|
HC RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY
|
Facility
|
IP
|
$15,687.60
|
|
|
Service Code
|
CPT 35266
|
| Hospital Charge Code |
36000124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,883.19 |
| Max. Negotiated Rate |
$14,118.84 |
| Rate for Payer: Aetna Commercial |
$13,334.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,196.94
|
| Rate for Payer: Cash Price |
$12,550.08
|
| Rate for Payer: Cofinity Advantage |
$10,981.32
|
| Rate for Payer: Cofinity Commercial |
$13,491.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,550.08
|
| Rate for Payer: Healthscope Commercial |
$14,118.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,334.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,765.70
|
| Rate for Payer: PHP Commercial |
$13,334.46
|
| Rate for Payer: Priority Health SBD |
$9,883.19
|
|
|
HC RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200213
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: BCBS Complete |
$2.35
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$4.55
|
| Rate for Payer: BCN Commercial |
$4.55
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$2.23
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Medicaid |
$4.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$12.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.27
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.42
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.41
|
| Rate for Payer: UHC Core |
$6.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.27
|
| Rate for Payer: UHC Exchange |
$6.41
|
| Rate for Payer: UHC Medicaid |
$2.23
|
| Rate for Payer: UHCCP Medicaid |
$2.23
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200213
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC RPR TITER
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200425
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC RPR TITER
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200425
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$4.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.50
|
| Rate for Payer: BCBS Complete |
$2.42
|
| Rate for Payer: BCBS MAPPO |
$4.40
|
| Rate for Payer: BCBS Trust/PPO |
$4.69
|
| Rate for Payer: BCN Commercial |
$4.69
|
| Rate for Payer: BCN Medicare Advantage |
$4.40
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.40
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$2.30
|
| Rate for Payer: Mclaren Medicare |
$4.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.62
|
| Rate for Payer: Meridian Medicaid |
$4.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$13.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$4.18
|
| Rate for Payer: PACE SWMI |
$4.40
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: PHP Medicare Advantage |
$4.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.40
|
| Rate for Payer: Priority Health Medicare |
$4.40
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.60
|
| Rate for Payer: UHC Core |
$6.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.40
|
| Rate for Payer: UHC Exchange |
$6.60
|
| Rate for Payer: UHC Medicaid |
$2.30
|
| Rate for Payer: UHCCP Medicaid |
$2.30
|
| Rate for Payer: VA VA |
$4.40
|
|
|
HC RSV DNA/RNA AMP PROBE
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
30600315
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.71 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna Medicare |
$73.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.75
|
| Rate for Payer: BCBS Complete |
$38.55
|
| Rate for Payer: BCBS MAPPO |
$70.20
|
| Rate for Payer: BCBS Trust/PPO |
$74.85
|
| Rate for Payer: BCN Commercial |
$74.85
|
| Rate for Payer: BCN Medicare Advantage |
$70.20
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Mclaren Medicaid |
$36.71
|
| Rate for Payer: Mclaren Medicare |
$70.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.71
|
| Rate for Payer: Meridian Medicaid |
$73.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$105.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Medicare |
$66.69
|
| Rate for Payer: PACE SWMI |
$70.20
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: PHP Medicare Advantage |
$70.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$70.20
|
| Rate for Payer: Priority Health Medicare |
$70.20
|
| Rate for Payer: Priority Health SBD |
$50.14
|
| Rate for Payer: Priority Health Tiered Network |
$56.16
|
| Rate for Payer: Railroad Medicare Medicare |
$70.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.30
|
| Rate for Payer: UHC Core |
$105.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.20
|
| Rate for Payer: UHC Exchange |
$105.30
|
| Rate for Payer: UHC Medicaid |
$36.71
|
| Rate for Payer: UHCCP Medicaid |
$36.71
|
| Rate for Payer: VA VA |
$70.20
|
|
|
HC RSV DNA/RNA AMP PROBE
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
30600315
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: Priority Health SBD |
$50.14
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 0.5ML IM
|
Facility
|
IP
|
$1,328.59
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
63600232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$837.01 |
| Max. Negotiated Rate |
$1,195.73 |
| Rate for Payer: Aetna Commercial |
$1,129.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$863.58
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cofinity Advantage |
$930.01
|
| Rate for Payer: Cofinity Commercial |
$1,142.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,062.87
|
| Rate for Payer: Healthscope Commercial |
$1,195.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$996.44
|
| Rate for Payer: PHP Commercial |
$1,129.30
|
| Rate for Payer: Priority Health SBD |
$837.01
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 0.5ML IM
|
Facility
|
OP
|
$1,328.59
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
63600232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$507.19 |
| Max. Negotiated Rate |
$1,465.28 |
| Rate for Payer: Aetna Commercial |
$1,129.30
|
| Rate for Payer: Aetna Medicare |
$664.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$863.58
|
| Rate for Payer: BCBS Complete |
$531.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,465.28
|
| Rate for Payer: BCN Commercial |
$1,465.28
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cofinity Advantage |
$930.01
|
| Rate for Payer: Cofinity Commercial |
$1,142.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,062.87
|
| Rate for Payer: Healthscope Commercial |
$1,195.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,062.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$996.44
|
| Rate for Payer: PHP Commercial |
$1,129.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$633.99
|
| Rate for Payer: Priority Health SBD |
$837.01
|
| Rate for Payer: Priority Health Tiered Network |
$507.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,178.22
|
| Rate for Payer: UHC Core |
$1,178.22
|
| Rate for Payer: UHC Exchange |
$1,178.22
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 1 ML IM
|
Facility
|
OP
|
$1,328.59
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
63600233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$507.19 |
| Max. Negotiated Rate |
$1,465.28 |
| Rate for Payer: Aetna Commercial |
$1,129.30
|
| Rate for Payer: Aetna Medicare |
$664.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$863.58
|
| Rate for Payer: BCBS Complete |
$531.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,465.28
|
| Rate for Payer: BCN Commercial |
$1,465.28
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cofinity Advantage |
$930.01
|
| Rate for Payer: Cofinity Commercial |
$1,142.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,062.87
|
| Rate for Payer: Healthscope Commercial |
$1,195.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,062.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$996.44
|
| Rate for Payer: PHP Commercial |
$1,129.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$633.99
|
| Rate for Payer: Priority Health SBD |
$837.01
|
| Rate for Payer: Priority Health Tiered Network |
$507.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,178.22
|
| Rate for Payer: UHC Core |
$1,178.22
|
| Rate for Payer: UHC Exchange |
$1,178.22
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 1 ML IM
|
Facility
|
IP
|
$1,328.59
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
63600233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$837.01 |
| Max. Negotiated Rate |
$1,195.73 |
| Rate for Payer: Aetna Commercial |
$1,129.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$863.58
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cofinity Advantage |
$930.01
|
| Rate for Payer: Cofinity Commercial |
$1,142.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,062.87
|
| Rate for Payer: Healthscope Commercial |
$1,195.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$996.44
|
| Rate for Payer: PHP Commercial |
$1,129.30
|
| Rate for Payer: Priority Health SBD |
$837.01
|
|
|
HC RT ANGLE BALL COR CANN
|
Facility
|
OP
|
$72.10
|
|
| Hospital Charge Code |
27000268
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$64.89 |
| Rate for Payer: Aetna Commercial |
$61.28
|
| Rate for Payer: Aetna Medicare |
$36.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.87
|
| Rate for Payer: BCBS Complete |
$28.84
|
| Rate for Payer: Cash Price |
$57.68
|
| Rate for Payer: Cofinity Advantage |
$50.47
|
| Rate for Payer: Cofinity Commercial |
$62.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.68
|
| Rate for Payer: Healthscope Commercial |
$64.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.08
|
| Rate for Payer: PHP Commercial |
$61.28
|
| Rate for Payer: Priority Health SBD |
$45.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.87
|
| Rate for Payer: UHC Core |
$37.56
|
| Rate for Payer: UHC Exchange |
$28.34
|
|
|
HC RT ANGLE BALL COR CANN
|
Facility
|
IP
|
$72.10
|
|
| Hospital Charge Code |
27000268
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.42 |
| Max. Negotiated Rate |
$64.89 |
| Rate for Payer: Aetna Commercial |
$61.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.87
|
| Rate for Payer: Cash Price |
$57.68
|
| Rate for Payer: Cofinity Advantage |
$50.47
|
| Rate for Payer: Cofinity Commercial |
$62.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.68
|
| Rate for Payer: Healthscope Commercial |
$64.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.08
|
| Rate for Payer: PHP Commercial |
$61.28
|
| Rate for Payer: Priority Health SBD |
$45.42
|
|
|
HC RUBELLA ANTIBODY IGC
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.74 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: Priority Health SBD |
$26.74
|
|
|
HC RUBELLA ANTIBODY IGC
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$15.34
|
| Rate for Payer: BCN Commercial |
$15.34
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Mclaren Medicaid |
$7.53
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: Meridian Medicaid |
$15.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$21.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.39
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health SBD |
$26.74
|
| Rate for Payer: Priority Health Tiered Network |
$11.51
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.59
|
| Rate for Payer: UHC Core |
$21.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.39
|
| Rate for Payer: UHC Exchange |
$21.59
|
| Rate for Payer: UHC Medicaid |
$7.53
|
| Rate for Payer: UHCCP Medicaid |
$7.53
|
| Rate for Payer: VA VA |
$14.39
|
|
|
HC RUBELLA ANTIBODY IGM
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.74 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: Priority Health SBD |
$26.74
|
|
|
HC RUBELLA ANTIBODY IGM
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$15.34
|
| Rate for Payer: BCN Commercial |
$15.34
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Mclaren Medicaid |
$7.53
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: Meridian Medicaid |
$15.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$21.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.39
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health SBD |
$26.74
|
| Rate for Payer: Priority Health Tiered Network |
$11.51
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.59
|
| Rate for Payer: UHC Core |
$21.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.39
|
| Rate for Payer: UHC Exchange |
$21.59
|
| Rate for Payer: UHC Medicaid |
$7.53
|
| Rate for Payer: UHCCP Medicaid |
$7.53
|
| Rate for Payer: VA VA |
$14.39
|
|
|
HC RUBEOLA VIRUS IGG
|
Facility
|
IP
|
$89.58
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
30200318
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.44 |
| Max. Negotiated Rate |
$80.62 |
| Rate for Payer: Aetna Commercial |
$76.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.23
|
| Rate for Payer: Cash Price |
$71.66
|
| Rate for Payer: Cofinity Advantage |
$62.71
|
| Rate for Payer: Cofinity Commercial |
$77.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.66
|
| Rate for Payer: Healthscope Commercial |
$80.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.19
|
| Rate for Payer: PHP Commercial |
$76.14
|
| Rate for Payer: Priority Health SBD |
$56.44
|
|
|
HC RUBEOLA VIRUS IGG
|
Facility
|
OP
|
$89.58
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
30200318
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$80.62 |
| Rate for Payer: Aetna Commercial |
$76.14
|
| Rate for Payer: Aetna Medicare |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$13.73
|
| Rate for Payer: BCN Commercial |
$13.73
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$71.66
|
| Rate for Payer: Cash Price |
$71.66
|
| Rate for Payer: Cofinity Advantage |
$62.71
|
| Rate for Payer: Cofinity Commercial |
$77.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$80.62
|
| Rate for Payer: Mclaren Medicaid |
$6.74
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$13.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.14
|
| Rate for Payer: Nomi Health Commercial |
$19.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.19
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$76.14
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.88
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health SBD |
$56.44
|
| Rate for Payer: Priority Health Tiered Network |
$10.30
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.32
|
| Rate for Payer: UHC Core |
$19.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.88
|
| Rate for Payer: UHC Exchange |
$19.32
|
| Rate for Payer: UHC Medicaid |
$6.74
|
| Rate for Payer: UHCCP Medicaid |
$6.74
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC RUBIDIUM PER STUDY DOSE
|
Facility
|
IP
|
$2,091.00
|
|
|
Service Code
|
HCPCS A9555
|
| Hospital Charge Code |
34300039
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,317.33 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Aetna Commercial |
$1,777.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,359.15
|
| Rate for Payer: Cash Price |
$1,672.80
|
| Rate for Payer: Cofinity Advantage |
$1,463.70
|
| Rate for Payer: Cofinity Commercial |
$1,798.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,672.80
|
| Rate for Payer: Healthscope Commercial |
$1,881.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,777.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,568.25
|
| Rate for Payer: PHP Commercial |
$1,777.35
|
| Rate for Payer: Priority Health SBD |
$1,317.33
|
|
|
HC RUBIDIUM PER STUDY DOSE
|
Facility
|
OP
|
$2,091.00
|
|
|
Service Code
|
HCPCS A9555
|
| Hospital Charge Code |
34300039
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$710.80 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Aetna Commercial |
$1,777.35
|
| Rate for Payer: Aetna Medicare |
$1,045.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,359.15
|
| Rate for Payer: BCBS Complete |
$836.40
|
| Rate for Payer: BCBS Trust/PPO |
$710.80
|
| Rate for Payer: BCN Commercial |
$710.80
|
| Rate for Payer: Cash Price |
$1,672.80
|
| Rate for Payer: Cash Price |
$1,672.80
|
| Rate for Payer: Cofinity Advantage |
$1,463.70
|
| Rate for Payer: Cofinity Commercial |
$1,798.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,672.80
|
| Rate for Payer: Healthscope Commercial |
$1,881.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,672.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,777.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,568.25
|
| Rate for Payer: PHP Commercial |
$1,777.35
|
| Rate for Payer: Priority Health SBD |
$1,317.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$882.88
|
| Rate for Payer: UHC Core |
$882.88
|
| Rate for Payer: UHC Exchange |
$882.88
|
|
|
HC RUSSELL VIPER VENOM TIME DILUTED
|
Facility
|
IP
|
$62.84
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
30500059
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$39.59 |
| Max. Negotiated Rate |
$56.56 |
| Rate for Payer: Aetna Commercial |
$53.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.85
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cofinity Advantage |
$43.99
|
| Rate for Payer: Cofinity Commercial |
$54.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.27
|
| Rate for Payer: Healthscope Commercial |
$56.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.13
|
| Rate for Payer: PHP Commercial |
$53.41
|
| Rate for Payer: Priority Health SBD |
$39.59
|
|
|
HC RUSSELL VIPER VENOM TIME DILUTED
|
Facility
|
OP
|
$62.84
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
30500059
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$56.56 |
| Rate for Payer: Aetna Commercial |
$53.41
|
| Rate for Payer: Aetna Medicare |
$9.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.97
|
| Rate for Payer: BCBS Complete |
$5.26
|
| Rate for Payer: BCBS MAPPO |
$9.58
|
| Rate for Payer: BCBS Trust/PPO |
$10.22
|
| Rate for Payer: BCN Commercial |
$10.22
|
| Rate for Payer: BCN Medicare Advantage |
$9.58
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cofinity Advantage |
$43.99
|
| Rate for Payer: Cofinity Commercial |
$54.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.58
|
| Rate for Payer: Healthscope Commercial |
$56.56
|
| Rate for Payer: Mclaren Medicaid |
$5.01
|
| Rate for Payer: Mclaren Medicare |
$9.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.06
|
| Rate for Payer: Meridian Medicaid |
$10.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.41
|
| Rate for Payer: Nomi Health Commercial |
$14.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.13
|
| Rate for Payer: PACE Medicare |
$9.10
|
| Rate for Payer: PACE SWMI |
$9.58
|
| Rate for Payer: PHP Commercial |
$53.41
|
| Rate for Payer: PHP Medicare Advantage |
$9.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.58
|
| Rate for Payer: Priority Health Medicare |
$9.58
|
| Rate for Payer: Priority Health SBD |
$39.59
|
| Rate for Payer: Priority Health Tiered Network |
$7.66
|
| Rate for Payer: Railroad Medicare Medicare |
$9.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.37
|
| Rate for Payer: UHC Core |
$14.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.58
|
| Rate for Payer: UHC Exchange |
$14.37
|
| Rate for Payer: UHC Medicaid |
$5.01
|
| Rate for Payer: UHCCP Medicaid |
$5.01
|
| Rate for Payer: VA VA |
$9.58
|
|
|
HC RUSSIAN THISTLE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200100
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC RUSSIAN THISTLE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200100
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
