|
HC PLT PHER LEUKO REDUCED
|
Facility
|
OP
|
$2,248.39
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$260.95 |
| Max. Negotiated Rate |
$2,248.39 |
| Rate for Payer: Aetna Commercial |
$2,023.55
|
| Rate for Payer: Aetna Medicare |
$498.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.67
|
| Rate for Payer: ASR ASR |
$2,180.94
|
| Rate for Payer: BCBS Complete |
$274.02
|
| Rate for Payer: BCBS MAPPO |
$498.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,853.80
|
| Rate for Payer: BCN Commercial |
$1,853.80
|
| Rate for Payer: BCN Medicare Advantage |
$498.94
|
| Rate for Payer: Cash Price |
$1,798.71
|
| Rate for Payer: Cash Price |
$1,798.71
|
| Rate for Payer: Cofinity Commercial |
$2,113.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,798.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.94
|
| Rate for Payer: Healthscope Commercial |
$2,180.94
|
| Rate for Payer: Healthscope Whirlpool |
$2,248.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$498.94
|
| Rate for Payer: Mclaren Commercial |
$2,023.55
|
| Rate for Payer: Mclaren Medicaid |
$498.94
|
| Rate for Payer: Mclaren Medicare |
$498.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.89
|
| Rate for Payer: Meridian Medicaid |
$274.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$548.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,911.13
|
| Rate for Payer: Nomi Health Commercial |
$1,843.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,686.29
|
| Rate for Payer: PACE Medicare |
$473.99
|
| Rate for Payer: PACE SWMI |
$498.94
|
| Rate for Payer: PHP Commercial |
$548.83
|
| Rate for Payer: PHP Medicaid |
$267.43
|
| Rate for Payer: PHP Medicare Advantage |
$498.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$962.40
|
| Rate for Payer: Priority Health Medicare |
$498.94
|
| Rate for Payer: Priority Health Narrow Network |
$769.92
|
| Rate for Payer: Railroad Medicare Medicare |
$498.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,978.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$498.94
|
| Rate for Payer: UHC Exchange |
$773.36
|
| Rate for Payer: UHC Medicaid |
$260.95
|
| Rate for Payer: UHCCP DNSP |
$498.94
|
| Rate for Payer: UHCCP Medicaid |
$260.95
|
| Rate for Payer: VA VA |
$498.94
|
|
|
HC PLT PHER LEUKO REDUCED
|
Facility
|
IP
|
$2,248.39
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,686.29 |
| Max. Negotiated Rate |
$2,248.39 |
| Rate for Payer: Aetna Commercial |
$2,023.55
|
| Rate for Payer: ASR ASR |
$2,180.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,846.38
|
| Rate for Payer: BCN Commercial |
$1,846.38
|
| Rate for Payer: Cash Price |
$1,798.71
|
| Rate for Payer: Cofinity Commercial |
$2,113.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,798.71
|
| Rate for Payer: Healthscope Commercial |
$2,180.94
|
| Rate for Payer: Healthscope Whirlpool |
$2,248.39
|
| Rate for Payer: Mclaren Commercial |
$2,023.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,911.13
|
| Rate for Payer: Nomi Health Commercial |
$1,843.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,686.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,978.58
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
IP
|
$2,944.40
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2,208.30 |
| Max. Negotiated Rate |
$2,944.40 |
| Rate for Payer: Aetna Commercial |
$2,649.96
|
| Rate for Payer: ASR ASR |
$2,856.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,417.94
|
| Rate for Payer: BCN Commercial |
$2,417.94
|
| Rate for Payer: Cash Price |
$2,355.52
|
| Rate for Payer: Cofinity Commercial |
$2,767.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,355.52
|
| Rate for Payer: Healthscope Commercial |
$2,856.07
|
| Rate for Payer: Healthscope Whirlpool |
$2,944.40
|
| Rate for Payer: Mclaren Commercial |
$2,649.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,502.74
|
| Rate for Payer: Nomi Health Commercial |
$2,414.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,208.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,591.07
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$2,944.40
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$347.16 |
| Max. Negotiated Rate |
$2,944.40 |
| Rate for Payer: Aetna Commercial |
$2,649.96
|
| Rate for Payer: Aetna Medicare |
$663.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$829.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$829.74
|
| Rate for Payer: ASR ASR |
$2,856.07
|
| Rate for Payer: BCBS Complete |
$364.55
|
| Rate for Payer: BCBS MAPPO |
$663.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,427.66
|
| Rate for Payer: BCN Commercial |
$2,427.66
|
| Rate for Payer: BCN Medicare Advantage |
$663.79
|
| Rate for Payer: Cash Price |
$2,355.52
|
| Rate for Payer: Cash Price |
$2,355.52
|
| Rate for Payer: Cofinity Commercial |
$2,767.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,355.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$663.79
|
| Rate for Payer: Healthscope Commercial |
$2,856.07
|
| Rate for Payer: Healthscope Whirlpool |
$2,944.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$663.79
|
| Rate for Payer: Mclaren Commercial |
$2,649.96
|
| Rate for Payer: Mclaren Medicaid |
$663.79
|
| Rate for Payer: Mclaren Medicare |
$663.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$696.98
|
| Rate for Payer: Meridian Medicaid |
$364.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$763.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$730.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,502.74
|
| Rate for Payer: Nomi Health Commercial |
$2,414.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,208.30
|
| Rate for Payer: PACE Medicare |
$630.60
|
| Rate for Payer: PACE SWMI |
$663.79
|
| Rate for Payer: PHP Commercial |
$730.17
|
| Rate for Payer: PHP Medicaid |
$355.79
|
| Rate for Payer: PHP Medicare Advantage |
$663.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,587.03
|
| Rate for Payer: Priority Health Medicare |
$663.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,269.63
|
| Rate for Payer: Railroad Medicare Medicare |
$663.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,591.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$663.79
|
| Rate for Payer: UHC Exchange |
$1,028.87
|
| Rate for Payer: UHC Medicaid |
$347.16
|
| Rate for Payer: UHCCP DNSP |
$663.79
|
| Rate for Payer: UHCCP Medicaid |
$347.16
|
| Rate for Payer: VA VA |
$663.79
|
|
|
HC PLT PHER LR IRR WASH
|
Facility
|
IP
|
$1,372.14
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000081
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,029.11 |
| Max. Negotiated Rate |
$1,372.14 |
| Rate for Payer: Aetna Commercial |
$1,234.93
|
| Rate for Payer: ASR ASR |
$1,330.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,126.80
|
| Rate for Payer: BCN Commercial |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,097.71
|
| Rate for Payer: Cofinity Commercial |
$1,289.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,097.71
|
| Rate for Payer: Healthscope Commercial |
$1,330.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,372.14
|
| Rate for Payer: Mclaren Commercial |
$1,234.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,166.32
|
| Rate for Payer: Nomi Health Commercial |
$1,125.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,029.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,207.48
|
|
|
HC PLT PHER LR IRR WASH
|
Facility
|
OP
|
$1,372.14
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000081
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$347.16 |
| Max. Negotiated Rate |
$1,587.03 |
| Rate for Payer: Aetna Commercial |
$1,234.93
|
| Rate for Payer: Aetna Medicare |
$663.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$829.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$829.74
|
| Rate for Payer: ASR ASR |
$1,330.98
|
| Rate for Payer: BCBS Complete |
$364.55
|
| Rate for Payer: BCBS MAPPO |
$663.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,131.33
|
| Rate for Payer: BCN Commercial |
$1,131.33
|
| Rate for Payer: BCN Medicare Advantage |
$663.79
|
| Rate for Payer: Cash Price |
$1,097.71
|
| Rate for Payer: Cash Price |
$1,097.71
|
| Rate for Payer: Cofinity Commercial |
$1,289.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,097.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$663.79
|
| Rate for Payer: Healthscope Commercial |
$1,330.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,372.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$663.79
|
| Rate for Payer: Mclaren Commercial |
$1,234.93
|
| Rate for Payer: Mclaren Medicaid |
$663.79
|
| Rate for Payer: Mclaren Medicare |
$663.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$696.98
|
| Rate for Payer: Meridian Medicaid |
$364.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$763.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$730.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,166.32
|
| Rate for Payer: Nomi Health Commercial |
$1,125.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,029.11
|
| Rate for Payer: PACE Medicare |
$630.60
|
| Rate for Payer: PACE SWMI |
$663.79
|
| Rate for Payer: PHP Commercial |
$730.17
|
| Rate for Payer: PHP Medicaid |
$355.79
|
| Rate for Payer: PHP Medicare Advantage |
$663.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,587.03
|
| Rate for Payer: Priority Health Medicare |
$663.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,269.63
|
| Rate for Payer: Railroad Medicare Medicare |
$663.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,207.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$663.79
|
| Rate for Payer: UHC Exchange |
$1,028.87
|
| Rate for Payer: UHC Medicaid |
$347.16
|
| Rate for Payer: UHCCP DNSP |
$663.79
|
| Rate for Payer: UHCCP Medicaid |
$347.16
|
| Rate for Payer: VA VA |
$663.79
|
|
|
HC PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13) IM
|
Facility
|
IP
|
$301.38
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
63600074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$226.03 |
| Max. Negotiated Rate |
$301.38 |
| Rate for Payer: Aetna Commercial |
$271.24
|
| Rate for Payer: ASR ASR |
$292.34
|
| Rate for Payer: BCBS Trust/PPO |
$247.49
|
| Rate for Payer: BCN Commercial |
$247.49
|
| Rate for Payer: Cash Price |
$241.10
|
| Rate for Payer: Cofinity Commercial |
$283.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.10
|
| Rate for Payer: Healthscope Commercial |
$292.34
|
| Rate for Payer: Healthscope Whirlpool |
$301.38
|
| Rate for Payer: Mclaren Commercial |
$271.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.17
|
| Rate for Payer: Nomi Health Commercial |
$247.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.21
|
|
|
HC PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13) IM
|
Facility
|
OP
|
$301.38
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
63600074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.51 |
| Max. Negotiated Rate |
$301.38 |
| Rate for Payer: Aetna Commercial |
$271.24
|
| Rate for Payer: Aetna Medicare |
$111.51
|
| Rate for Payer: ASR ASR |
$292.34
|
| Rate for Payer: BCBS Complete |
$120.55
|
| Rate for Payer: BCBS Trust/PPO |
$248.49
|
| Rate for Payer: BCN Commercial |
$248.49
|
| Rate for Payer: Cash Price |
$241.10
|
| Rate for Payer: Cash Price |
$241.10
|
| Rate for Payer: Cofinity Commercial |
$283.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.10
|
| Rate for Payer: Healthscope Commercial |
$292.34
|
| Rate for Payer: Healthscope Whirlpool |
$301.38
|
| Rate for Payer: Mclaren Commercial |
$271.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.17
|
| Rate for Payer: Nomi Health Commercial |
$247.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$257.99
|
| Rate for Payer: Priority Health Narrow Network |
$206.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.21
|
|
|
HC PNEUMOCOCCAL IGG AB CMPTS
|
Facility
|
IP
|
$26.83
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200190
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$26.83 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: ASR ASR |
$26.03
|
| Rate for Payer: BCBS Trust/PPO |
$22.03
|
| Rate for Payer: BCN Commercial |
$22.03
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$26.03
|
| Rate for Payer: Healthscope Whirlpool |
$26.83
|
| Rate for Payer: Mclaren Commercial |
$24.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: Nomi Health Commercial |
$22.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.61
|
|
|
HC PNEUMOCOCCAL IGG AB CMPTS
|
Facility
|
OP
|
$26.83
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200190
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$26.83 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna Medicare |
$14.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.74
|
| Rate for Payer: ASR ASR |
$26.03
|
| Rate for Payer: BCBS Complete |
$8.23
|
| Rate for Payer: BCBS MAPPO |
$14.99
|
| Rate for Payer: BCBS Trust/PPO |
$22.12
|
| Rate for Payer: BCN Commercial |
$22.12
|
| Rate for Payer: BCN Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$26.03
|
| Rate for Payer: Healthscope Whirlpool |
$26.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.99
|
| Rate for Payer: Mclaren Commercial |
$24.15
|
| Rate for Payer: Mclaren Medicaid |
$14.99
|
| Rate for Payer: Mclaren Medicare |
$14.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.74
|
| Rate for Payer: Meridian Medicaid |
$8.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: Nomi Health Commercial |
$22.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.12
|
| Rate for Payer: PACE Medicare |
$14.24
|
| Rate for Payer: PACE SWMI |
$14.99
|
| Rate for Payer: PHP Commercial |
$16.49
|
| Rate for Payer: PHP Medicaid |
$8.03
|
| Rate for Payer: PHP Medicare Advantage |
$14.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.51
|
| Rate for Payer: Priority Health Medicare |
$14.99
|
| Rate for Payer: Priority Health Narrow Network |
$18.81
|
| Rate for Payer: Railroad Medicare Medicare |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.99
|
| Rate for Payer: UHC Exchange |
$23.23
|
| Rate for Payer: UHC Medicaid |
$7.84
|
| Rate for Payer: UHCCP DNSP |
$14.99
|
| Rate for Payer: UHCCP Medicaid |
$7.84
|
| Rate for Payer: VA VA |
$14.99
|
|
|
HC PNEUMOCOCCAL IGG ABS 23 SEROTYPE
|
Facility
|
IP
|
$26.83
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200189
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$26.83 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: ASR ASR |
$26.03
|
| Rate for Payer: BCBS Trust/PPO |
$22.03
|
| Rate for Payer: BCN Commercial |
$22.03
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$26.03
|
| Rate for Payer: Healthscope Whirlpool |
$26.83
|
| Rate for Payer: Mclaren Commercial |
$24.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: Nomi Health Commercial |
$22.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.61
|
|
|
HC PNEUMOCOCCAL IGG ABS 23 SEROTYPE
|
Facility
|
OP
|
$26.83
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200189
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$26.83 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna Medicare |
$14.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.74
|
| Rate for Payer: ASR ASR |
$26.03
|
| Rate for Payer: BCBS Complete |
$8.23
|
| Rate for Payer: BCBS MAPPO |
$14.99
|
| Rate for Payer: BCBS Trust/PPO |
$22.12
|
| Rate for Payer: BCN Commercial |
$22.12
|
| Rate for Payer: BCN Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$26.03
|
| Rate for Payer: Healthscope Whirlpool |
$26.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.99
|
| Rate for Payer: Mclaren Commercial |
$24.15
|
| Rate for Payer: Mclaren Medicaid |
$14.99
|
| Rate for Payer: Mclaren Medicare |
$14.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.74
|
| Rate for Payer: Meridian Medicaid |
$8.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: Nomi Health Commercial |
$22.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.12
|
| Rate for Payer: PACE Medicare |
$14.24
|
| Rate for Payer: PACE SWMI |
$14.99
|
| Rate for Payer: PHP Commercial |
$16.49
|
| Rate for Payer: PHP Medicaid |
$8.03
|
| Rate for Payer: PHP Medicare Advantage |
$14.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.51
|
| Rate for Payer: Priority Health Medicare |
$14.99
|
| Rate for Payer: Priority Health Narrow Network |
$18.81
|
| Rate for Payer: Railroad Medicare Medicare |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.99
|
| Rate for Payer: UHC Exchange |
$23.23
|
| Rate for Payer: UHC Medicaid |
$7.84
|
| Rate for Payer: UHCCP DNSP |
$14.99
|
| Rate for Payer: UHCCP Medicaid |
$7.84
|
| Rate for Payer: VA VA |
$14.99
|
|
|
HC PNEUMOCOCCAL IGG ABS PRE & POST
|
Facility
|
IP
|
$8.49
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
30200226
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$8.49 |
| Rate for Payer: Aetna Commercial |
$7.64
|
| Rate for Payer: ASR ASR |
$8.24
|
| Rate for Payer: BCBS Trust/PPO |
$6.97
|
| Rate for Payer: BCN Commercial |
$6.97
|
| Rate for Payer: Cash Price |
$6.79
|
| Rate for Payer: Cofinity Commercial |
$7.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.79
|
| Rate for Payer: Healthscope Commercial |
$8.24
|
| Rate for Payer: Healthscope Whirlpool |
$8.49
|
| Rate for Payer: Mclaren Commercial |
$7.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.22
|
| Rate for Payer: Nomi Health Commercial |
$6.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.47
|
|
|
HC PNEUMOCOCCAL IGG ABS PRE & POST
|
Facility
|
OP
|
$8.49
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
30200226
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$19.96 |
| Rate for Payer: Aetna Commercial |
$7.64
|
| Rate for Payer: Aetna Medicare |
$12.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: ASR ASR |
$8.24
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$7.00
|
| Rate for Payer: BCN Commercial |
$7.00
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$6.79
|
| Rate for Payer: Cash Price |
$6.79
|
| Rate for Payer: Cofinity Commercial |
$7.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$8.24
|
| Rate for Payer: Healthscope Whirlpool |
$8.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.88
|
| Rate for Payer: Mclaren Commercial |
$7.64
|
| Rate for Payer: Mclaren Medicaid |
$12.88
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$7.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.22
|
| Rate for Payer: Nomi Health Commercial |
$6.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.37
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$14.17
|
| Rate for Payer: PHP Medicaid |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.44
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow Network |
$5.95
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.88
|
| Rate for Payer: UHC Exchange |
$19.96
|
| Rate for Payer: UHC Medicaid |
$6.74
|
| Rate for Payer: UHCCP DNSP |
$12.88
|
| Rate for Payer: UHCCP Medicaid |
$6.74
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC PNEUMOCOCCAL INJECTION
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
77100010
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.41 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: ASR ASR |
$30.27
|
| Rate for Payer: BCBS Trust/PPO |
$25.63
|
| Rate for Payer: BCN Commercial |
$25.63
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$30.27
|
| Rate for Payer: Healthscope Whirlpool |
$31.21
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
|
|
HC PNEUMOCOCCAL INJECTION
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
77100010
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.21 |
| Max. Negotiated Rate |
$72.32 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: Aetna Medicare |
$46.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.33
|
| Rate for Payer: ASR ASR |
$30.27
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS MAPPO |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$25.73
|
| Rate for Payer: BCN Commercial |
$25.73
|
| Rate for Payer: BCN Medicare Advantage |
$46.66
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.66
|
| Rate for Payer: Healthscope Commercial |
$30.27
|
| Rate for Payer: Healthscope Whirlpool |
$31.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$46.66
|
| Rate for Payer: Mclaren Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$46.66
|
| Rate for Payer: Mclaren Medicare |
$46.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.99
|
| Rate for Payer: Meridian Medicaid |
$25.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PACE Medicare |
$44.33
|
| Rate for Payer: PACE SWMI |
$46.66
|
| Rate for Payer: PHP Commercial |
$51.33
|
| Rate for Payer: PHP Medicaid |
$25.01
|
| Rate for Payer: PHP Medicare Advantage |
$46.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.27
|
| Rate for Payer: Priority Health Medicare |
$46.66
|
| Rate for Payer: Priority Health Narrow Network |
$16.21
|
| Rate for Payer: Railroad Medicare Medicare |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.66
|
| Rate for Payer: UHC Exchange |
$72.32
|
| Rate for Payer: UHC Medicaid |
$24.40
|
| Rate for Payer: UHCCP DNSP |
$46.66
|
| Rate for Payer: UHCCP Medicaid |
$24.40
|
| Rate for Payer: VA VA |
$46.66
|
|
|
HC PNEUMOCOCCAL VACCINE
|
Facility
|
IP
|
$151.76
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
63600029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.82 |
| Max. Negotiated Rate |
$151.76 |
| Rate for Payer: Aetna Commercial |
$136.58
|
| Rate for Payer: ASR ASR |
$147.21
|
| Rate for Payer: BCBS Trust/PPO |
$124.63
|
| Rate for Payer: BCN Commercial |
$124.63
|
| Rate for Payer: Cash Price |
$121.41
|
| Rate for Payer: Cofinity Commercial |
$142.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.41
|
| Rate for Payer: Healthscope Commercial |
$147.21
|
| Rate for Payer: Healthscope Whirlpool |
$151.76
|
| Rate for Payer: Mclaren Commercial |
$136.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.00
|
| Rate for Payer: Nomi Health Commercial |
$124.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.55
|
|
|
HC PNEUMOCOCCAL VACCINE
|
Facility
|
OP
|
$151.76
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
63600029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.15 |
| Max. Negotiated Rate |
$151.76 |
| Rate for Payer: Aetna Commercial |
$136.58
|
| Rate for Payer: Aetna Medicare |
$56.15
|
| Rate for Payer: ASR ASR |
$147.21
|
| Rate for Payer: BCBS Complete |
$60.70
|
| Rate for Payer: BCBS Trust/PPO |
$125.13
|
| Rate for Payer: BCN Commercial |
$125.13
|
| Rate for Payer: Cash Price |
$121.41
|
| Rate for Payer: Cash Price |
$121.41
|
| Rate for Payer: Cofinity Commercial |
$142.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.41
|
| Rate for Payer: Healthscope Commercial |
$147.21
|
| Rate for Payer: Healthscope Whirlpool |
$151.76
|
| Rate for Payer: Mclaren Commercial |
$136.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.00
|
| Rate for Payer: Nomi Health Commercial |
$124.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$133.48
|
| Rate for Payer: Priority Health Narrow Network |
$106.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.55
|
|
|
HC PNEUMOCYSTIS BY RAPID PCR
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600170
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$117.05 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: ASR ASR |
$151.38
|
| Rate for Payer: BCBS Trust/PPO |
$128.16
|
| Rate for Payer: BCN Commercial |
$128.16
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$146.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$151.38
|
| Rate for Payer: Healthscope Whirlpool |
$156.06
|
| Rate for Payer: Mclaren Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.33
|
|
|
HC PNEUMOCYSTIS BY RAPID PCR
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600170
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$151.38
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$128.67
|
| Rate for Payer: BCN Commercial |
$128.67
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$146.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$151.38
|
| Rate for Payer: Healthscope Whirlpool |
$156.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$140.45
|
| Rate for Payer: Mclaren Medicaid |
$35.09
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$136.74
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$109.40
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC PNEUMONIAE AB IGM BY IFA
|
Facility
|
IP
|
$151.90
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200309
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$113.92 |
| Max. Negotiated Rate |
$151.90 |
| Rate for Payer: Aetna Commercial |
$136.71
|
| Rate for Payer: ASR ASR |
$147.34
|
| Rate for Payer: BCBS Trust/PPO |
$124.74
|
| Rate for Payer: BCN Commercial |
$124.74
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cofinity Commercial |
$142.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.52
|
| Rate for Payer: Healthscope Commercial |
$147.34
|
| Rate for Payer: Healthscope Whirlpool |
$151.90
|
| Rate for Payer: Mclaren Commercial |
$136.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.12
|
| Rate for Payer: Nomi Health Commercial |
$124.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.67
|
|
|
HC PNEUMONIAE AB IGM BY IFA
|
Facility
|
OP
|
$151.90
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200309
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$151.90 |
| Rate for Payer: Aetna Commercial |
$136.71
|
| Rate for Payer: Aetna Medicare |
$13.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.55
|
| Rate for Payer: ASR ASR |
$147.34
|
| Rate for Payer: BCBS Complete |
$7.27
|
| Rate for Payer: BCBS MAPPO |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$125.24
|
| Rate for Payer: BCN Commercial |
$125.24
|
| Rate for Payer: BCN Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cofinity Commercial |
$142.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.24
|
| Rate for Payer: Healthscope Commercial |
$147.34
|
| Rate for Payer: Healthscope Whirlpool |
$151.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.24
|
| Rate for Payer: Mclaren Commercial |
$136.71
|
| Rate for Payer: Mclaren Medicaid |
$13.24
|
| Rate for Payer: Mclaren Medicare |
$13.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.90
|
| Rate for Payer: Meridian Medicaid |
$7.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.12
|
| Rate for Payer: Nomi Health Commercial |
$124.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.92
|
| Rate for Payer: PACE Medicare |
$12.58
|
| Rate for Payer: PACE SWMI |
$13.24
|
| Rate for Payer: PHP Commercial |
$14.56
|
| Rate for Payer: PHP Medicaid |
$7.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.98
|
| Rate for Payer: Priority Health Medicare |
$13.24
|
| Rate for Payer: Priority Health Narrow Network |
$52.79
|
| Rate for Payer: Railroad Medicare Medicare |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.24
|
| Rate for Payer: UHC Exchange |
$20.52
|
| Rate for Payer: UHC Medicaid |
$6.92
|
| Rate for Payer: UHCCP DNSP |
$13.24
|
| Rate for Payer: UHCCP Medicaid |
$6.92
|
| Rate for Payer: VA VA |
$13.24
|
|
|
HC POC BASIC METABOLIC PANEL W/ICAL
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
30100696
|
|
Hospital Revenue Code
|
301
|
| 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 POC BASIC METABOLIC PANEL W/ICAL
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
30100696
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$13.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.16
|
| Rate for Payer: ASR ASR |
$51.47
|
| Rate for Payer: BCBS Complete |
$7.54
|
| Rate for Payer: BCBS MAPPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$43.75
|
| Rate for Payer: BCN Commercial |
$43.75
|
| Rate for Payer: BCN Medicare Advantage |
$13.73
|
| 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: Health Alliance Plan Medicare Advantage |
$13.73
|
| Rate for Payer: Healthscope Commercial |
$51.47
|
| Rate for Payer: Healthscope Whirlpool |
$53.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.73
|
| Rate for Payer: Mclaren Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$13.73
|
| Rate for Payer: Mclaren Medicare |
$13.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.42
|
| Rate for Payer: Meridian Medicaid |
$7.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.10
|
| 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: PACE Medicare |
$13.04
|
| Rate for Payer: PACE SWMI |
$13.73
|
| Rate for Payer: PHP Commercial |
$15.10
|
| Rate for Payer: PHP Medicaid |
$7.36
|
| Rate for Payer: PHP Medicare Advantage |
$13.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.49
|
| Rate for Payer: Priority Health Medicare |
$13.73
|
| Rate for Payer: Priority Health Narrow Network |
$37.20
|
| Rate for Payer: Railroad Medicare Medicare |
$13.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.73
|
| Rate for Payer: UHC Exchange |
$21.28
|
| Rate for Payer: UHC Medicaid |
$7.18
|
| Rate for Payer: UHCCP DNSP |
$13.73
|
| Rate for Payer: UHCCP Medicaid |
$7.18
|
| Rate for Payer: VA VA |
$13.73
|
|
|
HC POC BLOOD GAS
|
Facility
|
OP
|
$168.52
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
30100499
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$168.52 |
| Rate for Payer: Aetna Commercial |
$151.67
|
| Rate for Payer: Aetna Medicare |
$78.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.46
|
| Rate for Payer: ASR ASR |
$163.46
|
| Rate for Payer: BCBS Complete |
$43.26
|
| Rate for Payer: BCBS MAPPO |
$78.77
|
| Rate for Payer: BCBS Trust/PPO |
$138.94
|
| Rate for Payer: BCN Commercial |
$138.94
|
| Rate for Payer: BCN Medicare Advantage |
$78.77
|
| Rate for Payer: Cash Price |
$134.82
|
| Rate for Payer: Cash Price |
$134.82
|
| Rate for Payer: Cofinity Commercial |
$158.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.77
|
| Rate for Payer: Healthscope Commercial |
$163.46
|
| Rate for Payer: Healthscope Whirlpool |
$168.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$78.77
|
| Rate for Payer: Mclaren Commercial |
$151.67
|
| Rate for Payer: Mclaren Medicaid |
$78.77
|
| Rate for Payer: Mclaren Medicare |
$78.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.71
|
| Rate for Payer: Meridian Medicaid |
$43.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$86.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.24
|
| Rate for Payer: Nomi Health Commercial |
$138.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.39
|
| Rate for Payer: PACE Medicare |
$74.83
|
| Rate for Payer: PACE SWMI |
$78.77
|
| Rate for Payer: PHP Commercial |
$86.65
|
| Rate for Payer: PHP Medicaid |
$42.22
|
| Rate for Payer: PHP Medicare Advantage |
$78.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$147.66
|
| Rate for Payer: Priority Health Medicare |
$78.77
|
| Rate for Payer: Priority Health Narrow Network |
$118.13
|
| Rate for Payer: Railroad Medicare Medicare |
$78.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$78.77
|
| Rate for Payer: UHC Exchange |
$122.09
|
| Rate for Payer: UHC Medicaid |
$41.20
|
| Rate for Payer: UHCCP DNSP |
$78.77
|
| Rate for Payer: UHCCP Medicaid |
$41.20
|
| Rate for Payer: VA VA |
$78.77
|
|
