|
HC SACRAL NERVE STIM, TEST LEAD, EACH
|
Facility
|
OP
|
$1,379.57
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27200315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.17 |
| Max. Negotiated Rate |
$1,241.61 |
| Rate for Payer: Aetna Commercial |
$1,172.63
|
| Rate for Payer: Aetna Medicare |
$689.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$896.72
|
| Rate for Payer: BCBS Complete |
$551.83
|
| Rate for Payer: Cash Price |
$1,103.66
|
| Rate for Payer: Cofinity Advantage |
$965.70
|
| Rate for Payer: Cofinity Commercial |
$1,186.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,103.66
|
| Rate for Payer: Healthscope Commercial |
$1,241.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,103.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,172.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,034.68
|
| Rate for Payer: PHP Commercial |
$1,172.63
|
| Rate for Payer: Priority Health SBD |
$869.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$896.72
|
| Rate for Payer: UHC Core |
$718.76
|
| Rate for Payer: UHC Exchange |
$542.17
|
|
|
HC SACRAL NERVE STIM, TEST LEAD, EACH
|
Facility
|
IP
|
$1,379.57
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27200315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$869.13 |
| Max. Negotiated Rate |
$1,241.61 |
| Rate for Payer: Aetna Commercial |
$1,172.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$896.72
|
| Rate for Payer: Cash Price |
$1,103.66
|
| Rate for Payer: Cofinity Advantage |
$965.70
|
| Rate for Payer: Cofinity Commercial |
$1,186.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,103.66
|
| Rate for Payer: Healthscope Commercial |
$1,241.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,172.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,034.68
|
| Rate for Payer: PHP Commercial |
$1,172.63
|
| Rate for Payer: Priority Health SBD |
$869.13
|
|
|
HC SAFE SHEATH LEAD INTRODUCER
|
Facility
|
OP
|
$2,000.00
|
|
| Hospital Charge Code |
27200400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$786.00 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,700.00
|
| Rate for Payer: Aetna Medicare |
$1,000.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,300.00
|
| Rate for Payer: BCBS Complete |
$800.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cofinity Advantage |
$1,400.00
|
| Rate for Payer: Cofinity Commercial |
$1,720.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,600.00
|
| Rate for Payer: Healthscope Commercial |
$1,800.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,600.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,700.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,500.00
|
| Rate for Payer: PHP Commercial |
$1,700.00
|
| Rate for Payer: Priority Health SBD |
$1,260.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,300.00
|
| Rate for Payer: UHC Core |
$1,042.00
|
| Rate for Payer: UHC Exchange |
$786.00
|
|
|
HC SAFE SHEATH LEAD INTRODUCER
|
Facility
|
IP
|
$2,000.00
|
|
| Hospital Charge Code |
27200400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,260.00 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,700.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cofinity Advantage |
$1,400.00
|
| Rate for Payer: Cofinity Commercial |
$1,720.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,600.00
|
| Rate for Payer: Healthscope Commercial |
$1,800.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,700.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,500.00
|
| Rate for Payer: PHP Commercial |
$1,700.00
|
| Rate for Payer: Priority Health SBD |
$1,260.00
|
|
|
HC SALICYLATE LVL.
|
Facility
|
IP
|
$104.49
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100649
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.83 |
| Max. Negotiated Rate |
$94.04 |
| Rate for Payer: Aetna Commercial |
$88.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.92
|
| Rate for Payer: Cash Price |
$83.59
|
| Rate for Payer: Cofinity Advantage |
$73.14
|
| Rate for Payer: Cofinity Commercial |
$89.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.59
|
| Rate for Payer: Healthscope Commercial |
$94.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.37
|
| Rate for Payer: PHP Commercial |
$88.82
|
| Rate for Payer: Priority Health SBD |
$65.83
|
|
|
HC SALICYLATE LVL.
|
Facility
|
OP
|
$104.49
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100649
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$94.04 |
| Rate for Payer: Aetna Commercial |
$88.82
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$66.26
|
| Rate for Payer: BCN Commercial |
$66.26
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$83.59
|
| Rate for Payer: Cash Price |
$83.59
|
| Rate for Payer: Cofinity Advantage |
$73.14
|
| Rate for Payer: Cofinity Commercial |
$89.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$94.04
|
| Rate for Payer: Mclaren Medicaid |
$32.50
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.82
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.37
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$88.82
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$65.83
|
| Rate for Payer: Priority Health Tiered Network |
$49.71
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.21
|
| Rate for Payer: UHC Core |
$93.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$93.21
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC SALICYLATE THERAPEUTIC DRUG ASSAY
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 80179
|
| Hospital Charge Code |
30100730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.74 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: Priority Health SBD |
$26.74
|
|
|
HC SALICYLATE THERAPEUTIC DRUG ASSAY
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 80179
|
| Hospital Charge Code |
30100730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.87
|
| Rate for Payer: BCN Commercial |
$19.87
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Mclaren Medicaid |
$9.75
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$27.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.64
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$26.74
|
| Rate for Payer: Priority Health Tiered Network |
$14.91
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.96
|
| Rate for Payer: UHC Core |
$27.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$27.96
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC SALMON IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200059
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC SALMON IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200059
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC SAMARIUM 153 THERAPEUTIC PER TREATMENT DOSE
|
Facility
|
IP
|
$12,927.24
|
|
|
Service Code
|
HCPCS A9604
|
| Hospital Charge Code |
34400005
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$8,144.16 |
| Max. Negotiated Rate |
$11,634.52 |
| Rate for Payer: Aetna Commercial |
$10,988.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,402.71
|
| Rate for Payer: Cash Price |
$10,341.79
|
| Rate for Payer: Cofinity Advantage |
$9,049.07
|
| Rate for Payer: Cofinity Commercial |
$11,117.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,341.79
|
| Rate for Payer: Healthscope Commercial |
$11,634.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,988.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,695.43
|
| Rate for Payer: PHP Commercial |
$10,988.15
|
| Rate for Payer: Priority Health SBD |
$8,144.16
|
|
|
HC SAMARIUM 153 THERAPEUTIC PER TREATMENT DOSE
|
Facility
|
OP
|
$12,927.24
|
|
|
Service Code
|
HCPCS A9604
|
| Hospital Charge Code |
34400005
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$1,652.58 |
| Max. Negotiated Rate |
$23,147.74 |
| Rate for Payer: Aetna Commercial |
$10,988.15
|
| Rate for Payer: Aetna Medicare |
$3,286.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,402.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,949.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,949.75
|
| Rate for Payer: BCBS Complete |
$1,735.36
|
| Rate for Payer: BCBS MAPPO |
$3,159.80
|
| Rate for Payer: BCBS Trust/PPO |
$23,147.74
|
| Rate for Payer: BCN Commercial |
$23,147.74
|
| Rate for Payer: BCN Medicare Advantage |
$3,159.80
|
| Rate for Payer: Cash Price |
$10,341.79
|
| Rate for Payer: Cash Price |
$10,341.79
|
| Rate for Payer: Cofinity Advantage |
$9,049.07
|
| Rate for Payer: Cofinity Commercial |
$11,117.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,341.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,159.80
|
| Rate for Payer: Healthscope Commercial |
$11,634.52
|
| Rate for Payer: Mclaren Medicaid |
$1,652.58
|
| Rate for Payer: Mclaren Medicare |
$3,159.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,317.79
|
| Rate for Payer: Meridian Medicaid |
$3,317.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,633.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,475.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,988.15
|
| Rate for Payer: Nomi Health Commercial |
$9,479.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,695.43
|
| Rate for Payer: PACE Medicare |
$3,001.81
|
| Rate for Payer: PACE SWMI |
$3,159.80
|
| Rate for Payer: PHP Commercial |
$10,988.15
|
| Rate for Payer: PHP Medicare Advantage |
$3,159.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,965.90
|
| Rate for Payer: Priority Health Medicare |
$3,159.80
|
| Rate for Payer: Priority Health SBD |
$8,144.16
|
| Rate for Payer: Priority Health Tiered Network |
$7,972.72
|
| Rate for Payer: Railroad Medicare Medicare |
$3,159.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,213.67
|
| Rate for Payer: UHC Core |
$5,213.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,159.80
|
| Rate for Payer: UHC Exchange |
$5,213.67
|
| Rate for Payer: UHC Medicaid |
$1,652.58
|
| Rate for Payer: UHCCP Medicaid |
$1,652.58
|
| Rate for Payer: VA VA |
$3,159.80
|
|
|
HC SARS CORONAVIRUS 2 IGG AB,S
|
Facility
|
IP
|
$72.17
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
30200479
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.47 |
| Max. Negotiated Rate |
$64.95 |
| Rate for Payer: Aetna Commercial |
$61.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.91
|
| Rate for Payer: Cash Price |
$57.74
|
| Rate for Payer: Cofinity Advantage |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$62.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.74
|
| Rate for Payer: Healthscope Commercial |
$64.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.13
|
| Rate for Payer: PHP Commercial |
$61.34
|
| Rate for Payer: Priority Health SBD |
$45.47
|
|
|
HC SARS CORONAVIRUS 2 IGG AB,S
|
Facility
|
OP
|
$72.17
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
30200479
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.03 |
| Max. Negotiated Rate |
$126.39 |
| Rate for Payer: Aetna Commercial |
$61.34
|
| Rate for Payer: Aetna Medicare |
$43.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.66
|
| Rate for Payer: BCBS Complete |
$23.14
|
| Rate for Payer: BCBS MAPPO |
$42.13
|
| Rate for Payer: BCN Medicare Advantage |
$42.13
|
| Rate for Payer: Cash Price |
$57.74
|
| Rate for Payer: Cash Price |
$57.74
|
| Rate for Payer: Cofinity Advantage |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$62.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.13
|
| Rate for Payer: Healthscope Commercial |
$64.95
|
| Rate for Payer: Mclaren Medicaid |
$22.03
|
| Rate for Payer: Mclaren Medicare |
$42.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.24
|
| Rate for Payer: Meridian Medicaid |
$44.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.34
|
| Rate for Payer: Nomi Health Commercial |
$126.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.13
|
| Rate for Payer: PACE Medicare |
$40.02
|
| Rate for Payer: PACE SWMI |
$42.13
|
| Rate for Payer: PHP Commercial |
$61.34
|
| Rate for Payer: PHP Medicare Advantage |
$42.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$42.13
|
| Rate for Payer: Priority Health Medicare |
$42.13
|
| Rate for Payer: Priority Health SBD |
$45.47
|
| Rate for Payer: Priority Health Tiered Network |
$33.70
|
| Rate for Payer: Railroad Medicare Medicare |
$42.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.20
|
| Rate for Payer: UHC Core |
$63.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.13
|
| Rate for Payer: UHC Exchange |
$63.20
|
| Rate for Payer: UHC Medicaid |
$22.03
|
| Rate for Payer: UHCCP Medicaid |
$22.03
|
| Rate for Payer: VA VA |
$42.13
|
|
|
HC SARS-COV-2 COVID-19 AMP PRB
|
Facility
|
IP
|
$167.08
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
30600339
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$105.26 |
| Max. Negotiated Rate |
$150.37 |
| Rate for Payer: Aetna Commercial |
$142.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.60
|
| Rate for Payer: Cash Price |
$133.66
|
| Rate for Payer: Cofinity Advantage |
$116.96
|
| Rate for Payer: Cofinity Commercial |
$143.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.66
|
| Rate for Payer: Healthscope Commercial |
$150.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.31
|
| Rate for Payer: PHP Commercial |
$142.02
|
| Rate for Payer: Priority Health SBD |
$105.26
|
|
|
HC SARS-COV-2 COVID-19 AMP PRB
|
Facility
|
OP
|
$167.08
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
30600339
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$153.93 |
| Rate for Payer: Aetna Commercial |
$142.02
|
| Rate for Payer: Aetna Medicare |
$53.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.14
|
| Rate for Payer: BCBS Complete |
$28.18
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$99.51
|
| Rate for Payer: BCN Commercial |
$99.51
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$133.66
|
| Rate for Payer: Cash Price |
$133.66
|
| Rate for Payer: Cofinity Advantage |
$116.96
|
| Rate for Payer: Cofinity Commercial |
$143.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$150.37
|
| Rate for Payer: Mclaren Medicaid |
$26.84
|
| Rate for Payer: Mclaren Medicare |
$51.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: Meridian Medicaid |
$53.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.02
|
| Rate for Payer: Nomi Health Commercial |
$153.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.31
|
| Rate for Payer: PACE Medicare |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Commercial |
$142.02
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$51.31
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health SBD |
$105.26
|
| Rate for Payer: Priority Health Tiered Network |
$41.05
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.97
|
| Rate for Payer: UHC Core |
$76.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.31
|
| Rate for Payer: UHC Exchange |
$76.97
|
| Rate for Payer: UHC Medicaid |
$26.84
|
| Rate for Payer: UHCCP Medicaid |
$26.84
|
| Rate for Payer: VA VA |
$51.31
|
|
|
HC SARS-COV2/FLU A&B
|
Facility
|
OP
|
$222.85
|
|
|
Service Code
|
CPT 87636
|
| Hospital Charge Code |
30600318
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$427.89 |
| Rate for Payer: Aetna Commercial |
$189.42
|
| Rate for Payer: Aetna Medicare |
$148.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.85
|
| 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 |
$78.33
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$152.07
|
| Rate for Payer: BCN Commercial |
$152.07
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$178.28
|
| Rate for Payer: Cash Price |
$178.28
|
| Rate for Payer: Cofinity Advantage |
$156.00
|
| Rate for Payer: Cofinity Commercial |
$191.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$200.56
|
| Rate for Payer: Mclaren Medicaid |
$74.60
|
| 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 |
$149.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$156.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.42
|
| Rate for Payer: Nomi Health Commercial |
$427.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.14
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$189.42
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$142.63
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health SBD |
$140.40
|
| Rate for Payer: Priority Health Tiered Network |
$114.10
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.95
|
| Rate for Payer: UHC Core |
$213.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$142.63
|
| Rate for Payer: UHC Exchange |
$213.95
|
| Rate for Payer: UHC Medicaid |
$74.60
|
| Rate for Payer: UHCCP Medicaid |
$74.60
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC SARS-COV2/FLU A&B
|
Facility
|
IP
|
$222.85
|
|
|
Service Code
|
CPT 87636
|
| Hospital Charge Code |
30600318
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$200.56 |
| Rate for Payer: Aetna Commercial |
$189.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.85
|
| Rate for Payer: Cash Price |
$178.28
|
| Rate for Payer: Cofinity Advantage |
$156.00
|
| Rate for Payer: Cofinity Commercial |
$191.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.28
|
| Rate for Payer: Healthscope Commercial |
$200.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.14
|
| Rate for Payer: PHP Commercial |
$189.42
|
| Rate for Payer: Priority Health SBD |
$140.40
|
|
|
HC SARS-COV2/FLU A&B/RSV
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600319
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cofinity Advantage |
$182.00
|
| Rate for Payer: Cofinity Commercial |
$223.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.00
|
| Rate for Payer: Healthscope Commercial |
$234.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.00
|
| Rate for Payer: PHP Commercial |
$221.00
|
| Rate for Payer: Priority Health SBD |
$163.80
|
|
|
HC SARS-COV2/FLU A&B/RSV
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600319
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$427.89 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Aetna Medicare |
$148.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.00
|
| 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 |
$78.33
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$152.07
|
| Rate for Payer: BCN Commercial |
$152.07
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cofinity Advantage |
$182.00
|
| Rate for Payer: Cofinity Commercial |
$223.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$234.00
|
| Rate for Payer: Mclaren Medicaid |
$74.60
|
| 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 |
$149.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$156.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.00
|
| Rate for Payer: Nomi Health Commercial |
$427.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.00
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$221.00
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$142.63
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health SBD |
$163.80
|
| Rate for Payer: Priority Health Tiered Network |
$114.10
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.95
|
| Rate for Payer: UHC Core |
$213.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$142.63
|
| Rate for Payer: UHC Exchange |
$213.95
|
| Rate for Payer: UHC Medicaid |
$74.60
|
| Rate for Payer: UHCCP Medicaid |
$74.60
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC SARSCOV2 INF AB RSV AMP PRB
|
Facility
|
IP
|
$255.32
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600344
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$160.85 |
| Max. Negotiated Rate |
$229.79 |
| Rate for Payer: Aetna Commercial |
$217.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.96
|
| Rate for Payer: Cash Price |
$204.26
|
| Rate for Payer: Cofinity Advantage |
$178.72
|
| Rate for Payer: Cofinity Commercial |
$219.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.26
|
| Rate for Payer: Healthscope Commercial |
$229.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.49
|
| Rate for Payer: PHP Commercial |
$217.02
|
| Rate for Payer: Priority Health SBD |
$160.85
|
|
|
HC SARSCOV2 INF AB RSV AMP PRB
|
Facility
|
OP
|
$255.32
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600344
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$427.89 |
| Rate for Payer: Aetna Commercial |
$217.02
|
| Rate for Payer: Aetna Medicare |
$148.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.96
|
| 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 |
$78.33
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$152.07
|
| Rate for Payer: BCN Commercial |
$152.07
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$204.26
|
| Rate for Payer: Cash Price |
$204.26
|
| Rate for Payer: Cofinity Advantage |
$178.72
|
| Rate for Payer: Cofinity Commercial |
$219.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$229.79
|
| Rate for Payer: Mclaren Medicaid |
$74.60
|
| 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 |
$149.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$156.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.02
|
| Rate for Payer: Nomi Health Commercial |
$427.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.49
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$217.02
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$142.63
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health SBD |
$160.85
|
| Rate for Payer: Priority Health Tiered Network |
$114.10
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.95
|
| Rate for Payer: UHC Core |
$213.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$142.63
|
| Rate for Payer: UHC Exchange |
$213.95
|
| Rate for Payer: UHC Medicaid |
$74.60
|
| Rate for Payer: UHCCP Medicaid |
$74.60
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC SARSCOV2 INF AB RSV PCR CEPHEID
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600356
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.44
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Advantage |
$174.93
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| 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 |
$212.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.43
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: Priority Health SBD |
$157.44
|
|
|
HC SARSCOV2 INF AB RSV PCR CEPHEID
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600356
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$427.89 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna Medicare |
$148.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.44
|
| 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 |
$78.33
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$152.07
|
| Rate for Payer: BCN Commercial |
$152.07
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Advantage |
$174.93
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Mclaren Medicaid |
$74.60
|
| 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 |
$149.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$156.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: Nomi Health Commercial |
$427.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.43
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$142.63
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health SBD |
$157.44
|
| Rate for Payer: Priority Health Tiered Network |
$114.10
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.95
|
| Rate for Payer: UHC Core |
$213.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$142.63
|
| Rate for Payer: UHC Exchange |
$213.95
|
| Rate for Payer: UHC Medicaid |
$74.60
|
| Rate for Payer: UHCCP Medicaid |
$74.60
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC SARSCOV2 VAC 10MCG/0.3ML TRS-SUC IM
|
Facility
|
IP
|
$223.51
|
|
|
Service Code
|
CPT 91319
|
| Hospital Charge Code |
63600230
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.81 |
| Max. Negotiated Rate |
$201.16 |
| Rate for Payer: Aetna Commercial |
$189.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.28
|
| Rate for Payer: Cash Price |
$178.81
|
| Rate for Payer: Cofinity Advantage |
$156.46
|
| Rate for Payer: Cofinity Commercial |
$192.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.81
|
| Rate for Payer: Healthscope Commercial |
$201.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.63
|
| Rate for Payer: PHP Commercial |
$189.98
|
| Rate for Payer: Priority Health SBD |
$140.81
|
|
