|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
IP
|
$77.41
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.77 |
| Max. Negotiated Rate |
$69.67 |
| Rate for Payer: Aetna Commercial |
$65.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.32
|
| Rate for Payer: Cash Price |
$61.93
|
| Rate for Payer: Cofinity Commercial |
$54.19
|
| Rate for Payer: Cofinity Commercial |
$66.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.93
|
| Rate for Payer: Healthscope Commercial |
$69.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.80
|
| Rate for Payer: PHP Commercial |
$65.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: Priority Health SBD |
$48.77
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
OP
|
$77.41
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.96 |
| Max. Negotiated Rate |
$69.67 |
| Rate for Payer: Aetna Commercial |
$65.80
|
| Rate for Payer: Aetna Medicare |
$38.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.32
|
| Rate for Payer: BCBS Complete |
$30.96
|
| Rate for Payer: Cash Price |
$61.93
|
| Rate for Payer: Cofinity Commercial |
$54.19
|
| Rate for Payer: Cofinity Commercial |
$66.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.93
|
| Rate for Payer: Healthscope Commercial |
$69.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.80
|
| Rate for Payer: PHP Commercial |
$65.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: Priority Health SBD |
$48.77
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
OP
|
$521.24
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$69.41 |
| Max. Negotiated Rate |
$469.12 |
| Rate for Payer: Aetna Commercial |
$443.05
|
| Rate for Payer: Aetna Medicare |
$134.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$161.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$161.86
|
| Rate for Payer: BCBS Complete |
$72.88
|
| Rate for Payer: BCBS MAPPO |
$129.49
|
| Rate for Payer: BCN Medicare Advantage |
$129.49
|
| Rate for Payer: Cash Price |
$416.99
|
| Rate for Payer: Cash Price |
$416.99
|
| Rate for Payer: Cofinity Commercial |
$448.27
|
| Rate for Payer: Cofinity Commercial |
$364.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$364.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.49
|
| Rate for Payer: Healthscope Commercial |
$469.12
|
| Rate for Payer: Mclaren Medicaid |
$69.41
|
| Rate for Payer: Mclaren Medicare |
$129.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.96
|
| Rate for Payer: Meridian Medicaid |
$72.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.05
|
| Rate for Payer: PACE Medicare |
$123.02
|
| Rate for Payer: PACE SWMI |
$129.49
|
| Rate for Payer: PHP Commercial |
$443.05
|
| Rate for Payer: PHP Medicare Advantage |
$129.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.81
|
| Rate for Payer: Priority Health Medicare |
$129.49
|
| Rate for Payer: Priority Health SBD |
$328.38
|
| Rate for Payer: Railroad Medicare Medicare |
$129.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$364.50
|
| Rate for Payer: UHC Core |
$385.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.49
|
| Rate for Payer: UHC Exchange |
$385.72
|
| Rate for Payer: UHC Medicare Advantage |
$129.49
|
| Rate for Payer: UHCCP Medicaid |
$72.90
|
| Rate for Payer: VA VA |
$129.49
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
IP
|
$521.24
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$328.38 |
| Max. Negotiated Rate |
$469.12 |
| Rate for Payer: Aetna Commercial |
$443.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.81
|
| Rate for Payer: Cash Price |
$416.99
|
| Rate for Payer: Cofinity Commercial |
$364.87
|
| Rate for Payer: Cofinity Commercial |
$448.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$364.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.99
|
| Rate for Payer: Healthscope Commercial |
$469.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.05
|
| Rate for Payer: PHP Commercial |
$443.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.81
|
| Rate for Payer: Priority Health SBD |
$328.38
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
OP
|
$414.08
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$69.41 |
| Max. Negotiated Rate |
$372.67 |
| Rate for Payer: Aetna Commercial |
$351.97
|
| Rate for Payer: Aetna Medicare |
$134.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$161.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$161.86
|
| Rate for Payer: BCBS Complete |
$72.88
|
| Rate for Payer: BCBS MAPPO |
$129.49
|
| Rate for Payer: BCN Medicare Advantage |
$129.49
|
| Rate for Payer: Cash Price |
$331.26
|
| Rate for Payer: Cash Price |
$331.26
|
| Rate for Payer: Cofinity Commercial |
$356.11
|
| Rate for Payer: Cofinity Commercial |
$289.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$289.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.49
|
| Rate for Payer: Healthscope Commercial |
$372.67
|
| Rate for Payer: Mclaren Medicaid |
$69.41
|
| Rate for Payer: Mclaren Medicare |
$129.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.96
|
| Rate for Payer: Meridian Medicaid |
$72.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.97
|
| Rate for Payer: PACE Medicare |
$123.02
|
| Rate for Payer: PACE SWMI |
$129.49
|
| Rate for Payer: PHP Commercial |
$351.97
|
| Rate for Payer: PHP Medicare Advantage |
$129.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.15
|
| Rate for Payer: Priority Health Medicare |
$129.49
|
| Rate for Payer: Priority Health SBD |
$260.87
|
| Rate for Payer: Railroad Medicare Medicare |
$129.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$364.50
|
| Rate for Payer: UHC Core |
$306.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.49
|
| Rate for Payer: UHC Exchange |
$306.42
|
| Rate for Payer: UHC Medicare Advantage |
$129.49
|
| Rate for Payer: UHCCP Medicaid |
$72.90
|
| Rate for Payer: VA VA |
$129.49
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
IP
|
$414.08
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$260.87 |
| Max. Negotiated Rate |
$372.67 |
| Rate for Payer: Aetna Commercial |
$351.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.15
|
| Rate for Payer: Cash Price |
$331.26
|
| Rate for Payer: Cofinity Commercial |
$289.86
|
| Rate for Payer: Cofinity Commercial |
$356.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$289.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.26
|
| Rate for Payer: Healthscope Commercial |
$372.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.97
|
| Rate for Payer: PHP Commercial |
$351.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.15
|
| Rate for Payer: Priority Health SBD |
$260.87
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
IP
|
$701.23
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$441.77 |
| Max. Negotiated Rate |
$631.11 |
| Rate for Payer: Aetna Commercial |
$596.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.80
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cofinity Commercial |
$490.86
|
| Rate for Payer: Cofinity Commercial |
$603.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$490.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.98
|
| Rate for Payer: Healthscope Commercial |
$631.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.05
|
| Rate for Payer: PHP Commercial |
$596.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.80
|
| Rate for Payer: Priority Health SBD |
$441.77
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
OP
|
$701.23
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$137.47 |
| Max. Negotiated Rate |
$721.97 |
| Rate for Payer: Aetna Commercial |
$596.05
|
| Rate for Payer: Aetna Medicare |
$266.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$320.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$320.60
|
| Rate for Payer: BCBS Complete |
$144.35
|
| Rate for Payer: BCBS MAPPO |
$256.48
|
| Rate for Payer: BCN Medicare Advantage |
$256.48
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cofinity Commercial |
$603.06
|
| Rate for Payer: Cofinity Commercial |
$490.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$490.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$256.48
|
| Rate for Payer: Healthscope Commercial |
$631.11
|
| Rate for Payer: Mclaren Medicaid |
$137.47
|
| Rate for Payer: Mclaren Medicare |
$256.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$269.30
|
| Rate for Payer: Meridian Medicaid |
$144.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$294.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.05
|
| Rate for Payer: PACE Medicare |
$243.66
|
| Rate for Payer: PACE SWMI |
$256.48
|
| Rate for Payer: PHP Commercial |
$596.05
|
| Rate for Payer: PHP Medicare Advantage |
$256.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.80
|
| Rate for Payer: Priority Health Medicare |
$256.48
|
| Rate for Payer: Priority Health SBD |
$441.77
|
| Rate for Payer: Railroad Medicare Medicare |
$256.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$721.97
|
| Rate for Payer: UHC Core |
$518.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$256.48
|
| Rate for Payer: UHC Exchange |
$518.91
|
| Rate for Payer: UHC Medicare Advantage |
$256.48
|
| Rate for Payer: UHCCP Medicaid |
$144.40
|
| Rate for Payer: VA VA |
$256.48
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
OP
|
$421.54
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$137.47 |
| Max. Negotiated Rate |
$721.97 |
| Rate for Payer: Aetna Commercial |
$358.31
|
| Rate for Payer: Aetna Medicare |
$266.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$320.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$320.60
|
| Rate for Payer: BCBS Complete |
$144.35
|
| Rate for Payer: BCBS MAPPO |
$256.48
|
| Rate for Payer: BCN Medicare Advantage |
$256.48
|
| Rate for Payer: Cash Price |
$337.23
|
| Rate for Payer: Cash Price |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$362.52
|
| Rate for Payer: Cofinity Commercial |
$295.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$256.48
|
| Rate for Payer: Healthscope Commercial |
$379.39
|
| Rate for Payer: Mclaren Medicaid |
$137.47
|
| Rate for Payer: Mclaren Medicare |
$256.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$269.30
|
| Rate for Payer: Meridian Medicaid |
$144.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$294.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.31
|
| Rate for Payer: PACE Medicare |
$243.66
|
| Rate for Payer: PACE SWMI |
$256.48
|
| Rate for Payer: PHP Commercial |
$358.31
|
| Rate for Payer: PHP Medicare Advantage |
$256.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.00
|
| Rate for Payer: Priority Health Medicare |
$256.48
|
| Rate for Payer: Priority Health SBD |
$265.57
|
| Rate for Payer: Railroad Medicare Medicare |
$256.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$721.97
|
| Rate for Payer: UHC Core |
$311.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$256.48
|
| Rate for Payer: UHC Exchange |
$311.94
|
| Rate for Payer: UHC Medicare Advantage |
$256.48
|
| Rate for Payer: UHCCP Medicaid |
$144.40
|
| Rate for Payer: VA VA |
$256.48
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
IP
|
$421.54
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$265.57 |
| Max. Negotiated Rate |
$379.39 |
| Rate for Payer: Aetna Commercial |
$358.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.00
|
| Rate for Payer: Cash Price |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$295.08
|
| Rate for Payer: Cofinity Commercial |
$362.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.23
|
| Rate for Payer: Healthscope Commercial |
$379.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.31
|
| Rate for Payer: PHP Commercial |
$358.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.00
|
| Rate for Payer: Priority Health SBD |
$265.57
|
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
IP
|
$231.24
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$145.68 |
| Max. Negotiated Rate |
$208.12 |
| Rate for Payer: Aetna Commercial |
$196.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.31
|
| Rate for Payer: Cash Price |
$184.99
|
| Rate for Payer: Cofinity Commercial |
$161.87
|
| Rate for Payer: Cofinity Commercial |
$198.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.99
|
| Rate for Payer: Healthscope Commercial |
$208.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.55
|
| Rate for Payer: PHP Commercial |
$196.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.31
|
| Rate for Payer: Priority Health SBD |
$145.68
|
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
OP
|
$231.24
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$57.24 |
| Max. Negotiated Rate |
$300.60 |
| Rate for Payer: Aetna Commercial |
$196.55
|
| Rate for Payer: Aetna Medicare |
$111.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.49
|
| Rate for Payer: BCBS Complete |
$60.10
|
| Rate for Payer: BCBS MAPPO |
$106.79
|
| Rate for Payer: BCN Medicare Advantage |
$106.79
|
| Rate for Payer: Cash Price |
$184.99
|
| Rate for Payer: Cash Price |
$184.99
|
| Rate for Payer: Cofinity Commercial |
$198.87
|
| Rate for Payer: Cofinity Commercial |
$161.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.79
|
| Rate for Payer: Healthscope Commercial |
$208.12
|
| Rate for Payer: Mclaren Medicaid |
$57.24
|
| Rate for Payer: Mclaren Medicare |
$106.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.13
|
| Rate for Payer: Meridian Medicaid |
$60.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.55
|
| Rate for Payer: PACE Medicare |
$101.45
|
| Rate for Payer: PACE SWMI |
$106.79
|
| Rate for Payer: PHP Commercial |
$196.55
|
| Rate for Payer: PHP Medicare Advantage |
$106.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.31
|
| Rate for Payer: Priority Health Medicare |
$106.79
|
| Rate for Payer: Priority Health SBD |
$145.68
|
| Rate for Payer: Railroad Medicare Medicare |
$106.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.60
|
| Rate for Payer: UHC Core |
$171.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.79
|
| Rate for Payer: UHC Exchange |
$171.12
|
| Rate for Payer: UHC Medicare Advantage |
$106.79
|
| Rate for Payer: UHCCP Medicaid |
$60.12
|
| Rate for Payer: VA VA |
$106.79
|
|
|
HC ROUGH MARSH ELDER IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC ROUGH MARSH ELDER IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY
|
Facility
|
IP
|
$15,380.00
|
|
|
Service Code
|
CPT 35266
|
| Hospital Charge Code |
36000124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,689.40 |
| Max. Negotiated Rate |
$13,842.00 |
| Rate for Payer: Aetna Commercial |
$13,073.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,997.00
|
| Rate for Payer: Cash Price |
$12,304.00
|
| Rate for Payer: Cofinity Commercial |
$10,766.00
|
| Rate for Payer: Cofinity Commercial |
$13,226.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,766.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,304.00
|
| Rate for Payer: Healthscope Commercial |
$13,842.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,073.00
|
| Rate for Payer: PHP Commercial |
$13,073.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,997.00
|
| Rate for Payer: Priority Health SBD |
$9,689.40
|
|
|
HC RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY
|
Facility
|
OP
|
$15,380.00
|
|
|
Service Code
|
CPT 35266
|
| Hospital Charge Code |
36000124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,825.83 |
| Max. Negotiated Rate |
$14,840.35 |
| Rate for Payer: Aetna Commercial |
$13,073.00
|
| Rate for Payer: Aetna Medicare |
$5,482.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,997.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,590.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,590.09
|
| Rate for Payer: BCBS Complete |
$2,967.12
|
| Rate for Payer: BCBS MAPPO |
$5,272.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,272.07
|
| Rate for Payer: Cash Price |
$12,304.00
|
| Rate for Payer: Cash Price |
$12,304.00
|
| Rate for Payer: Cofinity Commercial |
$13,226.80
|
| Rate for Payer: Cofinity Commercial |
$10,766.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,766.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,304.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,272.07
|
| Rate for Payer: Healthscope Commercial |
$13,842.00
|
| Rate for Payer: Mclaren Medicaid |
$2,825.83
|
| Rate for Payer: Mclaren Medicare |
$5,272.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,535.67
|
| Rate for Payer: Meridian Medicaid |
$2,967.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,062.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,073.00
|
| Rate for Payer: PACE Medicare |
$5,008.47
|
| Rate for Payer: PACE SWMI |
$5,272.07
|
| Rate for Payer: PHP Commercial |
$13,073.00
|
| Rate for Payer: PHP Medicare Advantage |
$5,272.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,825.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,997.00
|
| Rate for Payer: Priority Health Medicare |
$5,272.07
|
| Rate for Payer: Priority Health SBD |
$9,689.40
|
| Rate for Payer: Railroad Medicare Medicare |
$5,272.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,840.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,272.07
|
| Rate for Payer: UHC Medicare Advantage |
$5,272.07
|
| Rate for Payer: UHCCP Medicaid |
$2,968.18
|
| Rate for Payer: VA VA |
$5,272.07
|
|
|
HC RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200213
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
|
|
HC RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200213
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Medicaid |
$2.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
| Rate for Payer: UHC Medicare Advantage |
$4.27
|
| Rate for Payer: UHCCP Medicaid |
$2.40
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC RPR TITER
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200425
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$4.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.50
|
| Rate for Payer: BCBS Complete |
$2.48
|
| Rate for Payer: BCBS MAPPO |
$4.40
|
| Rate for Payer: BCN Medicare Advantage |
$4.40
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.40
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$2.36
|
| Rate for Payer: Mclaren Medicare |
$4.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.62
|
| Rate for Payer: Meridian Medicaid |
$2.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PACE Medicare |
$4.18
|
| Rate for Payer: PACE SWMI |
$4.40
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$4.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health Medicare |
$4.40
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: Railroad Medicare Medicare |
$4.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.40
|
| Rate for Payer: UHC Medicare Advantage |
$4.40
|
| Rate for Payer: UHCCP Medicaid |
$2.48
|
| Rate for Payer: VA VA |
$4.40
|
|
|
HC RPR TITER
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200425
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
|
|
HC RSV DNA/RNA AMP PROBE
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
30600315
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health SBD |
$49.16
|
|
|
HC RSV DNA/RNA AMP PROBE
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
30600315
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$197.61 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$73.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.75
|
| Rate for Payer: BCBS Complete |
$39.51
|
| Rate for Payer: BCBS MAPPO |
$70.20
|
| Rate for Payer: BCN Medicare Advantage |
$70.20
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$37.63
|
| Rate for Payer: Mclaren Medicare |
$70.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.71
|
| Rate for Payer: Meridian Medicaid |
$39.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PACE Medicare |
$66.69
|
| Rate for Payer: PACE SWMI |
$70.20
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$70.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health Medicare |
$70.20
|
| Rate for Payer: Priority Health SBD |
$49.16
|
| Rate for Payer: Railroad Medicare Medicare |
$70.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.20
|
| Rate for Payer: UHC Medicare Advantage |
$70.20
|
| Rate for Payer: UHCCP Medicaid |
$39.52
|
| Rate for Payer: VA VA |
$70.20
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 0.5ML IM
|
Facility
|
OP
|
$1,302.54
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
63600232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$521.02 |
| Max. Negotiated Rate |
$1,172.29 |
| Rate for Payer: Aetna Commercial |
$1,107.16
|
| Rate for Payer: Aetna Medicare |
$651.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.65
|
| Rate for Payer: BCBS Complete |
$521.02
|
| Rate for Payer: Cash Price |
$1,042.03
|
| Rate for Payer: Cofinity Commercial |
$1,120.18
|
| Rate for Payer: Cofinity Commercial |
$911.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$911.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,042.03
|
| Rate for Payer: Healthscope Commercial |
$1,172.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,107.16
|
| Rate for Payer: PHP Commercial |
$1,107.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.65
|
| Rate for Payer: Priority Health SBD |
$820.60
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 0.5ML IM
|
Facility
|
IP
|
$1,302.54
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
63600232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$820.60 |
| Max. Negotiated Rate |
$1,172.29 |
| Rate for Payer: Aetna Commercial |
$1,107.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.65
|
| Rate for Payer: Cash Price |
$1,042.03
|
| Rate for Payer: Cofinity Commercial |
$1,120.18
|
| Rate for Payer: Cofinity Commercial |
$911.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$911.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,042.03
|
| Rate for Payer: Healthscope Commercial |
$1,172.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,107.16
|
| Rate for Payer: PHP Commercial |
$1,107.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.65
|
| Rate for Payer: Priority Health SBD |
$820.60
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 1 ML IM
|
Facility
|
IP
|
$1,302.54
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
63600233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$820.60 |
| Max. Negotiated Rate |
$1,172.29 |
| Rate for Payer: Aetna Commercial |
$1,107.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.65
|
| Rate for Payer: Cash Price |
$1,042.03
|
| Rate for Payer: Cofinity Commercial |
$1,120.18
|
| Rate for Payer: Cofinity Commercial |
$911.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$911.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,042.03
|
| Rate for Payer: Healthscope Commercial |
$1,172.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,107.16
|
| Rate for Payer: PHP Commercial |
$1,107.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.65
|
| Rate for Payer: Priority Health SBD |
$820.60
|
|
