|
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
|
|
|
HC IMMUNODIFFUSION AB OR AG FIRST
|
Facility
|
IP
|
$89.76
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
30200401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.55 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$76.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.34
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$77.19
|
| Rate for Payer: Cofinity Commercial |
$62.83
|
| Rate for Payer: Healthscope Commercial |
$80.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: PHP Commercial |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: Priority Health SBD |
$56.55
|
|
|
HC IMMUNODIFFUSION AB OR AG FIRST
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
30200401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$76.30
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$9.39
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$62.83
|
| Rate for Payer: Cofinity Commercial |
$77.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$80.78
|
| Rate for Payer: Mclaren Medicaid |
$6.55
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Medicaid |
$6.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$76.30
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health SBD |
$56.55
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.38
|
| Rate for Payer: UHC Core |
$20.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Exchange |
$11.98
|
| Rate for Payer: UHC Medicare Advantage |
$12.34
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC IMMUNOFIXATION
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
30200195
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$76.30
|
| Rate for Payer: Aetna Medicare |
$23.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.92
|
| Rate for Payer: BCBS Complete |
$12.83
|
| Rate for Payer: BCBS MAPPO |
$22.34
|
| Rate for Payer: BCBS Trust/PPO |
$13.12
|
| Rate for Payer: BCN Medicare Advantage |
$22.34
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$62.83
|
| Rate for Payer: Cofinity Commercial |
$77.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.34
|
| Rate for Payer: Healthscope Commercial |
$80.78
|
| Rate for Payer: Mclaren Medicaid |
$12.22
|
| Rate for Payer: Mclaren Medicare |
$22.34
|
| Rate for Payer: Meridian Medicaid |
$12.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: PACE Medicare |
$21.22
|
| Rate for Payer: PACE SWMI |
$22.34
|
| Rate for Payer: PHP Commercial |
$76.30
|
| Rate for Payer: PHP Medicare Advantage |
$22.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: Priority Health Medicare |
$22.34
|
| Rate for Payer: Priority Health SBD |
$56.55
|
| Rate for Payer: Railroad Medicare Medicare |
$22.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.81
|
| Rate for Payer: UHC Core |
$37.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.34
|
| Rate for Payer: UHC Exchange |
$22.34
|
| Rate for Payer: UHC Medicare Advantage |
$23.01
|
| Rate for Payer: VA VA |
$22.34
|
|
|
HC IMMUNOFIXATION
|
Facility
|
IP
|
$89.76
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
30200195
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.55 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$76.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.34
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$62.83
|
| Rate for Payer: Cofinity Commercial |
$77.19
|
| Rate for Payer: Healthscope Commercial |
$80.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: PHP Commercial |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: Priority Health SBD |
$56.55
|
|
|
HC IMMUNOFIXATION ELECTRO SERUM
|
Facility
|
OP
|
$165.80
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
30200194
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Aetna Commercial |
$140.93
|
| Rate for Payer: Aetna Medicare |
$23.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.92
|
| Rate for Payer: BCBS Complete |
$12.83
|
| Rate for Payer: BCBS MAPPO |
$22.34
|
| Rate for Payer: BCBS Trust/PPO |
$13.12
|
| Rate for Payer: BCN Medicare Advantage |
$22.34
|
| Rate for Payer: Cash Price |
$132.64
|
| Rate for Payer: Cash Price |
$132.64
|
| Rate for Payer: Cofinity Commercial |
$142.59
|
| Rate for Payer: Cofinity Commercial |
$116.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.34
|
| Rate for Payer: Healthscope Commercial |
$149.22
|
| Rate for Payer: Mclaren Medicaid |
$12.22
|
| Rate for Payer: Mclaren Medicare |
$22.34
|
| Rate for Payer: Meridian Medicaid |
$12.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.93
|
| Rate for Payer: PACE Medicare |
$21.22
|
| Rate for Payer: PACE SWMI |
$22.34
|
| Rate for Payer: PHP Commercial |
$140.93
|
| Rate for Payer: PHP Medicare Advantage |
$22.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.06
|
| Rate for Payer: Priority Health Medicare |
$22.34
|
| Rate for Payer: Priority Health SBD |
$104.45
|
| Rate for Payer: Railroad Medicare Medicare |
$22.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.81
|
| Rate for Payer: UHC Core |
$37.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.34
|
| Rate for Payer: UHC Exchange |
$22.34
|
| Rate for Payer: UHC Medicare Advantage |
$23.01
|
| Rate for Payer: VA VA |
$22.34
|
|
|
HC IMMUNOFIXATION ELECTRO SERUM
|
Facility
|
IP
|
$165.80
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
30200194
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.45 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Aetna Commercial |
$140.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.77
|
| Rate for Payer: Cash Price |
$132.64
|
| Rate for Payer: Cofinity Commercial |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$142.59
|
| Rate for Payer: Healthscope Commercial |
$149.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.93
|
| Rate for Payer: PHP Commercial |
$140.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.06
|
| Rate for Payer: Priority Health SBD |
$104.45
|
|
|
HC IMMUNOFIXATION ELEC URINE/CSF
|
Facility
|
OP
|
$165.80
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
30200196
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Aetna Commercial |
$140.93
|
| Rate for Payer: Aetna Medicare |
$30.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.69
|
| Rate for Payer: BCBS Complete |
$16.86
|
| Rate for Payer: BCBS MAPPO |
$29.35
|
| Rate for Payer: BCBS Trust/PPO |
$17.24
|
| Rate for Payer: BCN Medicare Advantage |
$29.35
|
| Rate for Payer: Cash Price |
$132.64
|
| Rate for Payer: Cash Price |
$132.64
|
| Rate for Payer: Cofinity Commercial |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$142.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.35
|
| Rate for Payer: Healthscope Commercial |
$149.22
|
| Rate for Payer: Mclaren Medicaid |
$16.05
|
| Rate for Payer: Mclaren Medicare |
$29.35
|
| Rate for Payer: Meridian Medicaid |
$16.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.93
|
| Rate for Payer: PACE Medicare |
$27.88
|
| Rate for Payer: PACE SWMI |
$29.35
|
| Rate for Payer: PHP Commercial |
$140.93
|
| Rate for Payer: PHP Medicare Advantage |
$29.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.06
|
| Rate for Payer: Priority Health Medicare |
$29.35
|
| Rate for Payer: Priority Health SBD |
$104.45
|
| Rate for Payer: Railroad Medicare Medicare |
$29.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.22
|
| Rate for Payer: UHC Core |
$49.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.35
|
| Rate for Payer: UHC Exchange |
$29.35
|
| Rate for Payer: UHC Medicare Advantage |
$30.23
|
| Rate for Payer: VA VA |
$29.35
|
|
|
HC IMMUNOFIXATION ELEC URINE/CSF
|
Facility
|
IP
|
$165.80
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
30200196
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.45 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Aetna Commercial |
$140.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.77
|
| Rate for Payer: Cash Price |
$132.64
|
| Rate for Payer: Cofinity Commercial |
$142.59
|
| Rate for Payer: Cofinity Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$149.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.93
|
| Rate for Payer: PHP Commercial |
$140.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.06
|
| Rate for Payer: Priority Health SBD |
$104.45
|
|
|
HC IMMUNOGLOBULIN A IGA
|
Facility
|
OP
|
$75.40
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$67.86 |
| Rate for Payer: Aetna Commercial |
$64.09
|
| Rate for Payer: Aetna Medicare |
$9.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.62
|
| Rate for Payer: BCBS Complete |
$5.34
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$7.29
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$64.84
|
| Rate for Payer: Cofinity Commercial |
$52.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$67.86
|
| Rate for Payer: Mclaren Medicaid |
$5.09
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Medicaid |
$5.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$64.09
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health SBD |
$47.50
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.16
|
| Rate for Payer: UHC Core |
$15.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.30
|
| Rate for Payer: UHC Exchange |
$9.30
|
| Rate for Payer: UHC Medicare Advantage |
$9.58
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC IMMUNOGLOBULIN A IGA
|
Facility
|
IP
|
$75.40
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$67.86 |
| Rate for Payer: Aetna Commercial |
$64.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.01
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$52.78
|
| Rate for Payer: Cofinity Commercial |
$64.84
|
| Rate for Payer: Healthscope Commercial |
$67.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: PHP Commercial |
$64.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: Priority Health SBD |
$47.50
|
|
|
HC IMMUNOGLOBULIN A (IGA), S
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna Commercial |
$33.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.35
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$27.30
|
| Rate for Payer: Cofinity Commercial |
$33.54
|
| Rate for Payer: Healthscope Commercial |
$35.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.15
|
| Rate for Payer: PHP Commercial |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health SBD |
$24.57
|
|
|
HC IMMUNOGLOBULIN A (IGA), S
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna Commercial |
$33.15
|
| Rate for Payer: Aetna Medicare |
$9.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.62
|
| Rate for Payer: BCBS Complete |
$5.34
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$7.29
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$33.54
|
| Rate for Payer: Cofinity Commercial |
$27.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$35.10
|
| Rate for Payer: Mclaren Medicaid |
$5.09
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Medicaid |
$5.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.15
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$33.15
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health SBD |
$24.57
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.16
|
| Rate for Payer: UHC Core |
$15.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.30
|
| Rate for Payer: UHC Exchange |
$9.30
|
| Rate for Payer: UHC Medicare Advantage |
$9.58
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC IMMUNOGLOBULIN E IGE ALLERGY SPECIFIC
|
Facility
|
OP
|
$62.02
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
30100213
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$55.82 |
| Rate for Payer: Aetna Commercial |
$52.72
|
| Rate for Payer: Aetna Medicare |
$17.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.58
|
| Rate for Payer: BCBS Complete |
$9.45
|
| Rate for Payer: BCBS MAPPO |
$16.46
|
| Rate for Payer: BCBS Trust/PPO |
$12.89
|
| Rate for Payer: BCN Medicare Advantage |
$16.46
|
| Rate for Payer: Cash Price |
$49.62
|
| Rate for Payer: Cash Price |
$49.62
|
| Rate for Payer: Cofinity Commercial |
$43.41
|
| Rate for Payer: Cofinity Commercial |
$53.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.46
|
| Rate for Payer: Healthscope Commercial |
$55.82
|
| Rate for Payer: Mclaren Medicaid |
$9.00
|
| Rate for Payer: Mclaren Medicare |
$16.46
|
| Rate for Payer: Meridian Medicaid |
$9.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.72
|
| Rate for Payer: PACE Medicare |
$15.64
|
| Rate for Payer: PACE SWMI |
$16.46
|
| Rate for Payer: PHP Commercial |
$52.72
|
| Rate for Payer: PHP Medicare Advantage |
$16.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.41
|
| Rate for Payer: Priority Health Medicare |
$16.46
|
| Rate for Payer: Priority Health SBD |
$39.07
|
| Rate for Payer: Railroad Medicare Medicare |
$16.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.75
|
| Rate for Payer: UHC Core |
$27.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.46
|
| Rate for Payer: UHC Exchange |
$16.46
|
| Rate for Payer: UHC Medicare Advantage |
$16.95
|
| Rate for Payer: VA VA |
$16.46
|
|
|
HC IMMUNOGLOBULIN E IGE ALLERGY SPECIFIC
|
Facility
|
IP
|
$62.02
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
30100213
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.07 |
| Max. Negotiated Rate |
$55.82 |
| Rate for Payer: Aetna Commercial |
$52.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.31
|
| Rate for Payer: Cash Price |
$49.62
|
| Rate for Payer: Cofinity Commercial |
$43.41
|
| Rate for Payer: Cofinity Commercial |
$53.34
|
| Rate for Payer: Healthscope Commercial |
$55.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.72
|
| Rate for Payer: PHP Commercial |
$52.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.41
|
| Rate for Payer: Priority Health SBD |
$39.07
|
|
|
HC IMMUNOGLOBULIN G IGG
|
Facility
|
IP
|
$75.40
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100207
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$67.86 |
| Rate for Payer: Aetna Commercial |
$64.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.01
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$64.84
|
| Rate for Payer: Cofinity Commercial |
$52.78
|
| Rate for Payer: Healthscope Commercial |
$67.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: PHP Commercial |
$64.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: Priority Health SBD |
$47.50
|
|
|
HC IMMUNOGLOBULIN G IGG
|
Facility
|
OP
|
$75.40
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100207
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$67.86 |
| Rate for Payer: Aetna Commercial |
$64.09
|
| Rate for Payer: Aetna Medicare |
$9.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.62
|
| Rate for Payer: BCBS Complete |
$5.34
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$7.29
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$64.84
|
| Rate for Payer: Cofinity Commercial |
$52.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$67.86
|
| Rate for Payer: Mclaren Medicaid |
$5.09
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Medicaid |
$5.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$64.09
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health SBD |
$47.50
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.16
|
| Rate for Payer: UHC Core |
$15.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.30
|
| Rate for Payer: UHC Exchange |
$9.30
|
| Rate for Payer: UHC Medicare Advantage |
$9.58
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC IMMUNOGLOBULIN M IGM
|
Facility
|
OP
|
$75.40
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100209
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$67.86 |
| Rate for Payer: Aetna Commercial |
$64.09
|
| Rate for Payer: Aetna Medicare |
$9.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.62
|
| Rate for Payer: BCBS Complete |
$5.34
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$7.29
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$52.78
|
| Rate for Payer: Cofinity Commercial |
$64.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$67.86
|
| Rate for Payer: Mclaren Medicaid |
$5.09
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Medicaid |
$5.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$64.09
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health SBD |
$47.50
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.16
|
| Rate for Payer: UHC Core |
$15.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.30
|
| Rate for Payer: UHC Exchange |
$9.30
|
| Rate for Payer: UHC Medicare Advantage |
$9.58
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC IMMUNOGLOBULIN M IGM
|
Facility
|
IP
|
$75.40
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100209
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$67.86 |
| Rate for Payer: Aetna Commercial |
$64.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.01
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$52.78
|
| Rate for Payer: Cofinity Commercial |
$64.84
|
| Rate for Payer: Healthscope Commercial |
$67.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: PHP Commercial |
$64.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: Priority Health SBD |
$47.50
|
|
|
HC IMMUNOGLOBULIN SUBCLASSES
|
Facility
|
OP
|
$22.44
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Aetna Commercial |
$19.07
|
| Rate for Payer: Aetna Medicare |
$9.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.62
|
| Rate for Payer: BCBS Complete |
$5.34
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$7.29
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cofinity Commercial |
$19.30
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Mclaren Medicaid |
$5.09
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Medicaid |
$5.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.07
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$19.07
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health SBD |
$14.14
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.16
|
| Rate for Payer: UHC Core |
$15.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.30
|
| Rate for Payer: UHC Exchange |
$9.30
|
| Rate for Payer: UHC Medicare Advantage |
$9.58
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC IMMUNOGLOBULIN SUBCLASSES
|
Facility
|
IP
|
$22.44
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Aetna Commercial |
$19.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.59
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.07
|
| Rate for Payer: PHP Commercial |
$19.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health SBD |
$14.14
|
|
|
HC IMMUNOHISTOCHEMISTRY EA ADDL STAIN PER SPECIMEN
|
Facility
|
OP
|
$150.27
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
31000118
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$54.56 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$127.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.68
|
| Rate for Payer: BCBS Complete |
$60.11
|
| Rate for Payer: BCBS Trust/PPO |
$72.40
|
| Rate for Payer: BCCCP Commercial |
$86.77
|
| Rate for Payer: Cash Price |
$120.22
|
| Rate for Payer: Cash Price |
$120.22
|
| Rate for Payer: Cofinity Commercial |
$105.19
|
| Rate for Payer: Cofinity Commercial |
$129.23
|
| Rate for Payer: Healthscope Commercial |
$135.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.73
|
| Rate for Payer: PHP Commercial |
$127.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.19
|
| Rate for Payer: Priority Health SBD |
$94.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.97
|
| Rate for Payer: UHC Core |
$54.56
|
| Rate for Payer: UHC Exchange |
$89.06
|
|
|
HC IMMUNOHISTOCHEMISTRY EA ADDL STAIN PER SPECIMEN
|
Facility
|
IP
|
$150.27
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
31000118
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$94.67 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$127.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.68
|
| Rate for Payer: Cash Price |
$120.22
|
| Rate for Payer: Cofinity Commercial |
$105.19
|
| Rate for Payer: Cofinity Commercial |
$129.23
|
| Rate for Payer: Healthscope Commercial |
$135.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.73
|
| Rate for Payer: PHP Commercial |
$127.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.19
|
| Rate for Payer: Priority Health SBD |
$94.67
|
|
|
HC IMMUNOHISTOCHEMISTRY STAIN
|
Facility
|
IP
|
$170.02
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
31000058
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$107.11 |
| Max. Negotiated Rate |
$153.02 |
| Rate for Payer: Aetna Commercial |
$144.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.51
|
| Rate for Payer: Cash Price |
$136.02
|
| Rate for Payer: Cofinity Commercial |
$119.01
|
| Rate for Payer: Cofinity Commercial |
$146.22
|
| Rate for Payer: Healthscope Commercial |
$153.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.52
|
| Rate for Payer: PHP Commercial |
$144.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.01
|
| Rate for Payer: Priority Health SBD |
$107.11
|
|
|
HC IMMUNOHISTOCHEMISTRY STAIN
|
Facility
|
OP
|
$170.02
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
31000058
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$464.37 |
| Rate for Payer: Aetna Commercial |
$144.52
|
| Rate for Payer: Aetna Medicare |
$158.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.98
|
| Rate for Payer: BCBS Complete |
$87.30
|
| Rate for Payer: BCBS MAPPO |
$151.98
|
| Rate for Payer: BCBS Trust/PPO |
$81.50
|
| Rate for Payer: BCCCP Commercial |
$100.83
|
| Rate for Payer: BCN Medicare Advantage |
$151.98
|
| Rate for Payer: Cash Price |
$136.02
|
| Rate for Payer: Cash Price |
$136.02
|
| Rate for Payer: Cofinity Commercial |
$119.01
|
| Rate for Payer: Cofinity Commercial |
$146.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.98
|
| Rate for Payer: Healthscope Commercial |
$153.02
|
| Rate for Payer: Mclaren Medicaid |
$83.13
|
| Rate for Payer: Mclaren Medicare |
$151.98
|
| Rate for Payer: Meridian Medicaid |
$87.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.52
|
| Rate for Payer: PACE Medicare |
$144.38
|
| Rate for Payer: PACE SWMI |
$151.98
|
| Rate for Payer: PHP Commercial |
$144.52
|
| Rate for Payer: PHP Medicare Advantage |
$151.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$464.37
|
| Rate for Payer: Priority Health Medicare |
$151.98
|
| Rate for Payer: Priority Health Narrow Network |
$371.50
|
| Rate for Payer: Priority Health SBD |
$107.11
|
| Rate for Payer: Railroad Medicare Medicare |
$151.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.54
|
| Rate for Payer: UHC Core |
$44.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.98
|
| Rate for Payer: UHC Exchange |
$104.13
|
| Rate for Payer: UHC Medicare Advantage |
$156.54
|
| Rate for Payer: VA VA |
$151.98
|
|
