|
HC ANTIBODY ELUTION
|
Facility
|
IP
|
$299.78
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
30200341
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$188.86 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Aetna Commercial |
$254.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.86
|
| Rate for Payer: Cash Price |
$239.82
|
| Rate for Payer: Cofinity Commercial |
$209.85
|
| Rate for Payer: Cofinity Commercial |
$257.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.82
|
| Rate for Payer: Healthscope Commercial |
$269.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.81
|
| Rate for Payer: PHP Commercial |
$254.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.86
|
| Rate for Payer: Priority Health SBD |
$188.86
|
|
|
HC ANTIBODY ELUTION
|
Facility
|
OP
|
$299.78
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
30200341
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$89.58 |
| Max. Negotiated Rate |
$470.43 |
| Rate for Payer: Aetna Commercial |
$254.81
|
| Rate for Payer: Aetna Medicare |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$208.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$208.90
|
| Rate for Payer: BCBS Complete |
$94.06
|
| Rate for Payer: BCBS MAPPO |
$167.12
|
| Rate for Payer: BCN Medicare Advantage |
$167.12
|
| Rate for Payer: Cash Price |
$239.82
|
| Rate for Payer: Cash Price |
$239.82
|
| Rate for Payer: Cofinity Commercial |
$257.81
|
| Rate for Payer: Cofinity Commercial |
$209.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.12
|
| Rate for Payer: Healthscope Commercial |
$269.80
|
| Rate for Payer: Mclaren Medicaid |
$89.58
|
| Rate for Payer: Mclaren Medicare |
$167.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.48
|
| Rate for Payer: Meridian Medicaid |
$94.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.81
|
| Rate for Payer: PACE Medicare |
$158.76
|
| Rate for Payer: PACE SWMI |
$167.12
|
| Rate for Payer: PHP Commercial |
$254.81
|
| Rate for Payer: PHP Medicare Advantage |
$167.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.86
|
| Rate for Payer: Priority Health Medicare |
$167.12
|
| Rate for Payer: Priority Health SBD |
$188.86
|
| Rate for Payer: Railroad Medicare Medicare |
$167.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.12
|
| Rate for Payer: UHC Medicare Advantage |
$167.12
|
| Rate for Payer: UHCCP Medicaid |
$94.09
|
| Rate for Payer: VA VA |
$167.12
|
|
|
HC ANTIBODY IDENTIFICATION
|
Facility
|
OP
|
$213.28
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
30200342
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$134.37 |
| Max. Negotiated Rate |
$987.55 |
| Rate for Payer: Aetna Commercial |
$181.29
|
| Rate for Payer: Aetna Medicare |
$364.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$438.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$438.54
|
| Rate for Payer: BCBS Complete |
$197.45
|
| Rate for Payer: BCBS MAPPO |
$350.83
|
| Rate for Payer: BCN Medicare Advantage |
$350.83
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cofinity Commercial |
$183.42
|
| Rate for Payer: Cofinity Commercial |
$149.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.83
|
| Rate for Payer: Healthscope Commercial |
$191.95
|
| Rate for Payer: Mclaren Medicaid |
$188.04
|
| Rate for Payer: Mclaren Medicare |
$350.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$368.37
|
| Rate for Payer: Meridian Medicaid |
$197.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$403.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.29
|
| Rate for Payer: PACE Medicare |
$333.29
|
| Rate for Payer: PACE SWMI |
$350.83
|
| Rate for Payer: PHP Commercial |
$181.29
|
| Rate for Payer: PHP Medicare Advantage |
$350.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.63
|
| Rate for Payer: Priority Health Medicare |
$350.83
|
| Rate for Payer: Priority Health SBD |
$134.37
|
| Rate for Payer: Railroad Medicare Medicare |
$350.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$987.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$350.83
|
| Rate for Payer: UHC Medicare Advantage |
$350.83
|
| Rate for Payer: UHCCP Medicaid |
$197.52
|
| Rate for Payer: VA VA |
$350.83
|
|
|
HC ANTIBODY IDENTIFICATION
|
Facility
|
IP
|
$213.28
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
30200342
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$134.37 |
| Max. Negotiated Rate |
$191.95 |
| Rate for Payer: Aetna Commercial |
$181.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.63
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cofinity Commercial |
$149.30
|
| Rate for Payer: Cofinity Commercial |
$183.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.62
|
| Rate for Payer: Healthscope Commercial |
$191.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.29
|
| Rate for Payer: PHP Commercial |
$181.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.63
|
| Rate for Payer: Priority Health SBD |
$134.37
|
|
|
HC ANTIBODY ID: LEUKOCYTE ANTIBODY
|
Facility
|
OP
|
$93.84
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
30200127
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$84.46 |
| Rate for Payer: Aetna Commercial |
$79.76
|
| Rate for Payer: Aetna Medicare |
$15.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: BCBS Complete |
$8.47
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cofinity Commercial |
$80.70
|
| Rate for Payer: Cofinity Commercial |
$65.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$84.46
|
| Rate for Payer: Mclaren Medicaid |
$8.07
|
| Rate for Payer: Mclaren Medicare |
$15.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: Meridian Medicaid |
$8.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.76
|
| Rate for Payer: PACE Medicare |
$14.30
|
| Rate for Payer: PACE SWMI |
$15.05
|
| Rate for Payer: PHP Commercial |
$79.76
|
| Rate for Payer: PHP Medicare Advantage |
$15.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.00
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health SBD |
$59.12
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.05
|
| Rate for Payer: UHC Medicare Advantage |
$15.05
|
| Rate for Payer: UHCCP Medicaid |
$8.47
|
| Rate for Payer: VA VA |
$15.05
|
|
|
HC ANTIBODY ID: LEUKOCYTE ANTIBODY
|
Facility
|
IP
|
$93.84
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
30200127
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.12 |
| Max. Negotiated Rate |
$84.46 |
| Rate for Payer: Aetna Commercial |
$79.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.00
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cofinity Commercial |
$65.69
|
| Rate for Payer: Cofinity Commercial |
$80.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.07
|
| Rate for Payer: Healthscope Commercial |
$84.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.76
|
| Rate for Payer: PHP Commercial |
$79.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.00
|
| Rate for Payer: Priority Health SBD |
$59.12
|
|
|
HC ANTIBODY LYME DISEASE
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200234
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$47.94 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$17.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.29
|
| Rate for Payer: BCBS Complete |
$9.58
|
| Rate for Payer: BCBS MAPPO |
$17.03
|
| Rate for Payer: BCN Medicare Advantage |
$17.03
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.03
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Mclaren Medicaid |
$9.13
|
| Rate for Payer: Mclaren Medicare |
$17.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.88
|
| Rate for Payer: Meridian Medicaid |
$9.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: PACE Medicare |
$16.18
|
| Rate for Payer: PACE SWMI |
$17.03
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$17.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health Medicare |
$17.03
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: Railroad Medicare Medicare |
$17.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.03
|
| Rate for Payer: UHC Medicare Advantage |
$17.03
|
| Rate for Payer: UHCCP Medicaid |
$9.59
|
| Rate for Payer: VA VA |
$17.03
|
|
|
HC ANTIBODY LYME DISEASE
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200234
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health SBD |
$29.50
|
|
|
HC ANTIBODY LYME DISEASE CONFIRMATION
|
Facility
|
IP
|
$34.33
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
30200233
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.63 |
| Max. Negotiated Rate |
$30.90 |
| Rate for Payer: Aetna Commercial |
$29.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.31
|
| Rate for Payer: Cash Price |
$27.46
|
| Rate for Payer: Cofinity Commercial |
$24.03
|
| Rate for Payer: Cofinity Commercial |
$29.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.46
|
| Rate for Payer: Healthscope Commercial |
$30.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.18
|
| Rate for Payer: PHP Commercial |
$29.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.31
|
| Rate for Payer: Priority Health SBD |
$21.63
|
|
|
HC ANTIBODY LYME DISEASE CONFIRMATION
|
Facility
|
OP
|
$34.33
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
30200233
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$43.60 |
| Rate for Payer: Aetna Commercial |
$29.18
|
| Rate for Payer: Aetna Medicare |
$16.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.36
|
| Rate for Payer: BCBS Complete |
$8.72
|
| Rate for Payer: BCBS MAPPO |
$15.49
|
| Rate for Payer: BCN Medicare Advantage |
$15.49
|
| Rate for Payer: Cash Price |
$27.46
|
| Rate for Payer: Cash Price |
$27.46
|
| Rate for Payer: Cofinity Commercial |
$29.52
|
| Rate for Payer: Cofinity Commercial |
$24.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$30.90
|
| Rate for Payer: Mclaren Medicaid |
$8.30
|
| Rate for Payer: Mclaren Medicare |
$15.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.26
|
| Rate for Payer: Meridian Medicaid |
$8.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.18
|
| Rate for Payer: PACE Medicare |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.49
|
| Rate for Payer: PHP Commercial |
$29.18
|
| Rate for Payer: PHP Medicare Advantage |
$15.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.31
|
| Rate for Payer: Priority Health Medicare |
$15.49
|
| Rate for Payer: Priority Health SBD |
$21.63
|
| Rate for Payer: Railroad Medicare Medicare |
$15.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.49
|
| Rate for Payer: UHC Medicare Advantage |
$15.49
|
| Rate for Payer: UHCCP Medicaid |
$8.72
|
| Rate for Payer: VA VA |
$15.49
|
|
|
HC ANTIBODY LYME DISEASE CSF
|
Facility
|
OP
|
$66.59
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200235
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna Medicare |
$17.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.29
|
| Rate for Payer: BCBS Complete |
$9.58
|
| Rate for Payer: BCBS MAPPO |
$17.03
|
| Rate for Payer: BCN Medicare Advantage |
$17.03
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Cofinity Commercial |
$46.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.03
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: Mclaren Medicaid |
$9.13
|
| Rate for Payer: Mclaren Medicare |
$17.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.88
|
| Rate for Payer: Meridian Medicaid |
$9.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: PACE Medicare |
$16.18
|
| Rate for Payer: PACE SWMI |
$17.03
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: PHP Medicare Advantage |
$17.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.28
|
| Rate for Payer: Priority Health Medicare |
$17.03
|
| Rate for Payer: Priority Health SBD |
$41.95
|
| Rate for Payer: Railroad Medicare Medicare |
$17.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.03
|
| Rate for Payer: UHC Medicare Advantage |
$17.03
|
| Rate for Payer: UHCCP Medicaid |
$9.59
|
| Rate for Payer: VA VA |
$17.03
|
|
|
HC ANTIBODY LYME DISEASE CSF
|
Facility
|
IP
|
$66.59
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200235
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.95 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.28
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.28
|
| Rate for Payer: Priority Health SBD |
$41.95
|
|
|
HC ANTIBODY THYROGLOBULIN
|
Facility
|
OP
|
$85.58
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
30200334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$77.02 |
| Rate for Payer: Aetna Commercial |
$72.74
|
| Rate for Payer: Aetna Medicare |
$16.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.89
|
| Rate for Payer: BCBS Complete |
$8.95
|
| Rate for Payer: BCBS MAPPO |
$15.91
|
| Rate for Payer: BCN Medicare Advantage |
$15.91
|
| Rate for Payer: Cash Price |
$68.46
|
| Rate for Payer: Cash Price |
$68.46
|
| Rate for Payer: Cofinity Commercial |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$59.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.91
|
| Rate for Payer: Healthscope Commercial |
$77.02
|
| Rate for Payer: Mclaren Medicaid |
$8.53
|
| Rate for Payer: Mclaren Medicare |
$15.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.71
|
| Rate for Payer: Meridian Medicaid |
$8.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.74
|
| Rate for Payer: PACE Medicare |
$15.11
|
| Rate for Payer: PACE SWMI |
$15.91
|
| Rate for Payer: PHP Commercial |
$72.74
|
| Rate for Payer: PHP Medicare Advantage |
$15.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.63
|
| Rate for Payer: Priority Health Medicare |
$15.91
|
| Rate for Payer: Priority Health SBD |
$53.92
|
| Rate for Payer: Railroad Medicare Medicare |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.91
|
| Rate for Payer: UHC Medicare Advantage |
$15.91
|
| Rate for Payer: UHCCP Medicaid |
$8.96
|
| Rate for Payer: VA VA |
$15.91
|
|
|
HC ANTIBODY THYROGLOBULIN
|
Facility
|
IP
|
$85.58
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
30200334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.92 |
| Max. Negotiated Rate |
$77.02 |
| Rate for Payer: Aetna Commercial |
$72.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.63
|
| Rate for Payer: Cash Price |
$68.46
|
| Rate for Payer: Cofinity Commercial |
$59.91
|
| Rate for Payer: Cofinity Commercial |
$73.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.46
|
| Rate for Payer: Healthscope Commercial |
$77.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.74
|
| Rate for Payer: PHP Commercial |
$72.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.63
|
| Rate for Payer: Priority Health SBD |
$53.92
|
|
|
HC ANTIBODY TITER
|
Facility
|
OP
|
$271.93
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200344
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$244.74 |
| Rate for Payer: Aetna Commercial |
$231.14
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.75
|
| 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 |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$217.54
|
| Rate for Payer: Cash Price |
$217.54
|
| Rate for Payer: Cofinity Commercial |
$233.86
|
| Rate for Payer: Cofinity Commercial |
$190.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$244.74
|
| Rate for Payer: Mclaren Medicaid |
$2.78
|
| 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 |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.14
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$231.14
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.75
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health SBD |
$171.32
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$2.92
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC ANTIBODY TITER
|
Facility
|
IP
|
$271.93
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200344
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$171.32 |
| Max. Negotiated Rate |
$244.74 |
| Rate for Payer: Aetna Commercial |
$231.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.75
|
| Rate for Payer: Cash Price |
$217.54
|
| Rate for Payer: Cofinity Commercial |
$190.35
|
| Rate for Payer: Cofinity Commercial |
$233.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.54
|
| Rate for Payer: Healthscope Commercial |
$244.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.14
|
| Rate for Payer: PHP Commercial |
$231.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.75
|
| Rate for Payer: Priority Health SBD |
$171.32
|
|
|
HC ANTIBODY TO ENA
|
Facility
|
IP
|
$56.70
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200399
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.72 |
| Max. Negotiated Rate |
$51.03 |
| Rate for Payer: Aetna Commercial |
$48.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.85
|
| Rate for Payer: Cash Price |
$45.36
|
| Rate for Payer: Cofinity Commercial |
$39.69
|
| Rate for Payer: Cofinity Commercial |
$48.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.36
|
| Rate for Payer: Healthscope Commercial |
$51.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.20
|
| Rate for Payer: PHP Commercial |
$48.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.85
|
| Rate for Payer: Priority Health SBD |
$35.72
|
|
|
HC ANTIBODY TO ENA
|
Facility
|
OP
|
$56.70
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200399
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$51.03 |
| Rate for Payer: Aetna Commercial |
$48.20
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.85
|
| 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 |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$45.36
|
| Rate for Payer: Cash Price |
$45.36
|
| Rate for Payer: Cofinity Commercial |
$48.76
|
| Rate for Payer: Cofinity Commercial |
$39.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$51.03
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| 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 |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.20
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$48.20
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.85
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$35.72
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$10.09
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC ANTIBODY TO ENA CMPT
|
Facility
|
IP
|
$56.70
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200400
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.72 |
| Max. Negotiated Rate |
$51.03 |
| Rate for Payer: Aetna Commercial |
$48.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.85
|
| Rate for Payer: Cash Price |
$45.36
|
| Rate for Payer: Cofinity Commercial |
$39.69
|
| Rate for Payer: Cofinity Commercial |
$48.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.36
|
| Rate for Payer: Healthscope Commercial |
$51.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.20
|
| Rate for Payer: PHP Commercial |
$48.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.85
|
| Rate for Payer: Priority Health SBD |
$35.72
|
|
|
HC ANTIBODY TO ENA CMPT
|
Facility
|
OP
|
$56.70
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200400
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$51.03 |
| Rate for Payer: Aetna Commercial |
$48.20
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.85
|
| 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 |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$45.36
|
| Rate for Payer: Cash Price |
$45.36
|
| Rate for Payer: Cofinity Commercial |
$48.76
|
| Rate for Payer: Cofinity Commercial |
$39.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$51.03
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| 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 |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.20
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$48.20
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.85
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$35.72
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$10.09
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC ANTICOAG EST PATIENT LEVEL I
|
Facility
|
IP
|
$182.14
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$163.93 |
| Rate for Payer: Aetna Commercial |
$154.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.39
|
| Rate for Payer: Cash Price |
$145.71
|
| Rate for Payer: Cofinity Commercial |
$127.50
|
| Rate for Payer: Cofinity Commercial |
$156.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.71
|
| Rate for Payer: Healthscope Commercial |
$163.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.82
|
| Rate for Payer: PHP Commercial |
$154.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.39
|
| Rate for Payer: Priority Health SBD |
$114.75
|
|
|
HC ANTICOAG EST PATIENT LEVEL I
|
Facility
|
OP
|
$182.14
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.86 |
| Max. Negotiated Rate |
$163.93 |
| Rate for Payer: Aetna Commercial |
$154.82
|
| Rate for Payer: Aetna Medicare |
$91.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.39
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: Cash Price |
$145.71
|
| Rate for Payer: Cofinity Commercial |
$127.50
|
| Rate for Payer: Cofinity Commercial |
$156.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.71
|
| Rate for Payer: Healthscope Commercial |
$163.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.82
|
| Rate for Payer: PHP Commercial |
$154.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.39
|
| Rate for Payer: Priority Health SBD |
$114.75
|
|
|
HC ANTIDIURETIC HORMONE
|
Facility
|
OP
|
$70.75
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
30100457
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$95.54 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna Medicare |
$35.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.42
|
| Rate for Payer: BCBS Complete |
$19.10
|
| Rate for Payer: BCBS MAPPO |
$33.94
|
| Rate for Payer: BCN Medicare Advantage |
$33.94
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Commercial |
$49.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.94
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Mclaren Medicaid |
$18.19
|
| Rate for Payer: Mclaren Medicare |
$33.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.64
|
| Rate for Payer: Meridian Medicaid |
$19.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: PACE Medicare |
$32.24
|
| Rate for Payer: PACE SWMI |
$33.94
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: PHP Medicare Advantage |
$33.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.99
|
| Rate for Payer: Priority Health Medicare |
$33.94
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: Railroad Medicare Medicare |
$33.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.94
|
| Rate for Payer: UHC Medicare Advantage |
$33.94
|
| Rate for Payer: UHCCP Medicaid |
$19.11
|
| Rate for Payer: VA VA |
$33.94
|
|
|
HC ANTIDIURETIC HORMONE
|
Facility
|
IP
|
$70.75
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
30100457
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.57 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.99
|
| Rate for Payer: Priority Health SBD |
$44.57
|
|
|
HC ANTIEMETIC ONDANSETRON ORAL
|
Facility
|
IP
|
$73.87
|
|
|
Service Code
|
HCPCS J8597
|
| Hospital Charge Code |
63600182
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.54 |
| Max. Negotiated Rate |
$66.48 |
| Rate for Payer: Aetna Commercial |
$62.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.02
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$51.71
|
| Rate for Payer: Cofinity Commercial |
$63.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Healthscope Commercial |
$66.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: PHP Commercial |
$62.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.02
|
| Rate for Payer: Priority Health SBD |
$46.54
|
|
