|
HC SARS CORONAVIRUS 2 IGG AB,S
|
Facility
|
IP
|
$70.75
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
30200479
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.57 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.99
|
| Rate for Payer: Priority Health SBD |
$44.57
|
|
|
HC SARS CORONAVIRUS 2 IGG AB,S
|
Facility
|
OP
|
$70.75
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
30200479
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.58 |
| Max. Negotiated Rate |
$118.59 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna Medicare |
$43.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| 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 |
$23.71
|
| Rate for Payer: BCBS MAPPO |
$42.13
|
| Rate for Payer: BCN Medicare Advantage |
$42.13
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Commercial |
$49.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.13
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Mclaren Medicaid |
$22.58
|
| 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 |
$23.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: PACE Medicare |
$40.02
|
| Rate for Payer: PACE SWMI |
$42.13
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: PHP Medicare Advantage |
$42.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.99
|
| Rate for Payer: Priority Health Medicare |
$42.13
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: Railroad Medicare Medicare |
$42.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.13
|
| Rate for Payer: UHC Medicare Advantage |
$42.13
|
| Rate for Payer: UHCCP Medicaid |
$23.72
|
| Rate for Payer: VA VA |
$42.13
|
|
|
HC SARS-COV-2 COVID-19 AMP PRB
|
Facility
|
OP
|
$154.02
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
30600339
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$144.43 |
| Rate for Payer: Aetna Commercial |
$130.92
|
| Rate for Payer: Aetna Medicare |
$53.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.11
|
| 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 |
$28.88
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$123.22
|
| Rate for Payer: Cash Price |
$123.22
|
| Rate for Payer: Cofinity Commercial |
$132.46
|
| Rate for Payer: Cofinity Commercial |
$107.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$138.62
|
| Rate for Payer: Mclaren Medicaid |
$27.50
|
| 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 |
$28.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.92
|
| Rate for Payer: PACE Medicare |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Commercial |
$130.92
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.11
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health SBD |
$97.03
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.31
|
| Rate for Payer: UHC Medicare Advantage |
$51.31
|
| Rate for Payer: UHCCP Medicaid |
$28.89
|
| Rate for Payer: VA VA |
$51.31
|
|
|
HC SARS-COV-2 COVID-19 AMP PRB
|
Facility
|
IP
|
$154.02
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
30600339
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$97.03 |
| Max. Negotiated Rate |
$138.62 |
| Rate for Payer: Aetna Commercial |
$130.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.11
|
| Rate for Payer: Cash Price |
$123.22
|
| Rate for Payer: Cofinity Commercial |
$107.81
|
| Rate for Payer: Cofinity Commercial |
$132.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.22
|
| Rate for Payer: Healthscope Commercial |
$138.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.92
|
| Rate for Payer: PHP Commercial |
$130.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.11
|
| Rate for Payer: Priority Health SBD |
$97.03
|
|
|
HC SARS-COV2/FLU A&B
|
Facility
|
OP
|
$218.48
|
|
|
Service Code
|
CPT 87636
|
| Hospital Charge Code |
30600318
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.45 |
| Max. Negotiated Rate |
$401.49 |
| Rate for Payer: Aetna Commercial |
$185.71
|
| Rate for Payer: Aetna Medicare |
$148.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: BCBS Complete |
$80.27
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$174.78
|
| Rate for Payer: Cash Price |
$174.78
|
| Rate for Payer: Cofinity Commercial |
$152.94
|
| Rate for Payer: Cofinity Commercial |
$187.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$196.63
|
| Rate for Payer: Mclaren Medicaid |
$76.45
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: Meridian Medicaid |
$80.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.71
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$185.71
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.01
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health SBD |
$137.64
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$401.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.63
|
| Rate for Payer: UHC Medicare Advantage |
$142.63
|
| Rate for Payer: UHCCP Medicaid |
$80.30
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC SARS-COV2/FLU A&B
|
Facility
|
IP
|
$218.48
|
|
|
Service Code
|
CPT 87636
|
| Hospital Charge Code |
30600318
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$137.64 |
| Max. Negotiated Rate |
$196.63 |
| Rate for Payer: Aetna Commercial |
$185.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.01
|
| Rate for Payer: Cash Price |
$174.78
|
| Rate for Payer: Cofinity Commercial |
$152.94
|
| Rate for Payer: Cofinity Commercial |
$187.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.78
|
| Rate for Payer: Healthscope Commercial |
$196.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.71
|
| Rate for Payer: PHP Commercial |
$185.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.01
|
| Rate for Payer: Priority Health SBD |
$137.64
|
|
|
HC SARS-COV2/FLU A&B/RSV
|
Facility
|
IP
|
$254.90
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600319
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$160.59 |
| Max. Negotiated Rate |
$229.41 |
| Rate for Payer: Aetna Commercial |
$216.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.69
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cofinity Commercial |
$178.43
|
| Rate for Payer: Cofinity Commercial |
$219.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.92
|
| Rate for Payer: Healthscope Commercial |
$229.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.66
|
| Rate for Payer: PHP Commercial |
$216.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.69
|
| Rate for Payer: Priority Health SBD |
$160.59
|
|
|
HC SARS-COV2/FLU A&B/RSV
|
Facility
|
OP
|
$254.90
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600319
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.45 |
| Max. Negotiated Rate |
$401.49 |
| Rate for Payer: Aetna Commercial |
$216.66
|
| Rate for Payer: Aetna Medicare |
$148.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: BCBS Complete |
$80.27
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cofinity Commercial |
$219.21
|
| Rate for Payer: Cofinity Commercial |
$178.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$229.41
|
| Rate for Payer: Mclaren Medicaid |
$76.45
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: Meridian Medicaid |
$80.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.66
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$216.66
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.69
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health SBD |
$160.59
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$401.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.63
|
| Rate for Payer: UHC Medicare Advantage |
$142.63
|
| Rate for Payer: UHCCP Medicaid |
$80.30
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC SARSCOV2 INF AB RSV AMP PRB
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600344
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.45 |
| Max. Negotiated Rate |
$401.49 |
| 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 |
$80.27
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| 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 Commercial |
$214.91
|
| Rate for Payer: Cofinity Commercial |
$174.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Mclaren Medicaid |
$76.45
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: Meridian Medicaid |
$80.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| 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 |
$76.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health SBD |
$157.44
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$401.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.63
|
| Rate for Payer: UHC Medicare Advantage |
$142.63
|
| Rate for Payer: UHCCP Medicaid |
$80.30
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC SARSCOV2 INF AB RSV AMP PRB
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600344
|
|
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 Commercial |
$174.93
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health SBD |
$157.44
|
|
|
HC SARSCOV2 VAC 10MCG/0.3ML TRS-SUC IM
|
Facility
|
OP
|
$219.13
|
|
|
Service Code
|
CPT 91319
|
| Hospital Charge Code |
63600230
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.65 |
| Max. Negotiated Rate |
$197.22 |
| Rate for Payer: Aetna Commercial |
$186.26
|
| Rate for Payer: Aetna Medicare |
$109.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.43
|
| Rate for Payer: BCBS Complete |
$87.65
|
| Rate for Payer: Cash Price |
$175.30
|
| Rate for Payer: Cofinity Commercial |
$153.39
|
| Rate for Payer: Cofinity Commercial |
$188.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.30
|
| Rate for Payer: Healthscope Commercial |
$197.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.26
|
| Rate for Payer: PHP Commercial |
$186.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.43
|
| Rate for Payer: Priority Health SBD |
$138.05
|
|
|
HC SARSCOV2 VAC 10MCG/0.3ML TRS-SUC IM
|
Facility
|
IP
|
$219.13
|
|
|
Service Code
|
CPT 91319
|
| Hospital Charge Code |
63600230
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$138.05 |
| Max. Negotiated Rate |
$197.22 |
| Rate for Payer: Aetna Commercial |
$186.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.43
|
| Rate for Payer: Cash Price |
$175.30
|
| Rate for Payer: Cofinity Commercial |
$153.39
|
| Rate for Payer: Cofinity Commercial |
$188.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.30
|
| Rate for Payer: Healthscope Commercial |
$197.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.26
|
| Rate for Payer: PHP Commercial |
$186.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.43
|
| Rate for Payer: Priority Health SBD |
$138.05
|
|
|
HC SARSCOV2 VAC 30MCG/0.3ML TRS-SUC IM
|
Facility
|
OP
|
$327.27
|
|
|
Service Code
|
CPT 91320
|
| Hospital Charge Code |
63600231
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.91 |
| Max. Negotiated Rate |
$294.54 |
| Rate for Payer: Aetna Commercial |
$278.18
|
| Rate for Payer: Aetna Medicare |
$163.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.73
|
| Rate for Payer: BCBS Complete |
$130.91
|
| Rate for Payer: Cash Price |
$261.82
|
| Rate for Payer: Cofinity Commercial |
$229.09
|
| Rate for Payer: Cofinity Commercial |
$281.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.82
|
| Rate for Payer: Healthscope Commercial |
$294.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.18
|
| Rate for Payer: PHP Commercial |
$278.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.73
|
| Rate for Payer: Priority Health SBD |
$206.18
|
|
|
HC SARSCOV2 VAC 30MCG/0.3ML TRS-SUC IM
|
Facility
|
IP
|
$327.27
|
|
|
Service Code
|
CPT 91320
|
| Hospital Charge Code |
63600231
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$206.18 |
| Max. Negotiated Rate |
$294.54 |
| Rate for Payer: Aetna Commercial |
$278.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.73
|
| Rate for Payer: Cash Price |
$261.82
|
| Rate for Payer: Cofinity Commercial |
$229.09
|
| Rate for Payer: Cofinity Commercial |
$281.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.82
|
| Rate for Payer: Healthscope Commercial |
$294.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.18
|
| Rate for Payer: PHP Commercial |
$278.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.73
|
| Rate for Payer: Priority Health SBD |
$206.18
|
|
|
HC SARSCOV2 VAC 3MCG/0.3ML TRS-SUC IM
|
Facility
|
IP
|
$163.65
|
|
|
Service Code
|
CPT 91318
|
| Hospital Charge Code |
63600229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.10 |
| Max. Negotiated Rate |
$147.28 |
| Rate for Payer: Aetna Commercial |
$139.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.37
|
| Rate for Payer: Cash Price |
$130.92
|
| Rate for Payer: Cofinity Commercial |
$114.56
|
| Rate for Payer: Cofinity Commercial |
$140.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.92
|
| Rate for Payer: Healthscope Commercial |
$147.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.10
|
| Rate for Payer: PHP Commercial |
$139.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.37
|
| Rate for Payer: Priority Health SBD |
$103.10
|
|
|
HC SARSCOV2 VAC 3MCG/0.3ML TRS-SUC IM
|
Facility
|
OP
|
$163.65
|
|
|
Service Code
|
CPT 91318
|
| Hospital Charge Code |
63600229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.46 |
| Max. Negotiated Rate |
$147.28 |
| Rate for Payer: Aetna Commercial |
$139.10
|
| Rate for Payer: Aetna Medicare |
$81.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.37
|
| Rate for Payer: BCBS Complete |
$65.46
|
| Rate for Payer: Cash Price |
$130.92
|
| Rate for Payer: Cofinity Commercial |
$114.56
|
| Rate for Payer: Cofinity Commercial |
$140.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.92
|
| Rate for Payer: Healthscope Commercial |
$147.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.10
|
| Rate for Payer: PHP Commercial |
$139.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.37
|
| Rate for Payer: Priority Health SBD |
$103.10
|
|
|
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 Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$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 |
$0.01 |
| 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: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
|
HC SARSCOV AG
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
30600336
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.94 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$36.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| 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 |
$19.88
|
| Rate for Payer: BCBS MAPPO |
$35.33
|
| Rate for Payer: BCN Medicare Advantage |
$35.33
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.33
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$18.94
|
| 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 |
$19.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PACE Medicare |
$33.56
|
| Rate for Payer: PACE SWMI |
$35.33
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$35.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health Medicare |
$35.33
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: Railroad Medicare Medicare |
$35.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.33
|
| Rate for Payer: UHC Medicare Advantage |
$35.33
|
| Rate for Payer: UHCCP Medicaid |
$19.89
|
| Rate for Payer: VA VA |
$35.33
|
|
|
HC SARSCOV AG
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
30600336
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health SBD |
$39.32
|
|
|
HC SARSCOV CORONAVIRUS AG IA
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
30600331
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health SBD |
$39.32
|
|
|
HC SARSCOV CORONAVIRUS AG IA
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
30600331
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.94 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$36.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| 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 |
$19.88
|
| Rate for Payer: BCBS MAPPO |
$35.33
|
| Rate for Payer: BCN Medicare Advantage |
$35.33
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.33
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$18.94
|
| 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 |
$19.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PACE Medicare |
$33.56
|
| Rate for Payer: PACE SWMI |
$35.33
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$35.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health Medicare |
$35.33
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: Railroad Medicare Medicare |
$35.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.33
|
| Rate for Payer: UHC Medicare Advantage |
$35.33
|
| Rate for Payer: UHCCP Medicaid |
$19.89
|
| Rate for Payer: VA VA |
$35.33
|
|
|
HC SARS FLU AB RSV
|
Facility
|
IP
|
$254.90
|
|
|
Service Code
|
CPT 0241U
|
| Hospital Charge Code |
30600313
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$160.59 |
| Max. Negotiated Rate |
$229.41 |
| Rate for Payer: Aetna Commercial |
$216.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.69
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cofinity Commercial |
$178.43
|
| Rate for Payer: Cofinity Commercial |
$219.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.92
|
| Rate for Payer: Healthscope Commercial |
$229.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.66
|
| Rate for Payer: PHP Commercial |
$216.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.69
|
| Rate for Payer: Priority Health SBD |
$160.59
|
|
|
HC SARS FLU AB RSV
|
Facility
|
OP
|
$254.90
|
|
|
Service Code
|
CPT 0241U
|
| Hospital Charge Code |
30600313
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$101.96 |
| Max. Negotiated Rate |
$229.41 |
| Rate for Payer: Aetna Commercial |
$216.66
|
| Rate for Payer: Aetna Medicare |
$127.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.69
|
| Rate for Payer: BCBS Complete |
$101.96
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cofinity Commercial |
$178.43
|
| Rate for Payer: Cofinity Commercial |
$219.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.92
|
| Rate for Payer: Healthscope Commercial |
$229.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.66
|
| Rate for Payer: PHP Commercial |
$216.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.69
|
| Rate for Payer: Priority Health SBD |
$160.59
|
|
|
HC SCALLOP IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200060
|
|
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
|
|
