|
HC ANTIGEN TYPE PATIENT
|
Facility
|
OP
|
$111.59
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
30200350
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$906.83 |
| Rate for Payer: Aetna Commercial |
$94.85
|
| Rate for Payer: Aetna Medicare |
$332.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.80
|
| Rate for Payer: BCBS Complete |
$183.72
|
| Rate for Payer: BCBS MAPPO |
$319.84
|
| Rate for Payer: BCBS Trust/PPO |
$3.00
|
| Rate for Payer: BCN Medicare Advantage |
$319.84
|
| Rate for Payer: Cash Price |
$89.27
|
| Rate for Payer: Cash Price |
$89.27
|
| Rate for Payer: Cofinity Commercial |
$95.97
|
| Rate for Payer: Cofinity Commercial |
$78.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.84
|
| Rate for Payer: Healthscope Commercial |
$100.43
|
| Rate for Payer: Mclaren Medicaid |
$174.95
|
| Rate for Payer: Mclaren Medicare |
$319.84
|
| Rate for Payer: Meridian Medicaid |
$183.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.85
|
| Rate for Payer: PACE Medicare |
$303.85
|
| Rate for Payer: PACE SWMI |
$319.84
|
| Rate for Payer: PHP Commercial |
$94.85
|
| Rate for Payer: PHP Medicare Advantage |
$319.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$906.83
|
| Rate for Payer: Priority Health Medicare |
$319.84
|
| Rate for Payer: Priority Health Narrow Network |
$725.46
|
| Rate for Payer: Priority Health SBD |
$70.30
|
| Rate for Payer: Railroad Medicare Medicare |
$319.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.60
|
| Rate for Payer: UHC Core |
$6.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.84
|
| Rate for Payer: UHC Exchange |
$3.83
|
| Rate for Payer: UHC Medicare Advantage |
$329.44
|
| Rate for Payer: VA VA |
$319.84
|
|
|
HC ANTIGEN TYPE PATIENT
|
Facility
|
IP
|
$111.59
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
30200350
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.30 |
| Max. Negotiated Rate |
$100.43 |
| Rate for Payer: Aetna Commercial |
$94.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.53
|
| Rate for Payer: Cash Price |
$89.27
|
| Rate for Payer: Cofinity Commercial |
$78.11
|
| Rate for Payer: Cofinity Commercial |
$95.97
|
| Rate for Payer: Healthscope Commercial |
$100.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.85
|
| Rate for Payer: PHP Commercial |
$94.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.11
|
| Rate for Payer: Priority Health SBD |
$70.30
|
|
|
HC ANTIGEN TYPE UNIT BBC
|
Facility
|
OP
|
$111.59
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
30200467
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$906.83 |
| Rate for Payer: Aetna Commercial |
$94.85
|
| Rate for Payer: Aetna Medicare |
$332.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.80
|
| Rate for Payer: BCBS Complete |
$183.72
|
| Rate for Payer: BCBS MAPPO |
$319.84
|
| Rate for Payer: BCBS Trust/PPO |
$4.97
|
| Rate for Payer: BCN Medicare Advantage |
$319.84
|
| Rate for Payer: Cash Price |
$89.27
|
| Rate for Payer: Cash Price |
$89.27
|
| Rate for Payer: Cofinity Commercial |
$78.11
|
| Rate for Payer: Cofinity Commercial |
$95.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.84
|
| Rate for Payer: Healthscope Commercial |
$100.43
|
| Rate for Payer: Mclaren Medicaid |
$174.95
|
| Rate for Payer: Mclaren Medicare |
$319.84
|
| Rate for Payer: Meridian Medicaid |
$183.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.85
|
| Rate for Payer: PACE Medicare |
$303.85
|
| Rate for Payer: PACE SWMI |
$319.84
|
| Rate for Payer: PHP Commercial |
$94.85
|
| Rate for Payer: PHP Medicare Advantage |
$319.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$906.83
|
| Rate for Payer: Priority Health Medicare |
$319.84
|
| Rate for Payer: Priority Health Narrow Network |
$725.46
|
| Rate for Payer: Priority Health SBD |
$70.30
|
| Rate for Payer: Railroad Medicare Medicare |
$319.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.62
|
| Rate for Payer: UHC Core |
$6.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.84
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$329.44
|
| Rate for Payer: VA VA |
$319.84
|
|
|
HC ANTIGEN TYPE UNIT BBC
|
Facility
|
IP
|
$111.59
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
30200467
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.30 |
| Max. Negotiated Rate |
$100.43 |
| Rate for Payer: Aetna Commercial |
$94.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.53
|
| Rate for Payer: Cash Price |
$89.27
|
| Rate for Payer: Cofinity Commercial |
$78.11
|
| Rate for Payer: Cofinity Commercial |
$95.97
|
| Rate for Payer: Healthscope Commercial |
$100.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.85
|
| Rate for Payer: PHP Commercial |
$94.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.11
|
| Rate for Payer: Priority Health SBD |
$70.30
|
|
|
HC ANTIGEN TYPE UNIT BMH
|
Facility
|
OP
|
$111.59
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
30200349
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$906.83 |
| Rate for Payer: Aetna Commercial |
$94.85
|
| Rate for Payer: Aetna Medicare |
$332.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.80
|
| Rate for Payer: BCBS Complete |
$183.72
|
| Rate for Payer: BCBS MAPPO |
$319.84
|
| Rate for Payer: BCBS Trust/PPO |
$4.97
|
| Rate for Payer: BCN Medicare Advantage |
$319.84
|
| Rate for Payer: Cash Price |
$89.27
|
| Rate for Payer: Cash Price |
$89.27
|
| Rate for Payer: Cofinity Commercial |
$95.97
|
| Rate for Payer: Cofinity Commercial |
$78.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.84
|
| Rate for Payer: Healthscope Commercial |
$100.43
|
| Rate for Payer: Mclaren Medicaid |
$174.95
|
| Rate for Payer: Mclaren Medicare |
$319.84
|
| Rate for Payer: Meridian Medicaid |
$183.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.85
|
| Rate for Payer: PACE Medicare |
$303.85
|
| Rate for Payer: PACE SWMI |
$319.84
|
| Rate for Payer: PHP Commercial |
$94.85
|
| Rate for Payer: PHP Medicare Advantage |
$319.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$906.83
|
| Rate for Payer: Priority Health Medicare |
$319.84
|
| Rate for Payer: Priority Health Narrow Network |
$725.46
|
| Rate for Payer: Priority Health SBD |
$70.30
|
| Rate for Payer: Railroad Medicare Medicare |
$319.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.62
|
| Rate for Payer: UHC Core |
$6.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.84
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$329.44
|
| Rate for Payer: VA VA |
$319.84
|
|
|
HC ANTIGEN TYPE UNIT BMH
|
Facility
|
IP
|
$111.59
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
30200349
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.30 |
| Max. Negotiated Rate |
$100.43 |
| Rate for Payer: Aetna Commercial |
$94.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.53
|
| Rate for Payer: Cash Price |
$89.27
|
| Rate for Payer: Cofinity Commercial |
$78.11
|
| Rate for Payer: Cofinity Commercial |
$95.97
|
| Rate for Payer: Healthscope Commercial |
$100.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.85
|
| Rate for Payer: PHP Commercial |
$94.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.11
|
| Rate for Payer: Priority Health SBD |
$70.30
|
|
|
HC ANTI-GLOMULER BASEMENT MEMBER
|
Facility
|
OP
|
$56.10
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100259
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$50.49 |
| Rate for Payer: Aetna Commercial |
$47.68
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$13.52
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$48.25
|
| Rate for Payer: Cofinity Commercial |
$39.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$50.49
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.68
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$47.68
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.27
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$35.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC Core |
$22.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC ANTI-GLOMULER BASEMENT MEMBER
|
Facility
|
IP
|
$56.10
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100259
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$50.49 |
| Rate for Payer: Aetna Commercial |
$47.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.46
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$39.27
|
| Rate for Payer: Cofinity Commercial |
$48.25
|
| Rate for Payer: Healthscope Commercial |
$50.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.68
|
| Rate for Payer: PHP Commercial |
$47.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.27
|
| Rate for Payer: Priority Health SBD |
$35.34
|
|
|
HC ANTIMITOCHONDRIAL AB
|
Facility
|
OP
|
$36.72
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100250
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Cofinity Commercial |
$25.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$23.13
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.84
|
| Rate for Payer: UHC Core |
$19.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC ANTIMITOCHONDRIAL AB
|
Facility
|
IP
|
$36.72
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100250
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.13 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health SBD |
$23.13
|
|
|
HC ANTIMULLERIAN HORMONE
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 82166
|
| Hospital Charge Code |
30100625
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.13 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna Commercial |
$102.85
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.28
|
| Rate for Payer: BCBS Complete |
$22.18
|
| Rate for Payer: BCBS MAPPO |
$38.62
|
| Rate for Payer: BCN Medicare Advantage |
$38.62
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cofinity Commercial |
$104.06
|
| Rate for Payer: Cofinity Commercial |
$84.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.62
|
| Rate for Payer: Healthscope Commercial |
$108.90
|
| Rate for Payer: Mclaren Medicaid |
$21.13
|
| Rate for Payer: Mclaren Medicare |
$38.62
|
| Rate for Payer: Meridian Medicaid |
$22.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.85
|
| Rate for Payer: PACE Medicare |
$36.69
|
| Rate for Payer: PACE SWMI |
$38.62
|
| Rate for Payer: PHP Commercial |
$102.85
|
| Rate for Payer: PHP Medicare Advantage |
$38.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.70
|
| Rate for Payer: Priority Health Medicare |
$38.62
|
| Rate for Payer: Priority Health SBD |
$76.23
|
| Rate for Payer: Railroad Medicare Medicare |
$38.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.34
|
| Rate for Payer: UHC Core |
$46.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.62
|
| Rate for Payer: UHC Exchange |
$38.62
|
| Rate for Payer: UHC Medicare Advantage |
$39.78
|
| Rate for Payer: VA VA |
$38.62
|
|
|
HC ANTIMULLERIAN HORMONE
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 82166
|
| Hospital Charge Code |
30100625
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.23 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna Commercial |
$102.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.65
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cofinity Commercial |
$104.06
|
| Rate for Payer: Cofinity Commercial |
$84.70
|
| Rate for Payer: Healthscope Commercial |
$108.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.85
|
| Rate for Payer: PHP Commercial |
$102.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.70
|
| Rate for Payer: Priority Health SBD |
$76.23
|
|
|
HC ANTINUCLEAR AB SCREEN CMPT
|
Facility
|
OP
|
$70.69
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200159
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$63.62 |
| Rate for Payer: Aetna Commercial |
$60.09
|
| Rate for Payer: Aetna Medicare |
$14.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.18
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: BCBS MAPPO |
$13.74
|
| Rate for Payer: BCBS Trust/PPO |
$10.76
|
| Rate for Payer: BCN Medicare Advantage |
$13.74
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Cofinity Commercial |
$49.48
|
| Rate for Payer: Cofinity Commercial |
$60.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.74
|
| Rate for Payer: Healthscope Commercial |
$63.62
|
| Rate for Payer: Mclaren Medicaid |
$7.52
|
| Rate for Payer: Mclaren Medicare |
$13.74
|
| Rate for Payer: Meridian Medicaid |
$7.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.09
|
| Rate for Payer: PACE Medicare |
$13.05
|
| Rate for Payer: PACE SWMI |
$13.74
|
| Rate for Payer: PHP Commercial |
$60.09
|
| Rate for Payer: PHP Medicare Advantage |
$13.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.48
|
| Rate for Payer: Priority Health Medicare |
$13.74
|
| Rate for Payer: Priority Health SBD |
$44.53
|
| Rate for Payer: Railroad Medicare Medicare |
$13.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.49
|
| Rate for Payer: UHC Core |
$23.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.74
|
| Rate for Payer: UHC Exchange |
$13.74
|
| Rate for Payer: UHC Medicare Advantage |
$14.15
|
| Rate for Payer: VA VA |
$13.74
|
|
|
HC ANTINUCLEAR AB SCREEN CMPT
|
Facility
|
IP
|
$70.69
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200159
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$63.62 |
| Rate for Payer: Aetna Commercial |
$60.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.95
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Cofinity Commercial |
$49.48
|
| Rate for Payer: Cofinity Commercial |
$60.79
|
| Rate for Payer: Healthscope Commercial |
$63.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.09
|
| Rate for Payer: PHP Commercial |
$60.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.48
|
| Rate for Payer: Priority Health SBD |
$44.53
|
|
|
HC ANTINUCLEAR AB SCREEN & DSDNA
|
Facility
|
OP
|
$70.69
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
30200135
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$63.62 |
| Rate for Payer: Aetna Commercial |
$60.09
|
| Rate for Payer: Aetna Medicare |
$12.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.11
|
| Rate for Payer: BCBS Complete |
$6.94
|
| Rate for Payer: BCBS MAPPO |
$12.09
|
| Rate for Payer: BCBS Trust/PPO |
$9.47
|
| Rate for Payer: BCN Medicare Advantage |
$12.09
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Cofinity Commercial |
$49.48
|
| Rate for Payer: Cofinity Commercial |
$60.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.09
|
| Rate for Payer: Healthscope Commercial |
$63.62
|
| Rate for Payer: Mclaren Medicaid |
$6.61
|
| Rate for Payer: Mclaren Medicare |
$12.09
|
| Rate for Payer: Meridian Medicaid |
$6.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.09
|
| Rate for Payer: PACE Medicare |
$11.49
|
| Rate for Payer: PACE SWMI |
$12.09
|
| Rate for Payer: PHP Commercial |
$60.09
|
| Rate for Payer: PHP Medicare Advantage |
$12.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.48
|
| Rate for Payer: Priority Health Medicare |
$12.09
|
| Rate for Payer: Priority Health SBD |
$44.53
|
| Rate for Payer: Railroad Medicare Medicare |
$12.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.51
|
| Rate for Payer: UHC Core |
$20.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.09
|
| Rate for Payer: UHC Exchange |
$12.09
|
| Rate for Payer: UHC Medicare Advantage |
$12.45
|
| Rate for Payer: VA VA |
$12.09
|
|
|
HC ANTINUCLEAR AB SCREEN & DSDNA
|
Facility
|
IP
|
$70.69
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
30200135
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$63.62 |
| Rate for Payer: Aetna Commercial |
$60.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.95
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Cofinity Commercial |
$49.48
|
| Rate for Payer: Cofinity Commercial |
$60.79
|
| Rate for Payer: Healthscope Commercial |
$63.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.09
|
| Rate for Payer: PHP Commercial |
$60.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.48
|
| Rate for Payer: Priority Health SBD |
$44.53
|
|
|
HC ANTINUCLEAR ANTIBODIES
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
30200134
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.92 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health SBD |
$28.92
|
|
|
HC ANTINUCLEAR ANTIBODIES
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
30200134
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$12.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.11
|
| Rate for Payer: BCBS Complete |
$6.94
|
| Rate for Payer: BCBS MAPPO |
$12.09
|
| Rate for Payer: BCBS Trust/PPO |
$9.47
|
| Rate for Payer: BCN Medicare Advantage |
$12.09
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.09
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Mclaren Medicaid |
$6.61
|
| Rate for Payer: Mclaren Medicare |
$12.09
|
| Rate for Payer: Meridian Medicaid |
$6.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PACE Medicare |
$11.49
|
| Rate for Payer: PACE SWMI |
$12.09
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: PHP Medicare Advantage |
$12.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health Medicare |
$12.09
|
| Rate for Payer: Priority Health SBD |
$28.92
|
| Rate for Payer: Railroad Medicare Medicare |
$12.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.51
|
| Rate for Payer: UHC Core |
$20.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.09
|
| Rate for Payer: UHC Exchange |
$12.09
|
| Rate for Payer: UHC Medicare Advantage |
$12.45
|
| Rate for Payer: VA VA |
$12.09
|
|
|
HC ANTINUCLEAR ANTIBODIES TITER
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
30200378
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$11.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.95
|
| Rate for Payer: BCBS Complete |
$6.41
|
| Rate for Payer: BCBS MAPPO |
$11.16
|
| Rate for Payer: BCBS Trust/PPO |
$8.74
|
| Rate for Payer: BCN Medicare Advantage |
$11.16
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$6.10
|
| Rate for Payer: Mclaren Medicare |
$11.16
|
| Rate for Payer: Meridian Medicaid |
$6.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$10.60
|
| Rate for Payer: PACE SWMI |
$11.16
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$11.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health Medicare |
$11.16
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: Railroad Medicare Medicare |
$11.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.39
|
| Rate for Payer: UHC Core |
$18.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.16
|
| Rate for Payer: UHC Exchange |
$11.16
|
| Rate for Payer: UHC Medicare Advantage |
$11.49
|
| Rate for Payer: VA VA |
$11.16
|
|
|
HC ANTINUCLEAR ANTIBODIES TITER
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
30200378
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health SBD |
$25.70
|
|
|
HC ANTI SMOOTH MUSCLE AB
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
30200177
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$9.44
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$13.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC ANTI SMOOTH MUSCLE AB
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
30200177
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.56 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health SBD |
$38.56
|
|
|
HC ANTISTREPTOLYSIN TITER/ASO
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
30200136
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna Medicare |
$7.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.12
|
| Rate for Payer: BCBS Complete |
$4.19
|
| Rate for Payer: BCBS MAPPO |
$7.30
|
| Rate for Payer: BCBS Trust/PPO |
$5.72
|
| Rate for Payer: BCN Medicare Advantage |
$7.30
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Cofinity Commercial |
$47.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.30
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Mclaren Medicaid |
$3.99
|
| Rate for Payer: Mclaren Medicare |
$7.30
|
| Rate for Payer: Meridian Medicaid |
$4.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PACE Medicare |
$6.94
|
| Rate for Payer: PACE SWMI |
$7.30
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: PHP Medicare Advantage |
$7.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health Medicare |
$7.30
|
| Rate for Payer: Priority Health SBD |
$42.84
|
| Rate for Payer: Railroad Medicare Medicare |
$7.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.76
|
| Rate for Payer: UHC Core |
$12.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.30
|
| Rate for Payer: UHC Exchange |
$7.30
|
| Rate for Payer: UHC Medicare Advantage |
$7.52
|
| Rate for Payer: VA VA |
$7.30
|
|
|
HC ANTISTREPTOLYSIN TITER/ASO
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
30200136
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.20
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$47.60
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health SBD |
$42.84
|
|
|
HC ANTI THROMBIN III
|
Facility
|
IP
|
$48.96
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
30500035
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.84 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: Priority Health SBD |
$30.84
|
|
