|
HC IMMUNIZATION EACH ADDL VACCINE
|
Facility
|
OP
|
$34.12
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
77100004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$45.51 |
| Rate for Payer: Aetna Commercial |
$29.00
|
| Rate for Payer: Aetna Medicare |
$17.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.18
|
| Rate for Payer: BCBS Complete |
$13.65
|
| Rate for Payer: BCBS Trust/PPO |
$45.51
|
| Rate for Payer: BCN Commercial |
$45.51
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cofinity Advantage |
$23.88
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.30
|
| Rate for Payer: Healthscope Commercial |
$30.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.59
|
| Rate for Payer: PHP Commercial |
$29.00
|
| Rate for Payer: Priority Health SBD |
$21.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.18
|
| Rate for Payer: UHC Core |
$17.78
|
| Rate for Payer: UHC Exchange |
$13.41
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE 18 YEARS OR YOUNGER
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
77100002
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$36.35 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$12.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$36.35
|
| Rate for Payer: BCN Commercial |
$36.35
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Advantage |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.12
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.81
|
| Rate for Payer: Priority Health SBD |
$16.07
|
| Rate for Payer: Priority Health Tiered Network |
$5.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.57
|
| Rate for Payer: UHC Core |
$13.29
|
| Rate for Payer: UHC Exchange |
$10.02
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE 18 YEARS OR YOUNGER
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
77100002
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Advantage |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.12
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health SBD |
$16.07
|
|
|
HC IMMUNIZATION NASAL ORAL 1ST
|
Facility
|
OP
|
$45.05
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
77100005
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$232.01 |
| Rate for Payer: Aetna Commercial |
$38.29
|
| Rate for Payer: Aetna Medicare |
$74.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.67
|
| Rate for Payer: BCBS Complete |
$39.40
|
| Rate for Payer: BCBS MAPPO |
$71.74
|
| Rate for Payer: BCBS Trust/PPO |
$51.71
|
| Rate for Payer: BCN Commercial |
$51.71
|
| Rate for Payer: BCN Medicare Advantage |
$71.74
|
| Rate for Payer: Cash Price |
$36.04
|
| Rate for Payer: Cash Price |
$36.04
|
| Rate for Payer: Cofinity Advantage |
$31.54
|
| Rate for Payer: Cofinity Commercial |
$38.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.74
|
| Rate for Payer: Healthscope Commercial |
$40.55
|
| Rate for Payer: Mclaren Medicaid |
$37.52
|
| Rate for Payer: Mclaren Medicare |
$71.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.33
|
| Rate for Payer: Meridian Medicaid |
$75.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.29
|
| Rate for Payer: Nomi Health Commercial |
$215.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.79
|
| Rate for Payer: PACE Medicare |
$68.15
|
| Rate for Payer: PACE SWMI |
$71.74
|
| Rate for Payer: PHP Commercial |
$38.29
|
| Rate for Payer: PHP Medicare Advantage |
$71.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$232.01
|
| Rate for Payer: Priority Health Medicare |
$71.74
|
| Rate for Payer: Priority Health SBD |
$28.38
|
| Rate for Payer: Priority Health Tiered Network |
$185.61
|
| Rate for Payer: Railroad Medicare Medicare |
$71.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.28
|
| Rate for Payer: UHC Core |
$23.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.74
|
| Rate for Payer: UHC Exchange |
$17.70
|
| Rate for Payer: UHC Medicaid |
$37.52
|
| Rate for Payer: UHCCP Medicaid |
$37.52
|
| Rate for Payer: VA VA |
$71.74
|
|
|
HC IMMUNIZATION NASAL ORAL 1ST
|
Facility
|
IP
|
$45.05
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
77100005
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$28.38 |
| Max. Negotiated Rate |
$40.55 |
| Rate for Payer: Aetna Commercial |
$38.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.28
|
| Rate for Payer: Cash Price |
$36.04
|
| Rate for Payer: Cofinity Advantage |
$31.54
|
| Rate for Payer: Cofinity Commercial |
$38.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.04
|
| Rate for Payer: Healthscope Commercial |
$40.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.79
|
| Rate for Payer: PHP Commercial |
$38.29
|
| Rate for Payer: Priority Health SBD |
$28.38
|
|
|
HC IMMUNIZATION ORAL/NASL EA ADD
|
Facility
|
OP
|
$33.05
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
77100006
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$12.99 |
| Max. Negotiated Rate |
$37.23 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: Aetna Medicare |
$16.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.48
|
| Rate for Payer: BCBS Complete |
$13.22
|
| Rate for Payer: BCBS Trust/PPO |
$37.23
|
| Rate for Payer: BCN Commercial |
$37.23
|
| Rate for Payer: Cash Price |
$26.44
|
| Rate for Payer: Cash Price |
$26.44
|
| Rate for Payer: Cofinity Advantage |
$23.14
|
| Rate for Payer: Cofinity Commercial |
$28.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.44
|
| Rate for Payer: Healthscope Commercial |
$29.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.79
|
| Rate for Payer: PHP Commercial |
$28.09
|
| Rate for Payer: Priority Health SBD |
$20.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.48
|
| Rate for Payer: UHC Core |
$17.22
|
| Rate for Payer: UHC Exchange |
$12.99
|
|
|
HC IMMUNIZATION ORAL/NASL EA ADD
|
Facility
|
IP
|
$33.05
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
77100006
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Aetna Commercial |
$28.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.48
|
| Rate for Payer: Cash Price |
$26.44
|
| Rate for Payer: Cofinity Advantage |
$23.14
|
| Rate for Payer: Cofinity Commercial |
$28.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.44
|
| Rate for Payer: Healthscope Commercial |
$29.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.79
|
| Rate for Payer: PHP Commercial |
$28.09
|
| Rate for Payer: Priority Health SBD |
$20.82
|
|
|
HC IMMUNOASSAY MULTI STEP
|
Facility
|
OP
|
$25.47
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100659
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna Commercial |
$21.65
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$12.30
|
| Rate for Payer: BCN Commercial |
$12.30
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Advantage |
$17.83
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Mclaren Medicaid |
$6.03
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.65
|
| Rate for Payer: Nomi Health Commercial |
$17.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.10
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$21.65
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.53
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$16.05
|
| Rate for Payer: Priority Health Tiered Network |
$9.22
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.30
|
| Rate for Payer: UHC Core |
$17.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.30
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC IMMUNOASSAY MULTI STEP
|
Facility
|
IP
|
$25.47
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100659
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna Commercial |
$21.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.56
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Advantage |
$17.83
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.10
|
| Rate for Payer: PHP Commercial |
$21.65
|
| Rate for Payer: Priority Health SBD |
$16.05
|
|
|
HC IMMUNOASSAY MULTI STEP ADDITIONAL
|
Facility
|
OP
|
$39.80
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$35.82 |
| Rate for Payer: Aetna Commercial |
$33.83
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$12.30
|
| Rate for Payer: BCN Commercial |
$12.30
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Advantage |
$27.86
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$35.82
|
| Rate for Payer: Mclaren Medicaid |
$6.03
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: Nomi Health Commercial |
$17.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.85
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$33.83
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.53
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$25.07
|
| Rate for Payer: Priority Health Tiered Network |
$9.22
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.30
|
| Rate for Payer: UHC Core |
$17.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.30
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC IMMUNOASSAY MULTI STEP ADDITIONAL
|
Facility
|
IP
|
$39.80
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.07 |
| Max. Negotiated Rate |
$35.82 |
| Rate for Payer: Aetna Commercial |
$33.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.87
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Advantage |
$27.86
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$35.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.85
|
| Rate for Payer: PHP Commercial |
$33.83
|
| Rate for Payer: Priority Health SBD |
$25.07
|
|
|
HC IMMUNOASSAY MULTI STEP FIRST
|
Facility
|
OP
|
$39.80
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$35.82 |
| Rate for Payer: Aetna Commercial |
$33.83
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$12.30
|
| Rate for Payer: BCN Commercial |
$12.30
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Advantage |
$27.86
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$35.82
|
| Rate for Payer: Mclaren Medicaid |
$6.03
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: Nomi Health Commercial |
$17.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.85
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$33.83
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.53
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$25.07
|
| Rate for Payer: Priority Health Tiered Network |
$9.22
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.30
|
| Rate for Payer: UHC Core |
$17.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.30
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC IMMUNOASSAY MULTI STEP FIRST
|
Facility
|
IP
|
$39.80
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.07 |
| Max. Negotiated Rate |
$35.82 |
| Rate for Payer: Aetna Commercial |
$33.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.87
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Advantage |
$27.86
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$35.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.85
|
| Rate for Payer: PHP Commercial |
$33.83
|
| Rate for Payer: Priority Health SBD |
$25.07
|
|
|
HC IMMUNODIFFUSION
|
Facility
|
IP
|
$127.97
|
|
|
Service Code
|
CPT 86329
|
| Hospital Charge Code |
30200191
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$80.62 |
| Max. Negotiated Rate |
$115.17 |
| Rate for Payer: Aetna Commercial |
$108.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.18
|
| Rate for Payer: Cash Price |
$102.38
|
| Rate for Payer: Cofinity Advantage |
$89.58
|
| Rate for Payer: Cofinity Commercial |
$110.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.38
|
| Rate for Payer: Healthscope Commercial |
$115.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.98
|
| Rate for Payer: PHP Commercial |
$108.77
|
| Rate for Payer: Priority Health SBD |
$80.62
|
|
|
HC IMMUNODIFFUSION
|
Facility
|
OP
|
$127.97
|
|
|
Service Code
|
CPT 86329
|
| Hospital Charge Code |
30200191
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$115.17 |
| Rate for Payer: Aetna Commercial |
$108.77
|
| Rate for Payer: Aetna Medicare |
$14.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.56
|
| Rate for Payer: BCBS Complete |
$7.72
|
| Rate for Payer: BCBS MAPPO |
$14.05
|
| Rate for Payer: BCBS Trust/PPO |
$14.98
|
| Rate for Payer: BCN Commercial |
$14.98
|
| Rate for Payer: BCN Medicare Advantage |
$14.05
|
| Rate for Payer: Cash Price |
$102.38
|
| Rate for Payer: Cash Price |
$102.38
|
| Rate for Payer: Cofinity Advantage |
$89.58
|
| Rate for Payer: Cofinity Commercial |
$110.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.05
|
| Rate for Payer: Healthscope Commercial |
$115.17
|
| Rate for Payer: Mclaren Medicaid |
$7.35
|
| Rate for Payer: Mclaren Medicare |
$14.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.75
|
| Rate for Payer: Meridian Medicaid |
$14.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.77
|
| Rate for Payer: Nomi Health Commercial |
$21.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.98
|
| Rate for Payer: PACE Medicare |
$13.35
|
| Rate for Payer: PACE SWMI |
$14.05
|
| Rate for Payer: PHP Commercial |
$108.77
|
| Rate for Payer: PHP Medicare Advantage |
$14.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.05
|
| Rate for Payer: Priority Health Medicare |
$14.05
|
| Rate for Payer: Priority Health SBD |
$80.62
|
| Rate for Payer: Priority Health Tiered Network |
$11.24
|
| Rate for Payer: Railroad Medicare Medicare |
$14.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.08
|
| Rate for Payer: UHC Core |
$21.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.05
|
| Rate for Payer: UHC Exchange |
$21.08
|
| Rate for Payer: UHC Medicaid |
$7.35
|
| Rate for Payer: UHCCP Medicaid |
$7.35
|
| Rate for Payer: VA VA |
$14.05
|
|
|
HC IMMUNODIFFUSION AB OR AG ADDITIONAL
|
Facility
|
IP
|
$80.65
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
30200402
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.81 |
| Max. Negotiated Rate |
$72.58 |
| Rate for Payer: Aetna Commercial |
$68.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.42
|
| Rate for Payer: Cash Price |
$64.52
|
| Rate for Payer: Cofinity Advantage |
$56.45
|
| Rate for Payer: Cofinity Commercial |
$69.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.52
|
| Rate for Payer: Healthscope Commercial |
$72.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.49
|
| Rate for Payer: PHP Commercial |
$68.55
|
| Rate for Payer: Priority Health SBD |
$50.81
|
|
|
HC IMMUNODIFFUSION AB OR AG ADDITIONAL
|
Facility
|
OP
|
$80.65
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
30200402
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$72.58 |
| Rate for Payer: Aetna Commercial |
$68.55
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.97
|
| Rate for Payer: BCBS Complete |
$6.58
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$12.78
|
| Rate for Payer: BCN Commercial |
$12.78
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$64.52
|
| Rate for Payer: Cash Price |
$64.52
|
| Rate for Payer: Cofinity Advantage |
$56.45
|
| Rate for Payer: Cofinity Commercial |
$69.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$72.58
|
| Rate for Payer: Mclaren Medicaid |
$6.27
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.55
|
| Rate for Payer: Nomi Health Commercial |
$17.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.49
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$68.55
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.98
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health SBD |
$50.81
|
| Rate for Payer: Priority Health Tiered Network |
$9.58
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.97
|
| Rate for Payer: UHC Core |
$17.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.98
|
| Rate for Payer: UHC Exchange |
$17.97
|
| Rate for Payer: UHC Medicaid |
$6.27
|
| Rate for Payer: UHCCP Medicaid |
$6.27
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC IMMUNODIFFUSION AB OR AG FIRST
|
Facility
|
IP
|
$93.39
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
30200401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.84 |
| Max. Negotiated Rate |
$84.05 |
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.70
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Advantage |
$65.37
|
| Rate for Payer: Cofinity Commercial |
$80.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$84.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: PHP Commercial |
$79.38
|
| Rate for Payer: Priority Health SBD |
$58.84
|
|
|
HC IMMUNODIFFUSION AB OR AG FIRST
|
Facility
|
OP
|
$93.39
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
30200401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$84.05 |
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.97
|
| Rate for Payer: BCBS Complete |
$6.58
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$12.78
|
| Rate for Payer: BCN Commercial |
$12.78
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Advantage |
$65.37
|
| Rate for Payer: Cofinity Commercial |
$80.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$84.05
|
| Rate for Payer: Mclaren Medicaid |
$6.27
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Nomi Health Commercial |
$17.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$79.38
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.98
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health SBD |
$58.84
|
| Rate for Payer: Priority Health Tiered Network |
$9.58
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.97
|
| Rate for Payer: UHC Core |
$17.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.98
|
| Rate for Payer: UHC Exchange |
$17.97
|
| Rate for Payer: UHC Medicaid |
$6.27
|
| Rate for Payer: UHCCP Medicaid |
$6.27
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC IMMUNOFIXATION
|
Facility
|
IP
|
$93.39
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
30200195
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.84 |
| Max. Negotiated Rate |
$84.05 |
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.70
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Advantage |
$65.37
|
| Rate for Payer: Cofinity Commercial |
$80.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$84.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: PHP Commercial |
$79.38
|
| Rate for Payer: Priority Health SBD |
$58.84
|
|
|
HC IMMUNOFIXATION
|
Facility
|
OP
|
$93.39
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
30200195
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$84.05 |
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: Aetna Medicare |
$23.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.93
|
| Rate for Payer: BCBS Complete |
$12.27
|
| Rate for Payer: BCBS MAPPO |
$22.34
|
| Rate for Payer: BCBS Trust/PPO |
$17.87
|
| Rate for Payer: BCN Commercial |
$17.87
|
| Rate for Payer: BCN Medicare Advantage |
$22.34
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Advantage |
$65.37
|
| Rate for Payer: Cofinity Commercial |
$80.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.34
|
| Rate for Payer: Healthscope Commercial |
$84.05
|
| Rate for Payer: Mclaren Medicaid |
$11.68
|
| Rate for Payer: Mclaren Medicare |
$22.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.46
|
| Rate for Payer: Meridian Medicaid |
$23.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Nomi Health Commercial |
$33.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: PACE Medicare |
$21.22
|
| Rate for Payer: PACE SWMI |
$22.34
|
| Rate for Payer: PHP Commercial |
$79.38
|
| Rate for Payer: PHP Medicare Advantage |
$22.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.34
|
| Rate for Payer: Priority Health Medicare |
$22.34
|
| Rate for Payer: Priority Health SBD |
$58.84
|
| Rate for Payer: Priority Health Tiered Network |
$17.87
|
| Rate for Payer: Railroad Medicare Medicare |
$22.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.51
|
| Rate for Payer: UHC Core |
$33.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.34
|
| Rate for Payer: UHC Exchange |
$33.51
|
| Rate for Payer: UHC Medicaid |
$11.68
|
| Rate for Payer: UHCCP Medicaid |
$11.68
|
| Rate for Payer: VA VA |
$22.34
|
|
|
HC IMMUNOFIXATION ELECTRO SERUM
|
Facility
|
OP
|
$172.50
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
30200194
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$155.25 |
| Rate for Payer: Aetna Commercial |
$146.62
|
| Rate for Payer: Aetna Medicare |
$23.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.93
|
| Rate for Payer: BCBS Complete |
$12.27
|
| Rate for Payer: BCBS MAPPO |
$22.34
|
| Rate for Payer: BCBS Trust/PPO |
$17.87
|
| Rate for Payer: BCN Commercial |
$17.87
|
| Rate for Payer: BCN Medicare Advantage |
$22.34
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cofinity Advantage |
$120.75
|
| Rate for Payer: Cofinity Commercial |
$148.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.34
|
| Rate for Payer: Healthscope Commercial |
$155.25
|
| Rate for Payer: Mclaren Medicaid |
$11.68
|
| Rate for Payer: Mclaren Medicare |
$22.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.46
|
| Rate for Payer: Meridian Medicaid |
$23.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.62
|
| Rate for Payer: Nomi Health Commercial |
$33.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.38
|
| Rate for Payer: PACE Medicare |
$21.22
|
| Rate for Payer: PACE SWMI |
$22.34
|
| Rate for Payer: PHP Commercial |
$146.62
|
| Rate for Payer: PHP Medicare Advantage |
$22.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.34
|
| Rate for Payer: Priority Health Medicare |
$22.34
|
| Rate for Payer: Priority Health SBD |
$108.67
|
| Rate for Payer: Priority Health Tiered Network |
$17.87
|
| Rate for Payer: Railroad Medicare Medicare |
$22.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.51
|
| Rate for Payer: UHC Core |
$33.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.34
|
| Rate for Payer: UHC Exchange |
$33.51
|
| Rate for Payer: UHC Medicaid |
$11.68
|
| Rate for Payer: UHCCP Medicaid |
$11.68
|
| Rate for Payer: VA VA |
$22.34
|
|
|
HC IMMUNOFIXATION ELECTRO SERUM
|
Facility
|
IP
|
$172.50
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
30200194
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$155.25 |
| Rate for Payer: Aetna Commercial |
$146.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.12
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cofinity Advantage |
$120.75
|
| Rate for Payer: Cofinity Commercial |
$148.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.00
|
| Rate for Payer: Healthscope Commercial |
$155.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.38
|
| Rate for Payer: PHP Commercial |
$146.62
|
| Rate for Payer: Priority Health SBD |
$108.67
|
|
|
HC IMMUNOFIXATION ELEC URINE/CSF
|
Facility
|
OP
|
$172.50
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
30200196
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$155.25 |
| Rate for Payer: Aetna Commercial |
$146.62
|
| Rate for Payer: Aetna Medicare |
$30.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.12
|
| 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 |
$16.12
|
| Rate for Payer: BCBS MAPPO |
$29.35
|
| Rate for Payer: BCBS Trust/PPO |
$23.47
|
| Rate for Payer: BCN Commercial |
$23.47
|
| Rate for Payer: BCN Medicare Advantage |
$29.35
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cofinity Advantage |
$120.75
|
| Rate for Payer: Cofinity Commercial |
$148.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.35
|
| Rate for Payer: Healthscope Commercial |
$155.25
|
| Rate for Payer: Mclaren Medicaid |
$15.35
|
| Rate for Payer: Mclaren Medicare |
$29.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.82
|
| Rate for Payer: Meridian Medicaid |
$30.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.62
|
| Rate for Payer: Nomi Health Commercial |
$44.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.38
|
| Rate for Payer: PACE Medicare |
$27.88
|
| Rate for Payer: PACE SWMI |
$29.35
|
| Rate for Payer: PHP Commercial |
$146.62
|
| Rate for Payer: PHP Medicare Advantage |
$29.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29.35
|
| Rate for Payer: Priority Health Medicare |
$29.35
|
| Rate for Payer: Priority Health SBD |
$108.67
|
| Rate for Payer: Priority Health Tiered Network |
$23.48
|
| Rate for Payer: Railroad Medicare Medicare |
$29.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.03
|
| Rate for Payer: UHC Core |
$44.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.35
|
| Rate for Payer: UHC Exchange |
$44.03
|
| Rate for Payer: UHC Medicaid |
$15.35
|
| Rate for Payer: UHCCP Medicaid |
$15.35
|
| Rate for Payer: VA VA |
$29.35
|
|
|
HC IMMUNOFIXATION ELEC URINE/CSF
|
Facility
|
IP
|
$172.50
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
30200196
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$155.25 |
| Rate for Payer: Aetna Commercial |
$146.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.12
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cofinity Advantage |
$120.75
|
| Rate for Payer: Cofinity Commercial |
$148.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.00
|
| Rate for Payer: Healthscope Commercial |
$155.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.38
|
| Rate for Payer: PHP Commercial |
$146.62
|
| Rate for Payer: Priority Health SBD |
$108.67
|
|
