|
HC FRUCTOSE SEMEN
|
Facility
|
IP
|
$94.90
|
|
|
Service Code
|
CPT 82757
|
| Hospital Charge Code |
30100206
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.79 |
| Max. Negotiated Rate |
$85.41 |
| Rate for Payer: Aetna Commercial |
$80.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.68
|
| Rate for Payer: Cash Price |
$75.92
|
| Rate for Payer: Cofinity Commercial |
$81.61
|
| Rate for Payer: Cofinity Commercial |
$66.43
|
| Rate for Payer: Healthscope Commercial |
$85.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.66
|
| Rate for Payer: PHP Commercial |
$80.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.43
|
| Rate for Payer: Priority Health SBD |
$59.79
|
|
|
HC F/U EP STUDY
|
Facility
|
IP
|
$5,503.49
|
|
|
Service Code
|
CPT 93624
|
| Hospital Charge Code |
48100040
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,467.20 |
| Max. Negotiated Rate |
$4,953.14 |
| Rate for Payer: Aetna Commercial |
$4,677.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,577.27
|
| Rate for Payer: Cash Price |
$4,402.79
|
| Rate for Payer: Cofinity Commercial |
$3,852.44
|
| Rate for Payer: Cofinity Commercial |
$4,733.00
|
| Rate for Payer: Healthscope Commercial |
$4,953.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,677.97
|
| Rate for Payer: PHP Commercial |
$4,677.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,852.44
|
| Rate for Payer: Priority Health SBD |
$3,467.20
|
|
|
HC F/U EP STUDY
|
Facility
|
OP
|
$5,503.49
|
|
|
Service Code
|
CPT 93624
|
| Hospital Charge Code |
48100040
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,467.20 |
| Max. Negotiated Rate |
$19,563.35 |
| Rate for Payer: Aetna Commercial |
$4,677.97
|
| Rate for Payer: Aetna Medicare |
$6,910.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,577.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,306.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,306.42
|
| Rate for Payer: BCBS Complete |
$3,816.97
|
| Rate for Payer: BCBS MAPPO |
$6,645.14
|
| Rate for Payer: BCBS Trust/PPO |
$19,563.35
|
| Rate for Payer: BCN Medicare Advantage |
$6,645.14
|
| Rate for Payer: Cash Price |
$4,402.79
|
| Rate for Payer: Cash Price |
$4,402.79
|
| Rate for Payer: Cofinity Commercial |
$4,733.00
|
| Rate for Payer: Cofinity Commercial |
$3,852.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,645.14
|
| Rate for Payer: Healthscope Commercial |
$4,953.14
|
| Rate for Payer: Mclaren Medicaid |
$3,634.89
|
| Rate for Payer: Mclaren Medicare |
$6,645.14
|
| Rate for Payer: Meridian Medicaid |
$3,816.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,977.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,641.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,677.97
|
| Rate for Payer: PACE Medicare |
$6,312.88
|
| Rate for Payer: PACE SWMI |
$6,645.14
|
| Rate for Payer: PHP Commercial |
$4,677.97
|
| Rate for Payer: PHP Medicare Advantage |
$6,645.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,634.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,852.44
|
| Rate for Payer: Priority Health Medicare |
$6,645.14
|
| Rate for Payer: Priority Health SBD |
$3,467.20
|
| Rate for Payer: Railroad Medicare Medicare |
$6,645.14
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,645.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,844.49
|
| Rate for Payer: VA VA |
$6,645.14
|
|
|
HC FUNC BACK EVAL
|
Facility
|
OP
|
$123.19
|
|
| Hospital Charge Code |
42400003
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$49.28 |
| Max. Negotiated Rate |
$110.87 |
| Rate for Payer: Aetna Commercial |
$104.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.07
|
| Rate for Payer: BCBS Complete |
$49.28
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Cofinity Commercial |
$105.94
|
| Rate for Payer: Cofinity Commercial |
$86.23
|
| Rate for Payer: Healthscope Commercial |
$110.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.71
|
| Rate for Payer: PHP Commercial |
$104.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.23
|
| Rate for Payer: Priority Health SBD |
$77.61
|
| Rate for Payer: UHC Core |
$91.16
|
|
|
HC FUNC BACK EVAL
|
Facility
|
IP
|
$123.19
|
|
| Hospital Charge Code |
42400003
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$77.61 |
| Max. Negotiated Rate |
$110.87 |
| Rate for Payer: Aetna Commercial |
$104.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.07
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Cofinity Commercial |
$105.94
|
| Rate for Payer: Cofinity Commercial |
$86.23
|
| Rate for Payer: Healthscope Commercial |
$110.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.71
|
| Rate for Payer: PHP Commercial |
$104.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.23
|
| Rate for Payer: Priority Health SBD |
$77.61
|
|
|
HC FUNGAL ID MOLD
|
Facility
|
OP
|
$66.10
|
|
|
Service Code
|
CPT 87107
|
| Hospital Charge Code |
30600085
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$59.49 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna Medicare |
$10.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.90
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.32
|
| Rate for Payer: BCBS Trust/PPO |
$8.08
|
| Rate for Payer: BCN Medicare Advantage |
$10.32
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cofinity Commercial |
$56.85
|
| Rate for Payer: Cofinity Commercial |
$46.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$59.49
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicare |
$10.32
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.18
|
| Rate for Payer: PACE Medicare |
$9.80
|
| Rate for Payer: PACE SWMI |
$10.32
|
| Rate for Payer: PHP Commercial |
$56.18
|
| Rate for Payer: PHP Medicare Advantage |
$10.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.27
|
| Rate for Payer: Priority Health Medicare |
$10.32
|
| Rate for Payer: Priority Health SBD |
$41.64
|
| Rate for Payer: Railroad Medicare Medicare |
$10.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.38
|
| Rate for Payer: UHC Core |
$17.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.32
|
| Rate for Payer: UHC Exchange |
$10.32
|
| Rate for Payer: UHC Medicare Advantage |
$10.63
|
| Rate for Payer: VA VA |
$10.32
|
|
|
HC FUNGAL ID MOLD
|
Facility
|
IP
|
$66.10
|
|
|
Service Code
|
CPT 87107
|
| Hospital Charge Code |
30600085
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.64 |
| Max. Negotiated Rate |
$59.49 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.96
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cofinity Commercial |
$46.27
|
| Rate for Payer: Cofinity Commercial |
$56.85
|
| Rate for Payer: Healthscope Commercial |
$59.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.18
|
| Rate for Payer: PHP Commercial |
$56.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.27
|
| Rate for Payer: Priority Health SBD |
$41.64
|
|
|
HC FUNGAL ID YEAST
|
Facility
|
IP
|
$66.10
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
30600084
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.64 |
| Max. Negotiated Rate |
$59.49 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.96
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cofinity Commercial |
$56.85
|
| Rate for Payer: Cofinity Commercial |
$46.27
|
| Rate for Payer: Healthscope Commercial |
$59.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.18
|
| Rate for Payer: PHP Commercial |
$56.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.27
|
| Rate for Payer: Priority Health SBD |
$41.64
|
|
|
HC FUNGAL ID YEAST
|
Facility
|
OP
|
$66.10
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
30600084
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$59.49 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna Medicare |
$10.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.90
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.32
|
| Rate for Payer: BCBS Trust/PPO |
$8.08
|
| Rate for Payer: BCN Medicare Advantage |
$10.32
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cofinity Commercial |
$56.85
|
| Rate for Payer: Cofinity Commercial |
$46.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$59.49
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicare |
$10.32
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.18
|
| Rate for Payer: PACE Medicare |
$9.80
|
| Rate for Payer: PACE SWMI |
$10.32
|
| Rate for Payer: PHP Commercial |
$56.18
|
| Rate for Payer: PHP Medicare Advantage |
$10.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.27
|
| Rate for Payer: Priority Health Medicare |
$10.32
|
| Rate for Payer: Priority Health SBD |
$41.64
|
| Rate for Payer: Railroad Medicare Medicare |
$10.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.38
|
| Rate for Payer: UHC Core |
$17.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.32
|
| Rate for Payer: UHC Exchange |
$10.32
|
| Rate for Payer: UHC Medicare Advantage |
$10.63
|
| Rate for Payer: VA VA |
$10.32
|
|
|
HC FUNGAL SEROLOGY SURVEY
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 87327
|
| Hospital Charge Code |
30600137
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$13.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.78
|
| Rate for Payer: BCBS Complete |
$7.71
|
| Rate for Payer: BCBS MAPPO |
$13.42
|
| Rate for Payer: BCBS Trust/PPO |
$10.51
|
| Rate for Payer: BCN Medicare Advantage |
$13.42
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.42
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$7.34
|
| Rate for Payer: Mclaren Medicare |
$13.42
|
| Rate for Payer: Meridian Medicaid |
$7.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$12.75
|
| Rate for Payer: PACE SWMI |
$13.42
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$13.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health Medicare |
$13.42
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: Railroad Medicare Medicare |
$13.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.10
|
| Rate for Payer: UHC Core |
$20.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.42
|
| Rate for Payer: UHC Exchange |
$13.42
|
| Rate for Payer: UHC Medicare Advantage |
$13.82
|
| Rate for Payer: VA VA |
$13.42
|
|
|
HC FUNGAL SEROLOGY SURVEY
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 87327
|
| Hospital Charge Code |
30600137
|
|
Hospital Revenue Code
|
306
|
| 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 FUNGAL SEROLOGY SURVEY CMPT1
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
30200229
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna Medicare |
$13.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.12
|
| Rate for Payer: BCBS Complete |
$7.41
|
| Rate for Payer: BCBS MAPPO |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$10.11
|
| Rate for Payer: BCN Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$28.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.90
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Mclaren Medicaid |
$7.06
|
| Rate for Payer: Mclaren Medicare |
$12.90
|
| Rate for Payer: Meridian Medicaid |
$7.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
| Rate for Payer: PACE Medicare |
$12.26
|
| Rate for Payer: PACE SWMI |
$12.90
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: PHP Medicare Advantage |
$12.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health Medicare |
$12.90
|
| Rate for Payer: Priority Health SBD |
$25.20
|
| Rate for Payer: Railroad Medicare Medicare |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.48
|
| Rate for Payer: UHC Core |
$21.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.90
|
| Rate for Payer: UHC Exchange |
$12.90
|
| Rate for Payer: UHC Medicare Advantage |
$13.29
|
| Rate for Payer: VA VA |
$12.90
|
|
|
HC FUNGAL SEROLOGY SURVEY CMPT1
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
30200229
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health SBD |
$25.20
|
|
|
HC FUNGAL SEROLOGY SURVEY CMPT 2
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
30200245
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health SBD |
$25.20
|
|
|
HC FUNGAL SEROLOGY SURVEY CMPT 2
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
30200245
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna Medicare |
$11.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.34
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS MAPPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$8.98
|
| Rate for Payer: BCN Medicare Advantage |
$11.47
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$28.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Mclaren Medicaid |
$6.27
|
| Rate for Payer: Mclaren Medicare |
$11.47
|
| Rate for Payer: Meridian Medicaid |
$6.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
| Rate for Payer: PACE Medicare |
$10.90
|
| Rate for Payer: PACE SWMI |
$11.47
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: PHP Medicare Advantage |
$11.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health Medicare |
$11.47
|
| Rate for Payer: Priority Health SBD |
$25.20
|
| Rate for Payer: Railroad Medicare Medicare |
$11.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.76
|
| Rate for Payer: UHC Core |
$19.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.47
|
| Rate for Payer: UHC Exchange |
$11.47
|
| Rate for Payer: UHC Medicare Advantage |
$11.81
|
| Rate for Payer: VA VA |
$11.47
|
|
|
HC FUNGAL SEROLOGY SURVEY CMPT 3
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
30200287
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$14.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.24
|
| Rate for Payer: BCBS Complete |
$7.92
|
| Rate for Payer: BCBS MAPPO |
$13.79
|
| Rate for Payer: BCBS Trust/PPO |
$10.80
|
| Rate for Payer: BCN Medicare Advantage |
$13.79
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.79
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$7.54
|
| Rate for Payer: Mclaren Medicare |
$13.79
|
| Rate for Payer: Meridian Medicaid |
$7.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$13.10
|
| Rate for Payer: PACE SWMI |
$13.79
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$13.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health Medicare |
$13.79
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: Railroad Medicare Medicare |
$13.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.55
|
| Rate for Payer: UHC Core |
$21.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.79
|
| Rate for Payer: UHC Exchange |
$13.79
|
| Rate for Payer: UHC Medicare Advantage |
$14.20
|
| Rate for Payer: VA VA |
$13.79
|
|
|
HC FUNGAL SEROLOGY SURVEY CMPT 3
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
30200287
|
|
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 FUNGITELL ASSAY
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
30600148
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Aetna Commercial |
$131.75
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$9.39
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$133.30
|
| Rate for Payer: Cofinity Commercial |
$108.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$139.50
|
| Rate for Payer: Mclaren Medicaid |
$6.55
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Medicaid |
$6.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.75
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$131.75
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.50
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health SBD |
$97.65
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.38
|
| Rate for Payer: UHC Core |
$20.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Exchange |
$11.98
|
| Rate for Payer: UHC Medicare Advantage |
$12.34
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC FUNGITELL ASSAY
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
30600148
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$97.65 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Aetna Commercial |
$131.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.75
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$108.50
|
| Rate for Payer: Cofinity Commercial |
$133.30
|
| Rate for Payer: Healthscope Commercial |
$139.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.75
|
| Rate for Payer: PHP Commercial |
$131.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.50
|
| Rate for Payer: Priority Health SBD |
$97.65
|
|
|
HC FUSARIUM PROLIFERATUM IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200085
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC FUSARIUM PROLIFERATUM IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200085
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC GABA-B-R AB CBA, SERUM
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200418
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$425.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$430.00
|
| Rate for Payer: Cofinity Commercial |
$350.00
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.00
|
| Rate for Payer: PHP Commercial |
$425.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.00
|
| Rate for Payer: Priority Health SBD |
$315.00
|
|
|
HC GABA-B-R AB CBA, SERUM
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200418
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$425.00
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.00
|
| 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 |
$7.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$350.00
|
| Rate for Payer: Cofinity Commercial |
$430.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| 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 |
$425.00
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$425.00
|
| 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 |
$350.00
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$315.00
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$20.48
|
| 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 GABA-B-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200419
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.75
|
| 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 |
$7.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$98.90
|
| Rate for Payer: Cofinity Commercial |
$80.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| 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 |
$97.75
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$97.75
|
| 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 |
$80.50
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$72.45
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$20.48
|
| 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 GABA-B-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200419
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$72.45 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.75
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$98.90
|
| Rate for Payer: Cofinity Commercial |
$80.50
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: PHP Commercial |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health SBD |
$72.45
|
|
