|
HC IMMUNOGLOBULIN A IGA
|
Facility
|
IP
|
$78.45
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$70.61 |
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Advantage |
$54.91
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: Priority Health SBD |
$49.42
|
|
|
HC IMMUNOGLOBULIN A IGA
|
Facility
|
OP
|
$78.45
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$70.61 |
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: Aetna Medicare |
$9.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| 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 |
$5.11
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$9.92
|
| Rate for Payer: BCN Commercial |
$9.92
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Advantage |
$54.91
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Mclaren Medicaid |
$4.86
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.77
|
| Rate for Payer: Meridian Medicaid |
$9.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$13.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.30
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health SBD |
$49.42
|
| Rate for Payer: Priority Health Tiered Network |
$7.44
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.95
|
| Rate for Payer: UHC Core |
$13.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.30
|
| Rate for Payer: UHC Exchange |
$13.95
|
| Rate for Payer: UHC Medicaid |
$4.86
|
| Rate for Payer: UHCCP Medicaid |
$4.86
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC IMMUNOGLOBULIN A (IGA), S
|
Facility
|
OP
|
$40.58
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$36.52 |
| Rate for Payer: Aetna Commercial |
$34.49
|
| Rate for Payer: Aetna Medicare |
$9.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.38
|
| 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 |
$5.11
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$9.92
|
| Rate for Payer: BCN Commercial |
$9.92
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$32.46
|
| Rate for Payer: Cash Price |
$32.46
|
| Rate for Payer: Cofinity Advantage |
$28.41
|
| Rate for Payer: Cofinity Commercial |
$34.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$36.52
|
| Rate for Payer: Mclaren Medicaid |
$4.86
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.77
|
| Rate for Payer: Meridian Medicaid |
$9.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.49
|
| Rate for Payer: Nomi Health Commercial |
$13.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.43
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$34.49
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.30
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health SBD |
$25.57
|
| Rate for Payer: Priority Health Tiered Network |
$7.44
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.95
|
| Rate for Payer: UHC Core |
$13.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.30
|
| Rate for Payer: UHC Exchange |
$13.95
|
| Rate for Payer: UHC Medicaid |
$4.86
|
| Rate for Payer: UHCCP Medicaid |
$4.86
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC IMMUNOGLOBULIN A (IGA), S
|
Facility
|
IP
|
$40.58
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$36.52 |
| Rate for Payer: Aetna Commercial |
$34.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.38
|
| Rate for Payer: Cash Price |
$32.46
|
| Rate for Payer: Cofinity Advantage |
$28.41
|
| Rate for Payer: Cofinity Commercial |
$34.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.46
|
| Rate for Payer: Healthscope Commercial |
$36.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.43
|
| Rate for Payer: PHP Commercial |
$34.49
|
| Rate for Payer: Priority Health SBD |
$25.57
|
|
|
HC IMMUNOGLOBULIN E IGE ALLERGY SPECIFIC
|
Facility
|
OP
|
$64.53
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
30100213
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$58.08 |
| Rate for Payer: Aetna Commercial |
$54.85
|
| Rate for Payer: Aetna Medicare |
$17.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.57
|
| Rate for Payer: BCBS Complete |
$9.04
|
| Rate for Payer: BCBS MAPPO |
$16.46
|
| Rate for Payer: BCBS Trust/PPO |
$17.56
|
| Rate for Payer: BCN Commercial |
$17.56
|
| Rate for Payer: BCN Medicare Advantage |
$16.46
|
| Rate for Payer: Cash Price |
$51.62
|
| Rate for Payer: Cash Price |
$51.62
|
| Rate for Payer: Cofinity Advantage |
$45.17
|
| Rate for Payer: Cofinity Commercial |
$55.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.46
|
| Rate for Payer: Healthscope Commercial |
$58.08
|
| Rate for Payer: Mclaren Medicaid |
$8.61
|
| Rate for Payer: Mclaren Medicare |
$16.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.28
|
| Rate for Payer: Meridian Medicaid |
$17.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.85
|
| Rate for Payer: Nomi Health Commercial |
$24.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.40
|
| Rate for Payer: PACE Medicare |
$15.64
|
| Rate for Payer: PACE SWMI |
$16.46
|
| Rate for Payer: PHP Commercial |
$54.85
|
| Rate for Payer: PHP Medicare Advantage |
$16.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.46
|
| Rate for Payer: Priority Health Medicare |
$16.46
|
| Rate for Payer: Priority Health SBD |
$40.65
|
| Rate for Payer: Priority Health Tiered Network |
$13.17
|
| Rate for Payer: Railroad Medicare Medicare |
$16.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.69
|
| Rate for Payer: UHC Core |
$24.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.46
|
| Rate for Payer: UHC Exchange |
$24.69
|
| Rate for Payer: UHC Medicaid |
$8.61
|
| Rate for Payer: UHCCP Medicaid |
$8.61
|
| Rate for Payer: VA VA |
$16.46
|
|
|
HC IMMUNOGLOBULIN E IGE ALLERGY SPECIFIC
|
Facility
|
IP
|
$64.53
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
30100213
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.65 |
| Max. Negotiated Rate |
$58.08 |
| Rate for Payer: Aetna Commercial |
$54.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.94
|
| Rate for Payer: Cash Price |
$51.62
|
| Rate for Payer: Cofinity Advantage |
$45.17
|
| Rate for Payer: Cofinity Commercial |
$55.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.62
|
| Rate for Payer: Healthscope Commercial |
$58.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.40
|
| Rate for Payer: PHP Commercial |
$54.85
|
| Rate for Payer: Priority Health SBD |
$40.65
|
|
|
HC IMMUNOGLOBULIN G IGG
|
Facility
|
IP
|
$78.45
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100207
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$70.61 |
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Advantage |
$54.91
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: Priority Health SBD |
$49.42
|
|
|
HC IMMUNOGLOBULIN G IGG
|
Facility
|
OP
|
$78.45
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100207
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$70.61 |
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: Aetna Medicare |
$9.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| 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 |
$5.11
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$9.92
|
| Rate for Payer: BCN Commercial |
$9.92
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Advantage |
$54.91
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Mclaren Medicaid |
$4.86
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.77
|
| Rate for Payer: Meridian Medicaid |
$9.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$13.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.30
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health SBD |
$49.42
|
| Rate for Payer: Priority Health Tiered Network |
$7.44
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.95
|
| Rate for Payer: UHC Core |
$13.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.30
|
| Rate for Payer: UHC Exchange |
$13.95
|
| Rate for Payer: UHC Medicaid |
$4.86
|
| Rate for Payer: UHCCP Medicaid |
$4.86
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC IMMUNOGLOBULIN M IGM
|
Facility
|
OP
|
$78.45
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100209
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$70.61 |
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: Aetna Medicare |
$9.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| 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 |
$5.11
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$9.92
|
| Rate for Payer: BCN Commercial |
$9.92
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Advantage |
$54.91
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Mclaren Medicaid |
$4.86
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.77
|
| Rate for Payer: Meridian Medicaid |
$9.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$13.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.30
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health SBD |
$49.42
|
| Rate for Payer: Priority Health Tiered Network |
$7.44
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.95
|
| Rate for Payer: UHC Core |
$13.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.30
|
| Rate for Payer: UHC Exchange |
$13.95
|
| Rate for Payer: UHC Medicaid |
$4.86
|
| Rate for Payer: UHCCP Medicaid |
$4.86
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC IMMUNOGLOBULIN M IGM
|
Facility
|
IP
|
$78.45
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100209
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$70.61 |
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Advantage |
$54.91
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: Priority Health SBD |
$49.42
|
|
|
HC IMMUNOGLOBULIN SUBCLASSES
|
Facility
|
IP
|
$23.35
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$21.02 |
| Rate for Payer: Aetna Commercial |
$19.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.18
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cofinity Advantage |
$16.34
|
| Rate for Payer: Cofinity Commercial |
$20.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.68
|
| Rate for Payer: Healthscope Commercial |
$21.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.51
|
| Rate for Payer: PHP Commercial |
$19.85
|
| Rate for Payer: Priority Health SBD |
$14.71
|
|
|
HC IMMUNOGLOBULIN SUBCLASSES
|
Facility
|
OP
|
$23.35
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$21.02 |
| Rate for Payer: Aetna Commercial |
$19.85
|
| Rate for Payer: Aetna Medicare |
$9.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.18
|
| 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 |
$5.11
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$9.92
|
| Rate for Payer: BCN Commercial |
$9.92
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cofinity Advantage |
$16.34
|
| Rate for Payer: Cofinity Commercial |
$20.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$21.02
|
| Rate for Payer: Mclaren Medicaid |
$4.86
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.77
|
| Rate for Payer: Meridian Medicaid |
$9.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.85
|
| Rate for Payer: Nomi Health Commercial |
$13.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.51
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$19.85
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.30
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health SBD |
$14.71
|
| Rate for Payer: Priority Health Tiered Network |
$7.44
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.95
|
| Rate for Payer: UHC Core |
$13.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.30
|
| Rate for Payer: UHC Exchange |
$13.95
|
| Rate for Payer: UHC Medicaid |
$4.86
|
| Rate for Payer: UHCCP Medicaid |
$4.86
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC IMMUNOHISTOCHEMISTRY EA ADDL STAIN PER SPECIMEN
|
Facility
|
IP
|
$197.36
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
31000118
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$177.62 |
| Rate for Payer: Aetna Commercial |
$167.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.28
|
| Rate for Payer: Cash Price |
$157.89
|
| Rate for Payer: Cofinity Advantage |
$138.15
|
| Rate for Payer: Cofinity Commercial |
$169.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.89
|
| Rate for Payer: Healthscope Commercial |
$177.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.02
|
| Rate for Payer: PHP Commercial |
$167.76
|
| Rate for Payer: Priority Health SBD |
$124.34
|
|
|
HC IMMUNOHISTOCHEMISTRY EA ADDL STAIN PER SPECIMEN
|
Facility
|
OP
|
$197.36
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
31000118
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$78.94 |
| Max. Negotiated Rate |
$177.62 |
| Rate for Payer: Aetna Commercial |
$167.76
|
| Rate for Payer: Aetna Medicare |
$98.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.28
|
| Rate for Payer: BCBS Complete |
$78.94
|
| Rate for Payer: BCBS Trust/PPO |
$117.55
|
| Rate for Payer: BCCCP Commercial |
$89.57
|
| Rate for Payer: BCN Commercial |
$117.55
|
| Rate for Payer: Cash Price |
$157.89
|
| Rate for Payer: Cash Price |
$157.89
|
| Rate for Payer: Cofinity Advantage |
$138.15
|
| Rate for Payer: Cofinity Commercial |
$169.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.89
|
| Rate for Payer: Healthscope Commercial |
$177.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.02
|
| Rate for Payer: PHP Commercial |
$167.76
|
| Rate for Payer: Priority Health SBD |
$124.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.44
|
| Rate for Payer: UHC Core |
$100.44
|
| Rate for Payer: UHC Exchange |
$100.44
|
|
|
HC IMMUNOHISTOCHEMISTRY STAIN
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
31000058
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.78 |
| Max. Negotiated Rate |
$548.99 |
| Rate for Payer: Aetna Commercial |
$191.25
|
| Rate for Payer: Aetna Medicare |
$176.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$134.01
|
| Rate for Payer: BCN Commercial |
$134.01
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Advantage |
$157.50
|
| Rate for Payer: Cofinity Commercial |
$193.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$202.50
|
| Rate for Payer: Mclaren Medicaid |
$88.78
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$178.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.25
|
| Rate for Payer: Nomi Health Commercial |
$509.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.75
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$191.25
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$548.99
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health SBD |
$141.75
|
| Rate for Payer: Priority Health Tiered Network |
$439.19
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.04
|
| Rate for Payer: UHC Core |
$257.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$257.04
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
|
HC IMMUNOHISTOCHEMISTRY STAIN
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
31000058
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$141.75 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna Commercial |
$191.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.25
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Advantage |
$157.50
|
| Rate for Payer: Cofinity Commercial |
$193.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.00
|
| Rate for Payer: Healthscope Commercial |
$202.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.75
|
| Rate for Payer: PHP Commercial |
$191.25
|
| Rate for Payer: Priority Health SBD |
$141.75
|
|
|
HC IMMUNOHISTOCHEMISTY MULTIPLEX STAINS
|
Facility
|
IP
|
$386.14
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
31000117
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$243.27 |
| Max. Negotiated Rate |
$347.53 |
| Rate for Payer: Aetna Commercial |
$328.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.99
|
| Rate for Payer: Cash Price |
$308.91
|
| Rate for Payer: Cofinity Advantage |
$270.30
|
| Rate for Payer: Cofinity Commercial |
$332.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.91
|
| Rate for Payer: Healthscope Commercial |
$347.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.61
|
| Rate for Payer: PHP Commercial |
$328.22
|
| Rate for Payer: Priority Health SBD |
$243.27
|
|
|
HC IMMUNOHISTOCHEMISTY MULTIPLEX STAINS
|
Facility
|
OP
|
$386.14
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
31000117
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$186.79 |
| Max. Negotiated Rate |
$1,155.01 |
| Rate for Payer: Aetna Commercial |
$328.22
|
| Rate for Payer: Aetna Medicare |
$371.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.99
|
| 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 |
$229.99
|
| Rate for Payer: BCN Commercial |
$229.99
|
| Rate for Payer: BCN Medicare Advantage |
$357.16
|
| Rate for Payer: Cash Price |
$308.91
|
| Rate for Payer: Cash Price |
$308.91
|
| Rate for Payer: Cofinity Advantage |
$270.30
|
| Rate for Payer: Cofinity Commercial |
$332.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.16
|
| Rate for Payer: Healthscope Commercial |
$347.53
|
| 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 |
$328.22
|
| Rate for Payer: Nomi Health Commercial |
$1,071.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.61
|
| Rate for Payer: PACE Medicare |
$339.30
|
| Rate for Payer: PACE SWMI |
$357.16
|
| Rate for Payer: PHP Commercial |
$328.22
|
| 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 |
$243.27
|
| 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 IMPELLA LVAD
|
Facility
|
IP
|
$47,152.14
|
|
| Hospital Charge Code |
27200132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29,705.85 |
| Max. Negotiated Rate |
$42,436.93 |
| Rate for Payer: Aetna Commercial |
$40,079.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,648.89
|
| Rate for Payer: Cash Price |
$37,721.71
|
| Rate for Payer: Cofinity Advantage |
$33,006.50
|
| Rate for Payer: Cofinity Commercial |
$40,550.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37,721.71
|
| Rate for Payer: Healthscope Commercial |
$42,436.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,079.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35,364.11
|
| Rate for Payer: PHP Commercial |
$40,079.32
|
| Rate for Payer: Priority Health SBD |
$29,705.85
|
|
|
HC IMPELLA LVAD
|
Facility
|
OP
|
$47,152.14
|
|
| Hospital Charge Code |
27200132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18,530.79 |
| Max. Negotiated Rate |
$42,436.93 |
| Rate for Payer: Aetna Commercial |
$40,079.32
|
| Rate for Payer: Aetna Medicare |
$23,576.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,648.89
|
| Rate for Payer: BCBS Complete |
$18,860.86
|
| Rate for Payer: Cash Price |
$37,721.71
|
| Rate for Payer: Cofinity Advantage |
$33,006.50
|
| Rate for Payer: Cofinity Commercial |
$40,550.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37,721.71
|
| Rate for Payer: Healthscope Commercial |
$42,436.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37,721.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,079.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35,364.11
|
| Rate for Payer: PHP Commercial |
$40,079.32
|
| Rate for Payer: Priority Health SBD |
$29,705.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,648.89
|
| Rate for Payer: UHC Core |
$24,566.26
|
| Rate for Payer: UHC Exchange |
$18,530.79
|
|
|
HC IMPELLA MONITORING KIT
|
Facility
|
OP
|
$346.24
|
|
| Hospital Charge Code |
27200133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.07 |
| Max. Negotiated Rate |
$311.62 |
| Rate for Payer: Aetna Commercial |
$294.30
|
| Rate for Payer: Aetna Medicare |
$173.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.06
|
| Rate for Payer: BCBS Complete |
$138.50
|
| Rate for Payer: Cash Price |
$276.99
|
| Rate for Payer: Cofinity Advantage |
$242.37
|
| Rate for Payer: Cofinity Commercial |
$297.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.99
|
| Rate for Payer: Healthscope Commercial |
$311.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.68
|
| Rate for Payer: PHP Commercial |
$294.30
|
| Rate for Payer: Priority Health SBD |
$218.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.06
|
| Rate for Payer: UHC Core |
$180.39
|
| Rate for Payer: UHC Exchange |
$136.07
|
|
|
HC IMPELLA MONITORING KIT
|
Facility
|
IP
|
$346.24
|
|
| Hospital Charge Code |
27200133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$218.13 |
| Max. Negotiated Rate |
$311.62 |
| Rate for Payer: Aetna Commercial |
$294.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.06
|
| Rate for Payer: Cash Price |
$276.99
|
| Rate for Payer: Cofinity Advantage |
$242.37
|
| Rate for Payer: Cofinity Commercial |
$297.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.99
|
| Rate for Payer: Healthscope Commercial |
$311.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.68
|
| Rate for Payer: PHP Commercial |
$294.30
|
| Rate for Payer: Priority Health SBD |
$218.13
|
|
|
HC IMPELLA REMOVAL
|
Facility
|
IP
|
$2,989.19
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
48100114
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,883.19 |
| Max. Negotiated Rate |
$2,690.27 |
| Rate for Payer: Aetna Commercial |
$2,540.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,942.97
|
| Rate for Payer: Cash Price |
$2,391.35
|
| Rate for Payer: Cofinity Advantage |
$2,092.43
|
| Rate for Payer: Cofinity Commercial |
$2,570.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,391.35
|
| Rate for Payer: Healthscope Commercial |
$2,690.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,540.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,241.89
|
| Rate for Payer: PHP Commercial |
$2,540.81
|
| Rate for Payer: Priority Health SBD |
$1,883.19
|
|
|
HC IMPELLA REMOVAL
|
Facility
|
OP
|
$2,989.19
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
48100114
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$542.42 |
| Max. Negotiated Rate |
$2,690.27 |
| Rate for Payer: Aetna Commercial |
$2,540.81
|
| Rate for Payer: Aetna Medicare |
$1,494.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,942.97
|
| Rate for Payer: BCBS Complete |
$1,195.68
|
| Rate for Payer: BCBS Trust/PPO |
$542.42
|
| Rate for Payer: BCN Commercial |
$542.42
|
| Rate for Payer: Cash Price |
$2,391.35
|
| Rate for Payer: Cash Price |
$2,391.35
|
| Rate for Payer: Cofinity Advantage |
$2,092.43
|
| Rate for Payer: Cofinity Commercial |
$2,570.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,391.35
|
| Rate for Payer: Healthscope Commercial |
$2,690.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,391.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,540.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,241.89
|
| Rate for Payer: PHP Commercial |
$2,540.81
|
| Rate for Payer: Priority Health SBD |
$1,883.19
|
|
|
HC IMPELLA RP FLEX
|
Facility
|
IP
|
$31,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19,687.50 |
| Max. Negotiated Rate |
$28,125.00 |
| Rate for Payer: Aetna Commercial |
$26,562.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,312.50
|
| Rate for Payer: Cash Price |
$25,000.00
|
| Rate for Payer: Cofinity Advantage |
$21,875.00
|
| Rate for Payer: Cofinity Commercial |
$26,875.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,000.00
|
| Rate for Payer: Healthscope Commercial |
$28,125.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,562.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,437.50
|
| Rate for Payer: PHP Commercial |
$26,562.50
|
| Rate for Payer: Priority Health SBD |
$19,687.50
|
|
