer: Cofinity Commercial |
$186.58
|
| Rate for Payer: Cofinity Commercial |
$151.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$195.26
|
| Rate for Payer: Mclaren Medicaid |
$76.45
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: Meridian Medicaid |
$80.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.41
|
| Rate for Payer: Nomi Health Commercial |
$213.94
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$184.41
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.63
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health Narrow Network |
$114.10
|
| Rate for Payer: Priority Health SBD |
$136.68
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.63
|
| Rate for Payer: UHC Medicare Advantage |
$142.63
|
| Rate for Payer: UHCCP Medicaid |
$80.30
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC INFLUENZA A/B DNA AMP PROBE
|
Facility
|
OP
|
$145.73
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30600314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$143.70 |
| Rate for Payer: Aetna Commercial |
$123.87
|
| Rate for Payer: Aetna Medicare |
$99.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.75
|
| Rate for Payer: BCBS Complete |
$53.92
|
| Rate for Payer: BCBS MAPPO |
$95.80
|
| Rate for Payer: BCBS Trust/PPO |
$84.80
|
| Rate for Payer: BCN Commercial |
$84.80
|
| Rate for Payer: BCN Medicare Advantage |
$95.80
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cofinity Commercial |
$125.33
|
| Rate for Payer: Cofinity Commercial |
$102.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.80
|
| Rate for Payer: Healthscope Commercial |
$131.16
|
| Rate for Payer: Mclaren Medicaid |
$51.35
|
| Rate for Payer: Mclaren Medicare |
$95.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.59
|
| Rate for Payer: Meridian Medicaid |
$53.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.87
|
| Rate for Payer: Nomi Health Commercial |
$143.70
|
| Rate for Payer: PACE Medicare |
$91.01
|
| Rate for Payer: PACE SWMI |
$95.80
|
| Rate for Payer: PHP Commercial |
$123.87
|
| Rate for Payer: PHP Medicare Advantage |
$95.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.80
|
| Rate for Payer: Priority Health Medicare |
$95.80
|
| Rate for Payer: Priority Health Narrow Network |
$76.64
|
| Rate for Payer: Priority Health SBD |
$91.81
|
| Rate for Payer: Railroad Medicare Medicare |
$95.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.80
|
| Rate for Payer: UHC Medicare Advantage |
$95.80
|
| Rate for Payer: UHCCP Medicaid |
$53.94
|
| Rate for Payer: VA VA |
$95.80
|
|
|
HC INFLUENZA A/B DNA AMP PROBE
|
Facility
|
IP
|
$145.73
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30600314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$91.81 |
| Max. Negotiated Rate |
$131.16 |
| Rate for Payer: Aetna Commercial |
$123.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.72
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cofinity Commercial |
$102.01
|
| Rate for Payer: Cofinity Commercial |
$125.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.58
|
| Rate for Payer: Healthscope Commercial |
$131.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.87
|
| Rate for Payer: PHP Commercial |
$123.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.72
|
| Rate for Payer: Priority Health SBD |
$91.81
|
|
|
HC INFLUENZA AND RSV BY PCR
|
Facility
|
IP
|
$223.34
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600213
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$140.70 |
| Max. Negotiated Rate |
$201.01 |
| Rate for Payer: Aetna Commercial |
$189.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.17
|
| Rate for Payer: Cash Price |
$178.67
|
| Rate for Payer: Cofinity Commercial |
$156.34
|
| Rate for Payer: Cofinity Commercial |
$192.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.67
|
| Rate for Payer: Healthscope Commercial |
$201.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.84
|
| Rate for Payer: PHP Commercial |
$189.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.17
|
| Rate for Payer: Priority Health SBD |
$140.70
|
|
|
HC INFLUENZA AND RSV BY PCR
|
Facility
|
OP
|
$223.34
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600213
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.45 |
| Max. Negotiated Rate |
$213.94 |
| Rate for Payer: Aetna Commercial |
$189.84
|
| Rate for Payer: Aetna Medicare |
$148.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: BCBS Complete |
$80.27
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$126.26
|
| Rate for Payer: BCN Commercial |
$126.26
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$178.67
|
| Rate for Payer: Cash Price |
$178.67
|
| Rate for Payer: Cofinity Commercial |
$192.07
|
| Rate for Payer: Cofinity Commercial |
$156.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$201.01
|
| Rate for Payer: Mclaren Medicaid |
$76.45
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: Meridian Medicaid |
$80.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.84
|
| Rate for Payer: Nomi Health Commercial |
$213.94
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$189.84
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.63
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health Narrow Network |
$114.10
|
| Rate for Payer: Priority Health SBD |
$140.70
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.63
|
| Rate for Payer: UHC Medicare Advantage |
$142.63
|
| Rate for Payer: UHCCP Medicaid |
$80.30
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC INFLUENZA INJECTION
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
77100009
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$142.07 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$47.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.51
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS MAPPO |
$45.21
|
| Rate for Payer: BCBS Trust/PPO |
$59.45
|
| Rate for Payer: BCN Commercial |
$59.45
|
| Rate for Payer: BCN Medicare Advantage |
$45.21
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.21
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$24.23
|
| Rate for Payer: Mclaren Medicare |
$45.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.47
|
| Rate for Payer: Meridian Medicaid |
$25.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$135.63
|
| Rate for Payer: PACE Medicare |
$42.95
|
| Rate for Payer: PACE SWMI |
$45.21
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$45.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.07
|
| Rate for Payer: Priority Health Medicare |
$45.21
|
| Rate for Payer: Priority Health Narrow Network |
$113.66
|
| Rate for Payer: Priority Health SBD |
$19.28
|
| Rate for Payer: Railroad Medicare Medicare |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.21
|
| Rate for Payer: UHC Medicare Advantage |
$45.21
|
| Rate for Payer: UHCCP Medicaid |
$25.45
|
| Rate for Payer: VA VA |
$45.21
|
|
|
HC INFLUENZA INJECTION
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
77100009
|
|
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 INFLUENZA VAC, INACTIV ADJUVANT IM
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 90653
|
| Hospital Charge Code |
63600251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.21 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Aetna Commercial |
$141.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.55
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$116.90
|
| Rate for Payer: Cofinity Commercial |
$143.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.60
|
| Rate for Payer: Healthscope Commercial |
$150.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.95
|
| Rate for Payer: PHP Commercial |
$141.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health SBD |
$105.21
|
|
|
HC INFLUENZA VAC, INACTIV ADJUVANT IM
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 90653
|
| Hospital Charge Code |
63600251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.79 |
| Max. Negotiated Rate |
$199.79 |
| Rate for Payer: Aetna Commercial |
$141.95
|
| Rate for Payer: Aetna Medicare |
$83.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.55
|
| Rate for Payer: BCBS Complete |
$66.80
|
| Rate for Payer: BCBS Trust/PPO |
$199.79
|
| Rate for Payer: BCN Commercial |
$199.79
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$143.62
|
| Rate for Payer: Cofinity Commercial |
$116.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.60
|
| Rate for Payer: Healthscope Commercial |
$150.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.95
|
| Rate for Payer: PHP Commercial |
$141.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.49
|
| Rate for Payer: Priority Health Narrow Network |
$66.79
|
| Rate for Payer: Priority Health SBD |
$105.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.18
|
|
|
HC INFLUENZA VIRUS VACCINE (IIV), SPLIT VIRUS, PRESERVATIVE FREE IM
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
63600073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.67 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna Commercial |
$92.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.85
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$76.30
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Healthscope Commercial |
$98.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.65
|
| Rate for Payer: PHP Commercial |
$92.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.85
|
| Rate for Payer: Priority Health SBD |
$68.67
|
|
|
HC INFLUENZA VIRUS VACCINE (IIV), SPLIT VIRUS, PRESERVATIVE FREE IM
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
63600073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$199.79 |
| Rate for Payer: Aetna Commercial |
$92.65
|
| Rate for Payer: Aetna Medicare |
$54.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.85
|
| Rate for Payer: BCBS Complete |
$43.60
|
| Rate for Payer: BCBS Trust/PPO |
$199.79
|
| Rate for Payer: BCN Commercial |
$199.79
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Cofinity Commercial |
$76.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Healthscope Commercial |
$98.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.65
|
| Rate for Payer: PHP Commercial |
$92.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.49
|
| Rate for Payer: Priority Health Narrow Network |
$66.79
|
| Rate for Payer: Priority Health SBD |
$68.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.18
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
63600079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
|
