|
HC LVDS PLT PER LEUKO RED IRRAD
|
Facility
|
IP
|
$2,832.80
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000088
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,784.66 |
| Max. Negotiated Rate |
$2,549.52 |
| Rate for Payer: Aetna Commercial |
$2,407.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,841.32
|
| Rate for Payer: Cash Price |
$2,266.24
|
| Rate for Payer: Cofinity Commercial |
$1,982.96
|
| Rate for Payer: Cofinity Commercial |
$2,436.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,982.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,266.24
|
| Rate for Payer: Healthscope Commercial |
$2,549.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,407.88
|
| Rate for Payer: PHP Commercial |
$2,407.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.32
|
| Rate for Payer: Priority Health SBD |
$1,784.66
|
|
|
HC LVDS PLT PHER LEUKO RED
|
Facility
|
IP
|
$2,200.05
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000087
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,386.03 |
| Max. Negotiated Rate |
$1,980.04 |
| Rate for Payer: Aetna Commercial |
$1,870.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,430.03
|
| Rate for Payer: Cash Price |
$1,760.04
|
| Rate for Payer: Cofinity Commercial |
$1,540.04
|
| Rate for Payer: Cofinity Commercial |
$1,892.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,540.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,760.04
|
| Rate for Payer: Healthscope Commercial |
$1,980.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,870.04
|
| Rate for Payer: PHP Commercial |
$1,870.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.03
|
| Rate for Payer: Priority Health SBD |
$1,386.03
|
|
|
HC LVDS PLT PHER LEUKO RED
|
Facility
|
OP
|
$2,200.05
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000087
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$255.81 |
| Max. Negotiated Rate |
$1,980.04 |
| Rate for Payer: Aetna Commercial |
$1,870.04
|
| Rate for Payer: Aetna Medicare |
$496.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,430.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$596.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$596.56
|
| Rate for Payer: BCBS Complete |
$268.60
|
| Rate for Payer: BCBS MAPPO |
$477.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,309.53
|
| Rate for Payer: BCN Commercial |
$1,309.53
|
| Rate for Payer: BCN Medicare Advantage |
$477.25
|
| Rate for Payer: Cash Price |
$1,760.04
|
| Rate for Payer: Cash Price |
$1,760.04
|
| Rate for Payer: Cofinity Commercial |
$1,892.04
|
| Rate for Payer: Cofinity Commercial |
$1,540.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,540.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,760.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$477.25
|
| Rate for Payer: Healthscope Commercial |
$1,980.04
|
| Rate for Payer: Mclaren Medicaid |
$255.81
|
| Rate for Payer: Mclaren Medicare |
$477.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$501.11
|
| Rate for Payer: Meridian Medicaid |
$268.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$548.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,870.04
|
| Rate for Payer: Nomi Health Commercial |
$1,431.75
|
| Rate for Payer: PACE Medicare |
$453.39
|
| Rate for Payer: PACE SWMI |
$477.25
|
| Rate for Payer: PHP Commercial |
$1,870.04
|
| Rate for Payer: PHP Medicare Advantage |
$477.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$255.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,500.00
|
| Rate for Payer: Priority Health Medicare |
$477.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,200.00
|
| Rate for Payer: Priority Health SBD |
$1,386.03
|
| Rate for Payer: Railroad Medicare Medicare |
$477.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,343.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$477.25
|
| Rate for Payer: UHC Exchange |
$1,628.04
|
| Rate for Payer: UHC Medicare Advantage |
$477.25
|
| Rate for Payer: UHCCP Medicaid |
$268.69
|
| Rate for Payer: VA VA |
$477.25
|
|
|
HC LV LEAD PLACEMENT
|
Facility
|
IP
|
$9,273.79
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
36100070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,842.49 |
| Max. Negotiated Rate |
$8,346.41 |
| Rate for Payer: Aetna Commercial |
$7,882.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,027.96
|
| Rate for Payer: Cash Price |
$7,419.03
|
| Rate for Payer: Cofinity Commercial |
$6,491.65
|
| Rate for Payer: Cofinity Commercial |
$7,975.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,491.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,419.03
|
| Rate for Payer: Healthscope Commercial |
$8,346.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,882.72
|
| Rate for Payer: PHP Commercial |
$7,882.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,027.96
|
| Rate for Payer: Priority Health SBD |
$5,842.49
|
|
|
HC LV LEAD PLACEMENT
|
Facility
|
OP
|
$9,273.79
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
36100070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$487.84 |
| Max. Negotiated Rate |
$11,353.00 |
| Rate for Payer: Aetna Commercial |
$7,882.72
|
| Rate for Payer: Aetna Medicare |
$4,636.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,027.96
|
| Rate for Payer: BCBS Complete |
$3,709.52
|
| Rate for Payer: BCBS Trust/PPO |
$10,528.29
|
| Rate for Payer: BCN Commercial |
$10,528.29
|
| Rate for Payer: Cash Price |
$7,419.03
|
| Rate for Payer: Cash Price |
$7,419.03
|
| Rate for Payer: Cash Price |
$7,419.03
|
| Rate for Payer: Cofinity Commercial |
$6,491.65
|
| Rate for Payer: Cofinity Commercial |
$7,975.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,491.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,419.03
|
| Rate for Payer: Healthscope Commercial |
$8,346.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,882.72
|
| Rate for Payer: PHP Commercial |
$7,882.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,027.96
|
| Rate for Payer: Priority Health SBD |
$5,842.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$487.84
|
| Rate for Payer: UHC Core |
$10,600.00
|
| Rate for Payer: UHC Exchange |
$11,353.00
|
|
|
HC LV LEAD REPOSITIONING
|
Facility
|
IP
|
$3,588.43
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
36100071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,260.71 |
| Max. Negotiated Rate |
$3,229.59 |
| Rate for Payer: Aetna Commercial |
$3,050.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,332.48
|
| Rate for Payer: Cash Price |
$2,870.74
|
| Rate for Payer: Cofinity Commercial |
$2,511.90
|
| Rate for Payer: Cofinity Commercial |
$3,086.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,511.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,870.74
|
| Rate for Payer: Healthscope Commercial |
$3,229.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,050.17
|
| Rate for Payer: PHP Commercial |
$3,050.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,332.48
|
| Rate for Payer: Priority Health SBD |
$2,260.71
|
|
|
HC LV LEAD REPOSITIONING
|
Facility
|
OP
|
$3,588.43
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
36100071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$517.56 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Commercial |
$3,050.17
|
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,332.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,140.26
|
| Rate for Payer: BCN Commercial |
$1,140.26
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$2,870.74
|
| Rate for Payer: Cash Price |
$2,870.74
|
| Rate for Payer: Cash Price |
$2,870.74
|
| Rate for Payer: Cofinity Commercial |
$2,511.90
|
| Rate for Payer: Cofinity Commercial |
$3,086.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,511.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,870.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$3,229.59
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,050.17
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Commercial |
$3,050.17
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,332.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Priority Health SBD |
$2,260.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$517.56
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,736.21
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
HC LYME AB CONFIRMATION CMPT
|
Facility
|
IP
|
$34.33
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
30200232
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.63 |
| Max. Negotiated Rate |
$30.90 |
| Rate for Payer: Aetna Commercial |
$29.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.31
|
| Rate for Payer: Cash Price |
$27.46
|
| Rate for Payer: Cofinity Commercial |
$24.03
|
| Rate for Payer: Cofinity Commercial |
$29.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.46
|
| Rate for Payer: Healthscope Commercial |
$30.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.18
|
| Rate for Payer: PHP Commercial |
$29.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.31
|
| Rate for Payer: Priority Health SBD |
$21.63
|
|
|
HC LYME AB CONFIRMATION CMPT
|
Facility
|
OP
|
$34.33
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
30200232
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$30.90 |
| Rate for Payer: Aetna Commercial |
$29.18
|
| Rate for Payer: Aetna Medicare |
$16.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.36
|
| Rate for Payer: BCBS Complete |
$8.72
|
| Rate for Payer: BCBS MAPPO |
$15.49
|
| Rate for Payer: BCBS Trust/PPO |
$13.72
|
| Rate for Payer: BCN Commercial |
$13.72
|
| Rate for Payer: BCN Medicare Advantage |
$15.49
|
| Rate for Payer: Cash Price |
$27.46
|
| Rate for Payer: Cash Price |
$27.46
|
| Rate for Payer: Cofinity Commercial |
$29.52
|
| Rate for Payer: Cofinity Commercial |
$24.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$30.90
|
| Rate for Payer: Mclaren Medicaid |
$8.30
|
| Rate for Payer: Mclaren Medicare |
$15.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.26
|
| Rate for Payer: Meridian Medicaid |
$8.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.18
|
| Rate for Payer: Nomi Health Commercial |
$23.24
|
| Rate for Payer: PACE Medicare |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.49
|
| Rate for Payer: PHP Commercial |
$29.18
|
| Rate for Payer: PHP Medicare Advantage |
$15.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.94
|
| Rate for Payer: Priority Health Medicare |
$15.49
|
| Rate for Payer: Priority Health Narrow Network |
$12.75
|
| Rate for Payer: Priority Health SBD |
$21.63
|
| Rate for Payer: Railroad Medicare Medicare |
$15.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.49
|
| Rate for Payer: UHC Medicare Advantage |
$15.49
|
| Rate for Payer: UHCCP Medicaid |
$8.72
|
| Rate for Payer: VA VA |
$15.49
|
|
|
HC LYME CSF COMPONENT 1
|
Facility
|
OP
|
$60.18
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100669
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$962.80 |
| Rate for Payer: Aetna Commercial |
$51.15
|
| Rate for Payer: Aetna Medicare |
$8.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.72
|
| Rate for Payer: BCBS Complete |
$4.38
|
| Rate for Payer: BCBS MAPPO |
$7.78
|
| Rate for Payer: BCBS Trust/PPO |
$6.89
|
| Rate for Payer: BCN Commercial |
$6.89
|
| Rate for Payer: BCN Medicare Advantage |
$7.78
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$42.13
|
| Rate for Payer: Cofinity Commercial |
$51.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$54.16
|
| Rate for Payer: Mclaren Medicaid |
$4.17
|
| Rate for Payer: Mclaren Medicare |
$7.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.17
|
| Rate for Payer: Meridian Medicaid |
$4.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.15
|
| Rate for Payer: Nomi Health Commercial |
$11.67
|
| Rate for Payer: PACE Medicare |
$7.39
|
| Rate for Payer: PACE SWMI |
$7.78
|
| Rate for Payer: PHP Commercial |
$51.15
|
| Rate for Payer: PHP Medicare Advantage |
$7.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.78
|
| Rate for Payer: Priority Health Medicare |
$7.78
|
| Rate for Payer: Priority Health Narrow Network |
$6.22
|
| Rate for Payer: Priority Health SBD |
$37.91
|
| Rate for Payer: Railroad Medicare Medicare |
$7.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.34
|
| Rate for Payer: UHC Core |
$962.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.78
|
| Rate for Payer: UHC Exchange |
$962.80
|
| Rate for Payer: UHC Medicare Advantage |
$7.78
|
| Rate for Payer: UHCCP Medicaid |
$4.38
|
| Rate for Payer: VA VA |
$7.78
|
|
|
HC LYME CSF COMPONENT 1
|
Facility
|
IP
|
$60.18
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100669
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$54.16 |
| Rate for Payer: Aetna Commercial |
$51.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.12
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$42.13
|
| Rate for Payer: Cofinity Commercial |
$51.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.14
|
| Rate for Payer: Healthscope Commercial |
$54.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.15
|
| Rate for Payer: PHP Commercial |
$51.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.12
|
| Rate for Payer: Priority Health SBD |
$37.91
|
|
|
HC LYME CSF COMPONENT 2
|
Facility
|
IP
|
$162.18
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.17 |
| Max. Negotiated Rate |
$145.96 |
| Rate for Payer: Aetna Commercial |
$137.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.42
|
| Rate for Payer: Cash Price |
$129.74
|
| Rate for Payer: Cofinity Commercial |
$113.53
|
| Rate for Payer: Cofinity Commercial |
$139.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.74
|
| Rate for Payer: Healthscope Commercial |
$145.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.85
|
| Rate for Payer: PHP Commercial |
$137.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.42
|
| Rate for Payer: Priority Health SBD |
$102.17
|
|
|
HC LYME CSF COMPONENT 2
|
Facility
|
OP
|
$162.18
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$145.96 |
| Rate for Payer: Aetna Commercial |
$137.85
|
| Rate for Payer: Aetna Medicare |
$17.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.42
|
| 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 |
$9.58
|
| Rate for Payer: BCBS MAPPO |
$17.03
|
| Rate for Payer: BCBS Trust/PPO |
$15.07
|
| Rate for Payer: BCN Commercial |
$15.07
|
| Rate for Payer: BCN Medicare Advantage |
$17.03
|
| Rate for Payer: Cash Price |
$129.74
|
| Rate for Payer: Cash Price |
$129.74
|
| Rate for Payer: Cofinity Commercial |
$139.47
|
| Rate for Payer: Cofinity Commercial |
$113.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.03
|
| Rate for Payer: Healthscope Commercial |
$145.96
|
| Rate for Payer: Mclaren Medicaid |
$9.13
|
| 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 |
$9.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.85
|
| Rate for Payer: Nomi Health Commercial |
$25.54
|
| Rate for Payer: PACE Medicare |
$16.18
|
| Rate for Payer: PACE SWMI |
$17.03
|
| Rate for Payer: PHP Commercial |
$137.85
|
| Rate for Payer: PHP Medicare Advantage |
$17.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.03
|
| Rate for Payer: Priority Health Medicare |
$17.03
|
| Rate for Payer: Priority Health Narrow Network |
$13.62
|
| Rate for Payer: Priority Health SBD |
$102.17
|
| Rate for Payer: Railroad Medicare Medicare |
$17.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.03
|
| Rate for Payer: UHC Medicare Advantage |
$17.03
|
| Rate for Payer: UHCCP Medicaid |
$9.59
|
| Rate for Payer: VA VA |
$17.03
|
|
|
HC LYME CSF COMPONENT 3
|
Facility
|
OP
|
$88.74
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$79.87 |
| Rate for Payer: Aetna Commercial |
$75.43
|
| Rate for Payer: Aetna Medicare |
$9.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.68
|
| 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 |
$5.23
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$8.24
|
| Rate for Payer: BCN Commercial |
$8.24
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$70.99
|
| Rate for Payer: Cash Price |
$70.99
|
| Rate for Payer: Cofinity Commercial |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$62.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$79.87
|
| Rate for Payer: Mclaren Medicaid |
$4.98
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.76
|
| Rate for Payer: Meridian Medicaid |
$5.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.43
|
| Rate for Payer: Nomi Health Commercial |
$13.95
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$75.43
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.57
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health Narrow Network |
$7.66
|
| Rate for Payer: Priority Health SBD |
$55.91
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.30
|
| Rate for Payer: UHC Medicare Advantage |
$9.30
|
| Rate for Payer: UHCCP Medicaid |
$5.24
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC LYME CSF COMPONENT 3
|
Facility
|
IP
|
$88.74
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.91 |
| Max. Negotiated Rate |
$79.87 |
| Rate for Payer: Aetna Commercial |
$75.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.68
|
| Rate for Payer: Cash Price |
$70.99
|
| Rate for Payer: Cofinity Commercial |
$62.12
|
| Rate for Payer: Cofinity Commercial |
$76.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.99
|
| Rate for Payer: Healthscope Commercial |
$79.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.43
|
| Rate for Payer: PHP Commercial |
$75.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.68
|
| Rate for Payer: Priority Health SBD |
$55.91
|
|
|
HC LYME CSF IGG AB INDEX
|
Facility
|
OP
|
$72.42
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$2,938.27 |
| Rate for Payer: Aetna Commercial |
$61.56
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.07
|
| 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 |
$2.79
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$50.69
|
| Rate for Payer: Cofinity Commercial |
$62.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Healthscope Commercial |
$65.18
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| 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 |
$2.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.56
|
| Rate for Payer: Nomi Health Commercial |
$7.42
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PHP Commercial |
$61.56
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.09
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Narrow Network |
$4.07
|
| Rate for Payer: Priority Health SBD |
$45.62
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.94
|
| Rate for Payer: UHC Core |
$2,938.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Exchange |
$2,938.27
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: UHCCP Medicaid |
$2.79
|
| Rate for Payer: VA VA |
$4.95
|
|
|
HC LYME CSF IGG AB INDEX
|
Facility
|
IP
|
$72.42
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.62 |
| Max. Negotiated Rate |
$65.18 |
| Rate for Payer: Aetna Commercial |
$61.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.07
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$50.69
|
| Rate for Payer: Cofinity Commercial |
$62.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.94
|
| Rate for Payer: Healthscope Commercial |
$65.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.56
|
| Rate for Payer: PHP Commercial |
$61.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.07
|
| Rate for Payer: Priority Health SBD |
$45.62
|
|
|
HC LYME DISEASE ANTIBODY
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health SBD |
$29.50
|
|
|
HC LYME DISEASE ANTIBODY
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$17.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| 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 |
$9.58
|
| Rate for Payer: BCBS MAPPO |
$17.03
|
| Rate for Payer: BCBS Trust/PPO |
$15.07
|
| Rate for Payer: BCN Commercial |
$15.07
|
| Rate for Payer: BCN Medicare Advantage |
$17.03
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.03
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Mclaren Medicaid |
$9.13
|
| 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 |
$9.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$25.54
|
| Rate for Payer: PACE Medicare |
$16.18
|
| Rate for Payer: PACE SWMI |
$17.03
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$17.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.03
|
| Rate for Payer: Priority Health Medicare |
$17.03
|
| Rate for Payer: Priority Health Narrow Network |
$13.62
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: Railroad Medicare Medicare |
$17.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.03
|
| Rate for Payer: UHC Medicare Advantage |
$17.03
|
| Rate for Payer: UHCCP Medicaid |
$9.59
|
| Rate for Payer: VA VA |
$17.03
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS
|
Facility
|
IP
|
$259.72
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200472
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$163.62 |
| Max. Negotiated Rate |
$233.75 |
| Rate for Payer: Aetna Commercial |
$220.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.82
|
| Rate for Payer: Cash Price |
$207.78
|
| Rate for Payer: Cofinity Commercial |
$181.80
|
| Rate for Payer: Cofinity Commercial |
$223.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.78
|
| Rate for Payer: Healthscope Commercial |
$233.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.76
|
| Rate for Payer: PHP Commercial |
$220.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.82
|
| Rate for Payer: Priority Health SBD |
$163.62
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS
|
Facility
|
OP
|
$259.72
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200472
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.28 |
| Max. Negotiated Rate |
$233.75 |
| Rate for Payer: Aetna Commercial |
$220.76
|
| Rate for Payer: Aetna Medicare |
$50.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.82
|
| 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 |
$27.59
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$43.40
|
| Rate for Payer: BCN Commercial |
$43.40
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$207.78
|
| Rate for Payer: Cash Price |
$207.78
|
| Rate for Payer: Cofinity Commercial |
$223.36
|
| Rate for Payer: Cofinity Commercial |
$181.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$233.75
|
| Rate for Payer: Mclaren Medicaid |
$26.28
|
| 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 |
$27.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.76
|
| Rate for Payer: Nomi Health Commercial |
$73.54
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$220.76
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.44
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health Narrow Network |
$40.35
|
| Rate for Payer: Priority Health SBD |
$163.62
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.03
|
| Rate for Payer: UHC Medicare Advantage |
$49.03
|
| Rate for Payer: UHCCP Medicaid |
$27.60
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS CMPT
|
Facility
|
IP
|
$280.09
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200475
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$176.46 |
| Max. Negotiated Rate |
$252.08 |
| Rate for Payer: Aetna Commercial |
$238.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.06
|
| Rate for Payer: Cash Price |
$224.07
|
| Rate for Payer: Cofinity Commercial |
$196.06
|
| Rate for Payer: Cofinity Commercial |
$240.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.07
|
| Rate for Payer: Healthscope Commercial |
$252.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.08
|
| Rate for Payer: PHP Commercial |
$238.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.06
|
| Rate for Payer: Priority Health SBD |
$176.46
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS CMPT
|
Facility
|
OP
|
$280.09
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200475
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.28 |
| Max. Negotiated Rate |
$252.08 |
| Rate for Payer: Aetna Commercial |
$238.08
|
| Rate for Payer: Aetna Medicare |
$50.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.06
|
| 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 |
$27.59
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$43.40
|
| Rate for Payer: BCN Commercial |
$43.40
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$224.07
|
| Rate for Payer: Cash Price |
$224.07
|
| Rate for Payer: Cofinity Commercial |
$240.88
|
| Rate for Payer: Cofinity Commercial |
$196.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$252.08
|
| Rate for Payer: Mclaren Medicaid |
$26.28
|
| 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 |
$27.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.08
|
| Rate for Payer: Nomi Health Commercial |
$73.54
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$238.08
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.44
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health Narrow Network |
$40.35
|
| Rate for Payer: Priority Health SBD |
$176.46
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.03
|
| Rate for Payer: UHC Medicare Advantage |
$49.03
|
| Rate for Payer: UHCCP Medicaid |
$27.60
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION MITOGEN
|
Facility
|
OP
|
$235.62
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.28 |
| Max. Negotiated Rate |
$212.06 |
| Rate for Payer: Aetna Commercial |
$200.28
|
| Rate for Payer: Aetna Medicare |
$50.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: BCBS Complete |
$27.59
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$43.40
|
| Rate for Payer: BCN Commercial |
$43.40
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cofinity Commercial |
$202.63
|
| Rate for Payer: Cofinity Commercial |
$164.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$212.06
|
| Rate for Payer: Mclaren Medicaid |
$26.28
|
| 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 |
$27.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.28
|
| Rate for Payer: Nomi Health Commercial |
$73.54
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$200.28
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.44
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health Narrow Network |
$40.35
|
| Rate for Payer: Priority Health SBD |
$148.44
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.03
|
| Rate for Payer: UHC Medicare Advantage |
$49.03
|
| Rate for Payer: UHCCP Medicaid |
$27.60
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION MITOGEN
|
Facility
|
IP
|
$235.62
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$148.44 |
| Max. Negotiated Rate |
$212.06 |
| Rate for Payer: Aetna Commercial |
$200.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.15
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cofinity Commercial |
$164.93
|
| Rate for Payer: Cofinity Commercial |
$202.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.50
|
| Rate for Payer: Healthscope Commercial |
$212.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.28
|
| Rate for Payer: PHP Commercial |
$200.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.15
|
| Rate for Payer: Priority Health SBD |
$148.44
|
|
