|
HC HEP A & HEP B VACC ADULT IM
|
Facility
|
OP
|
$159.18
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.90 |
| Max. Negotiated Rate |
$159.18 |
| Rate for Payer: Aetna Commercial |
$143.26
|
| Rate for Payer: Aetna Medicare |
$58.90
|
| Rate for Payer: ASR ASR |
$154.40
|
| Rate for Payer: BCBS Complete |
$63.67
|
| Rate for Payer: BCBS Trust/PPO |
$131.24
|
| Rate for Payer: BCN Commercial |
$131.24
|
| Rate for Payer: Cash Price |
$127.34
|
| Rate for Payer: Cash Price |
$127.34
|
| Rate for Payer: Cofinity Commercial |
$149.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.34
|
| Rate for Payer: Healthscope Commercial |
$154.40
|
| Rate for Payer: Healthscope Whirlpool |
$159.18
|
| Rate for Payer: Mclaren Commercial |
$143.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.30
|
| Rate for Payer: Nomi Health Commercial |
$130.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$150.69
|
| Rate for Payer: Priority Health Narrow Network |
$120.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.08
|
|
|
HC HEPARIN ANTI-XA
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
30500083
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$59.69 |
| Max. Negotiated Rate |
$79.59 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: ASR ASR |
$77.20
|
| Rate for Payer: BCBS Trust/PPO |
$65.36
|
| Rate for Payer: BCN Commercial |
$65.36
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$74.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$77.20
|
| Rate for Payer: Healthscope Whirlpool |
$79.59
|
| Rate for Payer: Mclaren Commercial |
$71.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.04
|
|
|
HC HEPARIN ANTI-XA
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
30500083
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$79.59 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: Aetna Medicare |
$13.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.36
|
| Rate for Payer: ASR ASR |
$77.20
|
| Rate for Payer: BCBS Complete |
$7.19
|
| Rate for Payer: BCBS MAPPO |
$13.09
|
| Rate for Payer: BCBS Trust/PPO |
$65.62
|
| Rate for Payer: BCN Commercial |
$65.62
|
| Rate for Payer: BCN Medicare Advantage |
$13.09
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$74.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.09
|
| Rate for Payer: Healthscope Commercial |
$77.20
|
| Rate for Payer: Healthscope Whirlpool |
$79.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.09
|
| Rate for Payer: Mclaren Commercial |
$71.63
|
| Rate for Payer: Mclaren Medicaid |
$13.09
|
| Rate for Payer: Mclaren Medicare |
$13.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.74
|
| Rate for Payer: Meridian Medicaid |
$7.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Medicare |
$12.44
|
| Rate for Payer: PACE SWMI |
$13.09
|
| Rate for Payer: PHP Commercial |
$14.40
|
| Rate for Payer: PHP Medicaid |
$7.02
|
| Rate for Payer: PHP Medicare Advantage |
$13.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$69.74
|
| Rate for Payer: Priority Health Medicare |
$13.09
|
| Rate for Payer: Priority Health Narrow Network |
$55.79
|
| Rate for Payer: Railroad Medicare Medicare |
$13.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.09
|
| Rate for Payer: UHC Exchange |
$20.29
|
| Rate for Payer: UHC Medicaid |
$6.85
|
| Rate for Payer: UHCCP DNSP |
$13.09
|
| Rate for Payer: UHCCP Medicaid |
$6.85
|
| Rate for Payer: VA VA |
$13.09
|
|
|
HC HEPARIN NEUTRALIZATION
|
Facility
|
OP
|
$47.24
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
30500050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$47.24 |
| Rate for Payer: Aetna Commercial |
$42.52
|
| Rate for Payer: Aetna Medicare |
$11.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.80
|
| Rate for Payer: ASR ASR |
$45.82
|
| Rate for Payer: BCBS Complete |
$6.50
|
| Rate for Payer: BCBS MAPPO |
$11.84
|
| Rate for Payer: BCBS Trust/PPO |
$38.95
|
| Rate for Payer: BCN Commercial |
$38.95
|
| Rate for Payer: BCN Medicare Advantage |
$11.84
|
| Rate for Payer: Cash Price |
$37.79
|
| Rate for Payer: Cash Price |
$37.79
|
| Rate for Payer: Cofinity Commercial |
$44.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$45.82
|
| Rate for Payer: Healthscope Whirlpool |
$47.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.84
|
| Rate for Payer: Mclaren Commercial |
$42.52
|
| Rate for Payer: Mclaren Medicaid |
$11.84
|
| Rate for Payer: Mclaren Medicare |
$11.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.43
|
| Rate for Payer: Meridian Medicaid |
$6.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.15
|
| Rate for Payer: Nomi Health Commercial |
$38.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.43
|
| Rate for Payer: PACE Medicare |
$11.25
|
| Rate for Payer: PACE SWMI |
$11.84
|
| Rate for Payer: PHP Commercial |
$13.02
|
| Rate for Payer: PHP Medicaid |
$6.35
|
| Rate for Payer: PHP Medicare Advantage |
$11.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41.39
|
| Rate for Payer: Priority Health Medicare |
$11.84
|
| Rate for Payer: Priority Health Narrow Network |
$33.12
|
| Rate for Payer: Railroad Medicare Medicare |
$11.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.84
|
| Rate for Payer: UHC Exchange |
$18.35
|
| Rate for Payer: UHC Medicaid |
$6.19
|
| Rate for Payer: UHCCP DNSP |
$11.84
|
| Rate for Payer: UHCCP Medicaid |
$6.19
|
| Rate for Payer: VA VA |
$11.84
|
|
|
HC HEPARIN NEUTRALIZATION
|
Facility
|
IP
|
$47.24
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
30500050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$35.43 |
| Max. Negotiated Rate |
$47.24 |
| Rate for Payer: Aetna Commercial |
$42.52
|
| Rate for Payer: ASR ASR |
$45.82
|
| Rate for Payer: BCBS Trust/PPO |
$38.79
|
| Rate for Payer: BCN Commercial |
$38.79
|
| Rate for Payer: Cash Price |
$37.79
|
| Rate for Payer: Cofinity Commercial |
$44.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.79
|
| Rate for Payer: Healthscope Commercial |
$45.82
|
| Rate for Payer: Healthscope Whirlpool |
$47.24
|
| Rate for Payer: Mclaren Commercial |
$42.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.15
|
| Rate for Payer: Nomi Health Commercial |
$38.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.57
|
|
|
HC HEPARIN PF4 AB HIT
|
Facility
|
OP
|
$249.38
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$276.60 |
| Rate for Payer: Aetna Commercial |
$224.44
|
| Rate for Payer: Aetna Medicare |
$18.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: ASR ASR |
$241.90
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$205.61
|
| Rate for Payer: BCN Commercial |
$205.61
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cofinity Commercial |
$234.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$241.90
|
| Rate for Payer: Healthscope Whirlpool |
$249.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.37
|
| Rate for Payer: Mclaren Commercial |
$224.44
|
| Rate for Payer: Mclaren Medicaid |
$18.37
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.97
|
| Rate for Payer: Nomi Health Commercial |
$204.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.03
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$20.21
|
| Rate for Payer: PHP Medicaid |
$9.85
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$276.60
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health Narrow Network |
$221.28
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.37
|
| Rate for Payer: UHC Exchange |
$28.47
|
| Rate for Payer: UHC Medicaid |
$9.61
|
| Rate for Payer: UHCCP DNSP |
$18.37
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$18.37
|
|
|
HC HEPARIN PF4 AB HIT
|
Facility
|
IP
|
$249.38
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$187.03 |
| Max. Negotiated Rate |
$249.38 |
| Rate for Payer: Aetna Commercial |
$224.44
|
| Rate for Payer: ASR ASR |
$241.90
|
| Rate for Payer: BCBS Trust/PPO |
$204.79
|
| Rate for Payer: BCN Commercial |
$204.79
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cofinity Commercial |
$234.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.50
|
| Rate for Payer: Healthscope Commercial |
$241.90
|
| Rate for Payer: Healthscope Whirlpool |
$249.38
|
| Rate for Payer: Mclaren Commercial |
$224.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.97
|
| Rate for Payer: Nomi Health Commercial |
$204.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.45
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
30100018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Trust/PPO |
$34.86
|
| Rate for Payer: BCN Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
30100018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$107.14 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: Aetna Medicare |
$8.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.21
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Complete |
$4.49
|
| Rate for Payer: BCBS MAPPO |
$8.17
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$35.00
|
| Rate for Payer: BCN Medicare Advantage |
$8.17
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.17
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.17
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Mclaren Medicaid |
$8.17
|
| Rate for Payer: Mclaren Medicare |
$8.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.58
|
| Rate for Payer: Meridian Medicaid |
$4.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$7.76
|
| Rate for Payer: PACE SWMI |
$8.17
|
| Rate for Payer: PHP Commercial |
$8.99
|
| Rate for Payer: PHP Medicaid |
$4.38
|
| Rate for Payer: PHP Medicare Advantage |
$8.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$107.14
|
| Rate for Payer: Priority Health Medicare |
$8.17
|
| Rate for Payer: Priority Health Narrow Network |
$85.71
|
| Rate for Payer: Railroad Medicare Medicare |
$8.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.17
|
| Rate for Payer: UHC Exchange |
$12.66
|
| Rate for Payer: UHC Medicaid |
$4.27
|
| Rate for Payer: UHCCP DNSP |
$8.17
|
| Rate for Payer: UHCCP Medicaid |
$4.27
|
| Rate for Payer: VA VA |
$8.17
|
|
|
HC HEPATIC VENOGRAPHY WO HEMODYNAMIC EVAL
|
Facility
|
OP
|
$3,622.26
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
32000323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$4,876.50 |
| Rate for Payer: Aetna Commercial |
$3,260.03
|
| Rate for Payer: Aetna Medicare |
$3,146.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: ASR ASR |
$3,513.59
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,986.55
|
| Rate for Payer: BCN Commercial |
$2,986.55
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$2,897.81
|
| Rate for Payer: Cash Price |
$2,897.81
|
| Rate for Payer: Cofinity Commercial |
$3,404.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,897.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,513.59
|
| Rate for Payer: Healthscope Whirlpool |
$3,622.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,146.13
|
| Rate for Payer: Mclaren Commercial |
$3,260.03
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$1,727.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,078.92
|
| Rate for Payer: Nomi Health Commercial |
$2,970.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,716.70
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,460.74
|
| Rate for Payer: PHP Medicaid |
$1,686.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,173.82
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,539.20
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,187.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$4,876.50
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP DNSP |
$3,146.13
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC HEPATIC VENOGRAPHY WO HEMODYNAMIC EVAL
|
Facility
|
IP
|
$3,622.26
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
32000323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,716.70 |
| Max. Negotiated Rate |
$3,622.26 |
| Rate for Payer: Aetna Commercial |
$3,260.03
|
| Rate for Payer: ASR ASR |
$3,513.59
|
| Rate for Payer: BCBS Trust/PPO |
$2,974.60
|
| Rate for Payer: BCN Commercial |
$2,974.60
|
| Rate for Payer: Cash Price |
$2,897.81
|
| Rate for Payer: Cofinity Commercial |
$3,404.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,897.81
|
| Rate for Payer: Healthscope Commercial |
$3,513.59
|
| Rate for Payer: Healthscope Whirlpool |
$3,622.26
|
| Rate for Payer: Mclaren Commercial |
$3,260.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,078.92
|
| Rate for Payer: Nomi Health Commercial |
$2,970.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,716.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,187.59
|
|
|
HC HEPATITIS A ANTIBODY IGM
|
Facility
|
IP
|
$133.38
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
30200299
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.03 |
| Max. Negotiated Rate |
$133.38 |
| Rate for Payer: Aetna Commercial |
$120.04
|
| Rate for Payer: ASR ASR |
$129.38
|
| Rate for Payer: BCBS Trust/PPO |
$109.53
|
| Rate for Payer: BCN Commercial |
$109.53
|
| Rate for Payer: Cash Price |
$106.70
|
| Rate for Payer: Cofinity Commercial |
$125.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.70
|
| Rate for Payer: Healthscope Commercial |
$129.38
|
| Rate for Payer: Healthscope Whirlpool |
$133.38
|
| Rate for Payer: Mclaren Commercial |
$120.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.37
|
| Rate for Payer: Nomi Health Commercial |
$109.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.37
|
|
|
HC HEPATITIS A ANTIBODY IGM
|
Facility
|
OP
|
$133.38
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
30200299
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$133.38 |
| Rate for Payer: Aetna Commercial |
$120.04
|
| Rate for Payer: Aetna Medicare |
$11.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.07
|
| Rate for Payer: ASR ASR |
$129.38
|
| Rate for Payer: BCBS Complete |
$6.18
|
| Rate for Payer: BCBS MAPPO |
$11.26
|
| Rate for Payer: BCBS Trust/PPO |
$109.97
|
| Rate for Payer: BCN Commercial |
$109.97
|
| Rate for Payer: BCN Medicare Advantage |
$11.26
|
| Rate for Payer: Cash Price |
$106.70
|
| Rate for Payer: Cash Price |
$106.70
|
| Rate for Payer: Cofinity Commercial |
$125.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$129.38
|
| Rate for Payer: Healthscope Whirlpool |
$133.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.26
|
| Rate for Payer: Mclaren Commercial |
$120.04
|
| Rate for Payer: Mclaren Medicaid |
$11.26
|
| Rate for Payer: Mclaren Medicare |
$11.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.82
|
| Rate for Payer: Meridian Medicaid |
$6.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.37
|
| Rate for Payer: Nomi Health Commercial |
$109.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.03
|
| Rate for Payer: PACE Medicare |
$10.70
|
| Rate for Payer: PACE SWMI |
$11.26
|
| Rate for Payer: PHP Commercial |
$12.39
|
| Rate for Payer: PHP Medicaid |
$6.04
|
| Rate for Payer: PHP Medicare Advantage |
$11.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$58.11
|
| Rate for Payer: Priority Health Medicare |
$11.26
|
| Rate for Payer: Priority Health Narrow Network |
$46.49
|
| Rate for Payer: Railroad Medicare Medicare |
$11.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.26
|
| Rate for Payer: UHC Exchange |
$17.45
|
| Rate for Payer: UHC Medicaid |
$5.89
|
| Rate for Payer: UHCCP DNSP |
$11.26
|
| Rate for Payer: UHCCP Medicaid |
$5.89
|
| Rate for Payer: VA VA |
$11.26
|
|
|
HC HEPATITIS ABC PANEL
|
Facility
|
IP
|
$312.12
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
30100017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$234.09 |
| Max. Negotiated Rate |
$312.12 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: ASR ASR |
$302.76
|
| Rate for Payer: BCBS Trust/PPO |
$256.31
|
| Rate for Payer: BCN Commercial |
$256.31
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$293.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Healthscope Commercial |
$302.76
|
| Rate for Payer: Healthscope Whirlpool |
$312.12
|
| Rate for Payer: Mclaren Commercial |
$280.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.67
|
|
|
HC HEPATITIS ABC PANEL
|
Facility
|
OP
|
$312.12
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
30100017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$312.12 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: Aetna Medicare |
$47.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.54
|
| Rate for Payer: ASR ASR |
$302.76
|
| Rate for Payer: BCBS Complete |
$26.16
|
| Rate for Payer: BCBS MAPPO |
$47.63
|
| Rate for Payer: BCBS Trust/PPO |
$257.34
|
| Rate for Payer: BCN Commercial |
$257.34
|
| Rate for Payer: BCN Medicare Advantage |
$47.63
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$293.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.63
|
| Rate for Payer: Healthscope Commercial |
$302.76
|
| Rate for Payer: Healthscope Whirlpool |
$312.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$47.63
|
| Rate for Payer: Mclaren Commercial |
$280.91
|
| Rate for Payer: Mclaren Medicaid |
$47.63
|
| Rate for Payer: Mclaren Medicare |
$47.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.01
|
| Rate for Payer: Meridian Medicaid |
$26.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$52.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.09
|
| Rate for Payer: PACE Medicare |
$45.25
|
| Rate for Payer: PACE SWMI |
$47.63
|
| Rate for Payer: PHP Commercial |
$52.39
|
| Rate for Payer: PHP Medicaid |
$25.53
|
| Rate for Payer: PHP Medicare Advantage |
$47.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$179.77
|
| Rate for Payer: Priority Health Medicare |
$47.63
|
| Rate for Payer: Priority Health Narrow Network |
$143.82
|
| Rate for Payer: Railroad Medicare Medicare |
$47.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$47.63
|
| Rate for Payer: UHC Exchange |
$73.83
|
| Rate for Payer: UHC Medicaid |
$24.91
|
| Rate for Payer: UHCCP DNSP |
$47.63
|
| Rate for Payer: UHCCP Medicaid |
$24.91
|
| Rate for Payer: VA VA |
$47.63
|
|
|
HC HEPATITIS A IGG
|
Facility
|
IP
|
$44.57
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.43 |
| Max. Negotiated Rate |
$44.57 |
| Rate for Payer: Aetna Commercial |
$40.11
|
| Rate for Payer: ASR ASR |
$43.23
|
| Rate for Payer: BCBS Trust/PPO |
$36.60
|
| Rate for Payer: BCN Commercial |
$36.60
|
| Rate for Payer: Cash Price |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$41.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.66
|
| Rate for Payer: Healthscope Commercial |
$43.23
|
| Rate for Payer: Healthscope Whirlpool |
$44.57
|
| Rate for Payer: Mclaren Commercial |
$40.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.88
|
| Rate for Payer: Nomi Health Commercial |
$36.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.22
|
|
|
HC HEPATITIS A IGG
|
Facility
|
OP
|
$44.57
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$44.57 |
| Rate for Payer: Aetna Commercial |
$40.11
|
| Rate for Payer: Aetna Medicare |
$12.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.49
|
| Rate for Payer: ASR ASR |
$43.23
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$12.39
|
| Rate for Payer: BCBS Trust/PPO |
$36.75
|
| Rate for Payer: BCN Commercial |
$36.75
|
| Rate for Payer: BCN Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$35.66
|
| Rate for Payer: Cash Price |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$41.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.39
|
| Rate for Payer: Healthscope Commercial |
$43.23
|
| Rate for Payer: Healthscope Whirlpool |
$44.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.39
|
| Rate for Payer: Mclaren Commercial |
$40.11
|
| Rate for Payer: Mclaren Medicaid |
$12.39
|
| Rate for Payer: Mclaren Medicare |
$12.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.01
|
| Rate for Payer: Meridian Medicaid |
$6.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.88
|
| Rate for Payer: Nomi Health Commercial |
$36.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.43
|
| Rate for Payer: PACE Medicare |
$11.77
|
| Rate for Payer: PACE SWMI |
$12.39
|
| Rate for Payer: PHP Commercial |
$13.63
|
| Rate for Payer: PHP Medicaid |
$6.64
|
| Rate for Payer: PHP Medicare Advantage |
$12.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39.05
|
| Rate for Payer: Priority Health Medicare |
$12.39
|
| Rate for Payer: Priority Health Narrow Network |
$31.24
|
| Rate for Payer: Railroad Medicare Medicare |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.39
|
| Rate for Payer: UHC Exchange |
$19.20
|
| Rate for Payer: UHC Medicaid |
$6.48
|
| Rate for Payer: UHCCP DNSP |
$12.39
|
| Rate for Payer: UHCCP Medicaid |
$6.48
|
| Rate for Payer: VA VA |
$12.39
|
|
|
HC HEPATITIS A TOTAL ANTIBODY
|
Facility
|
OP
|
$48.82
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200298
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$48.82 |
| Rate for Payer: Aetna Commercial |
$43.94
|
| Rate for Payer: Aetna Medicare |
$12.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.49
|
| Rate for Payer: ASR ASR |
$47.36
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$12.39
|
| Rate for Payer: BCBS Trust/PPO |
$40.25
|
| Rate for Payer: BCN Commercial |
$40.25
|
| Rate for Payer: BCN Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Commercial |
$45.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.39
|
| Rate for Payer: Healthscope Commercial |
$47.36
|
| Rate for Payer: Healthscope Whirlpool |
$48.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.39
|
| Rate for Payer: Mclaren Commercial |
$43.94
|
| Rate for Payer: Mclaren Medicaid |
$12.39
|
| Rate for Payer: Mclaren Medicare |
$12.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.01
|
| Rate for Payer: Meridian Medicaid |
$6.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.50
|
| Rate for Payer: Nomi Health Commercial |
$40.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: PACE Medicare |
$11.77
|
| Rate for Payer: PACE SWMI |
$12.39
|
| Rate for Payer: PHP Commercial |
$13.63
|
| Rate for Payer: PHP Medicaid |
$6.64
|
| Rate for Payer: PHP Medicare Advantage |
$12.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$42.78
|
| Rate for Payer: Priority Health Medicare |
$12.39
|
| Rate for Payer: Priority Health Narrow Network |
$34.22
|
| Rate for Payer: Railroad Medicare Medicare |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.39
|
| Rate for Payer: UHC Exchange |
$19.20
|
| Rate for Payer: UHC Medicaid |
$6.48
|
| Rate for Payer: UHCCP DNSP |
$12.39
|
| Rate for Payer: UHCCP Medicaid |
$6.48
|
| Rate for Payer: VA VA |
$12.39
|
|
|
HC HEPATITIS A TOTAL ANTIBODY
|
Facility
|
IP
|
$48.82
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200298
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$48.82 |
| Rate for Payer: Aetna Commercial |
$43.94
|
| Rate for Payer: ASR ASR |
$47.36
|
| Rate for Payer: BCBS Trust/PPO |
$40.09
|
| Rate for Payer: BCN Commercial |
$40.09
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Commercial |
$45.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Healthscope Commercial |
$47.36
|
| Rate for Payer: Healthscope Whirlpool |
$48.82
|
| Rate for Payer: Mclaren Commercial |
$43.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.50
|
| Rate for Payer: Nomi Health Commercial |
$40.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.96
|
|
|
HC HEPATITIS A VACCINE (HEPA) ADULT IM
|
Facility
|
OP
|
$93.39
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
63600067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$95.31 |
| Rate for Payer: Aetna Commercial |
$84.05
|
| Rate for Payer: Aetna Medicare |
$34.55
|
| Rate for Payer: ASR ASR |
$90.59
|
| Rate for Payer: BCBS Complete |
$37.36
|
| Rate for Payer: BCBS Trust/PPO |
$77.00
|
| Rate for Payer: BCN Commercial |
$77.00
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Commercial |
$87.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$90.59
|
| Rate for Payer: Healthscope Whirlpool |
$93.39
|
| Rate for Payer: Mclaren Commercial |
$84.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Nomi Health Commercial |
$76.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$95.31
|
| Rate for Payer: Priority Health Narrow Network |
$76.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.18
|
|
|
HC HEPATITIS A VACCINE (HEPA) ADULT IM
|
Facility
|
IP
|
$93.39
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
63600067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.04 |
| Max. Negotiated Rate |
$93.39 |
| Rate for Payer: Aetna Commercial |
$84.05
|
| Rate for Payer: ASR ASR |
$90.59
|
| Rate for Payer: BCBS Trust/PPO |
$76.69
|
| Rate for Payer: BCN Commercial |
$76.69
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Commercial |
$87.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$90.59
|
| Rate for Payer: Healthscope Whirlpool |
$93.39
|
| Rate for Payer: Mclaren Commercial |
$84.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Nomi Health Commercial |
$76.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.18
|
|
|
HC HEPATITIS A VAC (HEPA) PEDI/ADOLESCENT DOSAGE-2 DOSE SCHEDULE IM
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
63600068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Trust/PPO |
$43.57
|
| Rate for Payer: BCN Commercial |
$43.57
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
|
|
HC HEPATITIS A VAC (HEPA) PEDI/ADOLESCENT DOSAGE-2 DOSE SCHEDULE IM
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
63600068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$19.63
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Complete |
$21.22
|
| Rate for Payer: BCBS Trust/PPO |
$43.75
|
| Rate for Payer: BCN Commercial |
$43.75
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44.46
|
| Rate for Payer: Priority Health Narrow Network |
$35.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
IP
|
$101.96
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
30200295
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$76.47 |
| Max. Negotiated Rate |
$101.96 |
| Rate for Payer: Aetna Commercial |
$91.76
|
| Rate for Payer: ASR ASR |
$98.90
|
| Rate for Payer: BCBS Trust/PPO |
$83.73
|
| Rate for Payer: BCN Commercial |
$83.73
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$95.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Healthscope Commercial |
$98.90
|
| Rate for Payer: Healthscope Whirlpool |
$101.96
|
| Rate for Payer: Mclaren Commercial |
$91.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$83.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.72
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
OP
|
$101.96
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
30200295
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$101.96 |
| Rate for Payer: Aetna Commercial |
$91.76
|
| Rate for Payer: Aetna Medicare |
$11.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.71
|
| Rate for Payer: ASR ASR |
$98.90
|
| Rate for Payer: BCBS Complete |
$6.46
|
| Rate for Payer: BCBS MAPPO |
$11.77
|
| Rate for Payer: BCBS Trust/PPO |
$84.07
|
| Rate for Payer: BCN Commercial |
$84.07
|
| Rate for Payer: BCN Medicare Advantage |
$11.77
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$95.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.77
|
| Rate for Payer: Healthscope Commercial |
$98.90
|
| Rate for Payer: Healthscope Whirlpool |
$101.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.77
|
| Rate for Payer: Mclaren Commercial |
$91.76
|
| Rate for Payer: Mclaren Medicaid |
$11.77
|
| Rate for Payer: Mclaren Medicare |
$11.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.36
|
| Rate for Payer: Meridian Medicaid |
$6.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$83.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.47
|
| Rate for Payer: PACE Medicare |
$11.18
|
| Rate for Payer: PACE SWMI |
$11.77
|
| Rate for Payer: PHP Commercial |
$12.95
|
| Rate for Payer: PHP Medicaid |
$6.31
|
| Rate for Payer: PHP Medicare Advantage |
$11.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$89.34
|
| Rate for Payer: Priority Health Medicare |
$11.77
|
| Rate for Payer: Priority Health Narrow Network |
$71.47
|
| Rate for Payer: Railroad Medicare Medicare |
$11.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.77
|
| Rate for Payer: UHC Exchange |
$18.24
|
| Rate for Payer: UHC Medicaid |
$6.16
|
| Rate for Payer: UHCCP DNSP |
$11.77
|
| Rate for Payer: UHCCP Medicaid |
$6.16
|
| Rate for Payer: VA VA |
$11.77
|
|
