|
HC ANOSCOPY W/CONTROL BLEEDING
|
Facility
|
IP
|
$1,567.19
|
|
|
Service Code
|
CPT 46614
|
| Hospital Charge Code |
76100276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,018.67 |
| Max. Negotiated Rate |
$1,567.19 |
| Rate for Payer: Aetna Commercial |
$1,410.47
|
| Rate for Payer: ASR ASR |
$1,520.17
|
| Rate for Payer: ASR Commercial |
$1,520.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,277.10
|
| Rate for Payer: BCN Commercial |
$1,215.04
|
| Rate for Payer: Cash Price |
$1,253.75
|
| Rate for Payer: Cofinity Commercial |
$1,473.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,253.75
|
| Rate for Payer: Healthscope Commercial |
$1,567.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,520.17
|
| Rate for Payer: Mclaren Commercial |
$1,410.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,332.11
|
| Rate for Payer: Nomi Health Commercial |
$1,285.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,018.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,379.13
|
|
|
HC ANOSCOPY W/CONTROL BLEEDING
|
Facility
|
OP
|
$1,567.19
|
|
|
Service Code
|
CPT 46614
|
| Hospital Charge Code |
76100276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$1,782.39 |
| Rate for Payer: Aetna Commercial |
$1,410.47
|
| Rate for Payer: Aetna Medicare |
$1,149.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: ASR ASR |
$1,520.17
|
| Rate for Payer: ASR Commercial |
$1,520.17
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,283.37
|
| Rate for Payer: BCN Commercial |
$1,215.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Cash Price |
$1,253.75
|
| Rate for Payer: Cash Price |
$1,253.75
|
| Rate for Payer: Cofinity Commercial |
$1,473.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,253.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Healthscope Commercial |
$1,567.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,520.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,149.93
|
| Rate for Payer: Mclaren Commercial |
$1,410.47
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,332.11
|
| Rate for Payer: Nomi Health Commercial |
$1,285.10
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Commercial |
$1,264.92
|
| Rate for Payer: PHP Medicaid |
$616.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,018.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,373.17
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,098.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,379.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Exchange |
$1,782.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP DNSP |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
HC ANOSCOPY WITH DILATION
|
Facility
|
OP
|
$2,074.35
|
|
|
Service Code
|
CPT 46604
|
| Hospital Charge Code |
76100139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$2,074.35 |
| Rate for Payer: Aetna Commercial |
$1,866.91
|
| Rate for Payer: Aetna Medicare |
$1,149.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: ASR ASR |
$2,012.12
|
| Rate for Payer: ASR Commercial |
$2,012.12
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,698.69
|
| Rate for Payer: BCN Commercial |
$1,608.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Cash Price |
$1,659.48
|
| Rate for Payer: Cash Price |
$1,659.48
|
| Rate for Payer: Cofinity Commercial |
$1,949.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,659.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Healthscope Commercial |
$2,074.35
|
| Rate for Payer: Healthscope Whirlpool |
$2,012.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,149.93
|
| Rate for Payer: Mclaren Commercial |
$1,866.91
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,763.20
|
| Rate for Payer: Nomi Health Commercial |
$1,700.97
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Commercial |
$1,264.92
|
| Rate for Payer: PHP Medicaid |
$616.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,348.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,817.55
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,454.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,825.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Exchange |
$1,782.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP DNSP |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
HC ANOSCOPY WITH DILATION
|
Facility
|
IP
|
$2,074.35
|
|
|
Service Code
|
CPT 46604
|
| Hospital Charge Code |
76100139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,348.33 |
| Max. Negotiated Rate |
$2,074.35 |
| Rate for Payer: Aetna Commercial |
$1,866.91
|
| Rate for Payer: ASR ASR |
$2,012.12
|
| Rate for Payer: ASR Commercial |
$2,012.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,690.39
|
| Rate for Payer: BCN Commercial |
$1,608.24
|
| Rate for Payer: Cash Price |
$1,659.48
|
| Rate for Payer: Cofinity Commercial |
$1,949.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,659.48
|
| Rate for Payer: Healthscope Commercial |
$2,074.35
|
| Rate for Payer: Healthscope Whirlpool |
$2,012.12
|
| Rate for Payer: Mclaren Commercial |
$1,866.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,763.20
|
| Rate for Payer: Nomi Health Commercial |
$1,700.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,348.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,825.43
|
|
|
HC ANTIBODY ABSORPTION
|
Facility
|
IP
|
$117.81
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
39000028
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$76.58 |
| Max. Negotiated Rate |
$117.81 |
| Rate for Payer: Aetna Commercial |
$106.03
|
| Rate for Payer: ASR ASR |
$114.28
|
| Rate for Payer: ASR Commercial |
$114.28
|
| Rate for Payer: BCBS Trust/PPO |
$96.00
|
| Rate for Payer: BCN Commercial |
$91.34
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cofinity Commercial |
$110.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.25
|
| Rate for Payer: Healthscope Commercial |
$117.81
|
| Rate for Payer: Healthscope Whirlpool |
$114.28
|
| Rate for Payer: Mclaren Commercial |
$106.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.14
|
| Rate for Payer: Nomi Health Commercial |
$96.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.67
|
|
|
HC ANTIBODY ABSORPTION
|
Facility
|
OP
|
$117.81
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
39000028
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$117.81 |
| Rate for Payer: Aetna Commercial |
$106.03
|
| Rate for Payer: Aetna Medicare |
$57.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: ASR ASR |
$114.28
|
| Rate for Payer: ASR Commercial |
$114.28
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCBS Trust/PPO |
$96.47
|
| Rate for Payer: BCN Commercial |
$91.34
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cofinity Commercial |
$110.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$117.81
|
| Rate for Payer: Healthscope Whirlpool |
$114.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$57.93
|
| Rate for Payer: Mclaren Commercial |
$106.03
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.14
|
| Rate for Payer: Nomi Health Commercial |
$96.60
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Medicaid |
$31.05
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.23
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health Narrow Network |
$82.58
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$89.79
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP DNSP |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC ANTIBODY COXSACKIE A
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200261
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC ANTIBODY COXSACKIE A
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200261
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$13.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.29
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$7.33
|
| Rate for Payer: BCBS MAPPO |
$13.03
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$13.03
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.03
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.03
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$6.98
|
| Rate for Payer: Mclaren Medicare |
$13.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.68
|
| Rate for Payer: Meridian Medicaid |
$7.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Medicare |
$12.38
|
| Rate for Payer: PACE SWMI |
$13.03
|
| Rate for Payer: PHP Commercial |
$14.33
|
| Rate for Payer: PHP Medicaid |
$6.98
|
| Rate for Payer: PHP Medicare Advantage |
$13.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health Narrow Network |
$14.59
|
| Rate for Payer: Railroad Medicare Medicare |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.03
|
| Rate for Payer: UHC Exchange |
$20.20
|
| Rate for Payer: UHC Medicare Advantage |
$13.03
|
| Rate for Payer: UHCCP DNSP |
$13.03
|
| Rate for Payer: UHCCP Medicaid |
$6.98
|
| Rate for Payer: VA VA |
$13.03
|
|
|
HC ANTIBODY COXSACKIE B
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200260
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$13.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.29
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$7.33
|
| Rate for Payer: BCBS MAPPO |
$13.03
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$13.03
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.03
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.03
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$6.98
|
| Rate for Payer: Mclaren Medicare |
$13.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.68
|
| Rate for Payer: Meridian Medicaid |
$7.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Medicare |
$12.38
|
| Rate for Payer: PACE SWMI |
$13.03
|
| Rate for Payer: PHP Commercial |
$14.33
|
| Rate for Payer: PHP Medicaid |
$6.98
|
| Rate for Payer: PHP Medicare Advantage |
$13.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health Narrow Network |
$14.59
|
| Rate for Payer: Railroad Medicare Medicare |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.03
|
| Rate for Payer: UHC Exchange |
$20.20
|
| Rate for Payer: UHC Medicare Advantage |
$13.03
|
| Rate for Payer: UHCCP DNSP |
$13.03
|
| Rate for Payer: UHCCP Medicaid |
$6.98
|
| Rate for Payer: VA VA |
$13.03
|
|
|
HC ANTIBODY COXSACKIE B
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200260
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC ANTIBODY ECHOVIRUS
|
Facility
|
IP
|
$22.89
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200262
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$22.89 |
| Rate for Payer: Aetna Commercial |
$20.60
|
| Rate for Payer: ASR ASR |
$22.20
|
| Rate for Payer: ASR Commercial |
$22.20
|
| Rate for Payer: BCBS Trust/PPO |
$18.65
|
| Rate for Payer: BCN Commercial |
$17.75
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$21.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$22.89
|
| Rate for Payer: Healthscope Whirlpool |
$22.20
|
| Rate for Payer: Mclaren Commercial |
$20.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Nomi Health Commercial |
$18.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.14
|
|
|
HC ANTIBODY ECHOVIRUS
|
Facility
|
OP
|
$22.89
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200262
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$22.89 |
| Rate for Payer: Aetna Commercial |
$20.60
|
| Rate for Payer: Aetna Medicare |
$13.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.29
|
| Rate for Payer: ASR ASR |
$22.20
|
| Rate for Payer: ASR Commercial |
$22.20
|
| Rate for Payer: BCBS Complete |
$7.33
|
| Rate for Payer: BCBS MAPPO |
$13.03
|
| Rate for Payer: BCBS Trust/PPO |
$18.74
|
| Rate for Payer: BCN Commercial |
$17.75
|
| Rate for Payer: BCN Medicare Advantage |
$13.03
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$21.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.03
|
| Rate for Payer: Healthscope Commercial |
$22.89
|
| Rate for Payer: Healthscope Whirlpool |
$22.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.03
|
| Rate for Payer: Mclaren Commercial |
$20.60
|
| Rate for Payer: Mclaren Medicaid |
$6.98
|
| Rate for Payer: Mclaren Medicare |
$13.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.68
|
| Rate for Payer: Meridian Medicaid |
$7.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Nomi Health Commercial |
$18.77
|
| Rate for Payer: PACE Medicare |
$12.38
|
| Rate for Payer: PACE SWMI |
$13.03
|
| Rate for Payer: PHP Commercial |
$14.33
|
| Rate for Payer: PHP Medicaid |
$6.98
|
| Rate for Payer: PHP Medicare Advantage |
$13.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.06
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health Narrow Network |
$16.05
|
| Rate for Payer: Railroad Medicare Medicare |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.03
|
| Rate for Payer: UHC Exchange |
$20.20
|
| Rate for Payer: UHC Medicare Advantage |
$13.03
|
| Rate for Payer: UHCCP DNSP |
$13.03
|
| Rate for Payer: UHCCP Medicaid |
$6.98
|
| Rate for Payer: VA VA |
$13.03
|
|
|
HC ANTIBODY ECHOVIRUS CMPT
|
Facility
|
IP
|
$22.89
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200263
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$22.89 |
| Rate for Payer: Aetna Commercial |
$20.60
|
| Rate for Payer: ASR ASR |
$22.20
|
| Rate for Payer: ASR Commercial |
$22.20
|
| Rate for Payer: BCBS Trust/PPO |
$18.65
|
| Rate for Payer: BCN Commercial |
$17.75
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$21.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$22.89
|
| Rate for Payer: Healthscope Whirlpool |
$22.20
|
| Rate for Payer: Mclaren Commercial |
$20.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Nomi Health Commercial |
$18.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.14
|
|
|
HC ANTIBODY ECHOVIRUS CMPT
|
Facility
|
OP
|
$22.89
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200263
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$22.89 |
| Rate for Payer: Aetna Commercial |
$20.60
|
| Rate for Payer: Aetna Medicare |
$13.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.29
|
| Rate for Payer: ASR ASR |
$22.20
|
| Rate for Payer: ASR Commercial |
$22.20
|
| Rate for Payer: BCBS Complete |
$7.33
|
| Rate for Payer: BCBS MAPPO |
$13.03
|
| Rate for Payer: BCBS Trust/PPO |
$18.74
|
| Rate for Payer: BCN Commercial |
$17.75
|
| Rate for Payer: BCN Medicare Advantage |
$13.03
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$21.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.03
|
| Rate for Payer: Healthscope Commercial |
$22.89
|
| Rate for Payer: Healthscope Whirlpool |
$22.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.03
|
| Rate for Payer: Mclaren Commercial |
$20.60
|
| Rate for Payer: Mclaren Medicaid |
$6.98
|
| Rate for Payer: Mclaren Medicare |
$13.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.68
|
| Rate for Payer: Meridian Medicaid |
$7.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Nomi Health Commercial |
$18.77
|
| Rate for Payer: PACE Medicare |
$12.38
|
| Rate for Payer: PACE SWMI |
$13.03
|
| Rate for Payer: PHP Commercial |
$14.33
|
| Rate for Payer: PHP Medicaid |
$6.98
|
| Rate for Payer: PHP Medicare Advantage |
$13.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.06
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health Narrow Network |
$16.05
|
| Rate for Payer: Railroad Medicare Medicare |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.03
|
| Rate for Payer: UHC Exchange |
$20.20
|
| Rate for Payer: UHC Medicare Advantage |
$13.03
|
| Rate for Payer: UHCCP DNSP |
$13.03
|
| Rate for Payer: UHCCP Medicaid |
$6.98
|
| Rate for Payer: VA VA |
$13.03
|
|
|
HC ANTIBODY ELUTION
|
Facility
|
OP
|
$299.78
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
30200341
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$89.58 |
| Max. Negotiated Rate |
$299.78 |
| Rate for Payer: Aetna Commercial |
$269.80
|
| Rate for Payer: Aetna Medicare |
$167.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$208.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$208.90
|
| Rate for Payer: ASR ASR |
$290.79
|
| Rate for Payer: ASR Commercial |
$290.79
|
| Rate for Payer: BCBS Complete |
$94.06
|
| Rate for Payer: BCBS MAPPO |
$167.12
|
| Rate for Payer: BCBS Trust/PPO |
$245.49
|
| Rate for Payer: BCN Commercial |
$232.42
|
| Rate for Payer: BCN Medicare Advantage |
$167.12
|
| Rate for Payer: Cash Price |
$239.82
|
| Rate for Payer: Cash Price |
$239.82
|
| Rate for Payer: Cofinity Commercial |
$281.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.12
|
| Rate for Payer: Healthscope Commercial |
$299.78
|
| Rate for Payer: Healthscope Whirlpool |
$290.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$167.12
|
| Rate for Payer: Mclaren Commercial |
$269.80
|
| Rate for Payer: Mclaren Medicaid |
$89.58
|
| Rate for Payer: Mclaren Medicare |
$167.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.48
|
| Rate for Payer: Meridian Medicaid |
$94.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.81
|
| Rate for Payer: Nomi Health Commercial |
$245.82
|
| Rate for Payer: PACE Medicare |
$158.76
|
| Rate for Payer: PACE SWMI |
$167.12
|
| Rate for Payer: PHP Commercial |
$183.83
|
| Rate for Payer: PHP Medicaid |
$89.58
|
| Rate for Payer: PHP Medicare Advantage |
$167.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$262.67
|
| Rate for Payer: Priority Health Medicare |
$167.12
|
| Rate for Payer: Priority Health Narrow Network |
$210.15
|
| Rate for Payer: Railroad Medicare Medicare |
$167.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$263.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.12
|
| Rate for Payer: UHC Exchange |
$259.04
|
| Rate for Payer: UHC Medicare Advantage |
$167.12
|
| Rate for Payer: UHCCP DNSP |
$167.12
|
| Rate for Payer: UHCCP Medicaid |
$89.58
|
| Rate for Payer: VA VA |
$167.12
|
|
|
HC ANTIBODY ELUTION
|
Facility
|
IP
|
$299.78
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
30200341
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$194.86 |
| Max. Negotiated Rate |
$299.78 |
| Rate for Payer: Aetna Commercial |
$269.80
|
| Rate for Payer: ASR ASR |
$290.79
|
| Rate for Payer: ASR Commercial |
$290.79
|
| Rate for Payer: BCBS Trust/PPO |
$244.29
|
| Rate for Payer: BCN Commercial |
$232.42
|
| Rate for Payer: Cash Price |
$239.82
|
| Rate for Payer: Cofinity Commercial |
$281.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.82
|
| Rate for Payer: Healthscope Commercial |
$299.78
|
| Rate for Payer: Healthscope Whirlpool |
$290.79
|
| Rate for Payer: Mclaren Commercial |
$269.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.81
|
| Rate for Payer: Nomi Health Commercial |
$245.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$263.81
|
|
|
HC ANTIBODY IDENTIFICATION
|
Facility
|
IP
|
$213.28
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
30200342
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$138.63 |
| Max. Negotiated Rate |
$213.28 |
| Rate for Payer: Aetna Commercial |
$191.95
|
| Rate for Payer: ASR ASR |
$206.88
|
| Rate for Payer: ASR Commercial |
$206.88
|
| Rate for Payer: BCBS Trust/PPO |
$173.80
|
| Rate for Payer: BCN Commercial |
$165.36
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cofinity Commercial |
$200.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.62
|
| Rate for Payer: Healthscope Commercial |
$213.28
|
| Rate for Payer: Healthscope Whirlpool |
$206.88
|
| Rate for Payer: Mclaren Commercial |
$191.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.29
|
| Rate for Payer: Nomi Health Commercial |
$174.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.69
|
|
|
HC ANTIBODY IDENTIFICATION
|
Facility
|
OP
|
$213.28
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
30200342
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$138.63 |
| Max. Negotiated Rate |
$543.79 |
| Rate for Payer: Aetna Commercial |
$191.95
|
| Rate for Payer: Aetna Medicare |
$350.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$438.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$438.54
|
| Rate for Payer: ASR ASR |
$206.88
|
| Rate for Payer: ASR Commercial |
$206.88
|
| Rate for Payer: BCBS Complete |
$197.45
|
| Rate for Payer: BCBS MAPPO |
$350.83
|
| Rate for Payer: BCBS Trust/PPO |
$174.65
|
| Rate for Payer: BCN Commercial |
$165.36
|
| Rate for Payer: BCN Medicare Advantage |
$350.83
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cofinity Commercial |
$200.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.83
|
| Rate for Payer: Healthscope Commercial |
$213.28
|
| Rate for Payer: Healthscope Whirlpool |
$206.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$350.83
|
| Rate for Payer: Mclaren Commercial |
$191.95
|
| Rate for Payer: Mclaren Medicaid |
$188.04
|
| Rate for Payer: Mclaren Medicare |
$350.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$368.37
|
| Rate for Payer: Meridian Medicaid |
$197.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$403.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.29
|
| Rate for Payer: Nomi Health Commercial |
$174.89
|
| Rate for Payer: PACE Medicare |
$333.29
|
| Rate for Payer: PACE SWMI |
$350.83
|
| Rate for Payer: PHP Commercial |
$385.91
|
| Rate for Payer: PHP Medicaid |
$188.04
|
| Rate for Payer: PHP Medicare Advantage |
$350.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.88
|
| Rate for Payer: Priority Health Medicare |
$350.83
|
| Rate for Payer: Priority Health Narrow Network |
$149.51
|
| Rate for Payer: Railroad Medicare Medicare |
$350.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$350.83
|
| Rate for Payer: UHC Exchange |
$543.79
|
| Rate for Payer: UHC Medicare Advantage |
$350.83
|
| Rate for Payer: UHCCP DNSP |
$350.83
|
| Rate for Payer: UHCCP Medicaid |
$188.04
|
| Rate for Payer: VA VA |
$350.83
|
|
|
HC ANTIBODY ID: LEUKOCYTE ANTIBODY
|
Facility
|
OP
|
$93.84
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
30200127
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$84.46
|
| Rate for Payer: Aetna Medicare |
$15.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: ASR ASR |
$91.02
|
| Rate for Payer: ASR Commercial |
$91.02
|
| Rate for Payer: BCBS Complete |
$8.47
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCBS Trust/PPO |
$76.85
|
| Rate for Payer: BCN Commercial |
$72.75
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cofinity Commercial |
$88.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$93.84
|
| Rate for Payer: Healthscope Whirlpool |
$91.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$84.46
|
| Rate for Payer: Mclaren Medicaid |
$8.07
|
| Rate for Payer: Mclaren Medicare |
$15.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: Meridian Medicaid |
$8.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.76
|
| Rate for Payer: Nomi Health Commercial |
$76.95
|
| Rate for Payer: PACE Medicare |
$14.30
|
| Rate for Payer: PACE SWMI |
$15.05
|
| Rate for Payer: PHP Commercial |
$16.55
|
| Rate for Payer: PHP Medicaid |
$8.07
|
| Rate for Payer: PHP Medicare Advantage |
$15.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.22
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health Narrow Network |
$65.78
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.05
|
| Rate for Payer: UHC Exchange |
$23.33
|
| Rate for Payer: UHC Medicare Advantage |
$15.05
|
| Rate for Payer: UHCCP DNSP |
$15.05
|
| Rate for Payer: UHCCP Medicaid |
$8.07
|
| Rate for Payer: VA VA |
$15.05
|
|
|
HC ANTIBODY ID: LEUKOCYTE ANTIBODY
|
Facility
|
IP
|
$93.84
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
30200127
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$84.46
|
| Rate for Payer: ASR ASR |
$91.02
|
| Rate for Payer: ASR Commercial |
$91.02
|
| Rate for Payer: BCBS Trust/PPO |
$76.47
|
| Rate for Payer: BCN Commercial |
$72.75
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cofinity Commercial |
$88.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.07
|
| Rate for Payer: Healthscope Commercial |
$93.84
|
| Rate for Payer: Healthscope Whirlpool |
$91.02
|
| Rate for Payer: Mclaren Commercial |
$84.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.76
|
| Rate for Payer: Nomi Health Commercial |
$76.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.58
|
|
|
HC ANTIBODY LYME DISEASE
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200234
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$42.14
|
| Rate for Payer: ASR ASR |
$45.42
|
| Rate for Payer: ASR Commercial |
$45.42
|
| Rate for Payer: BCBS Trust/PPO |
$38.15
|
| Rate for Payer: BCN Commercial |
$36.30
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$44.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Healthscope Whirlpool |
$45.42
|
| Rate for Payer: Mclaren Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.20
|
|
|
HC ANTIBODY LYME DISEASE
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200234
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$42.14
|
| Rate for Payer: Aetna Medicare |
$17.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.29
|
| Rate for Payer: ASR ASR |
$45.42
|
| Rate for Payer: ASR Commercial |
$45.42
|
| Rate for Payer: BCBS Complete |
$9.58
|
| Rate for Payer: BCBS MAPPO |
$17.03
|
| Rate for Payer: BCBS Trust/PPO |
$38.34
|
| Rate for Payer: BCN Commercial |
$36.30
|
| 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 |
$44.01
|
| 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 |
$46.82
|
| Rate for Payer: Healthscope Whirlpool |
$45.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.03
|
| Rate for Payer: Mclaren 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 |
$38.39
|
| Rate for Payer: PACE Medicare |
$16.18
|
| Rate for Payer: PACE SWMI |
$17.03
|
| Rate for Payer: PHP Commercial |
$18.73
|
| Rate for Payer: PHP Medicaid |
$9.13
|
| 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 |
$41.02
|
| Rate for Payer: Priority Health Medicare |
$17.03
|
| Rate for Payer: Priority Health Narrow Network |
$32.82
|
| Rate for Payer: Railroad Medicare Medicare |
$17.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.03
|
| Rate for Payer: UHC Exchange |
$26.40
|
| Rate for Payer: UHC Medicare Advantage |
$17.03
|
| Rate for Payer: UHCCP DNSP |
$17.03
|
| Rate for Payer: UHCCP Medicaid |
$9.13
|
| Rate for Payer: VA VA |
$17.03
|
|
|
HC ANTIBODY LYME DISEASE CONFIRMATION
|
Facility
|
OP
|
$34.33
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
30200233
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$34.33 |
| Rate for Payer: Aetna Commercial |
$30.90
|
| Rate for Payer: Aetna Medicare |
$15.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.36
|
| Rate for Payer: ASR ASR |
$33.30
|
| Rate for Payer: ASR Commercial |
$33.30
|
| Rate for Payer: BCBS Complete |
$8.72
|
| Rate for Payer: BCBS MAPPO |
$15.49
|
| Rate for Payer: BCBS Trust/PPO |
$28.11
|
| Rate for Payer: BCN Commercial |
$26.62
|
| 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 |
$32.27
|
| 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 |
$34.33
|
| Rate for Payer: Healthscope Whirlpool |
$33.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.49
|
| Rate for Payer: Mclaren 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 |
$28.15
|
| Rate for Payer: PACE Medicare |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.49
|
| Rate for Payer: PHP Commercial |
$17.04
|
| Rate for Payer: PHP Medicaid |
$8.30
|
| 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 |
$30.08
|
| Rate for Payer: Priority Health Medicare |
$15.49
|
| Rate for Payer: Priority Health Narrow Network |
$24.07
|
| Rate for Payer: Railroad Medicare Medicare |
$15.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.49
|
| Rate for Payer: UHC Exchange |
$24.01
|
| Rate for Payer: UHC Medicare Advantage |
$15.49
|
| Rate for Payer: UHCCP DNSP |
$15.49
|
| Rate for Payer: UHCCP Medicaid |
$8.30
|
| Rate for Payer: VA VA |
$15.49
|
|
|
HC ANTIBODY LYME DISEASE CONFIRMATION
|
Facility
|
IP
|
$34.33
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
30200233
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.31 |
| Max. Negotiated Rate |
$34.33 |
| Rate for Payer: Aetna Commercial |
$30.90
|
| Rate for Payer: ASR ASR |
$33.30
|
| Rate for Payer: ASR Commercial |
$33.30
|
| Rate for Payer: BCBS Trust/PPO |
$27.98
|
| Rate for Payer: BCN Commercial |
$26.62
|
| Rate for Payer: Cash Price |
$27.46
|
| Rate for Payer: Cofinity Commercial |
$32.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.46
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Healthscope Whirlpool |
$33.30
|
| Rate for Payer: Mclaren Commercial |
$30.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.18
|
| Rate for Payer: Nomi Health Commercial |
$28.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.21
|
|
|
HC ANTIBODY LYME DISEASE CSF
|
Facility
|
OP
|
$66.59
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200235
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$66.59 |
| Rate for Payer: Aetna Commercial |
$59.93
|
| Rate for Payer: Aetna Medicare |
$17.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.29
|
| Rate for Payer: ASR ASR |
$64.59
|
| Rate for Payer: ASR Commercial |
$64.59
|
| Rate for Payer: BCBS Complete |
$9.58
|
| Rate for Payer: BCBS MAPPO |
$17.03
|
| Rate for Payer: BCBS Trust/PPO |
$54.53
|
| Rate for Payer: BCN Commercial |
$51.63
|
| Rate for Payer: BCN Medicare Advantage |
$17.03
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$62.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.03
|
| Rate for Payer: Healthscope Commercial |
$66.59
|
| Rate for Payer: Healthscope Whirlpool |
$64.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.03
|
| Rate for Payer: Mclaren Commercial |
$59.93
|
| 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 |
$56.60
|
| Rate for Payer: Nomi Health Commercial |
$54.60
|
| Rate for Payer: PACE Medicare |
$16.18
|
| Rate for Payer: PACE SWMI |
$17.03
|
| Rate for Payer: PHP Commercial |
$18.73
|
| Rate for Payer: PHP Medicaid |
$9.13
|
| 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 |
$43.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.35
|
| Rate for Payer: Priority Health Medicare |
$17.03
|
| Rate for Payer: Priority Health Narrow Network |
$46.68
|
| Rate for Payer: Railroad Medicare Medicare |
$17.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.03
|
| Rate for Payer: UHC Exchange |
$26.40
|
| Rate for Payer: UHC Medicare Advantage |
$17.03
|
| Rate for Payer: UHCCP DNSP |
$17.03
|
| Rate for Payer: UHCCP Medicaid |
$9.13
|
| Rate for Payer: VA VA |
$17.03
|
|
