|
HC HEPATITIS B SURFACE ANTIGEN
|
Facility
|
IP
|
$38.09
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600139
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.66 |
| Max. Negotiated Rate |
$38.09 |
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: ASR ASR |
$36.95
|
| Rate for Payer: BCBS Trust/PPO |
$29.53
|
| Rate for Payer: BCN Commercial |
$29.53
|
| Rate for Payer: Cash Price |
$30.47
|
| Rate for Payer: Cofinity Commercial |
$35.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.47
|
| Rate for Payer: Healthscope Commercial |
$38.09
|
| Rate for Payer: Healthscope Whirlpool |
$36.95
|
| Rate for Payer: Mclaren Commercial |
$34.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.52
|
|
|
HC HEPATITIS B SURFACE ANTIGEN NEUTRALIZATION
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
30600141
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: ASR ASR |
$70.81
|
| Rate for Payer: BCBS Trust/PPO |
$56.60
|
| Rate for Payer: BCN Commercial |
$56.60
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$68.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.40
|
| Rate for Payer: Healthscope Commercial |
$73.00
|
| Rate for Payer: Healthscope Whirlpool |
$70.81
|
| Rate for Payer: Mclaren Commercial |
$65.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.24
|
|
|
HC HEPATITIS B SURFACE ANTIGEN NEUTRALIZATION
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
30600141
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Aetna Medicare |
$10.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.91
|
| Rate for Payer: ASR ASR |
$70.81
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.33
|
| Rate for Payer: BCBS Trust/PPO |
$56.60
|
| Rate for Payer: BCN Commercial |
$56.60
|
| Rate for Payer: BCN Medicare Advantage |
$10.33
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$68.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.33
|
| Rate for Payer: Healthscope Commercial |
$73.00
|
| Rate for Payer: Healthscope Whirlpool |
$70.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.33
|
| Rate for Payer: Mclaren Commercial |
$65.70
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicare |
$10.33
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.05
|
| Rate for Payer: PACE Medicare |
$9.81
|
| Rate for Payer: PACE SWMI |
$10.33
|
| Rate for Payer: PHP Commercial |
$11.36
|
| Rate for Payer: PHP Medicaid |
$5.65
|
| Rate for Payer: PHP Medicare Advantage |
$10.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.43
|
| Rate for Payer: Priority Health Medicare |
$10.33
|
| Rate for Payer: Priority Health Narrow Network |
$51.83
|
| Rate for Payer: Railroad Medicare Medicare |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.24
|
| Rate for Payer: UHC Medicare Advantage |
$10.64
|
| Rate for Payer: VA VA |
$10.33
|
|
|
HC HEPATITIS B VACCINE ADULT, 3 DOSE IM
|
Facility
|
OP
|
$82.62
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
63600026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.05 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$74.36
|
| Rate for Payer: ASR ASR |
$80.14
|
| Rate for Payer: BCBS Complete |
$33.05
|
| Rate for Payer: BCBS Trust/PPO |
$64.06
|
| Rate for Payer: BCN Commercial |
$64.06
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$77.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.10
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Healthscope Whirlpool |
$80.14
|
| Rate for Payer: Mclaren Commercial |
$74.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.18
|
| Rate for Payer: Priority Health Narrow Network |
$58.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.71
|
|
|
HC HEPATITIS B VACCINE ADULT, 3 DOSE IM
|
Facility
|
IP
|
$82.62
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
63600026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.83 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$74.36
|
| Rate for Payer: ASR ASR |
$80.14
|
| Rate for Payer: BCBS Trust/PPO |
$64.06
|
| Rate for Payer: BCN Commercial |
$64.06
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$77.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.10
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Healthscope Whirlpool |
$80.14
|
| Rate for Payer: Mclaren Commercial |
$74.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.71
|
|
|
HC HEPATITIS C ANTIBODY
|
Facility
|
OP
|
$48.26
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
30200336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$48.26 |
| Rate for Payer: Aetna Commercial |
$43.43
|
| Rate for Payer: Aetna Medicare |
$14.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.84
|
| Rate for Payer: ASR ASR |
$46.81
|
| Rate for Payer: BCBS Complete |
$8.20
|
| Rate for Payer: BCBS MAPPO |
$14.27
|
| Rate for Payer: BCBS Trust/PPO |
$37.42
|
| Rate for Payer: BCN Commercial |
$37.42
|
| Rate for Payer: BCN Medicare Advantage |
$14.27
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Cofinity Commercial |
$45.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.27
|
| Rate for Payer: Healthscope Commercial |
$48.26
|
| Rate for Payer: Healthscope Whirlpool |
$46.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.27
|
| Rate for Payer: Mclaren Commercial |
$43.43
|
| Rate for Payer: Mclaren Medicaid |
$7.81
|
| Rate for Payer: Mclaren Medicare |
$14.27
|
| Rate for Payer: Meridian Medicaid |
$8.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.02
|
| Rate for Payer: PACE Medicare |
$13.56
|
| Rate for Payer: PACE SWMI |
$14.27
|
| Rate for Payer: PHP Commercial |
$15.70
|
| Rate for Payer: PHP Medicaid |
$7.81
|
| Rate for Payer: PHP Medicare Advantage |
$14.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.18
|
| Rate for Payer: Priority Health Medicare |
$14.27
|
| Rate for Payer: Priority Health Narrow Network |
$36.94
|
| Rate for Payer: Railroad Medicare Medicare |
$14.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.47
|
| Rate for Payer: UHC Medicare Advantage |
$14.70
|
| Rate for Payer: VA VA |
$14.27
|
|
|
HC HEPATITIS C ANTIBODY
|
Facility
|
IP
|
$48.26
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
30200336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.78 |
| Max. Negotiated Rate |
$48.26 |
| Rate for Payer: Aetna Commercial |
$43.43
|
| Rate for Payer: ASR ASR |
$46.81
|
| Rate for Payer: BCBS Trust/PPO |
$37.42
|
| Rate for Payer: BCN Commercial |
$37.42
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Cofinity Commercial |
$45.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.61
|
| Rate for Payer: Healthscope Commercial |
$48.26
|
| Rate for Payer: Healthscope Whirlpool |
$46.81
|
| Rate for Payer: Mclaren Commercial |
$43.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.47
|
|
|
HC HEPATITIS C ANTIBODY BY RIBA
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 86804
|
| Hospital Charge Code |
30200337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: ASR ASR |
$78.57
|
| Rate for Payer: BCBS Trust/PPO |
$62.80
|
| Rate for Payer: BCN Commercial |
$62.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$76.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.80
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Healthscope Whirlpool |
$78.57
|
| Rate for Payer: Mclaren Commercial |
$72.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.28
|
|
|
HC HEPATITIS C ANTIBODY BY RIBA
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 86804
|
| Hospital Charge Code |
30200337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Medicare |
$15.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.36
|
| Rate for Payer: ASR ASR |
$78.57
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS MAPPO |
$15.49
|
| Rate for Payer: BCBS Trust/PPO |
$62.80
|
| Rate for Payer: BCN Commercial |
$62.80
|
| Rate for Payer: BCN Medicare Advantage |
$15.49
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$76.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Healthscope Whirlpool |
$78.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.49
|
| Rate for Payer: Mclaren Commercial |
$72.90
|
| Rate for Payer: Mclaren Medicaid |
$8.47
|
| Rate for Payer: Mclaren Medicare |
$15.49
|
| Rate for Payer: Meridian Medicaid |
$8.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.85
|
| Rate for Payer: PACE Medicare |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.49
|
| Rate for Payer: PHP Commercial |
$17.04
|
| Rate for Payer: PHP Medicaid |
$8.47
|
| Rate for Payer: PHP Medicare Advantage |
$15.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.71
|
| Rate for Payer: Priority Health Medicare |
$15.49
|
| Rate for Payer: Priority Health Narrow Network |
$57.51
|
| Rate for Payer: Railroad Medicare Medicare |
$15.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.28
|
| Rate for Payer: UHC Medicare Advantage |
$15.95
|
| Rate for Payer: VA VA |
$15.49
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANT
|
Facility
|
OP
|
$149.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600295
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$230.90 |
| Rate for Payer: Aetna Commercial |
$134.95
|
| Rate for Payer: Aetna Medicare |
$42.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.55
|
| Rate for Payer: ASR ASR |
$145.44
|
| Rate for Payer: BCBS Complete |
$24.61
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$116.25
|
| Rate for Payer: BCN Commercial |
$116.25
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$119.95
|
| Rate for Payer: Cash Price |
$119.95
|
| Rate for Payer: Cofinity Commercial |
$140.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$149.94
|
| Rate for Payer: Healthscope Whirlpool |
$145.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.84
|
| Rate for Payer: Mclaren Commercial |
$134.95
|
| Rate for Payer: Mclaren Medicaid |
$23.43
|
| Rate for Payer: Mclaren Medicare |
$42.84
|
| Rate for Payer: Meridian Medicaid |
$24.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.45
|
| Rate for Payer: PACE Medicare |
$40.70
|
| Rate for Payer: PACE SWMI |
$42.84
|
| Rate for Payer: PHP Commercial |
$47.12
|
| Rate for Payer: PHP Medicaid |
$23.43
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.90
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health Narrow Network |
$184.72
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.95
|
| Rate for Payer: UHC Medicare Advantage |
$44.13
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANT
|
Facility
|
IP
|
$149.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600295
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$104.96 |
| Max. Negotiated Rate |
$149.94 |
| Rate for Payer: Aetna Commercial |
$134.95
|
| Rate for Payer: ASR ASR |
$145.44
|
| Rate for Payer: BCBS Trust/PPO |
$116.25
|
| Rate for Payer: BCN Commercial |
$116.25
|
| Rate for Payer: Cash Price |
$119.95
|
| Rate for Payer: Cofinity Commercial |
$140.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.95
|
| Rate for Payer: Healthscope Commercial |
$149.94
|
| Rate for Payer: Healthscope Whirlpool |
$145.44
|
| Rate for Payer: Mclaren Commercial |
$134.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.95
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANTIFICATION
|
Facility
|
IP
|
$149.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600157
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$104.96 |
| Max. Negotiated Rate |
$149.94 |
| Rate for Payer: Aetna Commercial |
$134.95
|
| Rate for Payer: ASR ASR |
$145.44
|
| Rate for Payer: BCBS Trust/PPO |
$116.25
|
| Rate for Payer: BCN Commercial |
$116.25
|
| Rate for Payer: Cash Price |
$119.95
|
| Rate for Payer: Cofinity Commercial |
$140.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.95
|
| Rate for Payer: Healthscope Commercial |
$149.94
|
| Rate for Payer: Healthscope Whirlpool |
$145.44
|
| Rate for Payer: Mclaren Commercial |
$134.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.95
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANTIFICATION
|
Facility
|
OP
|
$149.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600157
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$230.90 |
| Rate for Payer: Aetna Commercial |
$134.95
|
| Rate for Payer: Aetna Medicare |
$42.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.55
|
| Rate for Payer: ASR ASR |
$145.44
|
| Rate for Payer: BCBS Complete |
$24.61
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$116.25
|
| Rate for Payer: BCN Commercial |
$116.25
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$119.95
|
| Rate for Payer: Cash Price |
$119.95
|
| Rate for Payer: Cofinity Commercial |
$140.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$149.94
|
| Rate for Payer: Healthscope Whirlpool |
$145.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.84
|
| Rate for Payer: Mclaren Commercial |
$134.95
|
| Rate for Payer: Mclaren Medicaid |
$23.43
|
| Rate for Payer: Mclaren Medicare |
$42.84
|
| Rate for Payer: Meridian Medicaid |
$24.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.45
|
| Rate for Payer: PACE Medicare |
$40.70
|
| Rate for Payer: PACE SWMI |
$42.84
|
| Rate for Payer: PHP Commercial |
$47.12
|
| Rate for Payer: PHP Medicaid |
$23.43
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.90
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health Narrow Network |
$184.72
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.95
|
| Rate for Payer: UHC Medicare Advantage |
$44.13
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC HEPATITS B VACCINE (HEPB), PEDIATRIC/ADOLESCENT, 3 DOSE IM
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
63600086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.99 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: BCBS Trust/PPO |
$27.68
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$35.70
|
| Rate for Payer: Healthscope Whirlpool |
$34.63
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
|
|
HC HEPATITS B VACCINE (HEPB), PEDIATRIC/ADOLESCENT, 3 DOSE IM
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
63600086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: BCBS Complete |
$14.28
|
| Rate for Payer: BCBS Trust/PPO |
$27.68
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$35.70
|
| Rate for Payer: Healthscope Whirlpool |
$34.63
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.49
|
| Rate for Payer: Priority Health Narrow Network |
$25.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
|
|
HC HEP B ADMINISTRATION
|
Facility
|
OP
|
$33.50
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
77100008
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.09 |
| Max. Negotiated Rate |
$52.78 |
| Rate for Payer: Aetna Commercial |
$30.15
|
| Rate for Payer: Aetna Medicare |
$42.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.78
|
| Rate for Payer: ASR ASR |
$32.50
|
| Rate for Payer: BCBS Complete |
$24.25
|
| Rate for Payer: BCBS MAPPO |
$42.22
|
| Rate for Payer: BCBS Trust/PPO |
$25.97
|
| Rate for Payer: BCN Commercial |
$25.97
|
| Rate for Payer: BCN Medicare Advantage |
$42.22
|
| Rate for Payer: Cash Price |
$26.80
|
| Rate for Payer: Cash Price |
$26.80
|
| Rate for Payer: Cofinity Commercial |
$31.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.22
|
| Rate for Payer: Healthscope Commercial |
$33.50
|
| Rate for Payer: Healthscope Whirlpool |
$32.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.22
|
| Rate for Payer: Mclaren Commercial |
$30.15
|
| Rate for Payer: Mclaren Medicaid |
$23.09
|
| Rate for Payer: Mclaren Medicare |
$42.22
|
| Rate for Payer: Meridian Medicaid |
$24.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.48
|
| Rate for Payer: PACE Medicare |
$40.11
|
| Rate for Payer: PACE SWMI |
$42.22
|
| Rate for Payer: PHP Commercial |
$46.44
|
| Rate for Payer: PHP Medicaid |
$23.09
|
| Rate for Payer: PHP Medicare Advantage |
$42.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.48
|
| Rate for Payer: Priority Health Medicare |
$42.22
|
| Rate for Payer: Priority Health Narrow Network |
$23.78
|
| Rate for Payer: Railroad Medicare Medicare |
$42.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.48
|
| Rate for Payer: UHC Medicare Advantage |
$43.49
|
| Rate for Payer: VA VA |
$42.22
|
|
|
HC HEP B ADMINISTRATION
|
Facility
|
IP
|
$33.50
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
77100008
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.45 |
| Max. Negotiated Rate |
$33.50 |
| Rate for Payer: Aetna Commercial |
$30.15
|
| Rate for Payer: ASR ASR |
$32.50
|
| Rate for Payer: BCBS Trust/PPO |
$25.97
|
| Rate for Payer: BCN Commercial |
$25.97
|
| Rate for Payer: Cash Price |
$26.80
|
| Rate for Payer: Cofinity Commercial |
$31.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.80
|
| Rate for Payer: Healthscope Commercial |
$33.50
|
| Rate for Payer: Healthscope Whirlpool |
$32.50
|
| Rate for Payer: Mclaren Commercial |
$30.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.48
|
|
|
HC HEP B CORE AB TOTAL.
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200293
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: ASR ASR |
$95.06
|
| Rate for Payer: BCBS Trust/PPO |
$75.98
|
| Rate for Payer: BCN Commercial |
$75.98
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.40
|
| Rate for Payer: Healthscope Commercial |
$98.00
|
| Rate for Payer: Healthscope Whirlpool |
$95.06
|
| Rate for Payer: Mclaren Commercial |
$88.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.24
|
|
|
HC HEP B CORE AB TOTAL.
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200293
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$95.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$75.98
|
| Rate for Payer: BCN Commercial |
$75.98
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$98.00
|
| Rate for Payer: Healthscope Whirlpool |
$95.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$88.20
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.24
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$38.59
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.24
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC HEP B SURFACE ANTIGEN CONFIRMATION
|
Facility
|
IP
|
$45.03
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600140
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.52 |
| Max. Negotiated Rate |
$45.03 |
| Rate for Payer: Aetna Commercial |
$40.53
|
| Rate for Payer: ASR ASR |
$43.68
|
| Rate for Payer: BCBS Trust/PPO |
$34.91
|
| Rate for Payer: BCN Commercial |
$34.91
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cofinity Commercial |
$42.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.02
|
| Rate for Payer: Healthscope Commercial |
$45.03
|
| Rate for Payer: Healthscope Whirlpool |
$43.68
|
| Rate for Payer: Mclaren Commercial |
$40.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.63
|
|
|
HC HEP B SURFACE ANTIGEN CONFIRMATION
|
Facility
|
OP
|
$45.03
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600140
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$45.03 |
| Rate for Payer: Aetna Commercial |
$40.53
|
| Rate for Payer: Aetna Medicare |
$10.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.91
|
| Rate for Payer: ASR ASR |
$43.68
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.33
|
| Rate for Payer: BCBS Trust/PPO |
$34.91
|
| Rate for Payer: BCN Commercial |
$34.91
|
| Rate for Payer: BCN Medicare Advantage |
$10.33
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cofinity Commercial |
$42.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.33
|
| Rate for Payer: Healthscope Commercial |
$45.03
|
| Rate for Payer: Healthscope Whirlpool |
$43.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.33
|
| Rate for Payer: Mclaren Commercial |
$40.53
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicare |
$10.33
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.28
|
| Rate for Payer: PACE Medicare |
$9.81
|
| Rate for Payer: PACE SWMI |
$10.33
|
| Rate for Payer: PHP Commercial |
$11.36
|
| Rate for Payer: PHP Medicaid |
$5.65
|
| Rate for Payer: PHP Medicare Advantage |
$10.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.95
|
| Rate for Payer: Priority Health Medicare |
$10.33
|
| Rate for Payer: Priority Health Narrow Network |
$29.56
|
| Rate for Payer: Railroad Medicare Medicare |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.63
|
| Rate for Payer: UHC Medicare Advantage |
$10.64
|
| Rate for Payer: VA VA |
$10.33
|
|
|
HC HEP B VACC 2 DOSE ADULT IM
|
Facility
|
IP
|
$326.40
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
63600181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$228.48 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna Commercial |
$293.76
|
| Rate for Payer: ASR ASR |
$316.61
|
| Rate for Payer: BCBS Trust/PPO |
$253.06
|
| Rate for Payer: BCN Commercial |
$253.06
|
| Rate for Payer: Cash Price |
$261.12
|
| Rate for Payer: Cofinity Commercial |
$306.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.12
|
| Rate for Payer: Healthscope Commercial |
$326.40
|
| Rate for Payer: Healthscope Whirlpool |
$316.61
|
| Rate for Payer: Mclaren Commercial |
$293.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.23
|
|
|
HC HEP B VACC 2 DOSE ADULT IM
|
Facility
|
OP
|
$326.40
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
63600181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna Commercial |
$293.76
|
| Rate for Payer: ASR ASR |
$316.61
|
| Rate for Payer: BCBS Complete |
$130.56
|
| Rate for Payer: BCBS Trust/PPO |
$253.06
|
| Rate for Payer: BCN Commercial |
$253.06
|
| Rate for Payer: Cash Price |
$261.12
|
| Rate for Payer: Cash Price |
$261.12
|
| Rate for Payer: Cofinity Commercial |
$306.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.12
|
| Rate for Payer: Healthscope Commercial |
$326.40
|
| Rate for Payer: Healthscope Whirlpool |
$316.61
|
| Rate for Payer: Mclaren Commercial |
$293.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.23
|
|
|
HC HEP C GENO SUBTYPES
|
Facility
|
IP
|
$406.67
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600256
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$284.67 |
| Max. Negotiated Rate |
$406.67 |
| Rate for Payer: Aetna Commercial |
$366.00
|
| Rate for Payer: ASR ASR |
$394.47
|
| Rate for Payer: BCBS Trust/PPO |
$315.29
|
| Rate for Payer: BCN Commercial |
$315.29
|
| Rate for Payer: Cash Price |
$325.34
|
| Rate for Payer: Cofinity Commercial |
$382.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.34
|
| Rate for Payer: Healthscope Commercial |
$406.67
|
| Rate for Payer: Healthscope Whirlpool |
$394.47
|
| Rate for Payer: Mclaren Commercial |
$366.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$357.87
|
|
|
HC HEP C GENO SUBTYPES
|
Facility
|
OP
|
$406.67
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600256
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$140.83 |
| Max. Negotiated Rate |
$743.98 |
| Rate for Payer: Aetna Commercial |
$366.00
|
| Rate for Payer: Aetna Medicare |
$257.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$321.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$321.81
|
| Rate for Payer: ASR ASR |
$394.47
|
| Rate for Payer: BCBS Complete |
$147.88
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCBS Trust/PPO |
$315.29
|
| Rate for Payer: BCN Commercial |
$315.29
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$325.34
|
| Rate for Payer: Cash Price |
$325.34
|
| Rate for Payer: Cofinity Commercial |
$382.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Healthscope Commercial |
$406.67
|
| Rate for Payer: Healthscope Whirlpool |
$394.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$257.45
|
| Rate for Payer: Mclaren Commercial |
$366.00
|
| Rate for Payer: Mclaren Medicaid |
$140.83
|
| Rate for Payer: Mclaren Medicare |
$257.45
|
| Rate for Payer: Meridian Medicaid |
$147.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$270.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.67
|
| Rate for Payer: PACE Medicare |
$244.58
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PHP Commercial |
$283.20
|
| Rate for Payer: PHP Medicaid |
$140.83
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$743.98
|
| Rate for Payer: Priority Health Medicare |
$257.45
|
| Rate for Payer: Priority Health Narrow Network |
$595.18
|
| Rate for Payer: Railroad Medicare Medicare |
$257.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$357.87
|
| Rate for Payer: UHC Medicare Advantage |
$265.17
|
| Rate for Payer: VA VA |
$257.45
|
|
