|
HC HEP B ADMINISTRATION
|
Facility
|
IP
|
$34.85
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
77100008
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$31.36 |
| Rate for Payer: Aetna Commercial |
$29.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.65
|
| Rate for Payer: Cash Price |
$27.88
|
| Rate for Payer: Cofinity Advantage |
$24.39
|
| Rate for Payer: Cofinity Commercial |
$29.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.88
|
| Rate for Payer: Healthscope Commercial |
$31.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.14
|
| Rate for Payer: PHP Commercial |
$29.62
|
| Rate for Payer: Priority Health SBD |
$21.96
|
|
|
HC HEP B ADMINISTRATION
|
Facility
|
OP
|
$34.85
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
77100008
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.70 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna Commercial |
$29.62
|
| Rate for Payer: Aetna Medicare |
$48.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.33
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS MAPPO |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$58.24
|
| Rate for Payer: BCN Commercial |
$58.24
|
| Rate for Payer: BCN Medicare Advantage |
$46.66
|
| Rate for Payer: Cash Price |
$27.88
|
| Rate for Payer: Cash Price |
$27.88
|
| Rate for Payer: Cofinity Advantage |
$24.39
|
| Rate for Payer: Cofinity Commercial |
$29.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.66
|
| Rate for Payer: Healthscope Commercial |
$31.36
|
| Rate for Payer: Mclaren Medicaid |
$24.40
|
| Rate for Payer: Mclaren Medicare |
$46.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.99
|
| Rate for Payer: Meridian Medicaid |
$48.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.62
|
| Rate for Payer: Nomi Health Commercial |
$139.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.14
|
| Rate for Payer: PACE Medicare |
$44.33
|
| Rate for Payer: PACE SWMI |
$46.66
|
| Rate for Payer: PHP Commercial |
$29.62
|
| Rate for Payer: PHP Medicare Advantage |
$46.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$150.88
|
| Rate for Payer: Priority Health Medicare |
$46.66
|
| Rate for Payer: Priority Health SBD |
$21.96
|
| Rate for Payer: Priority Health Tiered Network |
$120.70
|
| Rate for Payer: Railroad Medicare Medicare |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.65
|
| Rate for Payer: UHC Core |
$18.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.66
|
| Rate for Payer: UHC Exchange |
$13.70
|
| Rate for Payer: UHC Medicaid |
$24.40
|
| Rate for Payer: UHCCP Medicaid |
$24.40
|
| Rate for Payer: VA VA |
$46.66
|
|
|
HC HEP B CORE AB TOTAL.
|
Facility
|
IP
|
$101.96
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200293
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$64.23 |
| Max. Negotiated Rate |
$91.76 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.27
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Advantage |
$71.37
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.47
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: Priority Health SBD |
$64.23
|
|
|
HC HEP B CORE AB TOTAL.
|
Facility
|
OP
|
$101.96
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200293
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$91.76 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$12.85
|
| Rate for Payer: BCN Commercial |
$12.85
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Advantage |
$71.37
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Mclaren Medicaid |
$6.30
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.47
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$64.23
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC HEP B SURFACE ANTIGEN CONFIRMATION
|
Facility
|
OP
|
$46.85
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600140
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$42.16 |
| Rate for Payer: Aetna Commercial |
$39.82
|
| Rate for Payer: Aetna Medicare |
$10.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.91
|
| Rate for Payer: BCBS Complete |
$5.67
|
| Rate for Payer: BCBS MAPPO |
$10.33
|
| Rate for Payer: BCBS Trust/PPO |
$11.02
|
| Rate for Payer: BCN Commercial |
$11.02
|
| Rate for Payer: BCN Medicare Advantage |
$10.33
|
| Rate for Payer: Cash Price |
$37.48
|
| Rate for Payer: Cash Price |
$37.48
|
| Rate for Payer: Cofinity Advantage |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$40.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.33
|
| Rate for Payer: Healthscope Commercial |
$42.16
|
| Rate for Payer: Mclaren Medicaid |
$5.40
|
| Rate for Payer: Mclaren Medicare |
$10.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.85
|
| Rate for Payer: Meridian Medicaid |
$10.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.82
|
| Rate for Payer: Nomi Health Commercial |
$15.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.14
|
| Rate for Payer: PACE Medicare |
$9.81
|
| Rate for Payer: PACE SWMI |
$10.33
|
| Rate for Payer: PHP Commercial |
$39.82
|
| Rate for Payer: PHP Medicare Advantage |
$10.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10.33
|
| Rate for Payer: Priority Health Medicare |
$10.33
|
| Rate for Payer: Priority Health SBD |
$29.52
|
| Rate for Payer: Priority Health Tiered Network |
$8.26
|
| Rate for Payer: Railroad Medicare Medicare |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.50
|
| Rate for Payer: UHC Core |
$15.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.33
|
| Rate for Payer: UHC Exchange |
$15.50
|
| Rate for Payer: UHC Medicaid |
$5.40
|
| Rate for Payer: UHCCP Medicaid |
$5.40
|
| Rate for Payer: VA VA |
$10.33
|
|
|
HC HEP B SURFACE ANTIGEN CONFIRMATION
|
Facility
|
IP
|
$46.85
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600140
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.52 |
| Max. Negotiated Rate |
$42.16 |
| Rate for Payer: Aetna Commercial |
$39.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.45
|
| Rate for Payer: Cash Price |
$37.48
|
| Rate for Payer: Cofinity Advantage |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$40.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.48
|
| Rate for Payer: Healthscope Commercial |
$42.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.14
|
| Rate for Payer: PHP Commercial |
$39.82
|
| Rate for Payer: Priority Health SBD |
$29.52
|
|
|
HC HEP B VACC 2 DOSE ADULT IM
|
Facility
|
IP
|
$339.59
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
63600181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$213.94 |
| Max. Negotiated Rate |
$305.63 |
| Rate for Payer: Aetna Commercial |
$288.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.73
|
| Rate for Payer: Cash Price |
$271.67
|
| Rate for Payer: Cofinity Advantage |
$237.71
|
| Rate for Payer: Cofinity Commercial |
$292.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.67
|
| Rate for Payer: Healthscope Commercial |
$305.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.69
|
| Rate for Payer: PHP Commercial |
$288.65
|
| Rate for Payer: Priority Health SBD |
$213.94
|
|
|
HC HEP B VACC 2 DOSE ADULT IM
|
Facility
|
OP
|
$339.59
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
63600181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.84 |
| Max. Negotiated Rate |
$383.52 |
| Rate for Payer: Aetna Commercial |
$288.65
|
| Rate for Payer: Aetna Medicare |
$169.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.73
|
| Rate for Payer: BCBS Complete |
$135.84
|
| Rate for Payer: BCBS Trust/PPO |
$383.52
|
| Rate for Payer: BCN Commercial |
$383.52
|
| Rate for Payer: Cash Price |
$271.67
|
| Rate for Payer: Cash Price |
$271.67
|
| Rate for Payer: Cofinity Advantage |
$237.71
|
| Rate for Payer: Cofinity Commercial |
$292.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.67
|
| Rate for Payer: Healthscope Commercial |
$305.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.69
|
| Rate for Payer: PHP Commercial |
$288.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$177.56
|
| Rate for Payer: Priority Health SBD |
$213.94
|
| Rate for Payer: Priority Health Tiered Network |
$142.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.97
|
| Rate for Payer: UHC Core |
$292.97
|
| Rate for Payer: UHC Exchange |
$292.97
|
|
|
HC HEP C GENO SUBTYPES
|
Facility
|
IP
|
$460.87
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600256
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$290.35 |
| Max. Negotiated Rate |
$414.78 |
| Rate for Payer: Aetna Commercial |
$391.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.57
|
| Rate for Payer: Cash Price |
$368.70
|
| Rate for Payer: Cofinity Advantage |
$322.61
|
| Rate for Payer: Cofinity Commercial |
$396.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.70
|
| Rate for Payer: Healthscope Commercial |
$414.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.65
|
| Rate for Payer: PHP Commercial |
$391.74
|
| Rate for Payer: Priority Health SBD |
$290.35
|
|
|
HC HEP C GENO SUBTYPES
|
Facility
|
OP
|
$460.87
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600256
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$134.65 |
| Max. Negotiated Rate |
$414.78 |
| Rate for Payer: Aetna Commercial |
$391.74
|
| Rate for Payer: Aetna Medicare |
$267.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$321.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$321.81
|
| Rate for Payer: BCBS Complete |
$141.39
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCBS Trust/PPO |
$274.50
|
| Rate for Payer: BCN Commercial |
$274.50
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$368.70
|
| Rate for Payer: Cash Price |
$368.70
|
| Rate for Payer: Cofinity Advantage |
$322.61
|
| Rate for Payer: Cofinity Commercial |
$396.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Healthscope Commercial |
$414.78
|
| Rate for Payer: Mclaren Medicaid |
$134.65
|
| Rate for Payer: Mclaren Medicare |
$257.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.32
|
| Rate for Payer: Meridian Medicaid |
$270.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$283.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.74
|
| Rate for Payer: Nomi Health Commercial |
$386.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.65
|
| Rate for Payer: PACE Medicare |
$244.58
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PHP Commercial |
$391.74
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$257.45
|
| Rate for Payer: Priority Health Medicare |
$257.45
|
| Rate for Payer: Priority Health SBD |
$290.35
|
| Rate for Payer: Priority Health Tiered Network |
$205.96
|
| Rate for Payer: Railroad Medicare Medicare |
$257.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.18
|
| Rate for Payer: UHC Core |
$386.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$257.45
|
| Rate for Payer: UHC Exchange |
$386.18
|
| Rate for Payer: UHC Medicaid |
$134.65
|
| Rate for Payer: UHCCP Medicaid |
$134.65
|
| Rate for Payer: VA VA |
$257.45
|
|
|
HC HER2 DUAL ISH
|
Facility
|
OP
|
$318.36
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000065
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$138.78 |
| Max. Negotiated Rate |
$1,155.01 |
| Rate for Payer: Aetna Commercial |
$270.61
|
| Rate for Payer: Aetna Medicare |
$371.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.45
|
| Rate for Payer: BCBS Complete |
$196.15
|
| Rate for Payer: BCBS MAPPO |
$357.16
|
| Rate for Payer: BCBS Trust/PPO |
$183.98
|
| Rate for Payer: BCCCP Commercial |
$138.78
|
| Rate for Payer: BCN Commercial |
$183.98
|
| Rate for Payer: BCN Medicare Advantage |
$357.16
|
| Rate for Payer: Cash Price |
$254.69
|
| Rate for Payer: Cash Price |
$254.69
|
| Rate for Payer: Cofinity Advantage |
$222.85
|
| Rate for Payer: Cofinity Commercial |
$273.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.16
|
| Rate for Payer: Healthscope Commercial |
$286.52
|
| Rate for Payer: Mclaren Medicaid |
$186.79
|
| Rate for Payer: Mclaren Medicare |
$357.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.02
|
| Rate for Payer: Meridian Medicaid |
$375.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$392.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.61
|
| Rate for Payer: Nomi Health Commercial |
$1,071.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.77
|
| Rate for Payer: PACE Medicare |
$339.30
|
| Rate for Payer: PACE SWMI |
$357.16
|
| Rate for Payer: PHP Commercial |
$270.61
|
| Rate for Payer: PHP Medicare Advantage |
$357.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,155.01
|
| Rate for Payer: Priority Health Medicare |
$357.16
|
| Rate for Payer: Priority Health SBD |
$200.57
|
| Rate for Payer: Priority Health Tiered Network |
$924.01
|
| Rate for Payer: Railroad Medicare Medicare |
$357.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$539.58
|
| Rate for Payer: UHC Core |
$539.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$357.16
|
| Rate for Payer: UHC Exchange |
$539.58
|
| Rate for Payer: UHC Medicaid |
$186.79
|
| Rate for Payer: UHCCP Medicaid |
$186.79
|
| Rate for Payer: VA VA |
$357.16
|
|
|
HC HER2 DUAL ISH
|
Facility
|
IP
|
$318.36
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000065
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$200.57 |
| Max. Negotiated Rate |
$286.52 |
| Rate for Payer: Aetna Commercial |
$270.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.93
|
| Rate for Payer: Cash Price |
$254.69
|
| Rate for Payer: Cofinity Advantage |
$222.85
|
| Rate for Payer: Cofinity Commercial |
$273.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.69
|
| Rate for Payer: Healthscope Commercial |
$286.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.77
|
| Rate for Payer: PHP Commercial |
$270.61
|
| Rate for Payer: Priority Health SBD |
$200.57
|
|
|
HC HER2 DUAL ISH CMPT
|
Facility
|
IP
|
$318.36
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000066
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$200.57 |
| Max. Negotiated Rate |
$286.52 |
| Rate for Payer: Aetna Commercial |
$270.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.93
|
| Rate for Payer: Cash Price |
$254.69
|
| Rate for Payer: Cofinity Advantage |
$222.85
|
| Rate for Payer: Cofinity Commercial |
$273.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.69
|
| Rate for Payer: Healthscope Commercial |
$286.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.77
|
| Rate for Payer: PHP Commercial |
$270.61
|
| Rate for Payer: Priority Health SBD |
$200.57
|
|
|
HC HER2 DUAL ISH CMPT
|
Facility
|
OP
|
$318.36
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000066
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$138.78 |
| Max. Negotiated Rate |
$1,155.01 |
| Rate for Payer: Aetna Commercial |
$270.61
|
| Rate for Payer: Aetna Medicare |
$371.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.45
|
| Rate for Payer: BCBS Complete |
$196.15
|
| Rate for Payer: BCBS MAPPO |
$357.16
|
| Rate for Payer: BCBS Trust/PPO |
$183.98
|
| Rate for Payer: BCCCP Commercial |
$138.78
|
| Rate for Payer: BCN Commercial |
$183.98
|
| Rate for Payer: BCN Medicare Advantage |
$357.16
|
| Rate for Payer: Cash Price |
$254.69
|
| Rate for Payer: Cash Price |
$254.69
|
| Rate for Payer: Cofinity Advantage |
$222.85
|
| Rate for Payer: Cofinity Commercial |
$273.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.16
|
| Rate for Payer: Healthscope Commercial |
$286.52
|
| Rate for Payer: Mclaren Medicaid |
$186.79
|
| Rate for Payer: Mclaren Medicare |
$357.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.02
|
| Rate for Payer: Meridian Medicaid |
$375.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$392.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.61
|
| Rate for Payer: Nomi Health Commercial |
$1,071.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.77
|
| Rate for Payer: PACE Medicare |
$339.30
|
| Rate for Payer: PACE SWMI |
$357.16
|
| Rate for Payer: PHP Commercial |
$270.61
|
| Rate for Payer: PHP Medicare Advantage |
$357.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,155.01
|
| Rate for Payer: Priority Health Medicare |
$357.16
|
| Rate for Payer: Priority Health SBD |
$200.57
|
| Rate for Payer: Priority Health Tiered Network |
$924.01
|
| Rate for Payer: Railroad Medicare Medicare |
$357.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$539.58
|
| Rate for Payer: UHC Core |
$539.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$357.16
|
| Rate for Payer: UHC Exchange |
$539.58
|
| Rate for Payer: UHC Medicaid |
$186.79
|
| Rate for Payer: UHCCP Medicaid |
$186.79
|
| Rate for Payer: VA VA |
$357.16
|
|
|
HC HER-2 NEU QUANTITATIVE
|
Facility
|
IP
|
$253.86
|
|
|
Service Code
|
CPT 83950
|
| Hospital Charge Code |
30100382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$159.93 |
| Max. Negotiated Rate |
$228.47 |
| Rate for Payer: Aetna Commercial |
$215.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.01
|
| Rate for Payer: Cash Price |
$203.09
|
| Rate for Payer: Cofinity Advantage |
$177.70
|
| Rate for Payer: Cofinity Commercial |
$218.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.09
|
| Rate for Payer: Healthscope Commercial |
$228.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.40
|
| Rate for Payer: PHP Commercial |
$215.78
|
| Rate for Payer: Priority Health SBD |
$159.93
|
|
|
HC HER-2 NEU QUANTITATIVE
|
Facility
|
OP
|
$253.86
|
|
|
Service Code
|
CPT 83950
|
| Hospital Charge Code |
30100382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.69 |
| Max. Negotiated Rate |
$228.47 |
| Rate for Payer: Aetna Commercial |
$215.78
|
| Rate for Payer: Aetna Medicare |
$66.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.51
|
| Rate for Payer: BCBS Complete |
$35.37
|
| Rate for Payer: BCBS MAPPO |
$64.41
|
| Rate for Payer: BCBS Trust/PPO |
$68.68
|
| Rate for Payer: BCN Commercial |
$68.68
|
| Rate for Payer: BCN Medicare Advantage |
$64.41
|
| Rate for Payer: Cash Price |
$203.09
|
| Rate for Payer: Cash Price |
$203.09
|
| Rate for Payer: Cofinity Advantage |
$177.70
|
| Rate for Payer: Cofinity Commercial |
$218.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.41
|
| Rate for Payer: Healthscope Commercial |
$228.47
|
| Rate for Payer: Mclaren Medicaid |
$33.69
|
| Rate for Payer: Mclaren Medicare |
$64.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.63
|
| Rate for Payer: Meridian Medicaid |
$67.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.78
|
| Rate for Payer: Nomi Health Commercial |
$96.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.40
|
| Rate for Payer: PACE Medicare |
$61.19
|
| Rate for Payer: PACE SWMI |
$64.41
|
| Rate for Payer: PHP Commercial |
$215.78
|
| Rate for Payer: PHP Medicare Advantage |
$64.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$64.41
|
| Rate for Payer: Priority Health Medicare |
$64.41
|
| Rate for Payer: Priority Health SBD |
$159.93
|
| Rate for Payer: Priority Health Tiered Network |
$51.53
|
| Rate for Payer: Railroad Medicare Medicare |
$64.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.62
|
| Rate for Payer: UHC Core |
$96.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$64.41
|
| Rate for Payer: UHC Exchange |
$96.62
|
| Rate for Payer: UHC Medicaid |
$33.69
|
| Rate for Payer: UHCCP Medicaid |
$33.69
|
| Rate for Payer: VA VA |
$64.41
|
|
|
HC HERPES PCR
|
Facility
|
IP
|
$74.29
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600211
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$66.86 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.29
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Advantage |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$63.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Healthscope Commercial |
$66.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: PHP Commercial |
$63.15
|
| Rate for Payer: Priority Health SBD |
$46.80
|
|
|
HC HERPES PCR
|
Facility
|
OP
|
$74.29
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600211
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$66.86 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$37.42
|
| Rate for Payer: BCN Commercial |
$37.42
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Advantage |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$63.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$66.86
|
| Rate for Payer: Mclaren Medicaid |
$18.35
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Nomi Health Commercial |
$52.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$63.15
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35.09
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$46.80
|
| Rate for Payer: Priority Health Tiered Network |
$28.07
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$52.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$52.64
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HERPES PCR COMPONENT
|
Facility
|
OP
|
$74.29
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600212
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$66.86 |
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$37.42
|
| Rate for Payer: BCN Commercial |
$37.42
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Advantage |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$63.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$66.86
|
| Rate for Payer: Mclaren Medicaid |
$18.35
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Nomi Health Commercial |
$52.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PHP Commercial |
$63.15
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35.09
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$46.80
|
| Rate for Payer: Priority Health Tiered Network |
$28.07
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$52.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$52.64
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HERPES PCR COMPONENT
|
Facility
|
IP
|
$74.29
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600212
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$66.86 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.29
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Advantage |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$63.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Healthscope Commercial |
$66.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: PHP Commercial |
$63.15
|
| Rate for Payer: Priority Health SBD |
$46.80
|
|
|
HC HERPES SIMPLEX IGG TYPE 1
|
Facility
|
OP
|
$50.95
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200281
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$45.85 |
| Rate for Payer: Aetna Commercial |
$43.31
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$40.76
|
| Rate for Payer: Cash Price |
$40.76
|
| Rate for Payer: Cofinity Advantage |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$43.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$45.85
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.31
|
| Rate for Payer: Nomi Health Commercial |
$19.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.21
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$43.31
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.19
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health SBD |
$32.10
|
| Rate for Payer: Priority Health Tiered Network |
$10.55
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.79
|
| Rate for Payer: UHC Core |
$19.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.19
|
| Rate for Payer: UHC Exchange |
$19.79
|
| Rate for Payer: UHC Medicaid |
$6.90
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC HERPES SIMPLEX IGG TYPE 1
|
Facility
|
IP
|
$50.95
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200281
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$45.85 |
| Rate for Payer: Aetna Commercial |
$43.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.12
|
| Rate for Payer: Cash Price |
$40.76
|
| Rate for Payer: Cofinity Advantage |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$43.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.76
|
| Rate for Payer: Healthscope Commercial |
$45.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.21
|
| Rate for Payer: PHP Commercial |
$43.31
|
| Rate for Payer: Priority Health SBD |
$32.10
|
|
|
HC HERPES SIMPLEX IGG TYPE 2
|
Facility
|
IP
|
$74.76
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200283
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.10 |
| Max. Negotiated Rate |
$67.28 |
| Rate for Payer: Aetna Commercial |
$63.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.59
|
| Rate for Payer: Cash Price |
$59.81
|
| Rate for Payer: Cofinity Advantage |
$52.33
|
| Rate for Payer: Cofinity Commercial |
$64.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.81
|
| Rate for Payer: Healthscope Commercial |
$67.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.07
|
| Rate for Payer: PHP Commercial |
$63.55
|
| Rate for Payer: Priority Health SBD |
$47.10
|
|
|
HC HERPES SIMPLEX IGG TYPE 2
|
Facility
|
OP
|
$74.76
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200283
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$67.28 |
| Rate for Payer: Aetna Commercial |
$63.55
|
| Rate for Payer: Aetna Medicare |
$20.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: BCBS Complete |
$10.63
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.63
|
| Rate for Payer: BCN Commercial |
$20.63
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$59.81
|
| Rate for Payer: Cash Price |
$59.81
|
| Rate for Payer: Cofinity Advantage |
$52.33
|
| Rate for Payer: Cofinity Commercial |
$64.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$67.28
|
| Rate for Payer: Mclaren Medicaid |
$10.12
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: Meridian Medicaid |
$20.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.55
|
| Rate for Payer: Nomi Health Commercial |
$29.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.07
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$63.55
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19.35
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health SBD |
$47.10
|
| Rate for Payer: Priority Health Tiered Network |
$15.48
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.03
|
| Rate for Payer: UHC Core |
$29.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19.35
|
| Rate for Payer: UHC Exchange |
$29.03
|
| Rate for Payer: UHC Medicaid |
$10.12
|
| Rate for Payer: UHCCP Medicaid |
$10.12
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC HERPES SIMPLEX IGM TYPE 1&2
|
Facility
|
IP
|
$49.88
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200278
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$44.89 |
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.42
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cofinity Advantage |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$42.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.90
|
| Rate for Payer: Healthscope Commercial |
$44.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.41
|
| Rate for Payer: PHP Commercial |
$42.40
|
| Rate for Payer: Priority Health SBD |
$31.42
|
|
