|
HC ALCOHOL ETHANOL LVL REFLEX
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100617
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Advantage |
$47.34
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: Priority Health SBD |
$42.61
|
|
|
HC ALDER IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200071
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC ALDER IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200071
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC ALDOLASE
|
Facility
|
OP
|
$44.74
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
30100079
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna Medicare |
$10.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.14
|
| Rate for Payer: BCBS Complete |
$5.33
|
| Rate for Payer: BCBS MAPPO |
$9.71
|
| Rate for Payer: BCBS Trust/PPO |
$10.35
|
| Rate for Payer: BCN Commercial |
$10.35
|
| Rate for Payer: BCN Medicare Advantage |
$9.71
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Advantage |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Mclaren Medicaid |
$5.08
|
| Rate for Payer: Mclaren Medicare |
$9.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.20
|
| Rate for Payer: Meridian Medicaid |
$10.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Nomi Health Commercial |
$14.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.55
|
| Rate for Payer: PACE Medicare |
$9.22
|
| Rate for Payer: PACE SWMI |
$9.71
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: PHP Medicare Advantage |
$9.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.71
|
| Rate for Payer: Priority Health Medicare |
$9.71
|
| Rate for Payer: Priority Health SBD |
$28.19
|
| Rate for Payer: Priority Health Tiered Network |
$7.77
|
| Rate for Payer: Railroad Medicare Medicare |
$9.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.57
|
| Rate for Payer: UHC Core |
$14.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.71
|
| Rate for Payer: UHC Exchange |
$14.57
|
| Rate for Payer: UHC Medicaid |
$5.08
|
| Rate for Payer: UHCCP Medicaid |
$5.08
|
| Rate for Payer: VA VA |
$9.71
|
|
|
HC ALDOLASE
|
Facility
|
IP
|
$44.74
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
30100079
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.19 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.08
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Advantage |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.55
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: Priority Health SBD |
$28.19
|
|
|
HC ALDOSTERONE SERUM
|
Facility
|
OP
|
$72.94
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
30100080
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$65.65 |
| Rate for Payer: Aetna Commercial |
$62.00
|
| Rate for Payer: Aetna Medicare |
$42.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.94
|
| Rate for Payer: BCBS Complete |
$22.38
|
| Rate for Payer: BCBS MAPPO |
$40.75
|
| Rate for Payer: BCBS Trust/PPO |
$43.44
|
| Rate for Payer: BCN Commercial |
$43.44
|
| Rate for Payer: BCN Medicare Advantage |
$40.75
|
| Rate for Payer: Cash Price |
$58.35
|
| Rate for Payer: Cash Price |
$58.35
|
| Rate for Payer: Cofinity Advantage |
$51.06
|
| Rate for Payer: Cofinity Commercial |
$62.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.75
|
| Rate for Payer: Healthscope Commercial |
$65.65
|
| Rate for Payer: Mclaren Medicaid |
$21.31
|
| Rate for Payer: Mclaren Medicare |
$40.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.79
|
| Rate for Payer: Meridian Medicaid |
$42.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.00
|
| Rate for Payer: Nomi Health Commercial |
$61.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.70
|
| Rate for Payer: PACE Medicare |
$38.71
|
| Rate for Payer: PACE SWMI |
$40.75
|
| Rate for Payer: PHP Commercial |
$62.00
|
| Rate for Payer: PHP Medicare Advantage |
$40.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$40.75
|
| Rate for Payer: Priority Health Medicare |
$40.75
|
| Rate for Payer: Priority Health SBD |
$45.95
|
| Rate for Payer: Priority Health Tiered Network |
$32.60
|
| Rate for Payer: Railroad Medicare Medicare |
$40.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.13
|
| Rate for Payer: UHC Core |
$61.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$40.75
|
| Rate for Payer: UHC Exchange |
$61.13
|
| Rate for Payer: UHC Medicaid |
$21.31
|
| Rate for Payer: UHCCP Medicaid |
$21.31
|
| Rate for Payer: VA VA |
$40.75
|
|
|
HC ALDOSTERONE SERUM
|
Facility
|
IP
|
$72.94
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
30100080
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.95 |
| Max. Negotiated Rate |
$65.65 |
| Rate for Payer: Aetna Commercial |
$62.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.41
|
| Rate for Payer: Cash Price |
$58.35
|
| Rate for Payer: Cofinity Advantage |
$51.06
|
| Rate for Payer: Cofinity Commercial |
$62.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.35
|
| Rate for Payer: Healthscope Commercial |
$65.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.70
|
| Rate for Payer: PHP Commercial |
$62.00
|
| Rate for Payer: Priority Health SBD |
$45.95
|
|
|
HC ALDOSTERONE URINE
|
Facility
|
OP
|
$91.26
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
30100081
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$82.13 |
| Rate for Payer: Aetna Commercial |
$77.57
|
| Rate for Payer: Aetna Medicare |
$42.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.94
|
| Rate for Payer: BCBS Complete |
$22.38
|
| Rate for Payer: BCBS MAPPO |
$40.75
|
| Rate for Payer: BCBS Trust/PPO |
$43.44
|
| Rate for Payer: BCN Commercial |
$43.44
|
| Rate for Payer: BCN Medicare Advantage |
$40.75
|
| Rate for Payer: Cash Price |
$73.01
|
| Rate for Payer: Cash Price |
$73.01
|
| Rate for Payer: Cofinity Advantage |
$63.88
|
| Rate for Payer: Cofinity Commercial |
$78.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.75
|
| Rate for Payer: Healthscope Commercial |
$82.13
|
| Rate for Payer: Mclaren Medicaid |
$21.31
|
| Rate for Payer: Mclaren Medicare |
$40.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.79
|
| Rate for Payer: Meridian Medicaid |
$42.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.57
|
| Rate for Payer: Nomi Health Commercial |
$61.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.44
|
| Rate for Payer: PACE Medicare |
$38.71
|
| Rate for Payer: PACE SWMI |
$40.75
|
| Rate for Payer: PHP Commercial |
$77.57
|
| Rate for Payer: PHP Medicare Advantage |
$40.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$40.75
|
| Rate for Payer: Priority Health Medicare |
$40.75
|
| Rate for Payer: Priority Health SBD |
$57.49
|
| Rate for Payer: Priority Health Tiered Network |
$32.60
|
| Rate for Payer: Railroad Medicare Medicare |
$40.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.13
|
| Rate for Payer: UHC Core |
$61.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$40.75
|
| Rate for Payer: UHC Exchange |
$61.13
|
| Rate for Payer: UHC Medicaid |
$21.31
|
| Rate for Payer: UHCCP Medicaid |
$21.31
|
| Rate for Payer: VA VA |
$40.75
|
|
|
HC ALDOSTERONE URINE
|
Facility
|
IP
|
$91.26
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
30100081
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.49 |
| Max. Negotiated Rate |
$82.13 |
| Rate for Payer: Aetna Commercial |
$77.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.32
|
| Rate for Payer: Cash Price |
$73.01
|
| Rate for Payer: Cofinity Advantage |
$63.88
|
| Rate for Payer: Cofinity Commercial |
$78.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.01
|
| Rate for Payer: Healthscope Commercial |
$82.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.44
|
| Rate for Payer: PHP Commercial |
$77.57
|
| Rate for Payer: Priority Health SBD |
$57.49
|
|
|
HC ALKALINE PHOS ISOENZYME CMPT
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
30100389
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Mclaren Medicaid |
$2.71
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$5.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$7.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.18
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: Priority Health Tiered Network |
$4.14
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.77
|
| Rate for Payer: UHC Core |
$7.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.18
|
| Rate for Payer: UHC Exchange |
$7.77
|
| Rate for Payer: UHC Medicaid |
$2.71
|
| Rate for Payer: UHCCP Medicaid |
$2.71
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC ALKALINE PHOS ISOENZYME CMPT
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
30100389
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.37
|
|
|
HC ALKALINE PHOSPHATASE
|
Facility
|
IP
|
$31.31
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
30100388
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$28.18 |
| Rate for Payer: Aetna Commercial |
$26.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.35
|
| Rate for Payer: Cash Price |
$25.05
|
| Rate for Payer: Cofinity Advantage |
$21.92
|
| Rate for Payer: Cofinity Commercial |
$26.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.05
|
| Rate for Payer: Healthscope Commercial |
$28.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.48
|
| Rate for Payer: PHP Commercial |
$26.61
|
| Rate for Payer: Priority Health SBD |
$19.73
|
|
|
HC ALKALINE PHOSPHATASE
|
Facility
|
OP
|
$31.31
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
30100388
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$28.18 |
| Rate for Payer: Aetna Commercial |
$26.61
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$25.05
|
| Rate for Payer: Cash Price |
$25.05
|
| Rate for Payer: Cofinity Advantage |
$21.92
|
| Rate for Payer: Cofinity Commercial |
$26.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$28.18
|
| Rate for Payer: Mclaren Medicaid |
$2.71
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$5.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.61
|
| Rate for Payer: Nomi Health Commercial |
$7.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.48
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$26.61
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.18
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health SBD |
$19.73
|
| Rate for Payer: Priority Health Tiered Network |
$4.14
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.77
|
| Rate for Payer: UHC Core |
$7.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.18
|
| Rate for Payer: UHC Exchange |
$7.77
|
| Rate for Payer: UHC Medicaid |
$2.71
|
| Rate for Payer: UHCCP Medicaid |
$2.71
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC ALKALINE PHOSPHATASE ISOENZYME
|
Facility
|
OP
|
$40.33
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
30100390
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.73 |
| Max. Negotiated Rate |
$36.30 |
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: Aetna Medicare |
$15.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.48
|
| Rate for Payer: BCBS Complete |
$8.12
|
| Rate for Payer: BCBS MAPPO |
$14.78
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: BCN Medicare Advantage |
$14.78
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Advantage |
$28.23
|
| Rate for Payer: Cofinity Commercial |
$34.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.78
|
| Rate for Payer: Healthscope Commercial |
$36.30
|
| Rate for Payer: Mclaren Medicaid |
$7.73
|
| Rate for Payer: Mclaren Medicare |
$14.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.52
|
| Rate for Payer: Meridian Medicaid |
$15.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Nomi Health Commercial |
$22.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: PACE Medicare |
$14.04
|
| Rate for Payer: PACE SWMI |
$14.78
|
| Rate for Payer: PHP Commercial |
$34.28
|
| Rate for Payer: PHP Medicare Advantage |
$14.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.78
|
| Rate for Payer: Priority Health Medicare |
$14.78
|
| Rate for Payer: Priority Health SBD |
$25.41
|
| Rate for Payer: Priority Health Tiered Network |
$11.82
|
| Rate for Payer: Railroad Medicare Medicare |
$14.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.17
|
| Rate for Payer: UHC Core |
$22.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.78
|
| Rate for Payer: UHC Exchange |
$22.17
|
| Rate for Payer: UHC Medicaid |
$7.73
|
| Rate for Payer: UHCCP Medicaid |
$7.73
|
| Rate for Payer: VA VA |
$14.78
|
|
|
HC ALKALINE PHOSPHATASE ISOENZYME
|
Facility
|
IP
|
$40.33
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
30100390
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.41 |
| Max. Negotiated Rate |
$36.30 |
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.21
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Advantage |
$28.23
|
| Rate for Payer: Cofinity Commercial |
$34.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$36.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: PHP Commercial |
$34.28
|
| Rate for Payer: Priority Health SBD |
$25.41
|
|
|
HC ALLERGEN SPECIFIC IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200014
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC ALLERGEN SPECIFIC IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200014
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC ALLERGEN SPECIFIC IGE REF LAB
|
Facility
|
OP
|
$14.86
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200126
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$13.37 |
| Rate for Payer: Aetna Commercial |
$12.63
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Advantage |
$10.40
|
| Rate for Payer: Cofinity Commercial |
$12.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$13.37
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$12.63
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$9.36
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC ALLERGEN SPECIFIC IGE REF LAB
|
Facility
|
IP
|
$14.86
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200126
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$13.37 |
| Rate for Payer: Aetna Commercial |
$12.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.66
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Advantage |
$10.40
|
| Rate for Payer: Cofinity Commercial |
$12.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$13.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: PHP Commercial |
$12.63
|
| Rate for Payer: Priority Health SBD |
$9.36
|
|
|
HC ALLERGEN SPECIFIC IGG ADDITIONAL
|
Facility
|
OP
|
$22.29
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
30200404
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$20.06 |
| Rate for Payer: Aetna Commercial |
$18.95
|
| Rate for Payer: Aetna Medicare |
$8.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.78
|
| Rate for Payer: BCBS Complete |
$4.29
|
| Rate for Payer: BCBS MAPPO |
$7.82
|
| Rate for Payer: BCBS Trust/PPO |
$8.34
|
| Rate for Payer: BCN Commercial |
$8.34
|
| Rate for Payer: BCN Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Cofinity Advantage |
$15.60
|
| Rate for Payer: Cofinity Commercial |
$19.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$20.06
|
| Rate for Payer: Mclaren Medicaid |
$4.09
|
| Rate for Payer: Mclaren Medicare |
$7.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.21
|
| Rate for Payer: Meridian Medicaid |
$8.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.95
|
| Rate for Payer: Nomi Health Commercial |
$11.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.72
|
| Rate for Payer: PACE Medicare |
$7.43
|
| Rate for Payer: PACE SWMI |
$7.82
|
| Rate for Payer: PHP Commercial |
$18.95
|
| Rate for Payer: PHP Medicare Advantage |
$7.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7.82
|
| Rate for Payer: Priority Health Medicare |
$7.82
|
| Rate for Payer: Priority Health SBD |
$14.04
|
| Rate for Payer: Priority Health Tiered Network |
$6.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.73
|
| Rate for Payer: UHC Core |
$11.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.82
|
| Rate for Payer: UHC Exchange |
$11.73
|
| Rate for Payer: UHC Medicaid |
$4.09
|
| Rate for Payer: UHCCP Medicaid |
$4.09
|
| Rate for Payer: VA VA |
$7.82
|
|
|
HC ALLERGEN SPECIFIC IGG ADDITIONAL
|
Facility
|
IP
|
$22.29
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
30200404
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$20.06 |
| Rate for Payer: Aetna Commercial |
$18.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.49
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Cofinity Advantage |
$15.60
|
| Rate for Payer: Cofinity Commercial |
$19.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.83
|
| Rate for Payer: Healthscope Commercial |
$20.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.72
|
| Rate for Payer: PHP Commercial |
$18.95
|
| Rate for Payer: Priority Health SBD |
$14.04
|
|
|
HC ALLERGEN SPECIFIC IGG FIRST
|
Facility
|
OP
|
$22.29
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
30200403
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$20.06 |
| Rate for Payer: Aetna Commercial |
$18.95
|
| Rate for Payer: Aetna Medicare |
$8.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.78
|
| Rate for Payer: BCBS Complete |
$4.29
|
| Rate for Payer: BCBS MAPPO |
$7.82
|
| Rate for Payer: BCBS Trust/PPO |
$8.34
|
| Rate for Payer: BCN Commercial |
$8.34
|
| Rate for Payer: BCN Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Cofinity Advantage |
$15.60
|
| Rate for Payer: Cofinity Commercial |
$19.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$20.06
|
| Rate for Payer: Mclaren Medicaid |
$4.09
|
| Rate for Payer: Mclaren Medicare |
$7.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.21
|
| Rate for Payer: Meridian Medicaid |
$8.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.95
|
| Rate for Payer: Nomi Health Commercial |
$11.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.72
|
| Rate for Payer: PACE Medicare |
$7.43
|
| Rate for Payer: PACE SWMI |
$7.82
|
| Rate for Payer: PHP Commercial |
$18.95
|
| Rate for Payer: PHP Medicare Advantage |
$7.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7.82
|
| Rate for Payer: Priority Health Medicare |
$7.82
|
| Rate for Payer: Priority Health SBD |
$14.04
|
| Rate for Payer: Priority Health Tiered Network |
$6.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.73
|
| Rate for Payer: UHC Core |
$11.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.82
|
| Rate for Payer: UHC Exchange |
$11.73
|
| Rate for Payer: UHC Medicaid |
$4.09
|
| Rate for Payer: UHCCP Medicaid |
$4.09
|
| Rate for Payer: VA VA |
$7.82
|
|
|
HC ALLERGEN SPECIFIC IGG FIRST
|
Facility
|
IP
|
$22.29
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
30200403
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$20.06 |
| Rate for Payer: Aetna Commercial |
$18.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.49
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Cofinity Advantage |
$15.60
|
| Rate for Payer: Cofinity Commercial |
$19.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.83
|
| Rate for Payer: Healthscope Commercial |
$20.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.72
|
| Rate for Payer: PHP Commercial |
$18.95
|
| Rate for Payer: Priority Health SBD |
$14.04
|
|
|
HC ALLERGEN SPEC IGE RECOMB EA
|
Facility
|
IP
|
$32.12
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$28.91 |
| Rate for Payer: Aetna Commercial |
$27.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.88
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cofinity Advantage |
$22.48
|
| Rate for Payer: Cofinity Commercial |
$27.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.70
|
| Rate for Payer: Healthscope Commercial |
$28.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.09
|
| Rate for Payer: PHP Commercial |
$27.30
|
| Rate for Payer: Priority Health SBD |
$20.24
|
|
|
HC ALLERGEN SPEC IGE RECOMB EA
|
Facility
|
OP
|
$32.12
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$28.91 |
| Rate for Payer: Aetna Commercial |
$27.30
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.12
|
| Rate for Payer: BCN Commercial |
$19.12
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cofinity Advantage |
$22.48
|
| Rate for Payer: Cofinity Commercial |
$27.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$28.91
|
| Rate for Payer: Mclaren Medicaid |
$9.38
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.30
|
| Rate for Payer: Nomi Health Commercial |
$26.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.09
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$27.30
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$20.24
|
| Rate for Payer: Priority Health Tiered Network |
$14.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.90
|
| Rate for Payer: UHC Core |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$26.90
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
