|
HC HEPATITIS A ANTIBODY IGM
|
Facility
|
OP
|
$128.20
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
30200299
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$128.20 |
| Rate for Payer: Aetna Commercial |
$115.38
|
| Rate for Payer: Aetna Medicare |
$11.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.08
|
| Rate for Payer: ASR ASR |
$124.35
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: BCBS MAPPO |
$11.26
|
| Rate for Payer: BCBS Trust/PPO |
$99.39
|
| Rate for Payer: BCN Commercial |
$99.39
|
| Rate for Payer: BCN Medicare Advantage |
$11.26
|
| Rate for Payer: Cash Price |
$102.56
|
| Rate for Payer: Cash Price |
$102.56
|
| Rate for Payer: Cofinity Commercial |
$120.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$128.20
|
| Rate for Payer: Healthscope Whirlpool |
$124.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.26
|
| Rate for Payer: Mclaren Commercial |
$115.38
|
| Rate for Payer: Mclaren Medicaid |
$6.16
|
| Rate for Payer: Mclaren Medicare |
$11.26
|
| Rate for Payer: Meridian Medicaid |
$6.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.97
|
| Rate for Payer: PACE Medicare |
$10.70
|
| Rate for Payer: PACE SWMI |
$11.26
|
| Rate for Payer: PHP Commercial |
$12.39
|
| Rate for Payer: PHP Medicaid |
$6.16
|
| Rate for Payer: PHP Medicare Advantage |
$11.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.25
|
| Rate for Payer: Priority Health Medicare |
$11.26
|
| Rate for Payer: Priority Health Narrow Network |
$39.40
|
| Rate for Payer: Railroad Medicare Medicare |
$11.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.82
|
| Rate for Payer: UHC Medicare Advantage |
$11.60
|
| Rate for Payer: VA VA |
$11.26
|
|
|
HC HEPATITIS A ANTIBODY IGM
|
Facility
|
IP
|
$128.20
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
30200299
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$89.74 |
| Max. Negotiated Rate |
$128.20 |
| Rate for Payer: Aetna Commercial |
$115.38
|
| Rate for Payer: ASR ASR |
$124.35
|
| Rate for Payer: BCBS Trust/PPO |
$99.39
|
| Rate for Payer: BCN Commercial |
$99.39
|
| Rate for Payer: Cash Price |
$102.56
|
| Rate for Payer: Cofinity Commercial |
$120.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.56
|
| Rate for Payer: Healthscope Commercial |
$128.20
|
| Rate for Payer: Healthscope Whirlpool |
$124.35
|
| Rate for Payer: Mclaren Commercial |
$115.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.82
|
|
|
HC HEPATITIS ABC PANEL
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
30100017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: BCBS Trust/PPO |
$232.59
|
| Rate for Payer: BCN Commercial |
$232.59
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$282.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$300.00
|
| Rate for Payer: Healthscope Whirlpool |
$291.00
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.00
|
|
|
HC HEPATITIS ABC PANEL
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
30100017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.05 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Medicare |
$47.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.54
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: BCBS Complete |
$27.36
|
| Rate for Payer: BCBS MAPPO |
$47.63
|
| Rate for Payer: BCBS Trust/PPO |
$232.59
|
| Rate for Payer: BCN Commercial |
$232.59
|
| Rate for Payer: BCN Medicare Advantage |
$47.63
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$282.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.63
|
| Rate for Payer: Healthscope Commercial |
$300.00
|
| Rate for Payer: Healthscope Whirlpool |
$291.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$47.63
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: Mclaren Medicaid |
$26.05
|
| Rate for Payer: Mclaren Medicare |
$47.63
|
| Rate for Payer: Meridian Medicaid |
$27.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PACE Medicare |
$45.25
|
| Rate for Payer: PACE SWMI |
$47.63
|
| Rate for Payer: PHP Commercial |
$52.39
|
| Rate for Payer: PHP Medicaid |
$26.05
|
| Rate for Payer: PHP Medicare Advantage |
$47.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.39
|
| Rate for Payer: Priority Health Medicare |
$47.63
|
| Rate for Payer: Priority Health Narrow Network |
$121.91
|
| Rate for Payer: Railroad Medicare Medicare |
$47.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.00
|
| Rate for Payer: UHC Medicare Advantage |
$49.06
|
| Rate for Payer: VA VA |
$47.63
|
|
|
HC HEPATITIS A IGG
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: BCBS Trust/PPO |
$33.21
|
| Rate for Payer: BCN Commercial |
$33.21
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$42.84
|
| Rate for Payer: Healthscope Whirlpool |
$41.55
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
HC HEPATITIS A IGG
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna Medicare |
$12.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.49
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: BCBS Complete |
$7.12
|
| Rate for Payer: BCBS MAPPO |
$12.39
|
| Rate for Payer: BCBS Trust/PPO |
$33.21
|
| Rate for Payer: BCN Commercial |
$33.21
|
| Rate for Payer: BCN Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.39
|
| Rate for Payer: Healthscope Commercial |
$42.84
|
| Rate for Payer: Healthscope Whirlpool |
$41.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.39
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: Mclaren Medicaid |
$6.78
|
| Rate for Payer: Mclaren Medicare |
$12.39
|
| Rate for Payer: Meridian Medicaid |
$7.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.41
|
| Rate for Payer: PACE Medicare |
$11.77
|
| Rate for Payer: PACE SWMI |
$12.39
|
| Rate for Payer: PHP Commercial |
$13.63
|
| Rate for Payer: PHP Medicaid |
$6.78
|
| Rate for Payer: PHP Medicare Advantage |
$12.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.98
|
| Rate for Payer: Priority Health Medicare |
$12.39
|
| Rate for Payer: Priority Health Narrow Network |
$30.42
|
| Rate for Payer: Railroad Medicare Medicare |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
| Rate for Payer: UHC Medicare Advantage |
$12.76
|
| Rate for Payer: VA VA |
$12.39
|
|
|
HC HEPATITIS A TOTAL ANTIBODY
|
Facility
|
IP
|
$46.92
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200298
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.84 |
| Max. Negotiated Rate |
$46.92 |
| Rate for Payer: Aetna Commercial |
$42.23
|
| Rate for Payer: ASR ASR |
$45.51
|
| Rate for Payer: BCBS Trust/PPO |
$36.38
|
| Rate for Payer: BCN Commercial |
$36.38
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$44.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Healthscope Commercial |
$46.92
|
| Rate for Payer: Healthscope Whirlpool |
$45.51
|
| Rate for Payer: Mclaren Commercial |
$42.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.29
|
|
|
HC HEPATITIS A TOTAL ANTIBODY
|
Facility
|
OP
|
$46.92
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200298
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$46.92 |
| Rate for Payer: Aetna Commercial |
$42.23
|
| Rate for Payer: Aetna Medicare |
$12.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.49
|
| Rate for Payer: ASR ASR |
$45.51
|
| Rate for Payer: BCBS Complete |
$7.12
|
| Rate for Payer: BCBS MAPPO |
$12.39
|
| Rate for Payer: BCBS Trust/PPO |
$36.38
|
| Rate for Payer: BCN Commercial |
$36.38
|
| Rate for Payer: BCN Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$44.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.39
|
| Rate for Payer: Healthscope Commercial |
$46.92
|
| Rate for Payer: Healthscope Whirlpool |
$45.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.39
|
| Rate for Payer: Mclaren Commercial |
$42.23
|
| Rate for Payer: Mclaren Medicaid |
$6.78
|
| Rate for Payer: Mclaren Medicare |
$12.39
|
| Rate for Payer: Meridian Medicaid |
$7.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.88
|
| Rate for Payer: PACE Medicare |
$11.77
|
| Rate for Payer: PACE SWMI |
$12.39
|
| Rate for Payer: PHP Commercial |
$13.63
|
| Rate for Payer: PHP Medicaid |
$6.78
|
| Rate for Payer: PHP Medicare Advantage |
$12.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.70
|
| Rate for Payer: Priority Health Medicare |
$12.39
|
| Rate for Payer: Priority Health Narrow Network |
$33.31
|
| Rate for Payer: Railroad Medicare Medicare |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.29
|
| Rate for Payer: UHC Medicare Advantage |
$12.76
|
| Rate for Payer: VA VA |
$12.39
|
|
|
HC HEPATITIS A VACCINE (HEPA) ADULT IM
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
63600067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$89.76 |
| Rate for Payer: Aetna Commercial |
$80.78
|
| Rate for Payer: ASR ASR |
$87.07
|
| Rate for Payer: BCBS Complete |
$35.90
|
| Rate for Payer: BCBS Trust/PPO |
$69.59
|
| Rate for Payer: BCN Commercial |
$69.59
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$84.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Healthscope Commercial |
$89.76
|
| Rate for Payer: Healthscope Whirlpool |
$87.07
|
| Rate for Payer: Mclaren Commercial |
$80.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.68
|
| Rate for Payer: Priority Health Narrow Network |
$63.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.99
|
|
|
HC HEPATITIS A VACCINE (HEPA) ADULT IM
|
Facility
|
IP
|
$89.76
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
63600067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.83 |
| Max. Negotiated Rate |
$89.76 |
| Rate for Payer: Aetna Commercial |
$80.78
|
| Rate for Payer: ASR ASR |
$87.07
|
| Rate for Payer: BCBS Trust/PPO |
$69.59
|
| Rate for Payer: BCN Commercial |
$69.59
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$84.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Healthscope Commercial |
$89.76
|
| Rate for Payer: Healthscope Whirlpool |
$87.07
|
| Rate for Payer: Mclaren Commercial |
$80.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.99
|
|
|
HC HEPATITIS A VAC (HEPA) PEDI/ADOLESCENT DOSAGE-2 DOSE SCHEDULE IM
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
63600068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.41
|
| Rate for Payer: Priority Health Narrow Network |
$36.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC HEPATITIS A VAC (HEPA) PEDI/ADOLESCENT DOSAGE-2 DOSE SCHEDULE IM
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
63600068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
30200295
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Medicare |
$11.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.71
|
| Rate for Payer: ASR ASR |
$95.06
|
| Rate for Payer: BCBS Complete |
$6.76
|
| Rate for Payer: BCBS MAPPO |
$11.77
|
| Rate for Payer: BCBS Trust/PPO |
$75.98
|
| Rate for Payer: BCN Commercial |
$75.98
|
| Rate for Payer: BCN Medicare Advantage |
$11.77
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.77
|
| Rate for Payer: Healthscope Commercial |
$98.00
|
| Rate for Payer: Healthscope Whirlpool |
$95.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.77
|
| Rate for Payer: Mclaren Commercial |
$88.20
|
| Rate for Payer: Mclaren Medicaid |
$6.44
|
| Rate for Payer: Mclaren Medicare |
$11.77
|
| Rate for Payer: Meridian Medicaid |
$6.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: PACE Medicare |
$11.18
|
| Rate for Payer: PACE SWMI |
$11.77
|
| Rate for Payer: PHP Commercial |
$12.95
|
| Rate for Payer: PHP Medicaid |
$6.44
|
| Rate for Payer: PHP Medicare Advantage |
$11.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.18
|
| Rate for Payer: Priority Health Medicare |
$11.77
|
| Rate for Payer: Priority Health Narrow Network |
$69.58
|
| Rate for Payer: Railroad Medicare Medicare |
$11.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.24
|
| Rate for Payer: UHC Medicare Advantage |
$12.12
|
| Rate for Payer: VA VA |
$11.77
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
30200295
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: ASR ASR |
$95.06
|
| Rate for Payer: BCBS Trust/PPO |
$75.98
|
| Rate for Payer: BCN Commercial |
$75.98
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.40
|
| Rate for Payer: Healthscope Commercial |
$98.00
|
| Rate for Payer: Healthscope Whirlpool |
$95.06
|
| Rate for Payer: Mclaren Commercial |
$88.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.24
|
|
|
HC HEPATITIS B CORE AB TOTAL.
|
Facility
|
OP
|
$47.84
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200294
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$48.24 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$46.40
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$37.09
|
| Rate for Payer: BCN Commercial |
$37.09
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$44.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$47.84
|
| Rate for Payer: Healthscope Whirlpool |
$46.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$43.06
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.66
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.59
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.24
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$38.59
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.10
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC HEPATITIS B CORE AB TOTAL.
|
Facility
|
IP
|
$47.84
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200294
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: ASR ASR |
$46.40
|
| Rate for Payer: BCBS Trust/PPO |
$37.09
|
| Rate for Payer: BCN Commercial |
$37.09
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$44.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.27
|
| Rate for Payer: Healthscope Commercial |
$47.84
|
| Rate for Payer: Healthscope Whirlpool |
$46.40
|
| Rate for Payer: Mclaren Commercial |
$43.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.10
|
|
|
HC HEPATITIS B DNA QUANTITATION
|
Facility
|
IP
|
$173.40
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
30600154
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$121.38 |
| Max. Negotiated Rate |
$173.40 |
| Rate for Payer: Aetna Commercial |
$156.06
|
| Rate for Payer: ASR ASR |
$168.20
|
| Rate for Payer: BCBS Trust/PPO |
$134.44
|
| Rate for Payer: BCN Commercial |
$134.44
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cofinity Commercial |
$163.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.72
|
| Rate for Payer: Healthscope Commercial |
$173.40
|
| Rate for Payer: Healthscope Whirlpool |
$168.20
|
| Rate for Payer: Mclaren Commercial |
$156.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.59
|
|
|
HC HEPATITIS B DNA QUANTITATION
|
Facility
|
OP
|
$173.40
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
30600154
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$173.40 |
| Rate for Payer: Aetna Commercial |
$156.06
|
| Rate for Payer: Aetna Medicare |
$42.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.55
|
| Rate for Payer: ASR ASR |
$168.20
|
| Rate for Payer: BCBS Complete |
$24.61
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$134.44
|
| Rate for Payer: BCN Commercial |
$134.44
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cofinity Commercial |
$163.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$173.40
|
| Rate for Payer: Healthscope Whirlpool |
$168.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.84
|
| Rate for Payer: Mclaren Commercial |
$156.06
|
| Rate for Payer: Mclaren Medicaid |
$23.43
|
| Rate for Payer: Mclaren Medicare |
$42.84
|
| Rate for Payer: Meridian Medicaid |
$24.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.39
|
| Rate for Payer: PACE Medicare |
$40.70
|
| Rate for Payer: PACE SWMI |
$42.84
|
| Rate for Payer: PHP Commercial |
$47.12
|
| Rate for Payer: PHP Medicaid |
$23.43
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.79
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health Narrow Network |
$123.11
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.59
|
| Rate for Payer: UHC Medicare Advantage |
$44.13
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC HEPATITIS BE ANTIBODY
|
Facility
|
IP
|
$46.92
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
30200297
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.84 |
| Max. Negotiated Rate |
$46.92 |
| Rate for Payer: Aetna Commercial |
$42.23
|
| Rate for Payer: ASR ASR |
$45.51
|
| Rate for Payer: BCBS Trust/PPO |
$36.38
|
| Rate for Payer: BCN Commercial |
$36.38
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$44.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Healthscope Commercial |
$46.92
|
| Rate for Payer: Healthscope Whirlpool |
$45.51
|
| Rate for Payer: Mclaren Commercial |
$42.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.29
|
|
|
HC HEPATITIS BE ANTIBODY
|
Facility
|
OP
|
$46.92
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
30200297
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$46.92 |
| Rate for Payer: Aetna Commercial |
$42.23
|
| Rate for Payer: Aetna Medicare |
$11.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.46
|
| Rate for Payer: ASR ASR |
$45.51
|
| Rate for Payer: BCBS Complete |
$6.65
|
| Rate for Payer: BCBS MAPPO |
$11.57
|
| Rate for Payer: BCBS Trust/PPO |
$36.38
|
| Rate for Payer: BCN Commercial |
$36.38
|
| Rate for Payer: BCN Medicare Advantage |
$11.57
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$44.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.57
|
| Rate for Payer: Healthscope Commercial |
$46.92
|
| Rate for Payer: Healthscope Whirlpool |
$45.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.57
|
| Rate for Payer: Mclaren Commercial |
$42.23
|
| Rate for Payer: Mclaren Medicaid |
$6.33
|
| Rate for Payer: Mclaren Medicare |
$11.57
|
| Rate for Payer: Meridian Medicaid |
$6.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.88
|
| Rate for Payer: PACE Medicare |
$10.99
|
| Rate for Payer: PACE SWMI |
$11.57
|
| Rate for Payer: PHP Commercial |
$12.73
|
| Rate for Payer: PHP Medicaid |
$6.33
|
| Rate for Payer: PHP Medicare Advantage |
$11.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.70
|
| Rate for Payer: Priority Health Medicare |
$11.57
|
| Rate for Payer: Priority Health Narrow Network |
$33.31
|
| Rate for Payer: Railroad Medicare Medicare |
$11.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.29
|
| Rate for Payer: UHC Medicare Advantage |
$11.92
|
| Rate for Payer: VA VA |
$11.57
|
|
|
HC HEPATITIS BE ANTIGEN
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
30600142
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: ASR ASR |
$83.42
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$66.68
|
| Rate for Payer: BCN Commercial |
$66.68
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cofinity Commercial |
$80.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$86.00
|
| Rate for Payer: Healthscope Whirlpool |
$83.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$77.40
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.10
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.31
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.26
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$61.06
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.68
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC HEPATITIS BE ANTIGEN
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
30600142
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: ASR ASR |
$83.42
|
| Rate for Payer: BCBS Trust/PPO |
$66.68
|
| Rate for Payer: BCN Commercial |
$66.68
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cofinity Commercial |
$80.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.80
|
| Rate for Payer: Healthscope Commercial |
$86.00
|
| Rate for Payer: Healthscope Whirlpool |
$83.42
|
| Rate for Payer: Mclaren Commercial |
$77.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.68
|
|
|
HC HEPATITIS B SURFACE ANTIBODY
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
30200296
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$10.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.42
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Complete |
$6.17
|
| Rate for Payer: BCBS MAPPO |
$10.74
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: BCN Medicare Advantage |
$10.74
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.74
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.74
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$5.87
|
| Rate for Payer: Mclaren Medicare |
$10.74
|
| Rate for Payer: Meridian Medicaid |
$6.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$10.20
|
| Rate for Payer: PACE SWMI |
$10.74
|
| Rate for Payer: PHP Commercial |
$11.81
|
| Rate for Payer: PHP Medicaid |
$5.87
|
| Rate for Payer: PHP Medicare Advantage |
$10.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.95
|
| Rate for Payer: Priority Health Medicare |
$10.74
|
| Rate for Payer: Priority Health Narrow Network |
$29.56
|
| Rate for Payer: Railroad Medicare Medicare |
$10.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
| Rate for Payer: UHC Medicare Advantage |
$11.06
|
| Rate for Payer: VA VA |
$10.74
|
|
|
HC HEPATITIS B SURFACE ANTIBODY
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
30200296
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC HEPATITIS B SURFACE ANTIGEN
|
Facility
|
OP
|
$38.09
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600139
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$38.09 |
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: Aetna Medicare |
$10.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.91
|
| Rate for Payer: ASR ASR |
$36.95
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.33
|
| Rate for Payer: BCBS Trust/PPO |
$29.53
|
| Rate for Payer: BCN Commercial |
$29.53
|
| Rate for Payer: BCN Medicare Advantage |
$10.33
|
| Rate for Payer: Cash Price |
$30.47
|
| Rate for Payer: Cash Price |
$30.47
|
| Rate for Payer: Cofinity Commercial |
$35.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.33
|
| Rate for Payer: Healthscope Commercial |
$38.09
|
| Rate for Payer: Healthscope Whirlpool |
$36.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.33
|
| Rate for Payer: Mclaren Commercial |
$34.28
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicare |
$10.33
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.38
|
| Rate for Payer: PACE Medicare |
$9.81
|
| Rate for Payer: PACE SWMI |
$10.33
|
| Rate for Payer: PHP Commercial |
$11.36
|
| Rate for Payer: PHP Medicaid |
$5.65
|
| Rate for Payer: PHP Medicare Advantage |
$10.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.95
|
| Rate for Payer: Priority Health Medicare |
$10.33
|
| Rate for Payer: Priority Health Narrow Network |
$29.56
|
| Rate for Payer: Railroad Medicare Medicare |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.52
|
| Rate for Payer: UHC Medicare Advantage |
$10.64
|
| Rate for Payer: VA VA |
$10.33
|
|
