|
HC HEPATITIS B SURFACE ANTIGEN
|
Facility
|
OP
|
$38.85
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600139
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$38.85 |
| Rate for Payer: Aetna Commercial |
$34.97
|
| 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 |
$37.68
|
| Rate for Payer: ASR Commercial |
$37.68
|
| Rate for Payer: BCBS Complete |
$5.81
|
| Rate for Payer: BCBS MAPPO |
$10.33
|
| Rate for Payer: BCBS Trust/PPO |
$31.81
|
| Rate for Payer: BCN Commercial |
$30.12
|
| Rate for Payer: BCN Medicare Advantage |
$10.33
|
| Rate for Payer: Cash Price |
$31.08
|
| Rate for Payer: Cash Price |
$31.08
|
| Rate for Payer: Cofinity Commercial |
$36.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.33
|
| Rate for Payer: Healthscope Commercial |
$38.85
|
| Rate for Payer: Healthscope Whirlpool |
$37.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.33
|
| Rate for Payer: Mclaren Commercial |
$34.97
|
| Rate for Payer: Mclaren Medicaid |
$5.54
|
| Rate for Payer: Mclaren Medicare |
$10.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.85
|
| Rate for Payer: Meridian Medicaid |
$5.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.02
|
| Rate for Payer: Nomi Health Commercial |
$31.86
|
| 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 |
$5.54
|
| Rate for Payer: PHP Medicare Advantage |
$10.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.04
|
| Rate for Payer: Priority Health Medicare |
$10.33
|
| Rate for Payer: Priority Health Narrow Network |
$27.23
|
| Rate for Payer: Railroad Medicare Medicare |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.33
|
| Rate for Payer: UHC Exchange |
$16.01
|
| Rate for Payer: UHC Medicare Advantage |
$10.33
|
| Rate for Payer: UHCCP DNSP |
$10.33
|
| Rate for Payer: UHCCP Medicaid |
$5.54
|
| Rate for Payer: VA VA |
$10.33
|
|
|
HC HEPATITIS B SURFACE ANTIGEN NEUTRALIZATION
|
Facility
|
OP
|
$74.46
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
30600141
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$74.46 |
| Rate for Payer: Aetna Commercial |
$67.01
|
| 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 |
$72.23
|
| Rate for Payer: ASR Commercial |
$72.23
|
| Rate for Payer: BCBS Complete |
$5.81
|
| Rate for Payer: BCBS MAPPO |
$10.33
|
| Rate for Payer: BCBS Trust/PPO |
$60.98
|
| Rate for Payer: BCN Commercial |
$57.73
|
| Rate for Payer: BCN Medicare Advantage |
$10.33
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cofinity Commercial |
$69.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.33
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Healthscope Whirlpool |
$72.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.33
|
| Rate for Payer: Mclaren Commercial |
$67.01
|
| Rate for Payer: Mclaren Medicaid |
$5.54
|
| Rate for Payer: Mclaren Medicare |
$10.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.85
|
| Rate for Payer: Meridian Medicaid |
$5.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.29
|
| Rate for Payer: Nomi Health Commercial |
$61.06
|
| 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 |
$5.54
|
| Rate for Payer: PHP Medicare Advantage |
$10.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.24
|
| Rate for Payer: Priority Health Medicare |
$10.33
|
| Rate for Payer: Priority Health Narrow Network |
$52.20
|
| Rate for Payer: Railroad Medicare Medicare |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.33
|
| Rate for Payer: UHC Exchange |
$16.01
|
| Rate for Payer: UHC Medicare Advantage |
$10.33
|
| Rate for Payer: UHCCP DNSP |
$10.33
|
| Rate for Payer: UHCCP Medicaid |
$5.54
|
| Rate for Payer: VA VA |
$10.33
|
|
|
HC HEPATITIS B SURFACE ANTIGEN NEUTRALIZATION
|
Facility
|
IP
|
$74.46
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
30600141
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$74.46 |
| Rate for Payer: Aetna Commercial |
$67.01
|
| Rate for Payer: ASR ASR |
$72.23
|
| Rate for Payer: ASR Commercial |
$72.23
|
| Rate for Payer: BCBS Trust/PPO |
$60.68
|
| Rate for Payer: BCN Commercial |
$57.73
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cofinity Commercial |
$69.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.57
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Healthscope Whirlpool |
$72.23
|
| Rate for Payer: Mclaren Commercial |
$67.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.29
|
| Rate for Payer: Nomi Health Commercial |
$61.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.52
|
|
|
HC HEPATITIS B VACCINE ADULT, 3 DOSE IM
|
Facility
|
OP
|
$84.27
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
63600026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.71 |
| Max. Negotiated Rate |
$84.27 |
| Rate for Payer: Aetna Commercial |
$75.84
|
| Rate for Payer: Aetna Medicare |
$42.13
|
| Rate for Payer: ASR ASR |
$81.74
|
| Rate for Payer: ASR Commercial |
$81.74
|
| Rate for Payer: BCBS Complete |
$33.71
|
| Rate for Payer: BCBS Trust/PPO |
$69.01
|
| Rate for Payer: BCN Commercial |
$65.33
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$79.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.42
|
| Rate for Payer: Healthscope Commercial |
$84.27
|
| Rate for Payer: Healthscope Whirlpool |
$81.74
|
| Rate for Payer: Mclaren Commercial |
$75.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.63
|
| Rate for Payer: Nomi Health Commercial |
$69.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.84
|
| Rate for Payer: Priority Health Narrow Network |
$59.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.16
|
|
|
HC HEPATITIS B VACCINE ADULT, 3 DOSE IM
|
Facility
|
IP
|
$84.27
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
63600026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$84.27 |
| Rate for Payer: Aetna Commercial |
$75.84
|
| Rate for Payer: ASR ASR |
$81.74
|
| Rate for Payer: ASR Commercial |
$81.74
|
| Rate for Payer: BCBS Trust/PPO |
$68.67
|
| Rate for Payer: BCN Commercial |
$65.33
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$79.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.42
|
| Rate for Payer: Healthscope Commercial |
$84.27
|
| Rate for Payer: Healthscope Whirlpool |
$81.74
|
| Rate for Payer: Mclaren Commercial |
$75.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.63
|
| Rate for Payer: Nomi Health Commercial |
$69.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.16
|
|
|
HC HEPATITIS C ANTIBODY
|
Facility
|
OP
|
$49.23
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
30200336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$49.23 |
| Rate for Payer: Aetna Commercial |
$44.31
|
| 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 |
$47.75
|
| Rate for Payer: ASR Commercial |
$47.75
|
| Rate for Payer: BCBS Complete |
$8.03
|
| Rate for Payer: BCBS MAPPO |
$14.27
|
| Rate for Payer: BCBS Trust/PPO |
$40.31
|
| Rate for Payer: BCN Commercial |
$38.17
|
| Rate for Payer: BCN Medicare Advantage |
$14.27
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cofinity Commercial |
$46.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.27
|
| Rate for Payer: Healthscope Commercial |
$49.23
|
| Rate for Payer: Healthscope Whirlpool |
$47.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.27
|
| Rate for Payer: Mclaren Commercial |
$44.31
|
| Rate for Payer: Mclaren Medicaid |
$7.65
|
| Rate for Payer: Mclaren Medicare |
$14.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.98
|
| Rate for Payer: Meridian Medicaid |
$8.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.85
|
| Rate for Payer: Nomi Health Commercial |
$40.37
|
| 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 |
$7.65
|
| Rate for Payer: PHP Medicare Advantage |
$14.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.14
|
| Rate for Payer: Priority Health Medicare |
$14.27
|
| Rate for Payer: Priority Health Narrow Network |
$34.51
|
| Rate for Payer: Railroad Medicare Medicare |
$14.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.27
|
| Rate for Payer: UHC Exchange |
$22.12
|
| Rate for Payer: UHC Medicare Advantage |
$14.27
|
| Rate for Payer: UHCCP DNSP |
$14.27
|
| Rate for Payer: UHCCP Medicaid |
$7.65
|
| Rate for Payer: VA VA |
$14.27
|
|
|
HC HEPATITIS C ANTIBODY
|
Facility
|
IP
|
$49.23
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
30200336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$49.23 |
| Rate for Payer: Aetna Commercial |
$44.31
|
| Rate for Payer: ASR ASR |
$47.75
|
| Rate for Payer: ASR Commercial |
$47.75
|
| Rate for Payer: BCBS Trust/PPO |
$40.12
|
| Rate for Payer: BCN Commercial |
$38.17
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cofinity Commercial |
$46.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.38
|
| Rate for Payer: Healthscope Commercial |
$49.23
|
| Rate for Payer: Healthscope Whirlpool |
$47.75
|
| Rate for Payer: Mclaren Commercial |
$44.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.85
|
| Rate for Payer: Nomi Health Commercial |
$40.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.32
|
|
|
HC HEPATITIS C ANTIBODY BY RIBA
|
Facility
|
IP
|
$82.62
|
|
|
Service Code
|
CPT 86804
|
| Hospital Charge Code |
30200337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$74.36
|
| Rate for Payer: ASR ASR |
$80.14
|
| Rate for Payer: ASR Commercial |
$80.14
|
| Rate for Payer: BCBS Trust/PPO |
$67.33
|
| 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 Commercial |
$70.23
|
| Rate for Payer: Nomi Health Commercial |
$67.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.71
|
|
|
HC HEPATITIS C ANTIBODY BY RIBA
|
Facility
|
OP
|
$82.62
|
|
|
Service Code
|
CPT 86804
|
| Hospital Charge Code |
30200337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$74.36
|
| 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 |
$80.14
|
| Rate for Payer: ASR Commercial |
$80.14
|
| Rate for Payer: BCBS Complete |
$8.72
|
| Rate for Payer: BCBS MAPPO |
$15.49
|
| Rate for Payer: BCBS Trust/PPO |
$67.66
|
| Rate for Payer: BCN Commercial |
$64.06
|
| Rate for Payer: BCN Medicare Advantage |
$15.49
|
| Rate for Payer: Cash Price |
$66.10
|
| 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: Health Alliance Plan Medicare Advantage |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Healthscope Whirlpool |
$80.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.49
|
| Rate for Payer: Mclaren Commercial |
$74.36
|
| Rate for Payer: Mclaren Medicaid |
$8.30
|
| Rate for Payer: Mclaren Medicare |
$15.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.26
|
| Rate for Payer: Meridian Medicaid |
$8.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.23
|
| Rate for Payer: Nomi Health Commercial |
$67.75
|
| 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 |
$8.30
|
| Rate for Payer: PHP Medicare Advantage |
$15.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.39
|
| Rate for Payer: Priority Health Medicare |
$15.49
|
| Rate for Payer: Priority Health Narrow Network |
$57.92
|
| Rate for Payer: Railroad Medicare Medicare |
$15.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.49
|
| Rate for Payer: UHC Exchange |
$24.01
|
| Rate for Payer: UHC Medicare Advantage |
$15.49
|
| Rate for Payer: UHCCP DNSP |
$15.49
|
| Rate for Payer: UHCCP Medicaid |
$8.30
|
| Rate for Payer: VA VA |
$15.49
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANT
|
Facility
|
OP
|
$152.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600295
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$152.94 |
| Rate for Payer: Aetna Commercial |
$137.65
|
| 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 |
$148.35
|
| Rate for Payer: ASR Commercial |
$148.35
|
| Rate for Payer: BCBS Complete |
$24.11
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$125.24
|
| Rate for Payer: BCN Commercial |
$118.57
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$122.35
|
| Rate for Payer: Cash Price |
$122.35
|
| Rate for Payer: Cofinity Commercial |
$143.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$152.94
|
| Rate for Payer: Healthscope Whirlpool |
$148.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.84
|
| Rate for Payer: Mclaren Commercial |
$137.65
|
| Rate for Payer: Mclaren Medicaid |
$22.96
|
| Rate for Payer: Mclaren Medicare |
$42.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.98
|
| Rate for Payer: Meridian Medicaid |
$24.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.00
|
| Rate for Payer: Nomi Health Commercial |
$125.41
|
| 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 |
$22.96
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.01
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health Narrow Network |
$107.21
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.84
|
| Rate for Payer: UHC Exchange |
$66.40
|
| Rate for Payer: UHC Medicare Advantage |
$42.84
|
| Rate for Payer: UHCCP DNSP |
$42.84
|
| Rate for Payer: UHCCP Medicaid |
$22.96
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANT
|
Facility
|
IP
|
$152.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600295
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$99.41 |
| Max. Negotiated Rate |
$152.94 |
| Rate for Payer: Aetna Commercial |
$137.65
|
| Rate for Payer: ASR ASR |
$148.35
|
| Rate for Payer: ASR Commercial |
$148.35
|
| Rate for Payer: BCBS Trust/PPO |
$124.63
|
| Rate for Payer: BCN Commercial |
$118.57
|
| Rate for Payer: Cash Price |
$122.35
|
| Rate for Payer: Cofinity Commercial |
$143.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.35
|
| Rate for Payer: Healthscope Commercial |
$152.94
|
| Rate for Payer: Healthscope Whirlpool |
$148.35
|
| Rate for Payer: Mclaren Commercial |
$137.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.00
|
| Rate for Payer: Nomi Health Commercial |
$125.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.59
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANTIFICATION
|
Facility
|
OP
|
$152.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600157
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$152.94 |
| Rate for Payer: Aetna Commercial |
$137.65
|
| 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 |
$148.35
|
| Rate for Payer: ASR Commercial |
$148.35
|
| Rate for Payer: BCBS Complete |
$24.11
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$125.24
|
| Rate for Payer: BCN Commercial |
$118.57
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$122.35
|
| Rate for Payer: Cash Price |
$122.35
|
| Rate for Payer: Cofinity Commercial |
$143.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$152.94
|
| Rate for Payer: Healthscope Whirlpool |
$148.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.84
|
| Rate for Payer: Mclaren Commercial |
$137.65
|
| Rate for Payer: Mclaren Medicaid |
$22.96
|
| Rate for Payer: Mclaren Medicare |
$42.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.98
|
| Rate for Payer: Meridian Medicaid |
$24.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.00
|
| Rate for Payer: Nomi Health Commercial |
$125.41
|
| 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 |
$22.96
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.01
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health Narrow Network |
$107.21
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.84
|
| Rate for Payer: UHC Exchange |
$66.40
|
| Rate for Payer: UHC Medicare Advantage |
$42.84
|
| Rate for Payer: UHCCP DNSP |
$42.84
|
| Rate for Payer: UHCCP Medicaid |
$22.96
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANTIFICATION
|
Facility
|
IP
|
$152.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600157
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$99.41 |
| Max. Negotiated Rate |
$152.94 |
| Rate for Payer: Aetna Commercial |
$137.65
|
| Rate for Payer: ASR ASR |
$148.35
|
| Rate for Payer: ASR Commercial |
$148.35
|
| Rate for Payer: BCBS Trust/PPO |
$124.63
|
| Rate for Payer: BCN Commercial |
$118.57
|
| Rate for Payer: Cash Price |
$122.35
|
| Rate for Payer: Cofinity Commercial |
$143.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.35
|
| Rate for Payer: Healthscope Commercial |
$152.94
|
| Rate for Payer: Healthscope Whirlpool |
$148.35
|
| Rate for Payer: Mclaren Commercial |
$137.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.00
|
| Rate for Payer: Nomi Health Commercial |
$125.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.59
|
|
|
HC HEPATITS B VACCINE (HEPB), PEDIATRIC/ADOLESCENT, 3 DOSE IM
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
63600086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$36.41 |
| Rate for Payer: Aetna Commercial |
$32.77
|
| Rate for Payer: ASR ASR |
$35.32
|
| Rate for Payer: ASR Commercial |
$35.32
|
| Rate for Payer: BCBS Trust/PPO |
$29.67
|
| Rate for Payer: BCN Commercial |
$28.23
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$36.41
|
| Rate for Payer: Healthscope Whirlpool |
$35.32
|
| Rate for Payer: Mclaren Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.04
|
|
|
HC HEPATITS B VACCINE (HEPB), PEDIATRIC/ADOLESCENT, 3 DOSE IM
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
63600086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$36.41 |
| Rate for Payer: Aetna Commercial |
$32.77
|
| Rate for Payer: Aetna Medicare |
$18.20
|
| Rate for Payer: ASR ASR |
$35.32
|
| Rate for Payer: ASR Commercial |
$35.32
|
| Rate for Payer: BCBS Complete |
$14.56
|
| Rate for Payer: BCBS Trust/PPO |
$29.82
|
| Rate for Payer: BCN Commercial |
$28.23
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$36.41
|
| Rate for Payer: Healthscope Whirlpool |
$35.32
|
| Rate for Payer: Mclaren Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.90
|
| Rate for Payer: Priority Health Narrow Network |
$25.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.04
|
|
|
HC HEP B ADMINISTRATION
|
Facility
|
OP
|
$34.17
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
77100008
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.21 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: Aetna Commercial |
$30.75
|
| Rate for Payer: Aetna Medicare |
$45.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: ASR ASR |
$33.14
|
| Rate for Payer: ASR Commercial |
$33.14
|
| Rate for Payer: BCBS Complete |
$25.33
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$27.98
|
| Rate for Payer: BCN Commercial |
$26.49
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Cofinity Commercial |
$32.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$34.17
|
| Rate for Payer: Healthscope Whirlpool |
$33.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$45.00
|
| Rate for Payer: Mclaren Commercial |
$30.75
|
| Rate for Payer: Mclaren Medicaid |
$24.12
|
| Rate for Payer: Mclaren Medicare |
$45.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: Meridian Medicaid |
$25.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.04
|
| Rate for Payer: Nomi Health Commercial |
$28.02
|
| Rate for Payer: PACE Medicare |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: PHP Medicaid |
$24.12
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.94
|
| Rate for Payer: Priority Health Medicare |
$45.00
|
| Rate for Payer: Priority Health Narrow Network |
$23.95
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.00
|
| Rate for Payer: UHC Exchange |
$69.75
|
| Rate for Payer: UHC Medicare Advantage |
$45.00
|
| Rate for Payer: UHCCP DNSP |
$45.00
|
| Rate for Payer: UHCCP Medicaid |
$24.12
|
| Rate for Payer: VA VA |
$45.00
|
|
|
HC HEP B ADMINISTRATION
|
Facility
|
IP
|
$34.17
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
77100008
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.21 |
| Max. Negotiated Rate |
$34.17 |
| Rate for Payer: Aetna Commercial |
$30.75
|
| Rate for Payer: ASR ASR |
$33.14
|
| Rate for Payer: ASR Commercial |
$33.14
|
| Rate for Payer: BCBS Trust/PPO |
$27.85
|
| Rate for Payer: BCN Commercial |
$26.49
|
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Cofinity Commercial |
$32.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.34
|
| Rate for Payer: Healthscope Commercial |
$34.17
|
| Rate for Payer: Healthscope Whirlpool |
$33.14
|
| Rate for Payer: Mclaren Commercial |
$30.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.04
|
| Rate for Payer: Nomi Health Commercial |
$28.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.07
|
|
|
HC HEP B CORE AB TOTAL.
|
Facility
|
IP
|
$99.96
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200293
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$99.96 |
| Rate for Payer: Healthscope Whirlpool |
$96.96
|
| Rate for Payer: Mclaren Commercial |
$89.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.97
|
| Rate for Payer: Nomi Health Commercial |
$81.97
|
| Rate for Payer: Aetna Commercial |
$89.96
|
| Rate for Payer: ASR ASR |
$96.96
|
| Rate for Payer: ASR Commercial |
$96.96
|
| Rate for Payer: BCBS Trust/PPO |
$81.46
|
| Rate for Payer: BCN Commercial |
$77.50
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$93.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Healthscope Commercial |
$99.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.96
|
|
|
HC HEP B CORE AB TOTAL.
|
Facility
|
OP
|
$99.96
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200293
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$99.96 |
| Rate for Payer: Aetna Commercial |
$89.96
|
| 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 |
$96.96
|
| Rate for Payer: ASR Commercial |
$96.96
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$81.86
|
| Rate for Payer: BCN Commercial |
$77.50
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$93.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$99.96
|
| Rate for Payer: Healthscope Whirlpool |
$96.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$89.96
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.97
|
| Rate for Payer: Nomi Health Commercial |
$81.97
|
| 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 |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.58
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$70.07
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC HEP B SURFACE ANTIGEN CONFIRMATION
|
Facility
|
IP
|
$45.93
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600140
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: ASR ASR |
$44.55
|
| Rate for Payer: ASR Commercial |
$44.55
|
| Rate for Payer: BCBS Trust/PPO |
$37.43
|
| Rate for Payer: BCN Commercial |
$35.61
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cofinity Commercial |
$43.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.74
|
| Rate for Payer: Healthscope Commercial |
$45.93
|
| Rate for Payer: Healthscope Whirlpool |
$44.55
|
| Rate for Payer: Mclaren Commercial |
$41.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.04
|
| Rate for Payer: Nomi Health Commercial |
$37.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.42
|
|
|
HC HEP B SURFACE ANTIGEN CONFIRMATION
|
Facility
|
OP
|
$45.93
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600140
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| 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 |
$44.55
|
| Rate for Payer: ASR Commercial |
$44.55
|
| Rate for Payer: BCBS Complete |
$5.81
|
| Rate for Payer: BCBS MAPPO |
$10.33
|
| Rate for Payer: BCBS Trust/PPO |
$37.61
|
| Rate for Payer: BCN Commercial |
$35.61
|
| Rate for Payer: BCN Medicare Advantage |
$10.33
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cofinity Commercial |
$43.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.33
|
| Rate for Payer: Healthscope Commercial |
$45.93
|
| Rate for Payer: Healthscope Whirlpool |
$44.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.33
|
| Rate for Payer: Mclaren Commercial |
$41.34
|
| Rate for Payer: Mclaren Medicaid |
$5.54
|
| Rate for Payer: Mclaren Medicare |
$10.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.85
|
| Rate for Payer: Meridian Medicaid |
$5.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.04
|
| Rate for Payer: Nomi Health Commercial |
$37.66
|
| 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 |
$5.54
|
| Rate for Payer: PHP Medicare Advantage |
$10.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.24
|
| Rate for Payer: Priority Health Medicare |
$10.33
|
| Rate for Payer: Priority Health Narrow Network |
$32.20
|
| Rate for Payer: Railroad Medicare Medicare |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.33
|
| Rate for Payer: UHC Exchange |
$16.01
|
| Rate for Payer: UHC Medicare Advantage |
$10.33
|
| Rate for Payer: UHCCP DNSP |
$10.33
|
| Rate for Payer: UHCCP Medicaid |
$5.54
|
| Rate for Payer: VA VA |
$10.33
|
|
|
HC HEP B VACC 2 DOSE ADULT IM
|
Facility
|
IP
|
$332.93
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
63600181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$216.40 |
| Max. Negotiated Rate |
$332.93 |
| Rate for Payer: Aetna Commercial |
$299.64
|
| Rate for Payer: ASR ASR |
$322.94
|
| Rate for Payer: ASR Commercial |
$322.94
|
| Rate for Payer: BCBS Trust/PPO |
$271.30
|
| Rate for Payer: BCN Commercial |
$258.12
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cofinity Commercial |
$312.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.34
|
| Rate for Payer: Healthscope Commercial |
$332.93
|
| Rate for Payer: Healthscope Whirlpool |
$322.94
|
| Rate for Payer: Mclaren Commercial |
$299.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.99
|
| Rate for Payer: Nomi Health Commercial |
$273.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.98
|
|
|
HC HEP B VACC 2 DOSE ADULT IM
|
Facility
|
OP
|
$332.93
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
63600181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.17 |
| Max. Negotiated Rate |
$332.93 |
| Rate for Payer: Aetna Commercial |
$299.64
|
| Rate for Payer: Aetna Medicare |
$166.47
|
| Rate for Payer: ASR ASR |
$322.94
|
| Rate for Payer: ASR Commercial |
$322.94
|
| Rate for Payer: BCBS Complete |
$133.17
|
| Rate for Payer: BCBS Trust/PPO |
$272.64
|
| Rate for Payer: BCN Commercial |
$258.12
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cofinity Commercial |
$312.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.34
|
| Rate for Payer: Healthscope Commercial |
$332.93
|
| Rate for Payer: Healthscope Whirlpool |
$322.94
|
| Rate for Payer: Mclaren Commercial |
$299.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.99
|
| Rate for Payer: Nomi Health Commercial |
$273.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$291.71
|
| Rate for Payer: Priority Health Narrow Network |
$233.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.98
|
|
|
HC HEP C GENO SUBTYPES
|
Facility
|
IP
|
$421.13
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600256
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$273.73 |
| Max. Negotiated Rate |
$421.13 |
| Rate for Payer: Aetna Commercial |
$379.02
|
| Rate for Payer: ASR ASR |
$408.50
|
| Rate for Payer: ASR Commercial |
$408.50
|
| Rate for Payer: BCBS Trust/PPO |
$343.18
|
| Rate for Payer: BCN Commercial |
$326.50
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cofinity Commercial |
$395.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.90
|
| Rate for Payer: Healthscope Commercial |
$421.13
|
| Rate for Payer: Healthscope Whirlpool |
$408.50
|
| Rate for Payer: Mclaren Commercial |
$379.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.96
|
| Rate for Payer: Nomi Health Commercial |
$345.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.59
|
|
|
HC HEP C GENO SUBTYPES
|
Facility
|
OP
|
$421.13
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600256
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$137.99 |
| Max. Negotiated Rate |
$421.13 |
| Rate for Payer: Aetna Commercial |
$379.02
|
| 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 |
$408.50
|
| Rate for Payer: ASR Commercial |
$408.50
|
| Rate for Payer: BCBS Complete |
$144.89
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCBS Trust/PPO |
$344.86
|
| Rate for Payer: BCN Commercial |
$326.50
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cofinity Commercial |
$395.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Healthscope Commercial |
$421.13
|
| Rate for Payer: Healthscope Whirlpool |
$408.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$257.45
|
| Rate for Payer: Mclaren Commercial |
$379.02
|
| Rate for Payer: Mclaren Medicaid |
$137.99
|
| Rate for Payer: Mclaren Medicare |
$257.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.32
|
| Rate for Payer: Meridian Medicaid |
$144.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.96
|
| Rate for Payer: Nomi Health Commercial |
$345.33
|
| Rate for Payer: PACE Medicare |
$244.58
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PHP Commercial |
$283.19
|
| Rate for Payer: PHP Medicaid |
$137.99
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$368.99
|
| Rate for Payer: Priority Health Medicare |
$257.45
|
| Rate for Payer: Priority Health Narrow Network |
$295.21
|
| Rate for Payer: Railroad Medicare Medicare |
$257.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.45
|
| Rate for Payer: UHC Exchange |
$399.05
|
| Rate for Payer: UHC Medicare Advantage |
$257.45
|
| Rate for Payer: UHCCP DNSP |
$257.45
|
| Rate for Payer: UHCCP Medicaid |
$137.99
|
| Rate for Payer: VA VA |
$257.45
|
|
