|
HC MED SURVEILLANCE SH
|
Facility
|
IP
|
$48.96
|
|
|
Service Code
|
HCPCS G0435
|
| Hospital Charge Code |
30200415
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.84 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.62
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.82
|
| Rate for Payer: Priority Health SBD |
$30.84
|
|
|
HC MED SURVEILLANCE SH
|
Facility
|
OP
|
$48.96
|
|
|
Service Code
|
HCPCS G0435
|
| Hospital Charge Code |
30200415
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: BCBS Complete |
$6.74
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$10.61
|
| Rate for Payer: BCN Commercial |
$10.61
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Cofinity Commercial |
$34.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Mclaren Medicaid |
$6.42
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$6.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.62
|
| Rate for Payer: Nomi Health Commercial |
$35.94
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.33
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow Network |
$9.86
|
| Rate for Payer: Priority Health SBD |
$30.84
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Medicare Advantage |
$11.98
|
| Rate for Payer: UHCCP Medicaid |
$6.74
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC MEDTRONIC CRT ICD
|
Facility
|
OP
|
$29,963.52
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500006
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$26,967.17 |
| Rate for Payer: Aetna Commercial |
$25,468.99
|
| Rate for Payer: Aetna Medicare |
$14,981.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,476.29
|
| Rate for Payer: BCBS Complete |
$11,985.41
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$23,970.82
|
| Rate for Payer: Cash Price |
$23,970.82
|
| Rate for Payer: Cofinity Commercial |
$20,974.46
|
| Rate for Payer: Cofinity Commercial |
$25,768.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,974.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,970.82
|
| Rate for Payer: Healthscope Commercial |
$26,967.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,468.99
|
| Rate for Payer: PHP Commercial |
$25,468.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,476.29
|
| Rate for Payer: Priority Health SBD |
$18,877.02
|
|
|
HC MEDTRONIC CRT ICD
|
Facility
|
IP
|
$29,963.52
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500006
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$18,877.02 |
| Max. Negotiated Rate |
$26,967.17 |
| Rate for Payer: Aetna Commercial |
$25,468.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,476.29
|
| Rate for Payer: Cash Price |
$23,970.82
|
| Rate for Payer: Cofinity Commercial |
$20,974.46
|
| Rate for Payer: Cofinity Commercial |
$25,768.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,974.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,970.82
|
| Rate for Payer: Healthscope Commercial |
$26,967.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,468.99
|
| Rate for Payer: PHP Commercial |
$25,468.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,476.29
|
| Rate for Payer: Priority Health SBD |
$18,877.02
|
|
|
HC MEDTRONIC CRT LEAD
|
Facility
|
IP
|
$6,207.54
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,910.75 |
| Max. Negotiated Rate |
$5,586.79 |
| Rate for Payer: Aetna Commercial |
$5,276.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,034.90
|
| Rate for Payer: Cash Price |
$4,966.03
|
| Rate for Payer: Cofinity Commercial |
$4,345.28
|
| Rate for Payer: Cofinity Commercial |
$5,338.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,345.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,966.03
|
| Rate for Payer: Healthscope Commercial |
$5,586.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,276.41
|
| Rate for Payer: PHP Commercial |
$5,276.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,034.90
|
| Rate for Payer: Priority Health SBD |
$3,910.75
|
|
|
HC MEDTRONIC CRT LEAD
|
Facility
|
OP
|
$6,207.54
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$5,586.79 |
| Rate for Payer: Aetna Commercial |
$5,276.41
|
| Rate for Payer: Aetna Medicare |
$3,103.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,034.90
|
| Rate for Payer: BCBS Complete |
$2,483.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$4,966.03
|
| Rate for Payer: Cash Price |
$4,966.03
|
| Rate for Payer: Cofinity Commercial |
$4,345.28
|
| Rate for Payer: Cofinity Commercial |
$5,338.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,345.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,966.03
|
| Rate for Payer: Healthscope Commercial |
$5,586.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,276.41
|
| Rate for Payer: PHP Commercial |
$5,276.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,034.90
|
| Rate for Payer: Priority Health SBD |
$3,910.75
|
|
|
HC MEDTRONIC DUAL PACEMAKER
|
Facility
|
OP
|
$8,843.40
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500007
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,537.36 |
| Max. Negotiated Rate |
$7,959.06 |
| Rate for Payer: Aetna Commercial |
$7,516.89
|
| Rate for Payer: Aetna Medicare |
$4,421.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,748.21
|
| Rate for Payer: BCBS Complete |
$3,537.36
|
| Rate for Payer: Cash Price |
$7,074.72
|
| Rate for Payer: Cofinity Commercial |
$6,190.38
|
| Rate for Payer: Cofinity Commercial |
$7,605.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,190.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,074.72
|
| Rate for Payer: Healthscope Commercial |
$7,959.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,516.89
|
| Rate for Payer: PHP Commercial |
$7,516.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,748.21
|
| Rate for Payer: Priority Health SBD |
$5,571.34
|
|
|
HC MEDTRONIC DUAL PACEMAKER
|
Facility
|
IP
|
$8,843.40
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500007
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,571.34 |
| Max. Negotiated Rate |
$7,959.06 |
| Rate for Payer: Aetna Commercial |
$7,516.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,748.21
|
| Rate for Payer: Cash Price |
$7,074.72
|
| Rate for Payer: Cofinity Commercial |
$6,190.38
|
| Rate for Payer: Cofinity Commercial |
$7,605.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,190.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,074.72
|
| Rate for Payer: Healthscope Commercial |
$7,959.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,516.89
|
| Rate for Payer: PHP Commercial |
$7,516.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,748.21
|
| Rate for Payer: Priority Health SBD |
$5,571.34
|
|
|
HC MEDTRONIC ICD DUAL
|
Facility
|
OP
|
$26,322.12
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,528.85 |
| Max. Negotiated Rate |
$23,689.91 |
| Rate for Payer: Aetna Commercial |
$22,373.80
|
| Rate for Payer: Aetna Medicare |
$13,161.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,109.38
|
| Rate for Payer: BCBS Complete |
$10,528.85
|
| Rate for Payer: Cash Price |
$21,057.70
|
| Rate for Payer: Cofinity Commercial |
$18,425.48
|
| Rate for Payer: Cofinity Commercial |
$22,637.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,425.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,057.70
|
| Rate for Payer: Healthscope Commercial |
$23,689.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,373.80
|
| Rate for Payer: PHP Commercial |
$22,373.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,109.38
|
| Rate for Payer: Priority Health SBD |
$16,582.94
|
|
|
HC MEDTRONIC ICD DUAL
|
Facility
|
IP
|
$26,322.12
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16,582.94 |
| Max. Negotiated Rate |
$23,689.91 |
| Rate for Payer: Aetna Commercial |
$22,373.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,109.38
|
| Rate for Payer: Cash Price |
$21,057.70
|
| Rate for Payer: Cofinity Commercial |
$22,637.02
|
| Rate for Payer: Cofinity Commercial |
$18,425.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,425.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,057.70
|
| Rate for Payer: Healthscope Commercial |
$23,689.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,373.80
|
| Rate for Payer: PHP Commercial |
$22,373.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,109.38
|
| Rate for Payer: Priority Health SBD |
$16,582.94
|
|
|
HC MEDTRONIC ICD SINGLE
|
Facility
|
OP
|
$23,825.16
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,530.06 |
| Max. Negotiated Rate |
$21,442.64 |
| Rate for Payer: Aetna Commercial |
$20,251.39
|
| Rate for Payer: Aetna Medicare |
$11,912.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,486.35
|
| Rate for Payer: BCBS Complete |
$9,530.06
|
| Rate for Payer: Cash Price |
$19,060.13
|
| Rate for Payer: Cofinity Commercial |
$16,677.61
|
| Rate for Payer: Cofinity Commercial |
$20,489.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$16,677.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,060.13
|
| Rate for Payer: Healthscope Commercial |
$21,442.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,251.39
|
| Rate for Payer: PHP Commercial |
$20,251.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,486.35
|
| Rate for Payer: Priority Health SBD |
$15,009.85
|
|
|
HC MEDTRONIC ICD SINGLE
|
Facility
|
IP
|
$23,825.16
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,009.85 |
| Max. Negotiated Rate |
$21,442.64 |
| Rate for Payer: Aetna Commercial |
$20,251.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,486.35
|
| Rate for Payer: Cash Price |
$19,060.13
|
| Rate for Payer: Cofinity Commercial |
$16,677.61
|
| Rate for Payer: Cofinity Commercial |
$20,489.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$16,677.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,060.13
|
| Rate for Payer: Healthscope Commercial |
$21,442.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,251.39
|
| Rate for Payer: PHP Commercial |
$20,251.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,486.35
|
| Rate for Payer: Priority Health SBD |
$15,009.85
|
|
|
HC MEDTRONIC SINGLE PACEMAKER
|
Facility
|
OP
|
$13,216.13
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500008
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,286.45 |
| Max. Negotiated Rate |
$11,894.52 |
| Rate for Payer: Aetna Commercial |
$11,233.71
|
| Rate for Payer: Aetna Medicare |
$6,608.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,590.48
|
| Rate for Payer: BCBS Complete |
$5,286.45
|
| Rate for Payer: Cash Price |
$10,572.90
|
| Rate for Payer: Cofinity Commercial |
$11,365.87
|
| Rate for Payer: Cofinity Commercial |
$9,251.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,251.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,572.90
|
| Rate for Payer: Healthscope Commercial |
$11,894.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,233.71
|
| Rate for Payer: PHP Commercial |
$11,233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,590.48
|
| Rate for Payer: Priority Health SBD |
$8,326.16
|
|
|
HC MEDTRONIC SINGLE PACEMAKER
|
Facility
|
IP
|
$13,216.13
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500008
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,326.16 |
| Max. Negotiated Rate |
$11,894.52 |
| Rate for Payer: Aetna Commercial |
$11,233.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,590.48
|
| Rate for Payer: Cash Price |
$10,572.90
|
| Rate for Payer: Cofinity Commercial |
$11,365.87
|
| Rate for Payer: Cofinity Commercial |
$9,251.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,251.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,572.90
|
| Rate for Payer: Healthscope Commercial |
$11,894.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,233.71
|
| Rate for Payer: PHP Commercial |
$11,233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,590.48
|
| Rate for Payer: Priority Health SBD |
$8,326.16
|
|
|
HC MEDTRONIC TACHY (ICD) LEAD
|
Facility
|
OP
|
$15,597.48
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,238.99 |
| Max. Negotiated Rate |
$14,037.73 |
| Rate for Payer: Aetna Commercial |
$13,257.86
|
| Rate for Payer: Aetna Medicare |
$7,798.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,138.36
|
| Rate for Payer: BCBS Complete |
$6,238.99
|
| Rate for Payer: Cash Price |
$12,477.98
|
| Rate for Payer: Cofinity Commercial |
$10,918.24
|
| Rate for Payer: Cofinity Commercial |
$13,413.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,918.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,477.98
|
| Rate for Payer: Healthscope Commercial |
$14,037.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,257.86
|
| Rate for Payer: PHP Commercial |
$13,257.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,138.36
|
| Rate for Payer: Priority Health SBD |
$9,826.41
|
|
|
HC MEDTRONIC TACHY (ICD) LEAD
|
Facility
|
IP
|
$15,597.48
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,826.41 |
| Max. Negotiated Rate |
$14,037.73 |
| Rate for Payer: Aetna Commercial |
$13,257.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,138.36
|
| Rate for Payer: Cash Price |
$12,477.98
|
| Rate for Payer: Cofinity Commercial |
$10,918.24
|
| Rate for Payer: Cofinity Commercial |
$13,413.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,918.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,477.98
|
| Rate for Payer: Healthscope Commercial |
$14,037.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,257.86
|
| Rate for Payer: PHP Commercial |
$13,257.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,138.36
|
| Rate for Payer: Priority Health SBD |
$9,826.41
|
|
|
HC MENACWY-TT VACCINE IM
|
Facility
|
OP
|
$187.27
|
|
|
Service Code
|
CPT 90619
|
| Hospital Charge Code |
63600210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$468.83 |
| Rate for Payer: Aetna Commercial |
$159.18
|
| Rate for Payer: Aetna Medicare |
$93.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.73
|
| Rate for Payer: BCBS Complete |
$74.91
|
| Rate for Payer: BCBS Trust/PPO |
$468.83
|
| Rate for Payer: BCN Commercial |
$468.83
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cofinity Commercial |
$161.05
|
| Rate for Payer: Cofinity Commercial |
$131.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.82
|
| Rate for Payer: Healthscope Commercial |
$168.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.18
|
| Rate for Payer: PHP Commercial |
$159.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.22
|
| Rate for Payer: Priority Health Narrow Network |
$152.18
|
| Rate for Payer: Priority Health SBD |
$117.98
|
|
|
HC MENACWY-TT VACCINE IM
|
Facility
|
IP
|
$187.27
|
|
|
Service Code
|
CPT 90619
|
| Hospital Charge Code |
63600210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.98 |
| Max. Negotiated Rate |
$168.54 |
| Rate for Payer: Aetna Commercial |
$159.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.73
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cofinity Commercial |
$131.09
|
| Rate for Payer: Cofinity Commercial |
$161.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.82
|
| Rate for Payer: Healthscope Commercial |
$168.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.18
|
| Rate for Payer: PHP Commercial |
$159.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.73
|
| Rate for Payer: Priority Health SBD |
$117.98
|
|
|
HC MENB-FHBP VACC 2/3 DOSE IM
|
Facility
|
OP
|
$526.91
|
|
|
Service Code
|
CPT 90621
|
| Hospital Charge Code |
63600187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$563.54 |
| Rate for Payer: Aetna Commercial |
$447.87
|
| Rate for Payer: Aetna Medicare |
$263.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.49
|
| Rate for Payer: BCBS Complete |
$210.76
|
| Rate for Payer: BCBS Trust/PPO |
$563.54
|
| Rate for Payer: BCN Commercial |
$563.54
|
| Rate for Payer: Cash Price |
$421.53
|
| Rate for Payer: Cash Price |
$421.53
|
| Rate for Payer: Cofinity Commercial |
$368.84
|
| Rate for Payer: Cofinity Commercial |
$453.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$368.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.53
|
| Rate for Payer: Healthscope Commercial |
$474.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.87
|
| Rate for Payer: PHP Commercial |
$447.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.75
|
| Rate for Payer: Priority Health Narrow Network |
$173.40
|
| Rate for Payer: Priority Health SBD |
$331.95
|
|
|
HC MENB-FHBP VACC 2/3 DOSE IM
|
Facility
|
IP
|
$526.91
|
|
|
Service Code
|
CPT 90621
|
| Hospital Charge Code |
63600187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$331.95 |
| Max. Negotiated Rate |
$474.22 |
| Rate for Payer: Aetna Commercial |
$447.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.49
|
| Rate for Payer: Cash Price |
$421.53
|
| Rate for Payer: Cofinity Commercial |
$368.84
|
| Rate for Payer: Cofinity Commercial |
$453.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$368.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.53
|
| Rate for Payer: Healthscope Commercial |
$474.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.87
|
| Rate for Payer: PHP Commercial |
$447.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.49
|
| Rate for Payer: Priority Health SBD |
$331.95
|
|
|
HC MENB RECOMB PROT W/OUT MEMBR VESIC VACC IM
|
Facility
|
IP
|
$263.16
|
|
|
Service Code
|
CPT 90620
|
| Hospital Charge Code |
63600122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.79 |
| Max. Negotiated Rate |
$236.84 |
| Rate for Payer: Aetna Commercial |
$223.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.05
|
| Rate for Payer: Cash Price |
$210.53
|
| Rate for Payer: Cofinity Commercial |
$184.21
|
| Rate for Payer: Cofinity Commercial |
$226.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.53
|
| Rate for Payer: Healthscope Commercial |
$236.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.69
|
| Rate for Payer: PHP Commercial |
$223.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.05
|
| Rate for Payer: Priority Health SBD |
$165.79
|
|
|
HC MENB RECOMB PROT W/OUT MEMBR VESIC VACC IM
|
Facility
|
OP
|
$263.16
|
|
|
Service Code
|
CPT 90620
|
| Hospital Charge Code |
63600122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.26 |
| Max. Negotiated Rate |
$610.06 |
| Rate for Payer: Aetna Commercial |
$223.69
|
| Rate for Payer: Aetna Medicare |
$131.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.05
|
| Rate for Payer: BCBS Complete |
$105.26
|
| Rate for Payer: BCBS Trust/PPO |
$610.06
|
| Rate for Payer: BCN Commercial |
$610.06
|
| Rate for Payer: Cash Price |
$210.53
|
| Rate for Payer: Cash Price |
$210.53
|
| Rate for Payer: Cofinity Commercial |
$226.32
|
| Rate for Payer: Cofinity Commercial |
$184.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.53
|
| Rate for Payer: Healthscope Commercial |
$236.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.69
|
| Rate for Payer: PHP Commercial |
$223.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$254.93
|
| Rate for Payer: Priority Health Narrow Network |
$203.94
|
| Rate for Payer: Priority Health SBD |
$165.79
|
|
|
HC MENENCEPH CMPT 10
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
30200307
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$12.74 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health SBD |
$8.91
|
|
|
HC MENENCEPH CMPT 10
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
30200307
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna Medicare |
$13.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.31
|
| Rate for Payer: BCBS Complete |
$7.34
|
| Rate for Payer: BCBS MAPPO |
$13.05
|
| Rate for Payer: BCBS Trust/PPO |
$11.56
|
| Rate for Payer: BCN Commercial |
$11.56
|
| Rate for Payer: BCN Medicare Advantage |
$13.05
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.05
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Mclaren Medicaid |
$6.99
|
| Rate for Payer: Mclaren Medicare |
$13.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.70
|
| Rate for Payer: Meridian Medicaid |
$7.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$19.58
|
| Rate for Payer: PACE Medicare |
$12.40
|
| Rate for Payer: PACE SWMI |
$13.05
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: PHP Medicare Advantage |
$13.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.43
|
| Rate for Payer: Priority Health Medicare |
$13.05
|
| Rate for Payer: Priority Health Narrow Network |
$10.74
|
| Rate for Payer: Priority Health SBD |
$8.91
|
| Rate for Payer: Railroad Medicare Medicare |
$13.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.05
|
| Rate for Payer: UHC Medicare Advantage |
$13.05
|
| Rate for Payer: UHCCP Medicaid |
$7.35
|
| Rate for Payer: VA VA |
$13.05
|
|
|
HC MENENCEPH CMPT 11
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
30200258
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$11.67
|
| Rate for Payer: BCN Commercial |
$11.67
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Mclaren Medicaid |
$7.07
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$7.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$19.78
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.57
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$10.86
|
| Rate for Payer: Priority Health SBD |
$8.91
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.19
|
| Rate for Payer: UHC Medicare Advantage |
$13.19
|
| Rate for Payer: UHCCP Medicaid |
$7.43
|
| Rate for Payer: VA VA |
$13.19
|
|
