|
HC LW / LASSO / ORBITER CATHETER
|
Facility
|
IP
|
$4,698.41
|
|
|
Service Code
|
HCPCS C1731
|
| Hospital Charge Code |
27200056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,960.00 |
| Max. Negotiated Rate |
$4,228.57 |
| Rate for Payer: Aetna Commercial |
$3,993.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,053.97
|
| Rate for Payer: Cash Price |
$3,758.73
|
| Rate for Payer: Cofinity Commercial |
$3,288.89
|
| Rate for Payer: Cofinity Commercial |
$4,040.63
|
| Rate for Payer: Healthscope Commercial |
$4,228.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,993.65
|
| Rate for Payer: PHP Commercial |
$3,993.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,288.89
|
| Rate for Payer: Priority Health SBD |
$2,960.00
|
|
|
HC LW / LASSO / ORBITER CATHETER
|
Facility
|
OP
|
$4,698.41
|
|
|
Service Code
|
HCPCS C1731
|
| Hospital Charge Code |
27200056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$4,228.57 |
| Rate for Payer: Aetna Commercial |
$3,993.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,053.97
|
| Rate for Payer: BCBS Complete |
$1,879.36
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$3,758.73
|
| Rate for Payer: Cash Price |
$3,758.73
|
| Rate for Payer: Cofinity Commercial |
$3,288.89
|
| Rate for Payer: Cofinity Commercial |
$4,040.63
|
| Rate for Payer: Healthscope Commercial |
$4,228.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,993.65
|
| Rate for Payer: PHP Commercial |
$3,993.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,288.89
|
| Rate for Payer: Priority Health SBD |
$2,960.00
|
|
|
HC LYME AB CONFIRMATION CMPT
|
Facility
|
OP
|
$33.66
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
30200232
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$30.29 |
| Rate for Payer: Aetna Commercial |
$28.61
|
| Rate for Payer: Aetna Medicare |
$16.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.36
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS MAPPO |
$15.49
|
| Rate for Payer: BCBS Trust/PPO |
$12.13
|
| Rate for Payer: BCN Medicare Advantage |
$15.49
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cofinity Commercial |
$28.95
|
| Rate for Payer: Cofinity Commercial |
$23.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$30.29
|
| Rate for Payer: Mclaren Medicaid |
$8.47
|
| Rate for Payer: Mclaren Medicare |
$15.49
|
| Rate for Payer: Meridian Medicaid |
$8.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.61
|
| Rate for Payer: PACE Medicare |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.49
|
| Rate for Payer: PHP Commercial |
$28.61
|
| Rate for Payer: PHP Medicare Advantage |
$15.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.56
|
| Rate for Payer: Priority Health Medicare |
$15.49
|
| Rate for Payer: Priority Health SBD |
$21.21
|
| Rate for Payer: Railroad Medicare Medicare |
$15.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.59
|
| Rate for Payer: UHC Core |
$26.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.49
|
| Rate for Payer: UHC Exchange |
$15.49
|
| Rate for Payer: UHC Medicare Advantage |
$15.95
|
| Rate for Payer: VA VA |
$15.49
|
|
|
HC LYME AB CONFIRMATION CMPT
|
Facility
|
IP
|
$33.66
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
30200232
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$30.29 |
| Rate for Payer: Aetna Commercial |
$28.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.88
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cofinity Commercial |
$23.56
|
| Rate for Payer: Cofinity Commercial |
$28.95
|
| Rate for Payer: Healthscope Commercial |
$30.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.61
|
| Rate for Payer: PHP Commercial |
$28.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.56
|
| Rate for Payer: Priority Health SBD |
$21.21
|
|
|
HC LYME CSF COMPONENT 1
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100669
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.17 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna Commercial |
$50.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.35
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$41.30
|
| Rate for Payer: Cofinity Commercial |
$50.74
|
| Rate for Payer: Healthscope Commercial |
$53.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.15
|
| Rate for Payer: PHP Commercial |
$50.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.30
|
| Rate for Payer: Priority Health SBD |
$37.17
|
|
|
HC LYME CSF COMPONENT 1
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100669
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna Commercial |
$50.15
|
| Rate for Payer: Aetna Medicare |
$8.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.72
|
| Rate for Payer: BCBS Complete |
$4.47
|
| Rate for Payer: BCBS MAPPO |
$7.78
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCN Medicare Advantage |
$7.78
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$41.30
|
| Rate for Payer: Cofinity Commercial |
$50.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$53.10
|
| Rate for Payer: Mclaren Medicaid |
$4.26
|
| Rate for Payer: Mclaren Medicare |
$7.78
|
| Rate for Payer: Meridian Medicaid |
$4.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.15
|
| Rate for Payer: PACE Medicare |
$7.39
|
| Rate for Payer: PACE SWMI |
$7.78
|
| Rate for Payer: PHP Commercial |
$50.15
|
| Rate for Payer: PHP Medicare Advantage |
$7.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.30
|
| Rate for Payer: Priority Health Medicare |
$7.78
|
| Rate for Payer: Priority Health SBD |
$37.17
|
| Rate for Payer: Railroad Medicare Medicare |
$7.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.34
|
| Rate for Payer: UHC Core |
$8.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.78
|
| Rate for Payer: UHC Exchange |
$7.78
|
| Rate for Payer: UHC Medicare Advantage |
$8.01
|
| Rate for Payer: VA VA |
$7.78
|
|
|
HC LYME CSF COMPONENT 2
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna Commercial |
$135.15
|
| Rate for Payer: Aetna Medicare |
$17.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.29
|
| Rate for Payer: BCBS Complete |
$9.78
|
| Rate for Payer: BCBS MAPPO |
$17.03
|
| Rate for Payer: BCBS Trust/PPO |
$13.33
|
| Rate for Payer: BCN Medicare Advantage |
$17.03
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cofinity Commercial |
$136.74
|
| Rate for Payer: Cofinity Commercial |
$111.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.03
|
| Rate for Payer: Healthscope Commercial |
$143.10
|
| Rate for Payer: Mclaren Medicaid |
$9.32
|
| Rate for Payer: Mclaren Medicare |
$17.03
|
| Rate for Payer: Meridian Medicaid |
$9.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.15
|
| Rate for Payer: PACE Medicare |
$16.18
|
| Rate for Payer: PACE SWMI |
$17.03
|
| Rate for Payer: PHP Commercial |
$135.15
|
| Rate for Payer: PHP Medicare Advantage |
$17.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.30
|
| Rate for Payer: Priority Health Medicare |
$17.03
|
| Rate for Payer: Priority Health SBD |
$100.17
|
| Rate for Payer: Railroad Medicare Medicare |
$17.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.44
|
| Rate for Payer: UHC Core |
$28.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.03
|
| Rate for Payer: UHC Exchange |
$17.03
|
| Rate for Payer: UHC Medicare Advantage |
$17.54
|
| Rate for Payer: VA VA |
$17.03
|
|
|
HC LYME CSF COMPONENT 2
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.17 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna Commercial |
$135.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.35
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cofinity Commercial |
$111.30
|
| Rate for Payer: Cofinity Commercial |
$136.74
|
| Rate for Payer: Healthscope Commercial |
$143.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.15
|
| Rate for Payer: PHP Commercial |
$135.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.30
|
| Rate for Payer: Priority Health SBD |
$100.17
|
|
|
HC LYME CSF COMPONENT 3
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna Commercial |
$73.95
|
| Rate for Payer: Aetna Medicare |
$9.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.55
|
| 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 |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cofinity Commercial |
$60.90
|
| Rate for Payer: Cofinity Commercial |
$74.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$78.30
|
| 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 |
$73.95
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$73.95
|
| 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 |
$60.90
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health SBD |
$54.81
|
| 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 LYME CSF COMPONENT 3
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.81 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna Commercial |
$73.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.55
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cofinity Commercial |
$60.90
|
| Rate for Payer: Cofinity Commercial |
$74.82
|
| Rate for Payer: Healthscope Commercial |
$78.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.95
|
| Rate for Payer: PHP Commercial |
$73.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.90
|
| Rate for Payer: Priority Health SBD |
$54.81
|
|
|
HC LYME CSF IGG AB INDEX
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.73 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna Commercial |
$60.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.15
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$49.70
|
| Rate for Payer: Cofinity Commercial |
$61.06
|
| Rate for Payer: Healthscope Commercial |
$63.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.35
|
| Rate for Payer: PHP Commercial |
$60.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.70
|
| Rate for Payer: Priority Health SBD |
$44.73
|
|
|
HC LYME CSF IGG AB INDEX
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna Commercial |
$60.35
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$49.70
|
| Rate for Payer: Cofinity Commercial |
$61.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Healthscope Commercial |
$63.90
|
| Rate for Payer: Mclaren Medicaid |
$2.71
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Meridian Medicaid |
$2.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.35
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PHP Commercial |
$60.35
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.70
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health SBD |
$44.73
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.94
|
| Rate for Payer: UHC Core |
$8.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Exchange |
$4.95
|
| Rate for Payer: UHC Medicare Advantage |
$5.10
|
| Rate for Payer: VA VA |
$4.95
|
|
|
HC LYME DISEASE ANTIBODY
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$17.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.29
|
| Rate for Payer: BCBS Complete |
$9.78
|
| Rate for Payer: BCBS MAPPO |
$17.03
|
| Rate for Payer: BCBS Trust/PPO |
$13.33
|
| Rate for Payer: BCN Medicare Advantage |
$17.03
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.03
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Mclaren Medicaid |
$9.32
|
| Rate for Payer: Mclaren Medicare |
$17.03
|
| Rate for Payer: Meridian Medicaid |
$9.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PACE Medicare |
$16.18
|
| Rate for Payer: PACE SWMI |
$17.03
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: PHP Medicare Advantage |
$17.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health Medicare |
$17.03
|
| Rate for Payer: Priority Health SBD |
$28.92
|
| Rate for Payer: Railroad Medicare Medicare |
$17.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.44
|
| Rate for Payer: UHC Core |
$28.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.03
|
| Rate for Payer: UHC Exchange |
$17.03
|
| Rate for Payer: UHC Medicare Advantage |
$17.54
|
| Rate for Payer: VA VA |
$17.03
|
|
|
HC LYME DISEASE ANTIBODY
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.92 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health SBD |
$28.92
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS
|
Facility
|
IP
|
$254.63
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200472
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$160.42 |
| Max. Negotiated Rate |
$229.17 |
| Rate for Payer: Aetna Commercial |
$216.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.51
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cofinity Commercial |
$178.24
|
| Rate for Payer: Cofinity Commercial |
$218.98
|
| Rate for Payer: Healthscope Commercial |
$229.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.44
|
| Rate for Payer: PHP Commercial |
$216.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.24
|
| Rate for Payer: Priority Health SBD |
$160.42
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS
|
Facility
|
OP
|
$254.63
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200472
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.82 |
| Max. Negotiated Rate |
$229.17 |
| Rate for Payer: Aetna Commercial |
$216.44
|
| Rate for Payer: Aetna Medicare |
$50.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: BCBS Complete |
$28.16
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$38.39
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cofinity Commercial |
$218.98
|
| Rate for Payer: Cofinity Commercial |
$178.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$229.17
|
| Rate for Payer: Mclaren Medicaid |
$26.82
|
| Rate for Payer: Mclaren Medicare |
$49.03
|
| Rate for Payer: Meridian Medicaid |
$28.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.44
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$216.44
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.24
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health SBD |
$160.42
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.84
|
| Rate for Payer: UHC Core |
$83.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.03
|
| Rate for Payer: UHC Exchange |
$49.03
|
| Rate for Payer: UHC Medicare Advantage |
$50.50
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS CMPT
|
Facility
|
IP
|
$274.60
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200475
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$173.00 |
| Max. Negotiated Rate |
$247.14 |
| Rate for Payer: Aetna Commercial |
$233.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.49
|
| Rate for Payer: Cash Price |
$219.68
|
| Rate for Payer: Cofinity Commercial |
$236.16
|
| Rate for Payer: Cofinity Commercial |
$192.22
|
| Rate for Payer: Healthscope Commercial |
$247.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.41
|
| Rate for Payer: PHP Commercial |
$233.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.22
|
| Rate for Payer: Priority Health SBD |
$173.00
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS CMPT
|
Facility
|
OP
|
$274.60
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200475
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.82 |
| Max. Negotiated Rate |
$247.14 |
| Rate for Payer: Aetna Commercial |
$233.41
|
| Rate for Payer: Aetna Medicare |
$50.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: BCBS Complete |
$28.16
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$38.39
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$219.68
|
| Rate for Payer: Cash Price |
$219.68
|
| Rate for Payer: Cofinity Commercial |
$236.16
|
| Rate for Payer: Cofinity Commercial |
$192.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$247.14
|
| Rate for Payer: Mclaren Medicaid |
$26.82
|
| Rate for Payer: Mclaren Medicare |
$49.03
|
| Rate for Payer: Meridian Medicaid |
$28.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.41
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$233.41
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.22
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health SBD |
$173.00
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.84
|
| Rate for Payer: UHC Core |
$83.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.03
|
| Rate for Payer: UHC Exchange |
$49.03
|
| Rate for Payer: UHC Medicare Advantage |
$50.50
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION MITOGEN
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.82 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Aetna Medicare |
$50.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: BCBS Complete |
$28.16
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$38.39
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$161.70
|
| Rate for Payer: Cofinity Commercial |
$198.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$207.90
|
| Rate for Payer: Mclaren Medicaid |
$26.82
|
| Rate for Payer: Mclaren Medicare |
$49.03
|
| Rate for Payer: Meridian Medicaid |
$28.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$196.35
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$196.35
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.70
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health SBD |
$145.53
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.84
|
| Rate for Payer: UHC Core |
$83.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.03
|
| Rate for Payer: UHC Exchange |
$49.03
|
| Rate for Payer: UHC Medicare Advantage |
$50.50
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION MITOGEN
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$145.53 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.15
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$161.70
|
| Rate for Payer: Cofinity Commercial |
$198.66
|
| Rate for Payer: Healthscope Commercial |
$207.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$196.35
|
| Rate for Payer: PHP Commercial |
$196.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.70
|
| Rate for Payer: Priority Health SBD |
$145.53
|
|
|
HC LYMPHOCYTE PROLIFERATION, MITOGENS
|
Facility
|
IP
|
$254.63
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200473
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$160.42 |
| Max. Negotiated Rate |
$229.17 |
| Rate for Payer: Aetna Commercial |
$216.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.51
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cofinity Commercial |
$178.24
|
| Rate for Payer: Cofinity Commercial |
$218.98
|
| Rate for Payer: Healthscope Commercial |
$229.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.44
|
| Rate for Payer: PHP Commercial |
$216.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.24
|
| Rate for Payer: Priority Health SBD |
$160.42
|
|
|
HC LYMPHOCYTE PROLIFERATION, MITOGENS
|
Facility
|
OP
|
$254.63
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200473
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.82 |
| Max. Negotiated Rate |
$229.17 |
| Rate for Payer: Aetna Commercial |
$216.44
|
| Rate for Payer: Aetna Medicare |
$50.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: BCBS Complete |
$28.16
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$38.39
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cofinity Commercial |
$218.98
|
| Rate for Payer: Cofinity Commercial |
$178.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$229.17
|
| Rate for Payer: Mclaren Medicaid |
$26.82
|
| Rate for Payer: Mclaren Medicare |
$49.03
|
| Rate for Payer: Meridian Medicaid |
$28.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.44
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$216.44
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.24
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health SBD |
$160.42
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.84
|
| Rate for Payer: UHC Core |
$83.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.03
|
| Rate for Payer: UHC Exchange |
$49.03
|
| Rate for Payer: UHC Medicare Advantage |
$50.50
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION, MITOGENS CMPT
|
Facility
|
OP
|
$274.60
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200474
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.82 |
| Max. Negotiated Rate |
$247.14 |
| Rate for Payer: Aetna Commercial |
$233.41
|
| Rate for Payer: Aetna Medicare |
$50.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: BCBS Complete |
$28.16
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$38.39
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$219.68
|
| Rate for Payer: Cash Price |
$219.68
|
| Rate for Payer: Cofinity Commercial |
$192.22
|
| Rate for Payer: Cofinity Commercial |
$236.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$247.14
|
| Rate for Payer: Mclaren Medicaid |
$26.82
|
| Rate for Payer: Mclaren Medicare |
$49.03
|
| Rate for Payer: Meridian Medicaid |
$28.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.41
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$233.41
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.22
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health SBD |
$173.00
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.84
|
| Rate for Payer: UHC Core |
$83.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.03
|
| Rate for Payer: UHC Exchange |
$49.03
|
| Rate for Payer: UHC Medicare Advantage |
$50.50
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION, MITOGENS CMPT
|
Facility
|
IP
|
$274.60
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200474
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$173.00 |
| Max. Negotiated Rate |
$247.14 |
| Rate for Payer: Aetna Commercial |
$233.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.49
|
| Rate for Payer: Cash Price |
$219.68
|
| Rate for Payer: Cofinity Commercial |
$236.16
|
| Rate for Payer: Cofinity Commercial |
$192.22
|
| Rate for Payer: Healthscope Commercial |
$247.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.41
|
| Rate for Payer: PHP Commercial |
$233.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.22
|
| Rate for Payer: Priority Health SBD |
$173.00
|
|
|
HC LYMPHOMA IMMUNOPHENO 2
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT 85060
|
| Hospital Charge Code |
30500014
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$9.64
|
|
