|
HC IMM COUNSELING WO ADMIN, > 10 MIN UP TO 20 MIN
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 90483
|
| Hospital Charge Code |
77100069
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$36.00
|
| Rate for Payer: Aetna Medicare |
$14.80
|
| Rate for Payer: ASR ASR |
$38.80
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$32.98
|
| Rate for Payer: BCN Commercial |
$32.98
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$37.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$38.80
|
| Rate for Payer: Healthscope Whirlpool |
$40.00
|
| Rate for Payer: Mclaren Commercial |
$36.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.00
|
| Rate for Payer: Nomi Health Commercial |
$32.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.87
|
| Rate for Payer: Priority Health Narrow Network |
$8.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.20
|
|
|
HC IMM COUNSELING WO ADMIN, > 10 MIN UP TO 20 MIN
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 90483
|
| Hospital Charge Code |
77100069
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$36.00
|
| Rate for Payer: ASR ASR |
$38.80
|
| Rate for Payer: BCBS Trust/PPO |
$32.85
|
| Rate for Payer: BCN Commercial |
$32.85
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$37.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$38.80
|
| Rate for Payer: Healthscope Whirlpool |
$40.00
|
| Rate for Payer: Mclaren Commercial |
$36.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.00
|
| Rate for Payer: Nomi Health Commercial |
$32.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.20
|
|
|
HC IMM COUNSELING WO ADMIN, > 20 MIN
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 90484
|
| Hospital Charge Code |
77100070
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: ASR ASR |
$43.65
|
| Rate for Payer: BCBS Trust/PPO |
$36.95
|
| Rate for Payer: BCN Commercial |
$36.95
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$42.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$43.65
|
| Rate for Payer: Healthscope Whirlpool |
$45.00
|
| Rate for Payer: Mclaren Commercial |
$40.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.25
|
| Rate for Payer: Nomi Health Commercial |
$36.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.60
|
|
|
HC IMM COUNSELING WO ADMIN, > 20 MIN
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 90484
|
| Hospital Charge Code |
77100070
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Medicare |
$16.65
|
| Rate for Payer: ASR ASR |
$43.65
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS Trust/PPO |
$37.10
|
| Rate for Payer: BCN Commercial |
$37.10
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$42.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$43.65
|
| Rate for Payer: Healthscope Whirlpool |
$45.00
|
| Rate for Payer: Mclaren Commercial |
$40.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.25
|
| Rate for Payer: Nomi Health Commercial |
$36.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15.08
|
| Rate for Payer: Priority Health Narrow Network |
$12.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.60
|
|
|
HC IMM COUNSELING WO ADMIN, 3 MIN UP TO 10 MIN
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 90482
|
| Hospital Charge Code |
77100068
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: ASR ASR |
$33.95
|
| Rate for Payer: BCBS Trust/PPO |
$28.74
|
| Rate for Payer: BCN Commercial |
$28.74
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$33.95
|
| Rate for Payer: Healthscope Whirlpool |
$35.00
|
| Rate for Payer: Mclaren Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Nomi Health Commercial |
$28.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.80
|
|
|
HC IMM COUNSELING WO ADMIN, 3 MIN UP TO 10 MIN
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 90482
|
| Hospital Charge Code |
77100068
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Medicare |
$12.95
|
| Rate for Payer: ASR ASR |
$33.95
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$28.86
|
| Rate for Payer: BCN Commercial |
$28.86
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$33.95
|
| Rate for Payer: Healthscope Whirlpool |
$35.00
|
| Rate for Payer: Mclaren Commercial |
$31.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Nomi Health Commercial |
$28.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.31
|
| Rate for Payer: Priority Health Narrow Network |
$5.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.80
|
|
|
HC IMMUNIZATION 18YEARS OR YOUNGER
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
77100001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: BCBS Trust/PPO |
$25.13
|
| Rate for Payer: BCN Commercial |
$25.13
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$29.68
|
| Rate for Payer: Healthscope Whirlpool |
$30.60
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
|
|
HC IMMUNIZATION 18YEARS OR YOUNGER
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
77100001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$11.32 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna Medicare |
$11.32
|
| Rate for Payer: ASR ASR |
$29.68
|
| Rate for Payer: BCBS Complete |
$12.24
|
| Rate for Payer: BCBS Trust/PPO |
$25.23
|
| Rate for Payer: BCN Commercial |
$25.23
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$28.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$29.68
|
| Rate for Payer: Healthscope Whirlpool |
$30.60
|
| Rate for Payer: Mclaren Commercial |
$27.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$26.81
|
| Rate for Payer: Priority Health Narrow Network |
$21.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.93
|
|
|
HC IMMUNIZATION 1ST VACCINE
|
Facility
|
OP
|
$33.66
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
77100003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.21 |
| Max. Negotiated Rate |
$111.20 |
| Rate for Payer: Aetna Commercial |
$30.29
|
| Rate for Payer: Aetna Medicare |
$71.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.67
|
| Rate for Payer: ASR ASR |
$32.65
|
| Rate for Payer: BCBS Complete |
$39.40
|
| Rate for Payer: BCBS MAPPO |
$71.74
|
| Rate for Payer: BCBS Trust/PPO |
$27.75
|
| Rate for Payer: BCN Commercial |
$27.75
|
| Rate for Payer: BCN Medicare Advantage |
$71.74
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cofinity Commercial |
$31.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.74
|
| Rate for Payer: Healthscope Commercial |
$32.65
|
| Rate for Payer: Healthscope Whirlpool |
$33.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$71.74
|
| Rate for Payer: Mclaren Commercial |
$30.29
|
| Rate for Payer: Mclaren Medicaid |
$71.74
|
| Rate for Payer: Mclaren Medicare |
$71.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.33
|
| Rate for Payer: Meridian Medicaid |
$39.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.61
|
| Rate for Payer: Nomi Health Commercial |
$27.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.25
|
| Rate for Payer: PACE Medicare |
$68.15
|
| Rate for Payer: PACE SWMI |
$71.74
|
| Rate for Payer: PHP Commercial |
$78.91
|
| Rate for Payer: PHP Medicaid |
$38.45
|
| Rate for Payer: PHP Medicare Advantage |
$71.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.27
|
| Rate for Payer: Priority Health Medicare |
$71.74
|
| Rate for Payer: Priority Health Narrow Network |
$16.21
|
| Rate for Payer: Railroad Medicare Medicare |
$71.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.74
|
| Rate for Payer: UHC Exchange |
$111.20
|
| Rate for Payer: UHC Medicaid |
$37.52
|
| Rate for Payer: UHCCP DNSP |
$71.74
|
| Rate for Payer: UHCCP Medicaid |
$37.52
|
| Rate for Payer: VA VA |
$71.74
|
|
|
HC IMMUNIZATION 1ST VACCINE
|
Facility
|
IP
|
$33.66
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
77100003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Aetna Commercial |
$30.29
|
| Rate for Payer: ASR ASR |
$32.65
|
| Rate for Payer: BCBS Trust/PPO |
$27.64
|
| Rate for Payer: BCN Commercial |
$27.64
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cofinity Commercial |
$31.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.93
|
| Rate for Payer: Healthscope Commercial |
$32.65
|
| Rate for Payer: Healthscope Whirlpool |
$33.66
|
| Rate for Payer: Mclaren Commercial |
$30.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.61
|
| Rate for Payer: Nomi Health Commercial |
$27.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.62
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE
|
Facility
|
IP
|
$34.12
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
77100004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.59 |
| Max. Negotiated Rate |
$34.12 |
| Rate for Payer: Aetna Commercial |
$30.71
|
| Rate for Payer: ASR ASR |
$33.10
|
| Rate for Payer: BCBS Trust/PPO |
$28.02
|
| Rate for Payer: BCN Commercial |
$28.02
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cofinity Commercial |
$32.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.30
|
| Rate for Payer: Healthscope Commercial |
$33.10
|
| Rate for Payer: Healthscope Whirlpool |
$34.12
|
| Rate for Payer: Mclaren Commercial |
$30.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.00
|
| Rate for Payer: Nomi Health Commercial |
$27.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.03
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE
|
Facility
|
OP
|
$34.12
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
77100004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$34.12 |
| Rate for Payer: Aetna Commercial |
$30.71
|
| Rate for Payer: Aetna Medicare |
$12.62
|
| Rate for Payer: ASR ASR |
$33.10
|
| Rate for Payer: BCBS Complete |
$13.65
|
| Rate for Payer: BCBS Trust/PPO |
$28.13
|
| Rate for Payer: BCN Commercial |
$28.13
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cofinity Commercial |
$32.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.30
|
| Rate for Payer: Healthscope Commercial |
$33.10
|
| Rate for Payer: Healthscope Whirlpool |
$34.12
|
| Rate for Payer: Mclaren Commercial |
$30.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.00
|
| Rate for Payer: Nomi Health Commercial |
$27.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.27
|
| Rate for Payer: Priority Health Narrow Network |
$16.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.03
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE 18 YEARS OR YOUNGER
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
77100002
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna Medicare |
$9.44
|
| Rate for Payer: ASR ASR |
$24.73
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$21.02
|
| Rate for Payer: BCN Commercial |
$21.02
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$24.73
|
| Rate for Payer: Healthscope Whirlpool |
$25.50
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.34
|
| Rate for Payer: Priority Health Narrow Network |
$17.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE 18 YEARS OR YOUNGER
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
77100002
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$19.12 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.73
|
| Rate for Payer: BCBS Trust/PPO |
$20.94
|
| Rate for Payer: BCN Commercial |
$20.94
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$24.73
|
| Rate for Payer: Healthscope Whirlpool |
$25.50
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
HC IMMUNIZATION NASAL ORAL 1ST
|
Facility
|
OP
|
$45.05
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
77100005
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$31.58 |
| Max. Negotiated Rate |
$111.20 |
| Rate for Payer: Aetna Commercial |
$40.55
|
| Rate for Payer: Aetna Medicare |
$71.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.67
|
| Rate for Payer: ASR ASR |
$43.70
|
| Rate for Payer: BCBS Complete |
$39.40
|
| Rate for Payer: BCBS MAPPO |
$71.74
|
| Rate for Payer: BCBS Trust/PPO |
$37.14
|
| Rate for Payer: BCN Commercial |
$37.14
|
| Rate for Payer: BCN Medicare Advantage |
$71.74
|
| Rate for Payer: Cash Price |
$36.04
|
| Rate for Payer: Cash Price |
$36.04
|
| Rate for Payer: Cofinity Commercial |
$42.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.74
|
| Rate for Payer: Healthscope Commercial |
$43.70
|
| Rate for Payer: Healthscope Whirlpool |
$45.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$71.74
|
| Rate for Payer: Mclaren Commercial |
$40.55
|
| Rate for Payer: Mclaren Medicaid |
$71.74
|
| Rate for Payer: Mclaren Medicare |
$71.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.33
|
| Rate for Payer: Meridian Medicaid |
$39.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.29
|
| Rate for Payer: Nomi Health Commercial |
$36.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.79
|
| Rate for Payer: PACE Medicare |
$68.15
|
| Rate for Payer: PACE SWMI |
$71.74
|
| Rate for Payer: PHP Commercial |
$78.91
|
| Rate for Payer: PHP Medicaid |
$38.45
|
| Rate for Payer: PHP Medicare Advantage |
$71.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39.47
|
| Rate for Payer: Priority Health Medicare |
$71.74
|
| Rate for Payer: Priority Health Narrow Network |
$31.58
|
| Rate for Payer: Railroad Medicare Medicare |
$71.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.74
|
| Rate for Payer: UHC Exchange |
$111.20
|
| Rate for Payer: UHC Medicaid |
$37.52
|
| Rate for Payer: UHCCP DNSP |
$71.74
|
| Rate for Payer: UHCCP Medicaid |
$37.52
|
| Rate for Payer: VA VA |
$71.74
|
|
|
HC IMMUNIZATION NASAL ORAL 1ST
|
Facility
|
IP
|
$45.05
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
77100005
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$33.79 |
| Max. Negotiated Rate |
$45.05 |
| Rate for Payer: Aetna Commercial |
$40.55
|
| Rate for Payer: ASR ASR |
$43.70
|
| Rate for Payer: BCBS Trust/PPO |
$37.00
|
| Rate for Payer: BCN Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$36.04
|
| Rate for Payer: Cofinity Commercial |
$42.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.04
|
| Rate for Payer: Healthscope Commercial |
$43.70
|
| Rate for Payer: Healthscope Whirlpool |
$45.05
|
| Rate for Payer: Mclaren Commercial |
$40.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.29
|
| Rate for Payer: Nomi Health Commercial |
$36.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.64
|
|
|
HC IMMUNIZATION ORAL/NASL EA ADD
|
Facility
|
OP
|
$33.05
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
77100006
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna Medicare |
$12.23
|
| Rate for Payer: ASR ASR |
$32.06
|
| Rate for Payer: BCBS Complete |
$13.22
|
| Rate for Payer: BCBS Trust/PPO |
$27.25
|
| Rate for Payer: BCN Commercial |
$27.25
|
| Rate for Payer: Cash Price |
$26.44
|
| Rate for Payer: Cofinity Commercial |
$31.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.44
|
| Rate for Payer: Healthscope Commercial |
$32.06
|
| Rate for Payer: Healthscope Whirlpool |
$33.05
|
| Rate for Payer: Mclaren Commercial |
$29.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.09
|
| Rate for Payer: Nomi Health Commercial |
$27.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28.96
|
| Rate for Payer: Priority Health Narrow Network |
$23.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.08
|
|
|
HC IMMUNIZATION ORAL/NASL EA ADD
|
Facility
|
IP
|
$33.05
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
77100006
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$24.79 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: ASR ASR |
$32.06
|
| Rate for Payer: BCBS Trust/PPO |
$27.14
|
| Rate for Payer: BCN Commercial |
$27.14
|
| Rate for Payer: Cash Price |
$26.44
|
| Rate for Payer: Cofinity Commercial |
$31.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.44
|
| Rate for Payer: Healthscope Commercial |
$32.06
|
| Rate for Payer: Healthscope Whirlpool |
$33.05
|
| Rate for Payer: Mclaren Commercial |
$29.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.09
|
| Rate for Payer: Nomi Health Commercial |
$27.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.08
|
|
|
HC IMMUNOASSAY MULTI STEP
|
Facility
|
IP
|
$25.47
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100659
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$25.47 |
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: ASR ASR |
$24.71
|
| Rate for Payer: BCBS Trust/PPO |
$20.92
|
| Rate for Payer: BCN Commercial |
$20.92
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Commercial |
$23.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Healthscope Commercial |
$24.71
|
| Rate for Payer: Healthscope Whirlpool |
$25.47
|
| Rate for Payer: Mclaren Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.65
|
| Rate for Payer: Nomi Health Commercial |
$20.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.41
|
|
|
HC IMMUNOASSAY MULTI STEP
|
Facility
|
OP
|
$25.47
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100659
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$232.43 |
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: ASR ASR |
$24.71
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$21.00
|
| Rate for Payer: BCN Commercial |
$21.00
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Commercial |
$23.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$24.71
|
| Rate for Payer: Healthscope Whirlpool |
$25.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$22.92
|
| Rate for Payer: Mclaren Medicaid |
$11.53
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.65
|
| Rate for Payer: Nomi Health Commercial |
$20.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.10
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.18
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$232.43
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$185.94
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP DNSP |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC IMMUNOASSAY MULTI STEP ADDITIONAL
|
Facility
|
OP
|
$39.80
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$232.43 |
| Rate for Payer: Aetna Commercial |
$35.82
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: ASR ASR |
$38.61
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$32.82
|
| Rate for Payer: BCN Commercial |
$32.82
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$38.61
|
| Rate for Payer: Healthscope Whirlpool |
$39.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$35.82
|
| Rate for Payer: Mclaren Medicaid |
$11.53
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: Nomi Health Commercial |
$32.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.85
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.18
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$232.43
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$185.94
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP DNSP |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC IMMUNOASSAY MULTI STEP ADDITIONAL
|
Facility
|
IP
|
$39.80
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$39.80 |
| Rate for Payer: Aetna Commercial |
$35.82
|
| Rate for Payer: ASR ASR |
$38.61
|
| Rate for Payer: BCBS Trust/PPO |
$32.68
|
| Rate for Payer: BCN Commercial |
$32.68
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$38.61
|
| Rate for Payer: Healthscope Whirlpool |
$39.80
|
| Rate for Payer: Mclaren Commercial |
$35.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: Nomi Health Commercial |
$32.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.02
|
|
|
HC IMMUNOASSAY MULTI STEP FIRST
|
Facility
|
OP
|
$39.80
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$232.43 |
| Rate for Payer: Aetna Commercial |
$35.82
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: ASR ASR |
$38.61
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$32.82
|
| Rate for Payer: BCN Commercial |
$32.82
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$38.61
|
| Rate for Payer: Healthscope Whirlpool |
$39.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$35.82
|
| Rate for Payer: Mclaren Medicaid |
$11.53
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: Nomi Health Commercial |
$32.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.85
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.18
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$232.43
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$185.94
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP DNSP |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC IMMUNOASSAY MULTI STEP FIRST
|
Facility
|
IP
|
$39.80
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$39.80 |
| Rate for Payer: Aetna Commercial |
$35.82
|
| Rate for Payer: ASR ASR |
$38.61
|
| Rate for Payer: BCBS Trust/PPO |
$32.68
|
| Rate for Payer: BCN Commercial |
$32.68
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$38.61
|
| Rate for Payer: Healthscope Whirlpool |
$39.80
|
| Rate for Payer: Mclaren Commercial |
$35.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: Nomi Health Commercial |
$32.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.02
|
|
|
HC IMMUNODIFFUSION
|
Facility
|
IP
|
$127.97
|
|
|
Service Code
|
CPT 86329
|
| Hospital Charge Code |
30200191
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$95.98 |
| Max. Negotiated Rate |
$127.97 |
| Rate for Payer: Aetna Commercial |
$115.17
|
| Rate for Payer: ASR ASR |
$124.13
|
| Rate for Payer: BCBS Trust/PPO |
$105.09
|
| Rate for Payer: BCN Commercial |
$105.09
|
| Rate for Payer: Cash Price |
$102.38
|
| Rate for Payer: Cofinity Commercial |
$120.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.38
|
| Rate for Payer: Healthscope Commercial |
$124.13
|
| Rate for Payer: Healthscope Whirlpool |
$127.97
|
| Rate for Payer: Mclaren Commercial |
$115.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.77
|
| Rate for Payer: Nomi Health Commercial |
$104.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.61
|
|
