|
HC HIV DNA BY PCR
|
Facility
|
OP
|
$87.72
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
30600159
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$78.95 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$75.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$78.95
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.56
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$74.56
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.40
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$55.26
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HIV DNA BY PCR
|
Facility
|
IP
|
$87.72
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
30600159
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$55.26 |
| Max. Negotiated Rate |
$78.95 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$75.44
|
| Rate for Payer: Healthscope Commercial |
$78.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.56
|
| Rate for Payer: PHP Commercial |
$74.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.40
|
| Rate for Payer: Priority Health SBD |
$55.26
|
|
|
HC HIV QUANTITATIVE
|
Facility
|
OP
|
$140.80
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
30600299
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.55 |
| Max. Negotiated Rate |
$144.62 |
| Rate for Payer: Aetna Commercial |
$119.68
|
| Rate for Payer: Aetna Medicare |
$88.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.38
|
| Rate for Payer: BCBS Complete |
$48.88
|
| Rate for Payer: BCBS MAPPO |
$85.10
|
| Rate for Payer: BCBS Trust/PPO |
$66.64
|
| Rate for Payer: BCN Medicare Advantage |
$85.10
|
| Rate for Payer: Cash Price |
$112.64
|
| Rate for Payer: Cash Price |
$112.64
|
| Rate for Payer: Cofinity Commercial |
$98.56
|
| Rate for Payer: Cofinity Commercial |
$121.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.10
|
| Rate for Payer: Healthscope Commercial |
$126.72
|
| Rate for Payer: Mclaren Medicaid |
$46.55
|
| Rate for Payer: Mclaren Medicare |
$85.10
|
| Rate for Payer: Meridian Medicaid |
$48.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.68
|
| Rate for Payer: PACE Medicare |
$80.84
|
| Rate for Payer: PACE SWMI |
$85.10
|
| Rate for Payer: PHP Commercial |
$119.68
|
| Rate for Payer: PHP Medicare Advantage |
$85.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.56
|
| Rate for Payer: Priority Health Medicare |
$85.10
|
| Rate for Payer: Priority Health SBD |
$88.70
|
| Rate for Payer: Railroad Medicare Medicare |
$85.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.12
|
| Rate for Payer: UHC Core |
$144.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.10
|
| Rate for Payer: UHC Exchange |
$85.10
|
| Rate for Payer: UHC Medicare Advantage |
$87.65
|
| Rate for Payer: VA VA |
$85.10
|
|
|
HC HIV QUANTITATIVE
|
Facility
|
IP
|
$140.80
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
30600299
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$88.70 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$119.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.52
|
| Rate for Payer: Cash Price |
$112.64
|
| Rate for Payer: Cofinity Commercial |
$121.09
|
| Rate for Payer: Cofinity Commercial |
$98.56
|
| Rate for Payer: Healthscope Commercial |
$126.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.68
|
| Rate for Payer: PHP Commercial |
$119.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.56
|
| Rate for Payer: Priority Health SBD |
$88.70
|
|
|
HC HIV RNA BY PCR
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
30600160
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$128.52 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.40
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: Priority Health SBD |
$128.52
|
|
|
HC HIV RNA BY PCR
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
30600160
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.55 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: Aetna Medicare |
$88.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.38
|
| Rate for Payer: BCBS Complete |
$48.88
|
| Rate for Payer: BCBS MAPPO |
$85.10
|
| Rate for Payer: BCBS Trust/PPO |
$66.64
|
| Rate for Payer: BCN Medicare Advantage |
$85.10
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Cofinity Commercial |
$142.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.10
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Mclaren Medicaid |
$46.55
|
| Rate for Payer: Mclaren Medicare |
$85.10
|
| Rate for Payer: Meridian Medicaid |
$48.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.40
|
| Rate for Payer: PACE Medicare |
$80.84
|
| Rate for Payer: PACE SWMI |
$85.10
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: PHP Medicare Advantage |
$85.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: Priority Health Medicare |
$85.10
|
| Rate for Payer: Priority Health SBD |
$128.52
|
| Rate for Payer: Railroad Medicare Medicare |
$85.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.12
|
| Rate for Payer: UHC Core |
$144.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.10
|
| Rate for Payer: UHC Exchange |
$85.10
|
| Rate for Payer: UHC Medicare Advantage |
$87.65
|
| Rate for Payer: VA VA |
$85.10
|
|
|
HC HIV RNA QUANT REFLEX GENOTYPE
|
Facility
|
IP
|
$130.56
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
30600161
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$117.50 |
| Rate for Payer: Aetna Commercial |
$110.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.86
|
| Rate for Payer: Cash Price |
$104.45
|
| Rate for Payer: Cofinity Commercial |
$91.39
|
| Rate for Payer: Cofinity Commercial |
$112.28
|
| Rate for Payer: Healthscope Commercial |
$117.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.98
|
| Rate for Payer: PHP Commercial |
$110.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.39
|
| Rate for Payer: Priority Health SBD |
$82.25
|
|
|
HC HIV RNA QUANT REFLEX GENOTYPE
|
Facility
|
OP
|
$130.56
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
30600161
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.55 |
| Max. Negotiated Rate |
$144.62 |
| Rate for Payer: Aetna Commercial |
$110.98
|
| Rate for Payer: Aetna Medicare |
$88.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.38
|
| Rate for Payer: BCBS Complete |
$48.88
|
| Rate for Payer: BCBS MAPPO |
$85.10
|
| Rate for Payer: BCBS Trust/PPO |
$66.64
|
| Rate for Payer: BCN Medicare Advantage |
$85.10
|
| Rate for Payer: Cash Price |
$104.45
|
| Rate for Payer: Cash Price |
$104.45
|
| Rate for Payer: Cofinity Commercial |
$112.28
|
| Rate for Payer: Cofinity Commercial |
$91.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.10
|
| Rate for Payer: Healthscope Commercial |
$117.50
|
| Rate for Payer: Mclaren Medicaid |
$46.55
|
| Rate for Payer: Mclaren Medicare |
$85.10
|
| Rate for Payer: Meridian Medicaid |
$48.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.98
|
| Rate for Payer: PACE Medicare |
$80.84
|
| Rate for Payer: PACE SWMI |
$85.10
|
| Rate for Payer: PHP Commercial |
$110.98
|
| Rate for Payer: PHP Medicare Advantage |
$85.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.39
|
| Rate for Payer: Priority Health Medicare |
$85.10
|
| Rate for Payer: Priority Health SBD |
$82.25
|
| Rate for Payer: Railroad Medicare Medicare |
$85.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.12
|
| Rate for Payer: UHC Core |
$144.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.10
|
| Rate for Payer: UHC Exchange |
$85.10
|
| Rate for Payer: UHC Medicare Advantage |
$87.65
|
| Rate for Payer: VA VA |
$85.10
|
|
|
HC HIV TYPE 1 AB IFA
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200275
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.63 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna Commercial |
$85.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.65
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$70.70
|
| Rate for Payer: Cofinity Commercial |
$86.86
|
| Rate for Payer: Healthscope Commercial |
$90.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.85
|
| Rate for Payer: PHP Commercial |
$85.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.70
|
| Rate for Payer: Priority Health SBD |
$63.63
|
|
|
HC HIV TYPE 1 AB IFA
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200275
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna Commercial |
$85.85
|
| Rate for Payer: Aetna Medicare |
$20.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: BCBS Complete |
$11.11
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$15.15
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$70.70
|
| Rate for Payer: Cofinity Commercial |
$86.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$90.90
|
| Rate for Payer: Mclaren Medicaid |
$10.58
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Medicaid |
$11.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.85
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$85.85
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.70
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health SBD |
$63.63
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.22
|
| Rate for Payer: UHC Core |
$32.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.35
|
| Rate for Payer: UHC Exchange |
$19.35
|
| Rate for Payer: UHC Medicare Advantage |
$19.93
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC HIV TYPE 2 AB IMMUNOBLOT
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200274
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.15 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health SBD |
$66.15
|
|
|
HC HIV TYPE 2 AB IMMUNOBLOT
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200274
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna Medicare |
$20.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: BCBS Complete |
$11.11
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$15.15
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Mclaren Medicaid |
$10.58
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Medicaid |
$11.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health SBD |
$66.15
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.22
|
| Rate for Payer: UHC Core |
$32.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.35
|
| Rate for Payer: UHC Exchange |
$19.35
|
| Rate for Payer: UHC Medicare Advantage |
$19.93
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC HIV TYPE 2 ANTIBODY
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
30200291
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.10
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health SBD |
$41.77
|
|
|
HC HIV TYPE 2 ANTIBODY
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
30200291
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna Medicare |
$14.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.90
|
| Rate for Payer: BCBS Complete |
$7.77
|
| Rate for Payer: BCBS MAPPO |
$13.52
|
| Rate for Payer: BCBS Trust/PPO |
$10.59
|
| Rate for Payer: BCN Medicare Advantage |
$13.52
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.52
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Mclaren Medicaid |
$7.40
|
| Rate for Payer: Mclaren Medicare |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$7.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PACE Medicare |
$12.84
|
| Rate for Payer: PACE SWMI |
$13.52
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: PHP Medicare Advantage |
$13.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health Medicare |
$13.52
|
| Rate for Payer: Priority Health SBD |
$41.77
|
| Rate for Payer: Railroad Medicare Medicare |
$13.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.22
|
| Rate for Payer: UHC Core |
$22.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.52
|
| Rate for Payer: UHC Exchange |
$13.52
|
| Rate for Payer: UHC Medicare Advantage |
$13.93
|
| Rate for Payer: VA VA |
$13.52
|
|
|
HC HIV WESTERN BLOT CONFIRMATION
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200273
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health SBD |
$47.25
|
|
|
HC HIV WESTERN BLOT CONFIRMATION
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200273
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna Medicare |
$20.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: BCBS Complete |
$11.11
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$15.15
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Mclaren Medicaid |
$10.58
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Medicaid |
$11.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health SBD |
$47.25
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.22
|
| Rate for Payer: UHC Core |
$32.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.35
|
| Rate for Payer: UHC Exchange |
$19.35
|
| Rate for Payer: UHC Medicare Advantage |
$19.93
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC HLA57 GENOTYPE, ABACAVIR
|
Facility
|
IP
|
$260.84
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
31000137
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$164.33 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna Commercial |
$221.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.55
|
| Rate for Payer: Cash Price |
$208.67
|
| Rate for Payer: Cofinity Commercial |
$182.59
|
| Rate for Payer: Cofinity Commercial |
$224.32
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.71
|
| Rate for Payer: PHP Commercial |
$221.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.59
|
| Rate for Payer: Priority Health SBD |
$164.33
|
|
|
HC HLA57 GENOTYPE, ABACAVIR
|
Facility
|
OP
|
$260.84
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
31000137
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.94 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna Commercial |
$221.71
|
| Rate for Payer: Aetna Medicare |
$176.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.38
|
| Rate for Payer: BCBS Complete |
$97.59
|
| Rate for Payer: BCBS MAPPO |
$169.90
|
| Rate for Payer: BCBS Trust/PPO |
$133.05
|
| Rate for Payer: BCN Medicare Advantage |
$169.90
|
| Rate for Payer: Cash Price |
$208.67
|
| Rate for Payer: Cash Price |
$208.67
|
| Rate for Payer: Cofinity Commercial |
$182.59
|
| Rate for Payer: Cofinity Commercial |
$224.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.90
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Mclaren Medicaid |
$92.94
|
| Rate for Payer: Mclaren Medicare |
$169.90
|
| Rate for Payer: Meridian Medicaid |
$97.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$178.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.71
|
| Rate for Payer: PACE Medicare |
$161.40
|
| Rate for Payer: PACE SWMI |
$169.90
|
| Rate for Payer: PHP Commercial |
$221.71
|
| Rate for Payer: PHP Medicare Advantage |
$169.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.59
|
| Rate for Payer: Priority Health Medicare |
$169.90
|
| Rate for Payer: Priority Health SBD |
$164.33
|
| Rate for Payer: Railroad Medicare Medicare |
$169.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.88
|
| Rate for Payer: UHC Core |
$154.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.90
|
| Rate for Payer: UHC Exchange |
$169.90
|
| Rate for Payer: UHC Medicare Advantage |
$175.00
|
| Rate for Payer: VA VA |
$169.90
|
|
|
HC HLA B27 TISSUE TYPING
|
Facility
|
OP
|
$48.96
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
30200338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna Medicare |
$26.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.26
|
| Rate for Payer: BCBS Complete |
$14.83
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCBS Trust/PPO |
$20.21
|
| Rate for Payer: BCN Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Mclaren Medicaid |
$14.12
|
| Rate for Payer: Mclaren Medicare |
$25.81
|
| Rate for Payer: Meridian Medicaid |
$14.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PACE Medicare |
$24.52
|
| Rate for Payer: PACE SWMI |
$25.81
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: PHP Medicare Advantage |
$25.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health SBD |
$30.84
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.97
|
| Rate for Payer: UHC Core |
$43.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.81
|
| Rate for Payer: UHC Exchange |
$25.81
|
| Rate for Payer: UHC Medicare Advantage |
$26.58
|
| Rate for Payer: VA VA |
$25.81
|
|
|
HC HLA B27 TISSUE TYPING
|
Facility
|
IP
|
$48.96
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
30200338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.84 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: Priority Health SBD |
$30.84
|
|
|
HC HLA MATCH PLATELETS
|
Facility
|
IP
|
$2,702.70
|
|
|
Service Code
|
HCPCS P9052
|
| Hospital Charge Code |
39000062
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,702.70 |
| Max. Negotiated Rate |
$2,432.43 |
| Rate for Payer: Aetna Commercial |
$2,297.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,756.76
|
| Rate for Payer: Cash Price |
$2,162.16
|
| Rate for Payer: Cofinity Commercial |
$1,891.89
|
| Rate for Payer: Cofinity Commercial |
$2,324.32
|
| Rate for Payer: Healthscope Commercial |
$2,432.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,297.30
|
| Rate for Payer: PHP Commercial |
$2,297.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,891.89
|
| Rate for Payer: Priority Health SBD |
$1,702.70
|
|
|
HC HLA MATCH PLATELETS
|
Facility
|
OP
|
$2,702.70
|
|
|
Service Code
|
HCPCS P9052
|
| Hospital Charge Code |
39000062
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$368.14 |
| Max. Negotiated Rate |
$2,484.46 |
| Rate for Payer: Aetna Commercial |
$2,297.30
|
| Rate for Payer: Aetna Medicare |
$699.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,756.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$841.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$841.28
|
| Rate for Payer: BCBS Complete |
$386.58
|
| Rate for Payer: BCBS MAPPO |
$673.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,407.55
|
| Rate for Payer: BCN Medicare Advantage |
$673.02
|
| Rate for Payer: Cash Price |
$2,162.16
|
| Rate for Payer: Cash Price |
$2,162.16
|
| Rate for Payer: Cofinity Commercial |
$2,324.32
|
| Rate for Payer: Cofinity Commercial |
$1,891.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$673.02
|
| Rate for Payer: Healthscope Commercial |
$2,432.43
|
| Rate for Payer: Mclaren Medicaid |
$368.14
|
| Rate for Payer: Mclaren Medicare |
$673.02
|
| Rate for Payer: Meridian Medicaid |
$386.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$706.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$773.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,297.30
|
| Rate for Payer: PACE Medicare |
$639.37
|
| Rate for Payer: PACE SWMI |
$673.02
|
| Rate for Payer: PHP Commercial |
$2,297.30
|
| Rate for Payer: PHP Medicare Advantage |
$673.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,891.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,484.46
|
| Rate for Payer: Priority Health Medicare |
$673.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,987.57
|
| Rate for Payer: Priority Health SBD |
$1,702.70
|
| Rate for Payer: Railroad Medicare Medicare |
$673.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$673.02
|
| Rate for Payer: UHC Medicare Advantage |
$693.21
|
| Rate for Payer: VA VA |
$673.02
|
|
|
HC HOLTER MONITOR
|
Facility
|
OP
|
$652.67
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
73100001
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$587.40 |
| Rate for Payer: Aetna Commercial |
$554.77
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$424.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$82.90
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$522.14
|
| Rate for Payer: Cash Price |
$522.14
|
| Rate for Payer: Cofinity Commercial |
$456.87
|
| Rate for Payer: Cofinity Commercial |
$561.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$587.40
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$554.77
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$554.77
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.10
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health Narrow Network |
$280.88
|
| Rate for Payer: Priority Health SBD |
$411.18
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$18.01
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
HC HOLTER MONITOR
|
Facility
|
IP
|
$652.67
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
73100001
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$411.18 |
| Max. Negotiated Rate |
$587.40 |
| Rate for Payer: Aetna Commercial |
$554.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$424.24
|
| Rate for Payer: Cash Price |
$522.14
|
| Rate for Payer: Cofinity Commercial |
$456.87
|
| Rate for Payer: Cofinity Commercial |
$561.30
|
| Rate for Payer: Healthscope Commercial |
$587.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$554.77
|
| Rate for Payer: PHP Commercial |
$554.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.87
|
| Rate for Payer: Priority Health SBD |
$411.18
|
|
|
HC HOLTER SCAN
|
Facility
|
IP
|
$1,033.01
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
73100003
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$650.80 |
| Max. Negotiated Rate |
$929.71 |
| Rate for Payer: Aetna Commercial |
$878.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.46
|
| Rate for Payer: Cash Price |
$826.41
|
| Rate for Payer: Cofinity Commercial |
$723.11
|
| Rate for Payer: Cofinity Commercial |
$888.39
|
| Rate for Payer: Healthscope Commercial |
$929.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$878.06
|
| Rate for Payer: PHP Commercial |
$878.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$723.11
|
| Rate for Payer: Priority Health SBD |
$650.80
|
|
