|
HC V5264 EAR MOLD INSERT NOT DISPOSABLE ANY TYPE
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
47000005
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna Medicare |
$36.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: BCBS Complete |
$29.13
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Advantage |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.62
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health SBD |
$45.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.34
|
| Rate for Payer: UHC Core |
$37.94
|
| Rate for Payer: UHC Exchange |
$28.62
|
|
|
HC VACC AIIV4 NO PRSRV 0.5ML IM
|
Facility
|
OP
|
$185.47
|
|
|
Service Code
|
CPT 90694
|
| Hospital Charge Code |
63600224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.89 |
| Max. Negotiated Rate |
$167.39 |
| Rate for Payer: Aetna Commercial |
$157.65
|
| Rate for Payer: Aetna Medicare |
$92.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.56
|
| Rate for Payer: BCBS Complete |
$74.19
|
| Rate for Payer: BCBS Trust/PPO |
$167.39
|
| Rate for Payer: BCN Commercial |
$167.39
|
| Rate for Payer: Cash Price |
$148.38
|
| Rate for Payer: Cash Price |
$148.38
|
| Rate for Payer: Cofinity Advantage |
$129.83
|
| Rate for Payer: Cofinity Commercial |
$159.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.38
|
| Rate for Payer: Healthscope Commercial |
$166.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.10
|
| Rate for Payer: PHP Commercial |
$157.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$77.36
|
| Rate for Payer: Priority Health SBD |
$116.85
|
| Rate for Payer: Priority Health Tiered Network |
$61.89
|
|
|
HC VACC AIIV4 NO PRSRV 0.5ML IM
|
Facility
|
IP
|
$185.47
|
|
|
Service Code
|
CPT 90694
|
| Hospital Charge Code |
63600224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.85 |
| Max. Negotiated Rate |
$166.92 |
| Rate for Payer: Aetna Commercial |
$157.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.56
|
| Rate for Payer: Cash Price |
$148.38
|
| Rate for Payer: Cofinity Advantage |
$129.83
|
| Rate for Payer: Cofinity Commercial |
$159.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.38
|
| Rate for Payer: Healthscope Commercial |
$166.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.10
|
| Rate for Payer: PHP Commercial |
$157.65
|
| Rate for Payer: Priority Health SBD |
$116.85
|
|
|
HC VACC CCIIV4 ABX FREE 0.5 ML IM
|
Facility
|
OP
|
$69.38
|
|
|
Service Code
|
CPT 90756
|
| Hospital Charge Code |
63600223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna Medicare |
$34.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.10
|
| Rate for Payer: BCBS Complete |
$27.75
|
| Rate for Payer: BCBS Trust/PPO |
$70.23
|
| Rate for Payer: BCN Commercial |
$70.23
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cofinity Advantage |
$48.57
|
| Rate for Payer: Cofinity Commercial |
$59.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.50
|
| Rate for Payer: Healthscope Commercial |
$62.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.03
|
| Rate for Payer: PHP Commercial |
$58.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$32.38
|
| Rate for Payer: Priority Health SBD |
$43.71
|
| Rate for Payer: Priority Health Tiered Network |
$25.90
|
|
|
HC VACC CCIIV4 ABX FREE 0.5 ML IM
|
Facility
|
IP
|
$69.38
|
|
|
Service Code
|
CPT 90756
|
| Hospital Charge Code |
63600223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.71 |
| Max. Negotiated Rate |
$62.44 |
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.10
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cofinity Advantage |
$48.57
|
| Rate for Payer: Cofinity Commercial |
$59.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.50
|
| Rate for Payer: Healthscope Commercial |
$62.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.03
|
| Rate for Payer: PHP Commercial |
$58.97
|
| Rate for Payer: Priority Health SBD |
$43.71
|
|
|
HC VACC CCIIV4 NO PRSV 0.5 ML IM
|
Facility
|
OP
|
$74.29
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
63600222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.34 |
| Max. Negotiated Rate |
$74.12 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Aetna Medicare |
$37.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.29
|
| Rate for Payer: BCBS Complete |
$29.72
|
| Rate for Payer: BCBS Trust/PPO |
$74.12
|
| Rate for Payer: BCN Commercial |
$74.12
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Advantage |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$63.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Healthscope Commercial |
$66.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: PHP Commercial |
$63.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.17
|
| Rate for Payer: Priority Health SBD |
$46.80
|
| Rate for Payer: Priority Health Tiered Network |
$27.34
|
|
|
HC VACC CCIIV4 NO PRSV 0.5 ML IM
|
Facility
|
IP
|
$74.29
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
63600222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$66.86 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.29
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Advantage |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$63.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Healthscope Commercial |
$66.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: PHP Commercial |
$63.15
|
| Rate for Payer: Priority Health SBD |
$46.80
|
|
|
HC VACC RSV PREF BIVALENT IM
|
Facility
|
IP
|
$856.30
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
63600226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$539.47 |
| Max. Negotiated Rate |
$770.67 |
| Rate for Payer: Aetna Commercial |
$727.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$556.60
|
| Rate for Payer: Cash Price |
$685.04
|
| Rate for Payer: Cofinity Advantage |
$599.41
|
| Rate for Payer: Cofinity Commercial |
$736.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$685.04
|
| Rate for Payer: Healthscope Commercial |
$770.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$727.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$642.23
|
| Rate for Payer: PHP Commercial |
$727.86
|
| Rate for Payer: Priority Health SBD |
$539.47
|
|
|
HC VACC RSV PREF BIVALENT IM
|
Facility
|
OP
|
$856.30
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
63600226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$279.80 |
| Max. Negotiated Rate |
$785.68 |
| Rate for Payer: Aetna Commercial |
$727.86
|
| Rate for Payer: Aetna Medicare |
$428.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$556.60
|
| Rate for Payer: BCBS Complete |
$342.52
|
| Rate for Payer: BCBS Trust/PPO |
$785.68
|
| Rate for Payer: BCN Commercial |
$785.68
|
| Rate for Payer: Cash Price |
$685.04
|
| Rate for Payer: Cash Price |
$685.04
|
| Rate for Payer: Cofinity Advantage |
$599.41
|
| Rate for Payer: Cofinity Commercial |
$736.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$685.04
|
| Rate for Payer: Healthscope Commercial |
$770.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$685.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$727.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$642.23
|
| Rate for Payer: PHP Commercial |
$727.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$349.75
|
| Rate for Payer: Priority Health SBD |
$539.47
|
| Rate for Payer: Priority Health Tiered Network |
$279.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$631.75
|
| Rate for Payer: UHC Core |
$631.75
|
| Rate for Payer: UHC Exchange |
$631.75
|
|
|
HC VACC RSV PREF RECOMB ADJT IM
|
Facility
|
OP
|
$812.76
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
63600225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$279.39 |
| Max. Negotiated Rate |
$754.36 |
| Rate for Payer: Aetna Commercial |
$690.85
|
| Rate for Payer: Aetna Medicare |
$406.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$528.29
|
| Rate for Payer: BCBS Complete |
$325.10
|
| Rate for Payer: BCBS Trust/PPO |
$754.36
|
| Rate for Payer: BCN Commercial |
$754.36
|
| Rate for Payer: Cash Price |
$650.21
|
| Rate for Payer: Cash Price |
$650.21
|
| Rate for Payer: Cofinity Advantage |
$568.93
|
| Rate for Payer: Cofinity Commercial |
$698.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$650.21
|
| Rate for Payer: Healthscope Commercial |
$731.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$650.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.57
|
| Rate for Payer: PHP Commercial |
$690.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$349.24
|
| Rate for Payer: Priority Health SBD |
$512.04
|
| Rate for Payer: Priority Health Tiered Network |
$279.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$606.57
|
| Rate for Payer: UHC Core |
$606.57
|
| Rate for Payer: UHC Exchange |
$606.57
|
|
|
HC VACC RSV PREF RECOMB ADJT IM
|
Facility
|
IP
|
$812.76
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
63600225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$512.04 |
| Max. Negotiated Rate |
$731.48 |
| Rate for Payer: Aetna Commercial |
$690.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$528.29
|
| Rate for Payer: Cash Price |
$650.21
|
| Rate for Payer: Cofinity Advantage |
$568.93
|
| Rate for Payer: Cofinity Commercial |
$698.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$650.21
|
| Rate for Payer: Healthscope Commercial |
$731.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$690.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$609.57
|
| Rate for Payer: PHP Commercial |
$690.85
|
| Rate for Payer: Priority Health SBD |
$512.04
|
|
|
HC VAC WOUND PREVENA
|
Facility
|
IP
|
$1,511.95
|
|
| Hospital Charge Code |
27000697
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$952.53 |
| Max. Negotiated Rate |
$1,360.76 |
| Rate for Payer: Aetna Commercial |
$1,285.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$982.77
|
| Rate for Payer: Cash Price |
$1,209.56
|
| Rate for Payer: Cofinity Advantage |
$1,058.37
|
| Rate for Payer: Cofinity Commercial |
$1,300.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,209.56
|
| Rate for Payer: Healthscope Commercial |
$1,360.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,285.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,133.96
|
| Rate for Payer: PHP Commercial |
$1,285.16
|
| Rate for Payer: Priority Health SBD |
$952.53
|
|
|
HC VAC WOUND PREVENA
|
Facility
|
OP
|
$1,511.95
|
|
| Hospital Charge Code |
27000697
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$594.20 |
| Max. Negotiated Rate |
$1,360.76 |
| Rate for Payer: Aetna Commercial |
$1,285.16
|
| Rate for Payer: Aetna Medicare |
$755.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$982.77
|
| Rate for Payer: BCBS Complete |
$604.78
|
| Rate for Payer: Cash Price |
$1,209.56
|
| Rate for Payer: Cofinity Advantage |
$1,058.37
|
| Rate for Payer: Cofinity Commercial |
$1,300.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,209.56
|
| Rate for Payer: Healthscope Commercial |
$1,360.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,209.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,285.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,133.96
|
| Rate for Payer: PHP Commercial |
$1,285.16
|
| Rate for Payer: Priority Health SBD |
$952.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$982.77
|
| Rate for Payer: UHC Core |
$787.73
|
| Rate for Payer: UHC Exchange |
$594.20
|
|
|
HC VAGINAL DELIVERY (OB)
|
Facility
|
OP
|
$1,828.26
|
|
| Hospital Charge Code |
72000006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$718.51 |
| Max. Negotiated Rate |
$1,645.43 |
| Rate for Payer: Aetna Commercial |
$1,554.02
|
| Rate for Payer: Aetna Medicare |
$914.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,188.37
|
| Rate for Payer: BCBS Complete |
$731.30
|
| Rate for Payer: Cash Price |
$1,462.61
|
| Rate for Payer: Cofinity Advantage |
$1,279.78
|
| Rate for Payer: Cofinity Commercial |
$1,572.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,462.61
|
| Rate for Payer: Healthscope Commercial |
$1,645.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,462.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,554.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,371.19
|
| Rate for Payer: PHP Commercial |
$1,554.02
|
| Rate for Payer: Priority Health SBD |
$1,151.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,188.37
|
| Rate for Payer: UHC Core |
$952.52
|
| Rate for Payer: UHC Exchange |
$718.51
|
|
|
HC VAGINAL DELIVERY (OB)
|
Facility
|
IP
|
$1,828.26
|
|
| Hospital Charge Code |
72000006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,151.80 |
| Max. Negotiated Rate |
$1,645.43 |
| Rate for Payer: Aetna Commercial |
$1,554.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,188.37
|
| Rate for Payer: Cash Price |
$1,462.61
|
| Rate for Payer: Cofinity Advantage |
$1,279.78
|
| Rate for Payer: Cofinity Commercial |
$1,572.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,462.61
|
| Rate for Payer: Healthscope Commercial |
$1,645.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,554.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,371.19
|
| Rate for Payer: PHP Commercial |
$1,554.02
|
| Rate for Payer: Priority Health SBD |
$1,151.80
|
|
|
HC VALPROIC ACID DEPAKENE LVL
|
Facility
|
OP
|
$109.66
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
30100589
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Aetna Commercial |
$93.21
|
| Rate for Payer: Aetna Medicare |
$14.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.93
|
| Rate for Payer: BCBS Complete |
$7.44
|
| Rate for Payer: BCBS MAPPO |
$13.54
|
| Rate for Payer: BCBS Trust/PPO |
$14.44
|
| Rate for Payer: BCN Commercial |
$14.44
|
| Rate for Payer: BCN Medicare Advantage |
$13.54
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Advantage |
$76.76
|
| Rate for Payer: Cofinity Commercial |
$94.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.54
|
| Rate for Payer: Healthscope Commercial |
$98.69
|
| Rate for Payer: Mclaren Medicaid |
$7.08
|
| Rate for Payer: Mclaren Medicare |
$13.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.22
|
| Rate for Payer: Meridian Medicaid |
$14.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Nomi Health Commercial |
$20.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: PACE Medicare |
$12.86
|
| Rate for Payer: PACE SWMI |
$13.54
|
| Rate for Payer: PHP Commercial |
$93.21
|
| Rate for Payer: PHP Medicare Advantage |
$13.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.54
|
| Rate for Payer: Priority Health Medicare |
$13.54
|
| Rate for Payer: Priority Health SBD |
$69.09
|
| Rate for Payer: Priority Health Tiered Network |
$10.83
|
| Rate for Payer: Railroad Medicare Medicare |
$13.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.31
|
| Rate for Payer: UHC Core |
$20.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.54
|
| Rate for Payer: UHC Exchange |
$20.31
|
| Rate for Payer: UHC Medicaid |
$7.08
|
| Rate for Payer: UHCCP Medicaid |
$7.08
|
| Rate for Payer: VA VA |
$13.54
|
|
|
HC VALPROIC ACID DEPAKENE LVL
|
Facility
|
IP
|
$109.66
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
30100589
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Aetna Commercial |
$93.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.28
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Advantage |
$76.76
|
| Rate for Payer: Cofinity Commercial |
$94.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Healthscope Commercial |
$98.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: PHP Commercial |
$93.21
|
| Rate for Payer: Priority Health SBD |
$69.09
|
|
|
HC VALVE VENT NONADJ
|
Facility
|
IP
|
$53.06
|
|
| Hospital Charge Code |
27000277
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.43 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health SBD |
$33.43
|
|
|
HC VALVE VENT NONADJ
|
Facility
|
OP
|
$53.06
|
|
| Hospital Charge Code |
27000277
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$26.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: BCBS Complete |
$21.22
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.49
|
| Rate for Payer: UHC Core |
$27.64
|
| Rate for Payer: UHC Exchange |
$20.85
|
|
|
HC VALVE VENT ONE WAY
|
Facility
|
OP
|
$43.70
|
|
| Hospital Charge Code |
27000662
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.17 |
| Max. Negotiated Rate |
$39.33 |
| Rate for Payer: Aetna Commercial |
$37.15
|
| Rate for Payer: Aetna Medicare |
$21.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.41
|
| Rate for Payer: BCBS Complete |
$17.48
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Advantage |
$30.59
|
| Rate for Payer: Cofinity Commercial |
$37.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$39.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.77
|
| Rate for Payer: PHP Commercial |
$37.15
|
| Rate for Payer: Priority Health SBD |
$27.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.41
|
| Rate for Payer: UHC Core |
$22.77
|
| Rate for Payer: UHC Exchange |
$17.17
|
|
|
HC VALVE VENT ONE WAY
|
Facility
|
IP
|
$43.70
|
|
| Hospital Charge Code |
27000662
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.53 |
| Max. Negotiated Rate |
$39.33 |
| Rate for Payer: Aetna Commercial |
$37.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.41
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Advantage |
$30.59
|
| Rate for Payer: Cofinity Commercial |
$37.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$39.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.77
|
| Rate for Payer: PHP Commercial |
$37.15
|
| Rate for Payer: Priority Health SBD |
$27.53
|
|
|
HC VANCOMYCIN LEVEL
|
Facility
|
IP
|
$141.18
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
30100051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.94 |
| Max. Negotiated Rate |
$127.06 |
| Rate for Payer: Aetna Commercial |
$120.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.77
|
| Rate for Payer: Cash Price |
$112.94
|
| Rate for Payer: Cofinity Advantage |
$98.83
|
| Rate for Payer: Cofinity Commercial |
$121.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.94
|
| Rate for Payer: Healthscope Commercial |
$127.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.89
|
| Rate for Payer: PHP Commercial |
$120.00
|
| Rate for Payer: Priority Health SBD |
$88.94
|
|
|
HC VANCOMYCIN LEVEL
|
Facility
|
OP
|
$141.18
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
30100051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$127.06 |
| Rate for Payer: Aetna Commercial |
$120.00
|
| Rate for Payer: Aetna Medicare |
$14.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.93
|
| Rate for Payer: BCBS Complete |
$7.44
|
| Rate for Payer: BCBS MAPPO |
$13.54
|
| Rate for Payer: BCBS Trust/PPO |
$14.44
|
| Rate for Payer: BCN Commercial |
$14.44
|
| Rate for Payer: BCN Medicare Advantage |
$13.54
|
| Rate for Payer: Cash Price |
$112.94
|
| Rate for Payer: Cash Price |
$112.94
|
| Rate for Payer: Cofinity Advantage |
$98.83
|
| Rate for Payer: Cofinity Commercial |
$121.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.54
|
| Rate for Payer: Healthscope Commercial |
$127.06
|
| Rate for Payer: Mclaren Medicaid |
$7.08
|
| Rate for Payer: Mclaren Medicare |
$13.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.22
|
| Rate for Payer: Meridian Medicaid |
$14.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.00
|
| Rate for Payer: Nomi Health Commercial |
$20.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.89
|
| Rate for Payer: PACE Medicare |
$12.86
|
| Rate for Payer: PACE SWMI |
$13.54
|
| Rate for Payer: PHP Commercial |
$120.00
|
| Rate for Payer: PHP Medicare Advantage |
$13.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.54
|
| Rate for Payer: Priority Health Medicare |
$13.54
|
| Rate for Payer: Priority Health SBD |
$88.94
|
| Rate for Payer: Priority Health Tiered Network |
$10.83
|
| Rate for Payer: Railroad Medicare Medicare |
$13.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.31
|
| Rate for Payer: UHC Core |
$20.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.54
|
| Rate for Payer: UHC Exchange |
$20.31
|
| Rate for Payer: UHC Medicaid |
$7.08
|
| Rate for Payer: UHCCP Medicaid |
$7.08
|
| Rate for Payer: VA VA |
$13.54
|
|
|
HC VAP CHOLESTEROL
|
Facility
|
IP
|
$84.89
|
|
|
Service Code
|
CPT 83701
|
| Hospital Charge Code |
30100281
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.48 |
| Max. Negotiated Rate |
$76.40 |
| Rate for Payer: Aetna Commercial |
$72.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.18
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Cofinity Advantage |
$59.42
|
| Rate for Payer: Cofinity Commercial |
$73.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.91
|
| Rate for Payer: Healthscope Commercial |
$76.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.67
|
| Rate for Payer: PHP Commercial |
$72.16
|
| Rate for Payer: Priority Health SBD |
$53.48
|
|
|
HC VAP CHOLESTEROL
|
Facility
|
OP
|
$84.89
|
|
|
Service Code
|
CPT 83701
|
| Hospital Charge Code |
30100281
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$76.40 |
| Rate for Payer: Aetna Commercial |
$72.16
|
| Rate for Payer: Aetna Medicare |
$35.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.33
|
| Rate for Payer: BCBS Complete |
$18.60
|
| Rate for Payer: BCBS MAPPO |
$33.86
|
| Rate for Payer: BCN Medicare Advantage |
$33.86
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Cofinity Advantage |
$59.42
|
| Rate for Payer: Cofinity Commercial |
$73.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.86
|
| Rate for Payer: Healthscope Commercial |
$76.40
|
| Rate for Payer: Mclaren Medicaid |
$17.71
|
| Rate for Payer: Mclaren Medicare |
$33.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.55
|
| Rate for Payer: Meridian Medicaid |
$35.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.16
|
| Rate for Payer: Nomi Health Commercial |
$50.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.67
|
| Rate for Payer: PACE Medicare |
$32.17
|
| Rate for Payer: PACE SWMI |
$33.86
|
| Rate for Payer: PHP Commercial |
$72.16
|
| Rate for Payer: PHP Medicare Advantage |
$33.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33.86
|
| Rate for Payer: Priority Health Medicare |
$33.86
|
| Rate for Payer: Priority Health SBD |
$53.48
|
| Rate for Payer: Priority Health Tiered Network |
$27.09
|
| Rate for Payer: Railroad Medicare Medicare |
$33.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.79
|
| Rate for Payer: UHC Core |
$50.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33.86
|
| Rate for Payer: UHC Exchange |
$50.79
|
| Rate for Payer: UHC Medicaid |
$17.71
|
| Rate for Payer: UHCCP Medicaid |
$17.71
|
| Rate for Payer: VA VA |
$33.86
|
|
