|
HC SARSCOV2 VAC 10MCG/0.3ML TRS-SUC IM
|
Facility
|
OP
|
$223.51
|
|
|
Service Code
|
CPT 91319
|
| Hospital Charge Code |
63600230
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.84 |
| Max. Negotiated Rate |
$204.77 |
| Rate for Payer: Aetna Commercial |
$189.98
|
| Rate for Payer: Aetna Medicare |
$111.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.28
|
| Rate for Payer: BCBS Complete |
$89.40
|
| Rate for Payer: BCBS Trust/PPO |
$204.77
|
| Rate for Payer: BCN Commercial |
$204.77
|
| Rate for Payer: Cash Price |
$178.81
|
| 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: MI Amish Medical Board Commercial |
$178.81
|
| 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 Cigna Priority Health/HMO/PPO/Narrow Network |
$94.80
|
| Rate for Payer: Priority Health SBD |
$140.81
|
| Rate for Payer: Priority Health Tiered Network |
$75.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.42
|
| Rate for Payer: UHC Core |
$156.42
|
| Rate for Payer: UHC Exchange |
$156.42
|
|
|
HC SARSCOV2 VAC 30MCG/0.3ML TRS-SUC IM
|
Facility
|
IP
|
$333.82
|
|
|
Service Code
|
CPT 91320
|
| Hospital Charge Code |
63600231
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$210.31 |
| Max. Negotiated Rate |
$300.44 |
| Rate for Payer: Aetna Commercial |
$283.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.98
|
| Rate for Payer: Cash Price |
$267.06
|
| Rate for Payer: Cofinity Advantage |
$233.67
|
| Rate for Payer: Cofinity Commercial |
$287.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.06
|
| Rate for Payer: Healthscope Commercial |
$300.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.37
|
| Rate for Payer: PHP Commercial |
$283.75
|
| Rate for Payer: Priority Health SBD |
$210.31
|
|
|
HC SARSCOV2 VAC 30MCG/0.3ML TRS-SUC IM
|
Facility
|
OP
|
$333.82
|
|
|
Service Code
|
CPT 91320
|
| Hospital Charge Code |
63600231
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.53 |
| Max. Negotiated Rate |
$416.00 |
| Rate for Payer: Aetna Commercial |
$283.75
|
| Rate for Payer: Aetna Medicare |
$166.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.98
|
| Rate for Payer: BCBS Complete |
$133.53
|
| Rate for Payer: BCBS Trust/PPO |
$416.00
|
| Rate for Payer: BCN Commercial |
$416.00
|
| Rate for Payer: Cash Price |
$267.06
|
| Rate for Payer: Cash Price |
$267.06
|
| Rate for Payer: Cofinity Advantage |
$233.67
|
| Rate for Payer: Cofinity Commercial |
$287.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.06
|
| Rate for Payer: Healthscope Commercial |
$300.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.37
|
| Rate for Payer: PHP Commercial |
$283.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$168.37
|
| Rate for Payer: Priority Health SBD |
$210.31
|
| Rate for Payer: Priority Health Tiered Network |
$134.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.81
|
| Rate for Payer: UHC Core |
$277.81
|
| Rate for Payer: UHC Exchange |
$277.81
|
|
|
HC SARSCOV2 VAC 3MCG/0.3ML TRS-SUC IM
|
Facility
|
IP
|
$166.92
|
|
|
Service Code
|
CPT 91318
|
| Hospital Charge Code |
63600229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.16 |
| Max. Negotiated Rate |
$150.23 |
| Rate for Payer: Aetna Commercial |
$141.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.50
|
| Rate for Payer: Cash Price |
$133.54
|
| Rate for Payer: Cofinity Advantage |
$116.84
|
| Rate for Payer: Cofinity Commercial |
$143.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.54
|
| Rate for Payer: Healthscope Commercial |
$150.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.19
|
| Rate for Payer: PHP Commercial |
$141.88
|
| Rate for Payer: Priority Health SBD |
$105.16
|
|
|
HC SARSCOV2 VAC 3MCG/0.3ML TRS-SUC IM
|
Facility
|
OP
|
$166.92
|
|
|
Service Code
|
CPT 91318
|
| Hospital Charge Code |
63600229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.44 |
| Max. Negotiated Rate |
$150.23 |
| Rate for Payer: Aetna Commercial |
$141.88
|
| Rate for Payer: Aetna Medicare |
$83.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.50
|
| Rate for Payer: BCBS Complete |
$66.77
|
| Rate for Payer: BCBS Trust/PPO |
$141.59
|
| Rate for Payer: BCN Commercial |
$141.59
|
| Rate for Payer: Cash Price |
$133.54
|
| Rate for Payer: Cash Price |
$133.54
|
| Rate for Payer: Cofinity Advantage |
$116.84
|
| Rate for Payer: Cofinity Commercial |
$143.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.54
|
| Rate for Payer: Healthscope Commercial |
$150.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.19
|
| Rate for Payer: PHP Commercial |
$141.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$65.55
|
| Rate for Payer: Priority Health SBD |
$105.16
|
| Rate for Payer: Priority Health Tiered Network |
$52.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.03
|
| Rate for Payer: UHC Core |
$108.03
|
| Rate for Payer: UHC Exchange |
$108.03
|
|
|
HC SARSCOV2 VAC 5MCG/0.5ML IM NOVAVAX
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 91304
|
| Hospital Charge Code |
63600211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
|
HC SARSCOV2 VAC 5MCG/0.5ML IM NOVAVAX
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 91304
|
| Hospital Charge Code |
63600211
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$414.55 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$414.55
|
| Rate for Payer: BCN Commercial |
$414.55
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$191.92
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: Priority Health Tiered Network |
$153.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.67
|
| Rate for Payer: UHC Core |
$316.67
|
| Rate for Payer: UHC Exchange |
$316.67
|
|
|
HC SARSCOV2 VACCINE 25 MCG/0.25 ML FOR IM USE
|
Facility
|
IP
|
$345.69
|
|
|
Service Code
|
CPT 91321
|
| Hospital Charge Code |
63600276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$217.78 |
| Max. Negotiated Rate |
$311.12 |
| Rate for Payer: Aetna Commercial |
$293.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.70
|
| Rate for Payer: Cash Price |
$276.55
|
| Rate for Payer: Cofinity Advantage |
$241.98
|
| Rate for Payer: Cofinity Commercial |
$297.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.55
|
| Rate for Payer: Healthscope Commercial |
$311.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.27
|
| Rate for Payer: PHP Commercial |
$293.84
|
| Rate for Payer: Priority Health SBD |
$217.78
|
|
|
HC SARSCOV2 VACCINE 25 MCG/0.25 ML FOR IM USE
|
Facility
|
OP
|
$345.69
|
|
|
Service Code
|
CPT 91321
|
| Hospital Charge Code |
63600276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$317.65 |
| Rate for Payer: Aetna Commercial |
$293.84
|
| Rate for Payer: Aetna Medicare |
$172.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.70
|
| Rate for Payer: BCBS Complete |
$138.28
|
| Rate for Payer: BCBS Trust/PPO |
$317.65
|
| Rate for Payer: BCN Commercial |
$317.65
|
| Rate for Payer: Cash Price |
$276.55
|
| Rate for Payer: Cash Price |
$276.55
|
| Rate for Payer: Cofinity Advantage |
$241.98
|
| Rate for Payer: Cofinity Commercial |
$297.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.55
|
| Rate for Payer: Healthscope Commercial |
$311.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.27
|
| Rate for Payer: PHP Commercial |
$293.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$147.06
|
| Rate for Payer: Priority Health SBD |
$217.78
|
| Rate for Payer: Priority Health Tiered Network |
$117.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.65
|
| Rate for Payer: UHC Core |
$242.65
|
| Rate for Payer: UHC Exchange |
$242.65
|
|
|
HC SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE
|
Facility
|
IP
|
$345.69
|
|
|
Service Code
|
CPT 91322
|
| Hospital Charge Code |
63600277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$217.78 |
| Max. Negotiated Rate |
$311.12 |
| Rate for Payer: Aetna Commercial |
$293.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.70
|
| Rate for Payer: Cash Price |
$276.55
|
| Rate for Payer: Cofinity Advantage |
$241.98
|
| Rate for Payer: Cofinity Commercial |
$297.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.55
|
| Rate for Payer: Healthscope Commercial |
$311.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.27
|
| Rate for Payer: PHP Commercial |
$293.84
|
| Rate for Payer: Priority Health SBD |
$217.78
|
|
|
HC SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE
|
Facility
|
OP
|
$345.69
|
|
|
Service Code
|
CPT 91322
|
| Hospital Charge Code |
63600277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.32 |
| Max. Negotiated Rate |
$349.17 |
| Rate for Payer: Aetna Commercial |
$293.84
|
| Rate for Payer: Aetna Medicare |
$172.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.70
|
| Rate for Payer: BCBS Complete |
$138.28
|
| Rate for Payer: BCBS Trust/PPO |
$349.17
|
| Rate for Payer: BCN Commercial |
$349.17
|
| Rate for Payer: Cash Price |
$276.55
|
| Rate for Payer: Cash Price |
$276.55
|
| Rate for Payer: Cofinity Advantage |
$241.98
|
| Rate for Payer: Cofinity Commercial |
$297.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.55
|
| Rate for Payer: Healthscope Commercial |
$311.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.27
|
| Rate for Payer: PHP Commercial |
$293.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$161.65
|
| Rate for Payer: Priority Health SBD |
$217.78
|
| Rate for Payer: Priority Health Tiered Network |
$129.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.72
|
| Rate for Payer: UHC Core |
$266.72
|
| Rate for Payer: UHC Exchange |
$266.72
|
|
|
HC SARSCOV AG
|
Facility
|
OP
|
$63.67
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
30600336
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$105.99 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna Medicare |
$36.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.16
|
| Rate for Payer: BCBS Complete |
$19.40
|
| Rate for Payer: BCBS MAPPO |
$35.33
|
| Rate for Payer: BCBS Trust/PPO |
$50.23
|
| Rate for Payer: BCN Commercial |
$50.23
|
| Rate for Payer: BCN Medicare Advantage |
$35.33
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Advantage |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.33
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Mclaren Medicaid |
$18.48
|
| Rate for Payer: Mclaren Medicare |
$35.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.10
|
| Rate for Payer: Meridian Medicaid |
$37.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$105.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PACE Medicare |
$33.56
|
| Rate for Payer: PACE SWMI |
$35.33
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: PHP Medicare Advantage |
$35.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35.33
|
| Rate for Payer: Priority Health Medicare |
$35.33
|
| Rate for Payer: Priority Health SBD |
$40.11
|
| Rate for Payer: Priority Health Tiered Network |
$28.26
|
| Rate for Payer: Railroad Medicare Medicare |
$35.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.00
|
| Rate for Payer: UHC Core |
$53.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.33
|
| Rate for Payer: UHC Exchange |
$53.00
|
| Rate for Payer: UHC Medicaid |
$18.48
|
| Rate for Payer: UHCCP Medicaid |
$18.48
|
| Rate for Payer: VA VA |
$35.33
|
|
|
HC SARSCOV AG
|
Facility
|
IP
|
$63.67
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
30600336
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.11 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.39
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Advantage |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: Priority Health SBD |
$40.11
|
|
|
HC SARSCOV CORONAVIRUS AG IA
|
Facility
|
IP
|
$63.25
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
30600331
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.85 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| Rate for Payer: Cash Price |
$50.60
|
| Rate for Payer: Cofinity Advantage |
$44.27
|
| Rate for Payer: Cofinity Commercial |
$54.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.60
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.44
|
| Rate for Payer: PHP Commercial |
$53.76
|
| Rate for Payer: Priority Health SBD |
$39.85
|
|
|
HC SARSCOV CORONAVIRUS AG IA
|
Facility
|
OP
|
$63.25
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
30600331
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$105.99 |
| Rate for Payer: Aetna Commercial |
$53.76
|
| Rate for Payer: Aetna Medicare |
$36.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.16
|
| Rate for Payer: BCBS Complete |
$19.40
|
| Rate for Payer: BCBS MAPPO |
$35.33
|
| Rate for Payer: BCBS Trust/PPO |
$50.23
|
| Rate for Payer: BCN Commercial |
$50.23
|
| Rate for Payer: BCN Medicare Advantage |
$35.33
|
| Rate for Payer: Cash Price |
$50.60
|
| Rate for Payer: Cash Price |
$50.60
|
| Rate for Payer: Cofinity Advantage |
$44.27
|
| Rate for Payer: Cofinity Commercial |
$54.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.33
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Mclaren Medicaid |
$18.48
|
| Rate for Payer: Mclaren Medicare |
$35.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.10
|
| Rate for Payer: Meridian Medicaid |
$37.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.76
|
| Rate for Payer: Nomi Health Commercial |
$105.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.44
|
| Rate for Payer: PACE Medicare |
$33.56
|
| Rate for Payer: PACE SWMI |
$35.33
|
| Rate for Payer: PHP Commercial |
$53.76
|
| Rate for Payer: PHP Medicare Advantage |
$35.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35.33
|
| Rate for Payer: Priority Health Medicare |
$35.33
|
| Rate for Payer: Priority Health SBD |
$39.85
|
| Rate for Payer: Priority Health Tiered Network |
$28.26
|
| Rate for Payer: Railroad Medicare Medicare |
$35.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.00
|
| Rate for Payer: UHC Core |
$53.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.33
|
| Rate for Payer: UHC Exchange |
$53.00
|
| Rate for Payer: UHC Medicaid |
$18.48
|
| Rate for Payer: UHCCP Medicaid |
$18.48
|
| Rate for Payer: VA VA |
$35.33
|
|
|
HC SARS FLU AB RSV
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 0241U
|
| Hospital Charge Code |
30600313
|
|
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 FLU AB RSV
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 0241U
|
| Hospital Charge Code |
30600313
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Aetna Medicare |
$130.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.00
|
| Rate for Payer: BCBS Complete |
$104.00
|
| 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: MI Amish Medical Board Commercial |
$208.00
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.00
|
| Rate for Payer: UHC Core |
$130.00
|
| Rate for Payer: UHC Exchange |
$130.00
|
|
|
HC SCALLOP IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200060
|
|
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 SCALLOP IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200060
|
|
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 SCALP ELECTRODE
|
Facility
|
OP
|
$136.45
|
|
| Hospital Charge Code |
72000005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$53.62 |
| Max. Negotiated Rate |
$122.81 |
| Rate for Payer: Aetna Commercial |
$115.98
|
| Rate for Payer: Aetna Medicare |
$68.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.69
|
| Rate for Payer: BCBS Complete |
$54.58
|
| Rate for Payer: Cash Price |
$109.16
|
| Rate for Payer: Cofinity Advantage |
$95.52
|
| Rate for Payer: Cofinity Commercial |
$117.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.16
|
| Rate for Payer: Healthscope Commercial |
$122.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.34
|
| Rate for Payer: PHP Commercial |
$115.98
|
| Rate for Payer: Priority Health SBD |
$85.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.69
|
| Rate for Payer: UHC Core |
$71.09
|
| Rate for Payer: UHC Exchange |
$53.62
|
|
|
HC SCALP ELECTRODE
|
Facility
|
IP
|
$136.45
|
|
| Hospital Charge Code |
72000005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$85.96 |
| Max. Negotiated Rate |
$122.81 |
| Rate for Payer: Aetna Commercial |
$115.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.69
|
| Rate for Payer: Cash Price |
$109.16
|
| Rate for Payer: Cofinity Advantage |
$95.52
|
| Rate for Payer: Cofinity Commercial |
$117.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.16
|
| Rate for Payer: Healthscope Commercial |
$122.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.34
|
| Rate for Payer: PHP Commercial |
$115.98
|
| Rate for Payer: Priority Health SBD |
$85.96
|
|
|
HC SCHISTOSOMA SPECIES ANTIBODY, IGG, SERUM
|
Facility
|
OP
|
$101.76
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
30200489
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$91.58 |
| Rate for Payer: Aetna Commercial |
$86.50
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: BCBS Complete |
$7.15
|
| Rate for Payer: BCBS MAPPO |
$13.01
|
| Rate for Payer: BCBS Trust/PPO |
$13.87
|
| Rate for Payer: BCN Commercial |
$13.87
|
| Rate for Payer: BCN Medicare Advantage |
$13.01
|
| Rate for Payer: Cash Price |
$81.41
|
| Rate for Payer: Cash Price |
$81.41
|
| Rate for Payer: Cofinity Advantage |
$71.23
|
| Rate for Payer: Cofinity Commercial |
$87.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.01
|
| Rate for Payer: Healthscope Commercial |
$91.58
|
| Rate for Payer: Mclaren Medicaid |
$6.80
|
| Rate for Payer: Mclaren Medicare |
$13.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: Meridian Medicaid |
$13.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.50
|
| Rate for Payer: Nomi Health Commercial |
$19.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.32
|
| Rate for Payer: PACE Medicare |
$12.36
|
| Rate for Payer: PACE SWMI |
$13.01
|
| Rate for Payer: PHP Commercial |
$86.50
|
| Rate for Payer: PHP Medicare Advantage |
$13.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.01
|
| Rate for Payer: Priority Health Medicare |
$13.01
|
| Rate for Payer: Priority Health SBD |
$64.11
|
| Rate for Payer: Priority Health Tiered Network |
$10.41
|
| Rate for Payer: Railroad Medicare Medicare |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.52
|
| Rate for Payer: UHC Core |
$19.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.01
|
| Rate for Payer: UHC Exchange |
$19.52
|
| Rate for Payer: UHC Medicaid |
$6.80
|
| Rate for Payer: UHCCP Medicaid |
$6.80
|
| Rate for Payer: VA VA |
$13.01
|
|
|
HC SCHISTOSOMA SPECIES ANTIBODY, IGG, SERUM
|
Facility
|
IP
|
$101.76
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
30200489
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$64.11 |
| Max. Negotiated Rate |
$91.58 |
| Rate for Payer: Aetna Commercial |
$86.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.14
|
| Rate for Payer: Cash Price |
$81.41
|
| Rate for Payer: Cofinity Advantage |
$71.23
|
| Rate for Payer: Cofinity Commercial |
$87.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.41
|
| Rate for Payer: Healthscope Commercial |
$91.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.32
|
| Rate for Payer: PHP Commercial |
$86.50
|
| Rate for Payer: Priority Health SBD |
$64.11
|
|
|
HC SCISSORS
|
Facility
|
IP
|
$18.02
|
|
| Hospital Charge Code |
27000143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Aetna Commercial |
$15.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.71
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cofinity Advantage |
$12.61
|
| Rate for Payer: Cofinity Commercial |
$15.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$16.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.52
|
| Rate for Payer: PHP Commercial |
$15.32
|
| Rate for Payer: Priority Health SBD |
$11.35
|
|
|
HC SCISSORS
|
Facility
|
OP
|
$18.02
|
|
| Hospital Charge Code |
27000143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Aetna Commercial |
$15.32
|
| Rate for Payer: Aetna Medicare |
$9.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.71
|
| Rate for Payer: BCBS Complete |
$7.21
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cofinity Advantage |
$12.61
|
| Rate for Payer: Cofinity Commercial |
$15.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$16.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.52
|
| Rate for Payer: PHP Commercial |
$15.32
|
| Rate for Payer: Priority Health SBD |
$11.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.71
|
| Rate for Payer: UHC Core |
$9.39
|
| Rate for Payer: UHC Exchange |
$7.08
|
|
