|
HC IMFLUOR EACH ADDL AB STAIN (BILL ONLY)
|
Facility
|
OP
|
$103.91
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
31000085
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.56 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: Aetna Commercial |
$88.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.54
|
| Rate for Payer: BCBS Complete |
$41.56
|
| Rate for Payer: BCBS Trust/PPO |
$108.81
|
| Rate for Payer: Cash Price |
$83.13
|
| Rate for Payer: Cash Price |
$83.13
|
| Rate for Payer: Cofinity Commercial |
$89.36
|
| Rate for Payer: Cofinity Commercial |
$72.74
|
| Rate for Payer: Healthscope Commercial |
$93.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.32
|
| Rate for Payer: PHP Commercial |
$88.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.74
|
| Rate for Payer: Priority Health SBD |
$65.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.19
|
| Rate for Payer: UHC Core |
$52.45
|
| Rate for Payer: UHC Exchange |
$111.99
|
|
|
HC IMFLUOR EACH ADDL AB STAIN (BILL ONLY)
|
Facility
|
IP
|
$103.91
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
31000085
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.46 |
| Max. Negotiated Rate |
$93.52 |
| Rate for Payer: Aetna Commercial |
$88.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.54
|
| Rate for Payer: Cash Price |
$83.13
|
| Rate for Payer: Cofinity Commercial |
$89.36
|
| Rate for Payer: Cofinity Commercial |
$72.74
|
| Rate for Payer: Healthscope Commercial |
$93.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.32
|
| Rate for Payer: PHP Commercial |
$88.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.74
|
| Rate for Payer: Priority Health SBD |
$65.46
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
IP
|
$59.87
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
30500013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$37.72 |
| Max. Negotiated Rate |
$53.88 |
| Rate for Payer: Aetna Commercial |
$50.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.92
|
| Rate for Payer: Cash Price |
$47.90
|
| Rate for Payer: Cofinity Commercial |
$51.49
|
| Rate for Payer: Cofinity Commercial |
$41.91
|
| Rate for Payer: Healthscope Commercial |
$53.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.89
|
| Rate for Payer: PHP Commercial |
$50.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.91
|
| Rate for Payer: Priority Health SBD |
$37.72
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
OP
|
$59.87
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
30500013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$53.88 |
| Rate for Payer: Aetna Commercial |
$50.89
|
| Rate for Payer: Aetna Medicare |
$37.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.68
|
| Rate for Payer: BCBS Complete |
$20.53
|
| Rate for Payer: BCBS MAPPO |
$35.74
|
| Rate for Payer: BCBS Trust/PPO |
$27.99
|
| Rate for Payer: BCN Medicare Advantage |
$35.74
|
| Rate for Payer: Cash Price |
$47.90
|
| Rate for Payer: Cash Price |
$47.90
|
| Rate for Payer: Cofinity Commercial |
$51.49
|
| Rate for Payer: Cofinity Commercial |
$41.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.74
|
| Rate for Payer: Healthscope Commercial |
$53.88
|
| Rate for Payer: Mclaren Medicaid |
$19.55
|
| Rate for Payer: Mclaren Medicare |
$35.74
|
| Rate for Payer: Meridian Medicaid |
$20.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.89
|
| Rate for Payer: PACE Medicare |
$33.95
|
| Rate for Payer: PACE SWMI |
$35.74
|
| Rate for Payer: PHP Commercial |
$50.89
|
| Rate for Payer: PHP Medicare Advantage |
$35.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.91
|
| Rate for Payer: Priority Health Medicare |
$35.74
|
| Rate for Payer: Priority Health SBD |
$37.72
|
| Rate for Payer: Railroad Medicare Medicare |
$35.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.89
|
| Rate for Payer: UHC Core |
$45.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.74
|
| Rate for Payer: UHC Exchange |
$35.74
|
| Rate for Payer: UHC Medicare Advantage |
$36.81
|
| Rate for Payer: VA VA |
$35.74
|
|
|
HC IMMUNIZATION 18YEARS OR YOUNGER
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
77100001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health SBD |
$18.90
|
|
|
HC IMMUNIZATION 18YEARS OR YOUNGER
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
77100001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$71.80 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.50
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$71.80
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health SBD |
$18.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.85
|
| Rate for Payer: UHC Exchange |
$22.59
|
|
|
HC IMMUNIZATION 1ST VACCINE
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
77100003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$193.04 |
| Rate for Payer: Aetna Commercial |
$28.05
|
| Rate for Payer: Aetna Medicare |
$65.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.35
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$62.68
|
| Rate for Payer: BCBS Trust/PPO |
$74.88
|
| Rate for Payer: BCN Medicare Advantage |
$62.68
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$23.10
|
| Rate for Payer: Cofinity Commercial |
$28.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.68
|
| Rate for Payer: Healthscope Commercial |
$29.70
|
| Rate for Payer: Mclaren Medicaid |
$34.29
|
| Rate for Payer: Mclaren Medicare |
$62.68
|
| Rate for Payer: Meridian Medicaid |
$36.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.05
|
| Rate for Payer: PACE Medicare |
$59.55
|
| Rate for Payer: PACE SWMI |
$62.68
|
| Rate for Payer: PHP Commercial |
$28.05
|
| Rate for Payer: PHP Medicare Advantage |
$62.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.04
|
| Rate for Payer: Priority Health Medicare |
$62.68
|
| Rate for Payer: Priority Health Narrow Network |
$154.43
|
| Rate for Payer: Priority Health SBD |
$20.79
|
| Rate for Payer: Railroad Medicare Medicare |
$62.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.68
|
| Rate for Payer: UHC Exchange |
$20.30
|
| Rate for Payer: UHC Medicare Advantage |
$64.56
|
| Rate for Payer: VA VA |
$62.68
|
|
|
HC IMMUNIZATION 1ST VACCINE
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
77100003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna Commercial |
$28.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.45
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$23.10
|
| Rate for Payer: Cofinity Commercial |
$28.38
|
| Rate for Payer: Healthscope Commercial |
$29.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.05
|
| Rate for Payer: PHP Commercial |
$28.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.10
|
| Rate for Payer: Priority Health SBD |
$20.79
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE
|
Facility
|
IP
|
$33.45
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
77100004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.07 |
| Max. Negotiated Rate |
$30.10 |
| Rate for Payer: Aetna Commercial |
$28.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.74
|
| Rate for Payer: Cash Price |
$26.76
|
| Rate for Payer: Cofinity Commercial |
$23.42
|
| Rate for Payer: Cofinity Commercial |
$28.77
|
| Rate for Payer: Healthscope Commercial |
$30.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.43
|
| Rate for Payer: PHP Commercial |
$28.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.42
|
| Rate for Payer: Priority Health SBD |
$21.07
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE
|
Facility
|
OP
|
$33.45
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
77100004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$47.20 |
| Rate for Payer: Aetna Commercial |
$28.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.74
|
| Rate for Payer: BCBS Complete |
$13.38
|
| Rate for Payer: BCBS Trust/PPO |
$47.20
|
| Rate for Payer: Cash Price |
$26.76
|
| Rate for Payer: Cash Price |
$26.76
|
| Rate for Payer: Cofinity Commercial |
$23.42
|
| Rate for Payer: Cofinity Commercial |
$28.77
|
| Rate for Payer: Healthscope Commercial |
$30.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.43
|
| Rate for Payer: PHP Commercial |
$28.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.42
|
| Rate for Payer: Priority Health SBD |
$21.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.85
|
| Rate for Payer: UHC Exchange |
$14.41
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE 18 YEARS OR YOUNGER
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
77100002
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health SBD |
$15.75
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE 18 YEARS OR YOUNGER
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
77100002
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$38.18 |
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$38.18
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health SBD |
$15.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.36
|
| Rate for Payer: UHC Exchange |
$8.51
|
|
|
HC IMMUNIZATION NASAL ORAL 1ST
|
Facility
|
OP
|
$36.80
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
77100005
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$193.04 |
| Rate for Payer: Aetna Commercial |
$31.28
|
| Rate for Payer: Aetna Medicare |
$65.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.35
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$62.68
|
| Rate for Payer: BCBS Trust/PPO |
$53.80
|
| Rate for Payer: BCN Medicare Advantage |
$62.68
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Cofinity Commercial |
$31.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.68
|
| Rate for Payer: Healthscope Commercial |
$33.12
|
| Rate for Payer: Mclaren Medicaid |
$34.29
|
| Rate for Payer: Mclaren Medicare |
$62.68
|
| Rate for Payer: Meridian Medicaid |
$36.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.28
|
| Rate for Payer: PACE Medicare |
$59.55
|
| Rate for Payer: PACE SWMI |
$62.68
|
| Rate for Payer: PHP Commercial |
$31.28
|
| Rate for Payer: PHP Medicare Advantage |
$62.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.04
|
| Rate for Payer: Priority Health Medicare |
$62.68
|
| Rate for Payer: Priority Health Narrow Network |
$154.43
|
| Rate for Payer: Priority Health SBD |
$23.18
|
| Rate for Payer: Railroad Medicare Medicare |
$62.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.68
|
| Rate for Payer: UHC Exchange |
$16.37
|
| Rate for Payer: UHC Medicare Advantage |
$64.56
|
| Rate for Payer: VA VA |
$62.68
|
|
|
HC IMMUNIZATION NASAL ORAL 1ST
|
Facility
|
IP
|
$36.80
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
77100005
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$33.12 |
| Rate for Payer: Aetna Commercial |
$31.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.92
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Cofinity Commercial |
$31.65
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Healthscope Commercial |
$33.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.28
|
| Rate for Payer: PHP Commercial |
$31.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.76
|
| Rate for Payer: Priority Health SBD |
$23.18
|
|
|
HC IMMUNIZATION ORAL/NASL EA ADD
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
77100006
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$24.30 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.55
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$18.90
|
| Rate for Payer: Cofinity Commercial |
$23.22
|
| Rate for Payer: Healthscope Commercial |
$24.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.95
|
| Rate for Payer: PHP Commercial |
$22.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
| Rate for Payer: Priority Health SBD |
$17.01
|
|
|
HC IMMUNIZATION ORAL/NASL EA ADD
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
77100006
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$38.43 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.55
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$38.43
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$23.22
|
| Rate for Payer: Cofinity Commercial |
$18.90
|
| Rate for Payer: Healthscope Commercial |
$24.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.95
|
| Rate for Payer: PHP Commercial |
$22.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
| Rate for Payer: Priority Health SBD |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.97
|
| Rate for Payer: UHC Exchange |
$11.79
|
|
|
HC IMMUNOASSAY MULTI STEP
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100659
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.81
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.14
|
| Rate for Payer: Priority Health SBD |
$15.42
|
|
|
HC IMMUNOASSAY MULTI STEP
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100659
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| 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 |
$19.58
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| 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 |
$20.81
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$20.81
|
| 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 |
$17.14
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$15.42
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.84
|
| Rate for Payer: UHC Core |
$19.61
|
| 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 IMMUNOASSAY MULTI STEP ADDITIONAL
|
Facility
|
OP
|
$38.25
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$34.42 |
| Rate for Payer: Aetna Commercial |
$32.51
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.86
|
| 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 |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Cofinity Commercial |
$26.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$34.42
|
| 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 |
$32.51
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$32.51
|
| 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 |
$26.78
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$24.10
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.84
|
| Rate for Payer: UHC Core |
$19.61
|
| 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 IMMUNOASSAY MULTI STEP ADDITIONAL
|
Facility
|
IP
|
$38.25
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$34.42 |
| Rate for Payer: Aetna Commercial |
$32.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.86
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cofinity Commercial |
$26.78
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Healthscope Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.51
|
| Rate for Payer: PHP Commercial |
$32.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.78
|
| Rate for Payer: Priority Health SBD |
$24.10
|
|
|
HC IMMUNOASSAY MULTI STEP FIRST
|
Facility
|
OP
|
$38.25
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$34.42 |
| Rate for Payer: Aetna Commercial |
$32.51
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.86
|
| 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 |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Cofinity Commercial |
$26.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$34.42
|
| 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 |
$32.51
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$32.51
|
| 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 |
$26.78
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$24.10
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.84
|
| Rate for Payer: UHC Core |
$19.61
|
| 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 IMMUNOASSAY MULTI STEP FIRST
|
Facility
|
IP
|
$38.25
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$34.42 |
| Rate for Payer: Aetna Commercial |
$32.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.86
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cofinity Commercial |
$26.78
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Healthscope Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.51
|
| Rate for Payer: PHP Commercial |
$32.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.78
|
| Rate for Payer: Priority Health SBD |
$24.10
|
|
|
HC IMMUNODIFFUSION
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 86329
|
| Hospital Charge Code |
30200191
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna Commercial |
$104.55
|
| Rate for Payer: Aetna Medicare |
$14.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.56
|
| Rate for Payer: BCBS Complete |
$8.07
|
| Rate for Payer: BCBS MAPPO |
$14.05
|
| Rate for Payer: BCBS Trust/PPO |
$11.00
|
| Rate for Payer: BCN Medicare Advantage |
$14.05
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$86.10
|
| Rate for Payer: Cofinity Commercial |
$105.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.05
|
| Rate for Payer: Healthscope Commercial |
$110.70
|
| Rate for Payer: Mclaren Medicaid |
$7.69
|
| Rate for Payer: Mclaren Medicare |
$14.05
|
| Rate for Payer: Meridian Medicaid |
$8.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.55
|
| Rate for Payer: PACE Medicare |
$13.35
|
| Rate for Payer: PACE SWMI |
$14.05
|
| Rate for Payer: PHP Commercial |
$104.55
|
| Rate for Payer: PHP Medicare Advantage |
$14.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health Medicare |
$14.05
|
| Rate for Payer: Priority Health SBD |
$77.49
|
| Rate for Payer: Railroad Medicare Medicare |
$14.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.86
|
| Rate for Payer: UHC Core |
$23.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.05
|
| Rate for Payer: UHC Exchange |
$14.05
|
| Rate for Payer: UHC Medicare Advantage |
$14.47
|
| Rate for Payer: VA VA |
$14.05
|
|
|
HC IMMUNODIFFUSION
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 86329
|
| Hospital Charge Code |
30200191
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$77.49 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna Commercial |
$104.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.95
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$105.78
|
| Rate for Payer: Cofinity Commercial |
$86.10
|
| Rate for Payer: Healthscope Commercial |
$110.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.55
|
| Rate for Payer: PHP Commercial |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health SBD |
$77.49
|
|
|
HC IMMUNODIFFUSION AB OR AG ADDITIONAL
|
Facility
|
IP
|
$77.52
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
30200402
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$48.84 |
| Max. Negotiated Rate |
$69.77 |
| Rate for Payer: Aetna Commercial |
$65.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.39
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cofinity Commercial |
$54.26
|
| Rate for Payer: Cofinity Commercial |
$66.67
|
| Rate for Payer: Healthscope Commercial |
$69.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.89
|
| Rate for Payer: PHP Commercial |
$65.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.26
|
| Rate for Payer: Priority Health SBD |
$48.84
|
|
