|
HC LYME CSF COMPONENT 2
|
Facility
|
IP
|
$165.42
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$104.21 |
| Max. Negotiated Rate |
$148.88 |
| Rate for Payer: Aetna Commercial |
$140.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.52
|
| Rate for Payer: Cash Price |
$132.34
|
| Rate for Payer: Cofinity Advantage |
$115.79
|
| Rate for Payer: Cofinity Commercial |
$142.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.34
|
| Rate for Payer: Healthscope Commercial |
$148.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.06
|
| Rate for Payer: PHP Commercial |
$140.61
|
| Rate for Payer: Priority Health SBD |
$104.21
|
|
|
HC LYME CSF COMPONENT 3
|
Facility
|
OP
|
$90.51
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$81.46 |
| Rate for Payer: Aetna Commercial |
$76.93
|
| Rate for Payer: Aetna Medicare |
$9.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.83
|
| 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 |
$72.41
|
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Cofinity Advantage |
$63.36
|
| Rate for Payer: Cofinity Commercial |
$77.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$81.46
|
| 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 |
$76.93
|
| Rate for Payer: Nomi Health Commercial |
$13.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.88
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$76.93
|
| 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 |
$57.02
|
| 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 LYME CSF COMPONENT 3
|
Facility
|
IP
|
$90.51
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$81.46 |
| Rate for Payer: Aetna Commercial |
$76.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.83
|
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Cofinity Advantage |
$63.36
|
| Rate for Payer: Cofinity Commercial |
$77.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.41
|
| Rate for Payer: Healthscope Commercial |
$81.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.88
|
| Rate for Payer: PHP Commercial |
$76.93
|
| Rate for Payer: Priority Health SBD |
$57.02
|
|
|
HC LYME CSF IGG AB INDEX
|
Facility
|
OP
|
$73.87
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$66.48 |
| Rate for Payer: Aetna Commercial |
$62.79
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: BCBS Complete |
$2.72
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Advantage |
$51.71
|
| Rate for Payer: Cofinity Commercial |
$63.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Healthscope Commercial |
$66.48
|
| Rate for Payer: Mclaren Medicaid |
$2.59
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Medicaid |
$5.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: Nomi Health Commercial |
$7.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.40
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PHP Commercial |
$62.79
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.95
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health SBD |
$46.54
|
| Rate for Payer: Priority Health Tiered Network |
$3.96
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.43
|
| Rate for Payer: UHC Core |
$7.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.95
|
| Rate for Payer: UHC Exchange |
$7.43
|
| Rate for Payer: UHC Medicaid |
$2.59
|
| Rate for Payer: UHCCP Medicaid |
$2.59
|
| Rate for Payer: VA VA |
$4.95
|
|
|
HC LYME CSF IGG AB INDEX
|
Facility
|
IP
|
$73.87
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.54 |
| Max. Negotiated Rate |
$66.48 |
| Rate for Payer: Aetna Commercial |
$62.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.02
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Advantage |
$51.71
|
| Rate for Payer: Cofinity Commercial |
$63.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Healthscope Commercial |
$66.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.40
|
| Rate for Payer: PHP Commercial |
$62.79
|
| Rate for Payer: Priority Health SBD |
$46.54
|
|
|
HC LYME DISEASE ANTIBODY
|
Facility
|
IP
|
$47.76
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.09 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.04
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Advantage |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: Priority Health SBD |
$30.09
|
|
|
HC LYME DISEASE ANTIBODY
|
Facility
|
OP
|
$47.76
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna Medicare |
$17.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.29
|
| Rate for Payer: BCBS Complete |
$9.35
|
| Rate for Payer: BCBS MAPPO |
$17.03
|
| Rate for Payer: BCBS Trust/PPO |
$18.15
|
| Rate for Payer: BCN Commercial |
$18.15
|
| Rate for Payer: BCN Medicare Advantage |
$17.03
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Advantage |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.03
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Mclaren Medicaid |
$8.91
|
| Rate for Payer: Mclaren Medicare |
$17.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.88
|
| Rate for Payer: Meridian Medicaid |
$17.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$25.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: PACE Medicare |
$16.18
|
| Rate for Payer: PACE SWMI |
$17.03
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: PHP Medicare Advantage |
$17.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.03
|
| Rate for Payer: Priority Health Medicare |
$17.03
|
| Rate for Payer: Priority Health SBD |
$30.09
|
| Rate for Payer: Priority Health Tiered Network |
$13.62
|
| Rate for Payer: Railroad Medicare Medicare |
$17.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.55
|
| Rate for Payer: UHC Core |
$25.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.03
|
| Rate for Payer: UHC Exchange |
$25.55
|
| Rate for Payer: UHC Medicaid |
$8.91
|
| Rate for Payer: UHCCP Medicaid |
$8.91
|
| Rate for Payer: VA VA |
$17.03
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS
|
Facility
|
OP
|
$264.91
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200472
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$238.42 |
| Rate for Payer: Aetna Commercial |
$225.17
|
| Rate for Payer: Aetna Medicare |
$50.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: BCBS Complete |
$26.93
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$52.27
|
| Rate for Payer: BCN Commercial |
$52.27
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$211.93
|
| Rate for Payer: Cash Price |
$211.93
|
| Rate for Payer: Cofinity Advantage |
$185.44
|
| Rate for Payer: Cofinity Commercial |
$227.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$238.42
|
| Rate for Payer: Mclaren Medicaid |
$25.64
|
| Rate for Payer: Mclaren Medicare |
$49.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.48
|
| Rate for Payer: Meridian Medicaid |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.17
|
| Rate for Payer: Nomi Health Commercial |
$73.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.68
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$225.17
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$49.03
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health SBD |
$166.89
|
| Rate for Payer: Priority Health Tiered Network |
$39.22
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.55
|
| Rate for Payer: UHC Core |
$73.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.03
|
| Rate for Payer: UHC Exchange |
$73.55
|
| Rate for Payer: UHC Medicaid |
$25.64
|
| Rate for Payer: UHCCP Medicaid |
$25.64
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS
|
Facility
|
IP
|
$264.91
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200472
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$166.89 |
| Max. Negotiated Rate |
$238.42 |
| Rate for Payer: Aetna Commercial |
$225.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.19
|
| Rate for Payer: Cash Price |
$211.93
|
| Rate for Payer: Cofinity Advantage |
$185.44
|
| Rate for Payer: Cofinity Commercial |
$227.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.93
|
| Rate for Payer: Healthscope Commercial |
$238.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.68
|
| Rate for Payer: PHP Commercial |
$225.17
|
| Rate for Payer: Priority Health SBD |
$166.89
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS CMPT
|
Facility
|
IP
|
$285.69
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200475
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$179.98 |
| Max. Negotiated Rate |
$257.12 |
| Rate for Payer: Aetna Commercial |
$242.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.70
|
| Rate for Payer: Cash Price |
$228.55
|
| Rate for Payer: Cofinity Advantage |
$199.98
|
| Rate for Payer: Cofinity Commercial |
$245.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.55
|
| Rate for Payer: Healthscope Commercial |
$257.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.27
|
| Rate for Payer: PHP Commercial |
$242.84
|
| Rate for Payer: Priority Health SBD |
$179.98
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS CMPT
|
Facility
|
OP
|
$285.69
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200475
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$257.12 |
| Rate for Payer: Aetna Commercial |
$242.84
|
| Rate for Payer: Aetna Medicare |
$50.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: BCBS Complete |
$26.93
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$52.27
|
| Rate for Payer: BCN Commercial |
$52.27
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$228.55
|
| Rate for Payer: Cash Price |
$228.55
|
| Rate for Payer: Cofinity Advantage |
$199.98
|
| Rate for Payer: Cofinity Commercial |
$245.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$257.12
|
| Rate for Payer: Mclaren Medicaid |
$25.64
|
| Rate for Payer: Mclaren Medicare |
$49.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.48
|
| Rate for Payer: Meridian Medicaid |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.84
|
| Rate for Payer: Nomi Health Commercial |
$73.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.27
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$242.84
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$49.03
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health SBD |
$179.98
|
| Rate for Payer: Priority Health Tiered Network |
$39.22
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.55
|
| Rate for Payer: UHC Core |
$73.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.03
|
| Rate for Payer: UHC Exchange |
$73.55
|
| Rate for Payer: UHC Medicaid |
$25.64
|
| Rate for Payer: UHCCP Medicaid |
$25.64
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION MITOGEN
|
Facility
|
OP
|
$240.33
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$216.30 |
| Rate for Payer: Aetna Commercial |
$204.28
|
| Rate for Payer: Aetna Medicare |
$50.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: BCBS Complete |
$26.93
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$52.27
|
| Rate for Payer: BCN Commercial |
$52.27
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$192.26
|
| Rate for Payer: Cash Price |
$192.26
|
| Rate for Payer: Cofinity Advantage |
$168.23
|
| Rate for Payer: Cofinity Commercial |
$206.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$216.30
|
| Rate for Payer: Mclaren Medicaid |
$25.64
|
| Rate for Payer: Mclaren Medicare |
$49.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.48
|
| Rate for Payer: Meridian Medicaid |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.28
|
| Rate for Payer: Nomi Health Commercial |
$73.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.25
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$204.28
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$49.03
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health SBD |
$151.41
|
| Rate for Payer: Priority Health Tiered Network |
$39.22
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.55
|
| Rate for Payer: UHC Core |
$73.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.03
|
| Rate for Payer: UHC Exchange |
$73.55
|
| Rate for Payer: UHC Medicaid |
$25.64
|
| Rate for Payer: UHCCP Medicaid |
$25.64
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION MITOGEN
|
Facility
|
IP
|
$240.33
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$151.41 |
| Max. Negotiated Rate |
$216.30 |
| Rate for Payer: Aetna Commercial |
$204.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.21
|
| Rate for Payer: Cash Price |
$192.26
|
| Rate for Payer: Cofinity Advantage |
$168.23
|
| Rate for Payer: Cofinity Commercial |
$206.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.26
|
| Rate for Payer: Healthscope Commercial |
$216.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.25
|
| Rate for Payer: PHP Commercial |
$204.28
|
| Rate for Payer: Priority Health SBD |
$151.41
|
|
|
HC LYMPHOCYTE PROLIFERATION, MITOGENS
|
Facility
|
OP
|
$264.91
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200473
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$238.42 |
| Rate for Payer: Aetna Commercial |
$225.17
|
| Rate for Payer: Aetna Medicare |
$50.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: BCBS Complete |
$26.93
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$52.27
|
| Rate for Payer: BCN Commercial |
$52.27
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$211.93
|
| Rate for Payer: Cash Price |
$211.93
|
| Rate for Payer: Cofinity Advantage |
$185.44
|
| Rate for Payer: Cofinity Commercial |
$227.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$238.42
|
| Rate for Payer: Mclaren Medicaid |
$25.64
|
| Rate for Payer: Mclaren Medicare |
$49.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.48
|
| Rate for Payer: Meridian Medicaid |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.17
|
| Rate for Payer: Nomi Health Commercial |
$73.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.68
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$225.17
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$49.03
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health SBD |
$166.89
|
| Rate for Payer: Priority Health Tiered Network |
$39.22
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.55
|
| Rate for Payer: UHC Core |
$73.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.03
|
| Rate for Payer: UHC Exchange |
$73.55
|
| Rate for Payer: UHC Medicaid |
$25.64
|
| Rate for Payer: UHCCP Medicaid |
$25.64
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION, MITOGENS
|
Facility
|
IP
|
$264.91
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200473
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$166.89 |
| Max. Negotiated Rate |
$238.42 |
| Rate for Payer: Aetna Commercial |
$225.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.19
|
| Rate for Payer: Cash Price |
$211.93
|
| Rate for Payer: Cofinity Advantage |
$185.44
|
| Rate for Payer: Cofinity Commercial |
$227.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.93
|
| Rate for Payer: Healthscope Commercial |
$238.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.68
|
| Rate for Payer: PHP Commercial |
$225.17
|
| Rate for Payer: Priority Health SBD |
$166.89
|
|
|
HC LYMPHOCYTE PROLIFERATION, MITOGENS CMPT
|
Facility
|
IP
|
$285.69
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200474
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$179.98 |
| Max. Negotiated Rate |
$257.12 |
| Rate for Payer: Aetna Commercial |
$242.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.70
|
| Rate for Payer: Cash Price |
$228.55
|
| Rate for Payer: Cofinity Advantage |
$199.98
|
| Rate for Payer: Cofinity Commercial |
$245.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.55
|
| Rate for Payer: Healthscope Commercial |
$257.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.27
|
| Rate for Payer: PHP Commercial |
$242.84
|
| Rate for Payer: Priority Health SBD |
$179.98
|
|
|
HC LYMPHOCYTE PROLIFERATION, MITOGENS CMPT
|
Facility
|
OP
|
$285.69
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200474
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$257.12 |
| Rate for Payer: Aetna Commercial |
$242.84
|
| Rate for Payer: Aetna Medicare |
$50.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: BCBS Complete |
$26.93
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$52.27
|
| Rate for Payer: BCN Commercial |
$52.27
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$228.55
|
| Rate for Payer: Cash Price |
$228.55
|
| Rate for Payer: Cofinity Advantage |
$199.98
|
| Rate for Payer: Cofinity Commercial |
$245.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$257.12
|
| Rate for Payer: Mclaren Medicaid |
$25.64
|
| Rate for Payer: Mclaren Medicare |
$49.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.48
|
| Rate for Payer: Meridian Medicaid |
$51.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.84
|
| Rate for Payer: Nomi Health Commercial |
$73.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.27
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$242.84
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$49.03
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health SBD |
$179.98
|
| Rate for Payer: Priority Health Tiered Network |
$39.22
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.55
|
| Rate for Payer: UHC Core |
$73.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.03
|
| Rate for Payer: UHC Exchange |
$73.55
|
| Rate for Payer: UHC Medicaid |
$25.64
|
| Rate for Payer: UHCCP Medicaid |
$25.64
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOMA IMMUNOPHENO 2
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
CPT 85060
|
| Hospital Charge Code |
30500014
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$33.96 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.35
|
| Rate for Payer: BCBS Complete |
$6.37
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Advantage |
$11.14
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$14.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: PHP Commercial |
$13.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.61
|
| Rate for Payer: Priority Health SBD |
$10.03
|
| Rate for Payer: Priority Health Tiered Network |
$6.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.96
|
| Rate for Payer: UHC Core |
$33.96
|
| Rate for Payer: UHC Exchange |
$33.96
|
|
|
HC LYMPHOMA IMMUNOPHENO 2
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
CPT 85060
|
| Hospital Charge Code |
30500014
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.35
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Advantage |
$11.14
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$14.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: PHP Commercial |
$13.53
|
| Rate for Payer: Priority Health SBD |
$10.03
|
|
|
HC LYMPH SUPPLY CUSTOM GARMEN
|
Facility
|
IP
|
$686.66
|
|
| Hospital Charge Code |
96000003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$432.60 |
| Max. Negotiated Rate |
$617.99 |
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.33
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Advantage |
$480.66
|
| Rate for Payer: Cofinity Commercial |
$590.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Healthscope Commercial |
$617.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PHP Commercial |
$583.66
|
| Rate for Payer: Priority Health SBD |
$432.60
|
|
|
HC LYMPH SUPPLY CUSTOM GARMEN
|
Facility
|
OP
|
$686.66
|
|
| Hospital Charge Code |
96000003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$269.86 |
| Max. Negotiated Rate |
$617.99 |
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Aetna Medicare |
$343.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.33
|
| Rate for Payer: BCBS Complete |
$274.66
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Advantage |
$480.66
|
| Rate for Payer: Cofinity Commercial |
$590.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Healthscope Commercial |
$617.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$549.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PHP Commercial |
$583.66
|
| Rate for Payer: Priority Health SBD |
$432.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$446.33
|
| Rate for Payer: UHC Core |
$357.75
|
| Rate for Payer: UHC Exchange |
$269.86
|
|
|
HC LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS
|
Facility
|
IP
|
$3,805.47
|
|
|
Service Code
|
CPT 54162
|
| Hospital Charge Code |
36100617
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,397.45 |
| Max. Negotiated Rate |
$3,424.92 |
| Rate for Payer: Aetna Commercial |
$3,234.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,473.56
|
| Rate for Payer: Cash Price |
$3,044.38
|
| Rate for Payer: Cofinity Advantage |
$2,663.83
|
| Rate for Payer: Cofinity Commercial |
$3,272.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,044.38
|
| Rate for Payer: Healthscope Commercial |
$3,424.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,234.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,854.10
|
| Rate for Payer: PHP Commercial |
$3,234.65
|
| Rate for Payer: Priority Health SBD |
$2,397.45
|
|
|
HC LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS
|
Facility
|
OP
|
$3,805.47
|
|
|
Service Code
|
CPT 54162
|
| Hospital Charge Code |
36100617
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Commercial |
$3,234.65
|
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,473.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,384.78
|
| Rate for Payer: BCN Commercial |
$1,384.78
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$3,044.38
|
| Rate for Payer: Cash Price |
$3,044.38
|
| Rate for Payer: Cash Price |
$3,044.38
|
| Rate for Payer: Cofinity Advantage |
$2,663.83
|
| Rate for Payer: Cofinity Commercial |
$3,272.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,044.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$3,424.92
|
| Rate for Payer: Mclaren Medicaid |
$1,089.34
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,234.65
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,854.10
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$3,234.65
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health SBD |
$2,397.45
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC LYSIS INTRANASAL SYNECHIA
|
Facility
|
OP
|
$1,404.54
|
|
|
Service Code
|
CPT 30560
|
| Hospital Charge Code |
76100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.85 |
| Max. Negotiated Rate |
$1,737.88 |
| Rate for Payer: Aetna Commercial |
$1,193.86
|
| Rate for Payer: Aetna Medicare |
$558.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$912.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.74
|
| Rate for Payer: BCBS Complete |
$295.13
|
| Rate for Payer: BCBS MAPPO |
$537.39
|
| Rate for Payer: BCBS Trust/PPO |
$273.85
|
| Rate for Payer: BCN Commercial |
$273.85
|
| Rate for Payer: BCN Medicare Advantage |
$537.39
|
| Rate for Payer: Cash Price |
$1,123.63
|
| Rate for Payer: Cash Price |
$1,123.63
|
| Rate for Payer: Cash Price |
$1,123.63
|
| Rate for Payer: Cofinity Advantage |
$983.18
|
| Rate for Payer: Cofinity Commercial |
$1,207.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.39
|
| Rate for Payer: Healthscope Commercial |
$1,264.09
|
| Rate for Payer: Mclaren Medicaid |
$281.05
|
| Rate for Payer: Mclaren Medicare |
$537.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.26
|
| Rate for Payer: Meridian Medicaid |
$564.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,193.86
|
| Rate for Payer: Nomi Health Commercial |
$1,612.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,053.40
|
| Rate for Payer: PACE Medicare |
$510.52
|
| Rate for Payer: PACE SWMI |
$537.39
|
| Rate for Payer: PHP Commercial |
$1,193.86
|
| Rate for Payer: PHP Medicare Advantage |
$537.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,737.88
|
| Rate for Payer: Priority Health Medicare |
$537.39
|
| Rate for Payer: Priority Health SBD |
$884.86
|
| Rate for Payer: Priority Health Tiered Network |
$1,390.30
|
| Rate for Payer: Railroad Medicare Medicare |
$537.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$912.95
|
| Rate for Payer: UHC Core |
$731.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$537.39
|
| Rate for Payer: UHC Exchange |
$551.98
|
| Rate for Payer: UHC Medicaid |
$281.05
|
| Rate for Payer: UHCCP Medicaid |
$281.05
|
| Rate for Payer: VA VA |
$537.39
|
|
|
HC LYSIS INTRANASAL SYNECHIA
|
Facility
|
IP
|
$1,404.54
|
|
|
Service Code
|
CPT 30560
|
| Hospital Charge Code |
76100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$884.86 |
| Max. Negotiated Rate |
$1,264.09 |
| Rate for Payer: Aetna Commercial |
$1,193.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$912.95
|
| Rate for Payer: Cash Price |
$1,123.63
|
| Rate for Payer: Cofinity Advantage |
$983.18
|
| Rate for Payer: Cofinity Commercial |
$1,207.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.63
|
| Rate for Payer: Healthscope Commercial |
$1,264.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,193.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,053.40
|
| Rate for Payer: PHP Commercial |
$1,193.86
|
| Rate for Payer: Priority Health SBD |
$884.86
|
|
