|
HC HEPATITIS B CORE AB IGM
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
30200295
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Medicare |
$12.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.71
|
| Rate for Payer: BCBS Complete |
$6.76
|
| Rate for Payer: BCBS MAPPO |
$11.77
|
| Rate for Payer: BCBS Trust/PPO |
$9.22
|
| Rate for Payer: BCN Medicare Advantage |
$11.77
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$68.60
|
| Rate for Payer: Cofinity Commercial |
$84.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.77
|
| Rate for Payer: Healthscope Commercial |
$88.20
|
| Rate for Payer: Mclaren Medicaid |
$6.44
|
| Rate for Payer: Mclaren Medicare |
$11.77
|
| Rate for Payer: Meridian Medicaid |
$6.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: PACE Medicare |
$11.18
|
| Rate for Payer: PACE SWMI |
$11.77
|
| Rate for Payer: PHP Commercial |
$83.30
|
| Rate for Payer: PHP Medicare Advantage |
$11.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health Medicare |
$11.77
|
| Rate for Payer: Priority Health SBD |
$61.74
|
| Rate for Payer: Railroad Medicare Medicare |
$11.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.12
|
| Rate for Payer: UHC Core |
$20.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.77
|
| Rate for Payer: UHC Exchange |
$11.77
|
| Rate for Payer: UHC Medicare Advantage |
$12.12
|
| Rate for Payer: VA VA |
$11.77
|
|
|
HC HEPATITIS B CORE AB TOTAL.
|
Facility
|
IP
|
$47.84
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200294
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.14 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$41.14
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.66
|
| Rate for Payer: PHP Commercial |
$40.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.49
|
| Rate for Payer: Priority Health SBD |
$30.14
|
|
|
HC HEPATITIS B CORE AB TOTAL.
|
Facility
|
OP
|
$47.84
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200294
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.66
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$9.44
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$41.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| 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 |
$40.66
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$40.66
|
| 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 |
$33.49
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$30.14
|
| 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 HEPATITIS B DNA QUANTITATION
|
Facility
|
OP
|
$173.40
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
30600154
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$147.39
|
| Rate for Payer: Aetna Medicare |
$44.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.55
|
| Rate for Payer: BCBS Complete |
$24.61
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$33.55
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cofinity Commercial |
$121.38
|
| Rate for Payer: Cofinity Commercial |
$149.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$156.06
|
| Rate for Payer: Mclaren Medicaid |
$23.43
|
| Rate for Payer: Mclaren Medicare |
$42.84
|
| Rate for Payer: Meridian Medicaid |
$24.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.39
|
| Rate for Payer: PACE Medicare |
$40.70
|
| Rate for Payer: PACE SWMI |
$42.84
|
| Rate for Payer: PHP Commercial |
$147.39
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.38
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health SBD |
$109.24
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.41
|
| Rate for Payer: UHC Core |
$72.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.84
|
| Rate for Payer: UHC Exchange |
$42.84
|
| Rate for Payer: UHC Medicare Advantage |
$44.13
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC HEPATITIS B DNA QUANTITATION
|
Facility
|
IP
|
$173.40
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
30600154
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$109.24 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$147.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.71
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cofinity Commercial |
$121.38
|
| Rate for Payer: Cofinity Commercial |
$149.12
|
| Rate for Payer: Healthscope Commercial |
$156.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.39
|
| Rate for Payer: PHP Commercial |
$147.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.38
|
| Rate for Payer: Priority Health SBD |
$109.24
|
|
|
HC HEPATITIS BE ANTIBODY
|
Facility
|
OP
|
$46.92
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
30200297
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$42.23 |
| Rate for Payer: Aetna Commercial |
$39.88
|
| Rate for Payer: Aetna Medicare |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.46
|
| Rate for Payer: BCBS Complete |
$6.65
|
| Rate for Payer: BCBS MAPPO |
$11.57
|
| Rate for Payer: BCBS Trust/PPO |
$9.06
|
| Rate for Payer: BCN Medicare Advantage |
$11.57
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$40.35
|
| Rate for Payer: Cofinity Commercial |
$32.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.57
|
| Rate for Payer: Healthscope Commercial |
$42.23
|
| Rate for Payer: Mclaren Medicaid |
$6.33
|
| Rate for Payer: Mclaren Medicare |
$11.57
|
| Rate for Payer: Meridian Medicaid |
$6.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.88
|
| Rate for Payer: PACE Medicare |
$10.99
|
| Rate for Payer: PACE SWMI |
$11.57
|
| Rate for Payer: PHP Commercial |
$39.88
|
| Rate for Payer: PHP Medicare Advantage |
$11.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.84
|
| Rate for Payer: Priority Health Medicare |
$11.57
|
| Rate for Payer: Priority Health SBD |
$29.56
|
| Rate for Payer: Railroad Medicare Medicare |
$11.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.88
|
| Rate for Payer: UHC Core |
$19.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.57
|
| Rate for Payer: UHC Exchange |
$11.57
|
| Rate for Payer: UHC Medicare Advantage |
$11.92
|
| Rate for Payer: VA VA |
$11.57
|
|
|
HC HEPATITIS BE ANTIBODY
|
Facility
|
IP
|
$46.92
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
30200297
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$42.23 |
| Rate for Payer: Aetna Commercial |
$39.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.50
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$32.84
|
| Rate for Payer: Cofinity Commercial |
$40.35
|
| Rate for Payer: Healthscope Commercial |
$42.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.88
|
| Rate for Payer: PHP Commercial |
$39.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.84
|
| Rate for Payer: Priority Health SBD |
$29.56
|
|
|
HC HEPATITIS BE ANTIGEN
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
30600142
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$54.18 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna Commercial |
$73.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.90
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Cofinity Commercial |
$73.96
|
| Rate for Payer: Healthscope Commercial |
$77.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.10
|
| Rate for Payer: PHP Commercial |
$73.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.20
|
| Rate for Payer: Priority Health SBD |
$54.18
|
|
|
HC HEPATITIS BE ANTIGEN
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
30600142
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna Commercial |
$73.10
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Cofinity Commercial |
$73.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$77.40
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.10
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$73.10
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.20
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$54.18
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.84
|
| Rate for Payer: UHC Core |
$19.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC HEPATITIS B SURFACE ANTIBODY
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
30200296
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC HEPATITIS B SURFACE ANTIBODY
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
30200296
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$11.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.42
|
| Rate for Payer: BCBS Complete |
$6.17
|
| Rate for Payer: BCBS MAPPO |
$10.74
|
| Rate for Payer: BCBS Trust/PPO |
$8.42
|
| Rate for Payer: BCN Medicare Advantage |
$10.74
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.74
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$5.87
|
| Rate for Payer: Mclaren Medicare |
$10.74
|
| Rate for Payer: Meridian Medicaid |
$6.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$10.20
|
| Rate for Payer: PACE SWMI |
$10.74
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$10.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$10.74
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$10.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.89
|
| Rate for Payer: UHC Core |
$18.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.74
|
| Rate for Payer: UHC Exchange |
$10.74
|
| Rate for Payer: UHC Medicare Advantage |
$11.06
|
| Rate for Payer: VA VA |
$10.74
|
|
|
HC HEPATITIS B SURFACE ANTIGEN
|
Facility
|
OP
|
$38.09
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600139
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$34.28 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: Aetna Medicare |
$10.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.91
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.33
|
| Rate for Payer: BCBS Trust/PPO |
$8.09
|
| Rate for Payer: BCN Medicare Advantage |
$10.33
|
| Rate for Payer: Cash Price |
$30.47
|
| Rate for Payer: Cash Price |
$30.47
|
| Rate for Payer: Cofinity Commercial |
$26.66
|
| Rate for Payer: Cofinity Commercial |
$32.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.33
|
| Rate for Payer: Healthscope Commercial |
$34.28
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicare |
$10.33
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.38
|
| Rate for Payer: PACE Medicare |
$9.81
|
| Rate for Payer: PACE SWMI |
$10.33
|
| Rate for Payer: PHP Commercial |
$32.38
|
| Rate for Payer: PHP Medicare Advantage |
$10.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.66
|
| Rate for Payer: Priority Health Medicare |
$10.33
|
| Rate for Payer: Priority Health SBD |
$24.00
|
| Rate for Payer: Railroad Medicare Medicare |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.40
|
| Rate for Payer: UHC Core |
$17.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.33
|
| Rate for Payer: UHC Exchange |
$10.33
|
| Rate for Payer: UHC Medicare Advantage |
$10.64
|
| Rate for Payer: VA VA |
$10.33
|
|
|
HC HEPATITIS B SURFACE ANTIGEN
|
Facility
|
IP
|
$38.09
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600139
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$34.28 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.76
|
| Rate for Payer: Cash Price |
$30.47
|
| Rate for Payer: Cofinity Commercial |
$26.66
|
| Rate for Payer: Cofinity Commercial |
$32.76
|
| Rate for Payer: Healthscope Commercial |
$34.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.38
|
| Rate for Payer: PHP Commercial |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.66
|
| Rate for Payer: Priority Health SBD |
$24.00
|
|
|
HC HEPATITIS B SURFACE ANTIGEN NEUTRALIZATION
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
30600141
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$45.99 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna Commercial |
$62.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.45
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$51.10
|
| Rate for Payer: Cofinity Commercial |
$62.78
|
| Rate for Payer: Healthscope Commercial |
$65.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.05
|
| Rate for Payer: PHP Commercial |
$62.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.10
|
| Rate for Payer: Priority Health SBD |
$45.99
|
|
|
HC HEPATITIS B SURFACE ANTIGEN NEUTRALIZATION
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
30600141
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna Commercial |
$62.05
|
| Rate for Payer: Aetna Medicare |
$10.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.91
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.33
|
| Rate for Payer: BCBS Trust/PPO |
$8.09
|
| Rate for Payer: BCN Medicare Advantage |
$10.33
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$62.78
|
| Rate for Payer: Cofinity Commercial |
$51.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.33
|
| Rate for Payer: Healthscope Commercial |
$65.70
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicare |
$10.33
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.05
|
| Rate for Payer: PACE Medicare |
$9.81
|
| Rate for Payer: PACE SWMI |
$10.33
|
| Rate for Payer: PHP Commercial |
$62.05
|
| Rate for Payer: PHP Medicare Advantage |
$10.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.10
|
| Rate for Payer: Priority Health Medicare |
$10.33
|
| Rate for Payer: Priority Health SBD |
$45.99
|
| Rate for Payer: Railroad Medicare Medicare |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.40
|
| Rate for Payer: UHC Core |
$17.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.33
|
| Rate for Payer: UHC Exchange |
$10.33
|
| Rate for Payer: UHC Medicare Advantage |
$10.64
|
| Rate for Payer: VA VA |
$10.33
|
|
|
HC HEPATITIS B VACCINE ADULT, 3 DOSE IM
|
Facility
|
IP
|
$82.62
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
63600026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.05 |
| Max. Negotiated Rate |
$74.36 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.70
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$57.83
|
| Rate for Payer: Cofinity Commercial |
$71.05
|
| Rate for Payer: Healthscope Commercial |
$74.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.23
|
| Rate for Payer: PHP Commercial |
$70.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.83
|
| Rate for Payer: Priority Health SBD |
$52.05
|
|
|
HC HEPATITIS B VACCINE ADULT, 3 DOSE IM
|
Facility
|
OP
|
$82.62
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
63600026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.05 |
| Max. Negotiated Rate |
$212.26 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.70
|
| Rate for Payer: BCBS Complete |
$33.05
|
| Rate for Payer: BCBS Trust/PPO |
$212.26
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$57.83
|
| Rate for Payer: Cofinity Commercial |
$71.05
|
| Rate for Payer: Healthscope Commercial |
$74.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.23
|
| Rate for Payer: PHP Commercial |
$70.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.83
|
| Rate for Payer: Priority Health SBD |
$52.05
|
|
|
HC HEPATITIS C ANTIBODY
|
Facility
|
OP
|
$48.26
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
30200336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$43.43 |
| Rate for Payer: Aetna Commercial |
$41.02
|
| Rate for Payer: Aetna Medicare |
$14.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.84
|
| Rate for Payer: BCBS Complete |
$8.20
|
| Rate for Payer: BCBS MAPPO |
$14.27
|
| Rate for Payer: BCBS Trust/PPO |
$11.17
|
| Rate for Payer: BCN Medicare Advantage |
$14.27
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Cofinity Commercial |
$41.50
|
| Rate for Payer: Cofinity Commercial |
$33.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.27
|
| Rate for Payer: Healthscope Commercial |
$43.43
|
| Rate for Payer: Mclaren Medicaid |
$7.81
|
| Rate for Payer: Mclaren Medicare |
$14.27
|
| Rate for Payer: Meridian Medicaid |
$8.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.02
|
| Rate for Payer: PACE Medicare |
$13.56
|
| Rate for Payer: PACE SWMI |
$14.27
|
| Rate for Payer: PHP Commercial |
$41.02
|
| Rate for Payer: PHP Medicare Advantage |
$14.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.78
|
| Rate for Payer: Priority Health Medicare |
$14.27
|
| Rate for Payer: Priority Health SBD |
$30.40
|
| Rate for Payer: Railroad Medicare Medicare |
$14.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.12
|
| Rate for Payer: UHC Core |
$24.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.27
|
| Rate for Payer: UHC Exchange |
$14.27
|
| Rate for Payer: UHC Medicare Advantage |
$14.70
|
| Rate for Payer: VA VA |
$14.27
|
|
|
HC HEPATITIS C ANTIBODY
|
Facility
|
IP
|
$48.26
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
30200336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$43.43 |
| Rate for Payer: Aetna Commercial |
$41.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.37
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Cofinity Commercial |
$33.78
|
| Rate for Payer: Cofinity Commercial |
$41.50
|
| Rate for Payer: Healthscope Commercial |
$43.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.02
|
| Rate for Payer: PHP Commercial |
$41.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.78
|
| Rate for Payer: Priority Health SBD |
$30.40
|
|
|
HC HEPATITIS C ANTIBODY BY RIBA
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 86804
|
| Hospital Charge Code |
30200337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.03 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.65
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$56.70
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.85
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.70
|
| Rate for Payer: Priority Health SBD |
$51.03
|
|
|
HC HEPATITIS C ANTIBODY BY RIBA
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 86804
|
| Hospital Charge Code |
30200337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$16.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.65
|
| 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 |
$8.90
|
| Rate for Payer: BCBS MAPPO |
$15.49
|
| Rate for Payer: BCBS Trust/PPO |
$12.13
|
| Rate for Payer: BCN Medicare Advantage |
$15.49
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Cofinity Commercial |
$56.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Mclaren Medicaid |
$8.47
|
| Rate for Payer: Mclaren Medicare |
$15.49
|
| Rate for Payer: Meridian Medicaid |
$8.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.85
|
| Rate for Payer: PACE Medicare |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.49
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: PHP Medicare Advantage |
$15.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.70
|
| Rate for Payer: Priority Health Medicare |
$15.49
|
| Rate for Payer: Priority Health SBD |
$51.03
|
| Rate for Payer: Railroad Medicare Medicare |
$15.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.59
|
| Rate for Payer: UHC Core |
$26.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.49
|
| Rate for Payer: UHC Exchange |
$15.49
|
| Rate for Payer: UHC Medicare Advantage |
$15.95
|
| Rate for Payer: VA VA |
$15.49
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANT
|
Facility
|
OP
|
$149.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600295
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$134.95 |
| Rate for Payer: Aetna Commercial |
$127.45
|
| Rate for Payer: Aetna Medicare |
$44.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.55
|
| Rate for Payer: BCBS Complete |
$24.61
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$33.55
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$119.95
|
| Rate for Payer: Cash Price |
$119.95
|
| Rate for Payer: Cofinity Commercial |
$104.96
|
| Rate for Payer: Cofinity Commercial |
$128.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$134.95
|
| Rate for Payer: Mclaren Medicaid |
$23.43
|
| Rate for Payer: Mclaren Medicare |
$42.84
|
| Rate for Payer: Meridian Medicaid |
$24.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.45
|
| Rate for Payer: PACE Medicare |
$40.70
|
| Rate for Payer: PACE SWMI |
$42.84
|
| Rate for Payer: PHP Commercial |
$127.45
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.96
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health SBD |
$94.46
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.41
|
| Rate for Payer: UHC Core |
$72.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.84
|
| Rate for Payer: UHC Exchange |
$42.84
|
| Rate for Payer: UHC Medicare Advantage |
$44.13
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANT
|
Facility
|
IP
|
$149.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600295
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$134.95 |
| Rate for Payer: Aetna Commercial |
$127.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.46
|
| Rate for Payer: Cash Price |
$119.95
|
| Rate for Payer: Cofinity Commercial |
$104.96
|
| Rate for Payer: Cofinity Commercial |
$128.95
|
| Rate for Payer: Healthscope Commercial |
$134.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.45
|
| Rate for Payer: PHP Commercial |
$127.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.96
|
| Rate for Payer: Priority Health SBD |
$94.46
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANTIFICATION
|
Facility
|
IP
|
$149.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600157
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$134.95 |
| Rate for Payer: Aetna Commercial |
$127.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.46
|
| Rate for Payer: Cash Price |
$119.95
|
| Rate for Payer: Cofinity Commercial |
$104.96
|
| Rate for Payer: Cofinity Commercial |
$128.95
|
| Rate for Payer: Healthscope Commercial |
$134.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.45
|
| Rate for Payer: PHP Commercial |
$127.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.96
|
| Rate for Payer: Priority Health SBD |
$94.46
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANTIFICATION
|
Facility
|
OP
|
$149.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600157
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$134.95 |
| Rate for Payer: Aetna Commercial |
$127.45
|
| Rate for Payer: Aetna Medicare |
$44.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.55
|
| Rate for Payer: BCBS Complete |
$24.61
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$33.55
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$119.95
|
| Rate for Payer: Cash Price |
$119.95
|
| Rate for Payer: Cofinity Commercial |
$128.95
|
| Rate for Payer: Cofinity Commercial |
$104.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$134.95
|
| Rate for Payer: Mclaren Medicaid |
$23.43
|
| Rate for Payer: Mclaren Medicare |
$42.84
|
| Rate for Payer: Meridian Medicaid |
$24.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.45
|
| Rate for Payer: PACE Medicare |
$40.70
|
| Rate for Payer: PACE SWMI |
$42.84
|
| Rate for Payer: PHP Commercial |
$127.45
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.96
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health SBD |
$94.46
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.41
|
| Rate for Payer: UHC Core |
$72.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.84
|
| Rate for Payer: UHC Exchange |
$42.84
|
| Rate for Payer: UHC Medicare Advantage |
$44.13
|
| Rate for Payer: VA VA |
$42.84
|
|
