|
HC HIV 1,2 AB AND AG COMBO
|
Facility
|
OP
|
$48.96
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
30600261
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.17 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: Aetna Medicare |
$24.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.10
|
| Rate for Payer: ASR ASR |
$47.49
|
| Rate for Payer: BCBS Complete |
$13.83
|
| Rate for Payer: BCBS MAPPO |
$24.08
|
| Rate for Payer: BCBS Trust/PPO |
$37.96
|
| Rate for Payer: BCN Commercial |
$37.96
|
| Rate for Payer: BCN Medicare Advantage |
$24.08
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.08
|
| Rate for Payer: Healthscope Commercial |
$48.96
|
| Rate for Payer: Healthscope Whirlpool |
$47.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.08
|
| Rate for Payer: Mclaren Commercial |
$44.06
|
| Rate for Payer: Mclaren Medicaid |
$13.17
|
| Rate for Payer: Mclaren Medicare |
$24.08
|
| Rate for Payer: Meridian Medicaid |
$13.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PACE Medicare |
$22.88
|
| Rate for Payer: PACE SWMI |
$24.08
|
| Rate for Payer: PHP Commercial |
$26.49
|
| Rate for Payer: PHP Medicaid |
$13.17
|
| Rate for Payer: PHP Medicare Advantage |
$24.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.55
|
| Rate for Payer: Priority Health Medicare |
$24.08
|
| Rate for Payer: Priority Health Narrow Network |
$34.76
|
| Rate for Payer: Railroad Medicare Medicare |
$24.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.08
|
| Rate for Payer: UHC Medicare Advantage |
$24.80
|
| Rate for Payer: VA VA |
$24.08
|
|
|
HC HIV 1/2 AB DIFF HIV1
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
30200381
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare |
$8.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.11
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: BCBS Complete |
$5.11
|
| Rate for Payer: BCBS MAPPO |
$8.89
|
| Rate for Payer: BCBS Trust/PPO |
$58.15
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: BCN Medicare Advantage |
$8.89
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.89
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.89
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Mclaren Medicaid |
$4.86
|
| Rate for Payer: Mclaren Medicare |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$5.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PACE Medicare |
$8.45
|
| Rate for Payer: PACE SWMI |
$8.89
|
| Rate for Payer: PHP Commercial |
$9.78
|
| Rate for Payer: PHP Medicaid |
$4.86
|
| Rate for Payer: PHP Medicare Advantage |
$8.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.25
|
| Rate for Payer: Priority Health Medicare |
$8.89
|
| Rate for Payer: Priority Health Narrow Network |
$53.25
|
| Rate for Payer: Railroad Medicare Medicare |
$8.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
| Rate for Payer: UHC Medicare Advantage |
$9.16
|
| Rate for Payer: VA VA |
$8.89
|
|
|
HC HIV 1/2 AB DIFF HIV1
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
30200381
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: BCBS Trust/PPO |
$58.15
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC HIV 1/2 AB DIFF HIV2
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
30200382
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare |
$13.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.90
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: BCBS Complete |
$7.77
|
| Rate for Payer: BCBS MAPPO |
$13.52
|
| Rate for Payer: BCBS Trust/PPO |
$58.15
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: BCN Medicare Advantage |
$13.52
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.52
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.52
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Mclaren Medicaid |
$7.40
|
| Rate for Payer: Mclaren Medicare |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$7.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PACE Medicare |
$12.84
|
| Rate for Payer: PACE SWMI |
$13.52
|
| Rate for Payer: PHP Commercial |
$14.87
|
| Rate for Payer: PHP Medicaid |
$7.40
|
| Rate for Payer: PHP Medicare Advantage |
$13.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.25
|
| Rate for Payer: Priority Health Medicare |
$13.52
|
| Rate for Payer: Priority Health Narrow Network |
$53.25
|
| Rate for Payer: Railroad Medicare Medicare |
$13.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
| Rate for Payer: UHC Medicare Advantage |
$13.93
|
| Rate for Payer: VA VA |
$13.52
|
|
|
HC HIV 1/2 AB DIFF HIV2
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
30200382
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: BCBS Trust/PPO |
$58.15
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC HIV 1 ANTIGEN
|
Facility
|
IP
|
$41.72
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
30600214
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Aetna Commercial |
$37.55
|
| Rate for Payer: ASR ASR |
$40.47
|
| Rate for Payer: BCBS Trust/PPO |
$32.35
|
| Rate for Payer: BCN Commercial |
$32.35
|
| Rate for Payer: Cash Price |
$33.38
|
| Rate for Payer: Cofinity Commercial |
$39.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.38
|
| Rate for Payer: Healthscope Commercial |
$41.72
|
| Rate for Payer: Healthscope Whirlpool |
$40.47
|
| Rate for Payer: Mclaren Commercial |
$37.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.71
|
|
|
HC HIV 1 ANTIGEN
|
Facility
|
OP
|
$41.72
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
30600214
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Aetna Commercial |
$37.55
|
| Rate for Payer: Aetna Medicare |
$16.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.09
|
| Rate for Payer: ASR ASR |
$40.47
|
| Rate for Payer: BCBS Complete |
$9.23
|
| Rate for Payer: BCBS MAPPO |
$16.07
|
| Rate for Payer: BCBS Trust/PPO |
$32.35
|
| Rate for Payer: BCN Commercial |
$32.35
|
| Rate for Payer: BCN Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$33.38
|
| Rate for Payer: Cash Price |
$33.38
|
| Rate for Payer: Cofinity Commercial |
$39.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.07
|
| Rate for Payer: Healthscope Commercial |
$41.72
|
| Rate for Payer: Healthscope Whirlpool |
$40.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.07
|
| Rate for Payer: Mclaren Commercial |
$37.55
|
| Rate for Payer: Mclaren Medicaid |
$8.79
|
| Rate for Payer: Mclaren Medicare |
$16.07
|
| Rate for Payer: Meridian Medicaid |
$9.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.46
|
| Rate for Payer: PACE Medicare |
$15.27
|
| Rate for Payer: PACE SWMI |
$16.07
|
| Rate for Payer: PHP Commercial |
$17.68
|
| Rate for Payer: PHP Medicaid |
$8.79
|
| Rate for Payer: PHP Medicare Advantage |
$16.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.89
|
| Rate for Payer: Priority Health Medicare |
$16.07
|
| Rate for Payer: Priority Health Narrow Network |
$27.91
|
| Rate for Payer: Railroad Medicare Medicare |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.71
|
| Rate for Payer: UHC Medicare Advantage |
$16.55
|
| Rate for Payer: VA VA |
$16.07
|
|
|
HC HIV 1 GENOTYPE
|
Facility
|
OP
|
$428.40
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
30600178
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$140.83 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Aetna Commercial |
$385.56
|
| Rate for Payer: Aetna Medicare |
$257.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$321.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$321.81
|
| Rate for Payer: ASR ASR |
$415.55
|
| Rate for Payer: BCBS Complete |
$147.88
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCBS Trust/PPO |
$332.14
|
| Rate for Payer: BCN Commercial |
$332.14
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$342.72
|
| Rate for Payer: Cash Price |
$342.72
|
| Rate for Payer: Cofinity Commercial |
$402.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Healthscope Commercial |
$428.40
|
| Rate for Payer: Healthscope Whirlpool |
$415.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$257.45
|
| Rate for Payer: Mclaren Commercial |
$385.56
|
| Rate for Payer: Mclaren Medicaid |
$140.83
|
| Rate for Payer: Mclaren Medicare |
$257.45
|
| Rate for Payer: Meridian Medicaid |
$147.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$270.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.14
|
| Rate for Payer: PACE Medicare |
$244.58
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PHP Commercial |
$283.20
|
| Rate for Payer: PHP Medicaid |
$140.83
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$389.84
|
| Rate for Payer: Priority Health Medicare |
$257.45
|
| Rate for Payer: Priority Health Narrow Network |
$304.16
|
| Rate for Payer: Railroad Medicare Medicare |
$257.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.99
|
| Rate for Payer: UHC Medicare Advantage |
$265.17
|
| Rate for Payer: VA VA |
$257.45
|
|
|
HC HIV 1 GENOTYPE
|
Facility
|
IP
|
$428.40
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
30600178
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$299.88 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Aetna Commercial |
$385.56
|
| Rate for Payer: ASR ASR |
$415.55
|
| Rate for Payer: BCBS Trust/PPO |
$332.14
|
| Rate for Payer: BCN Commercial |
$332.14
|
| Rate for Payer: Cash Price |
$342.72
|
| Rate for Payer: Cofinity Commercial |
$402.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.72
|
| Rate for Payer: Healthscope Commercial |
$428.40
|
| Rate for Payer: Healthscope Whirlpool |
$415.55
|
| Rate for Payer: Mclaren Commercial |
$385.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.99
|
|
|
HC HIV 2 AB CONFIRMATION
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200383
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Medicare |
$19.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: ASR ASR |
$82.45
|
| Rate for Payer: BCBS Complete |
$11.11
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$65.90
|
| Rate for Payer: BCN Commercial |
$65.90
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cofinity Commercial |
$79.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$85.00
|
| Rate for Payer: Healthscope Whirlpool |
$82.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.35
|
| Rate for Payer: Mclaren Commercial |
$76.50
|
| Rate for Payer: Mclaren Medicaid |
$10.58
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Medicaid |
$11.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.25
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$21.28
|
| Rate for Payer: PHP Medicaid |
$10.58
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.35
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health Narrow Network |
$60.35
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.80
|
| Rate for Payer: UHC Medicare Advantage |
$19.93
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC HIV 2 AB CONFIRMATION
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200383
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: ASR ASR |
$82.45
|
| Rate for Payer: BCBS Trust/PPO |
$65.90
|
| Rate for Payer: BCN Commercial |
$65.90
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cofinity Commercial |
$79.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.00
|
| Rate for Payer: Healthscope Commercial |
$85.00
|
| Rate for Payer: Healthscope Whirlpool |
$82.45
|
| Rate for Payer: Mclaren Commercial |
$76.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.80
|
|
|
HC HIV ANTIBODY
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
30200292
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: ASR ASR |
$46.56
|
| Rate for Payer: BCBS Trust/PPO |
$37.21
|
| Rate for Payer: BCN Commercial |
$37.21
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$45.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.40
|
| Rate for Payer: Healthscope Commercial |
$48.00
|
| Rate for Payer: Healthscope Whirlpool |
$46.56
|
| Rate for Payer: Mclaren Commercial |
$43.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.24
|
|
|
HC HIV ANTIBODY
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
30200292
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Medicare |
$13.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.14
|
| Rate for Payer: ASR ASR |
$46.56
|
| Rate for Payer: BCBS Complete |
$7.88
|
| Rate for Payer: BCBS MAPPO |
$13.71
|
| Rate for Payer: BCBS Trust/PPO |
$37.21
|
| Rate for Payer: BCN Commercial |
$37.21
|
| Rate for Payer: BCN Medicare Advantage |
$13.71
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$45.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.71
|
| Rate for Payer: Healthscope Commercial |
$48.00
|
| Rate for Payer: Healthscope Whirlpool |
$46.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.71
|
| Rate for Payer: Mclaren Commercial |
$43.20
|
| Rate for Payer: Mclaren Medicaid |
$7.50
|
| Rate for Payer: Mclaren Medicare |
$13.71
|
| Rate for Payer: Meridian Medicaid |
$7.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.80
|
| Rate for Payer: PACE Medicare |
$13.02
|
| Rate for Payer: PACE SWMI |
$13.71
|
| Rate for Payer: PHP Commercial |
$15.08
|
| Rate for Payer: PHP Medicaid |
$7.50
|
| Rate for Payer: PHP Medicare Advantage |
$13.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.68
|
| Rate for Payer: Priority Health Medicare |
$13.71
|
| Rate for Payer: Priority Health Narrow Network |
$34.08
|
| Rate for Payer: Railroad Medicare Medicare |
$13.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.24
|
| Rate for Payer: UHC Medicare Advantage |
$14.12
|
| Rate for Payer: VA VA |
$13.71
|
|
|
HC HIV DNA BY PCR
|
Facility
|
OP
|
$87.72
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
30600159
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Aetna Commercial |
$78.95
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$85.09
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$68.01
|
| Rate for Payer: BCN Commercial |
$68.01
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$82.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$87.72
|
| Rate for Payer: Healthscope Whirlpool |
$85.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$78.95
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.56
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$19.19
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.83
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$62.28
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.19
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HIV DNA BY PCR
|
Facility
|
IP
|
$87.72
|
|
|
Service Code
|
CPT 87535
|
| Hospital Charge Code |
30600159
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$61.40 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Aetna Commercial |
$78.95
|
| Rate for Payer: ASR ASR |
$85.09
|
| Rate for Payer: BCBS Trust/PPO |
$68.01
|
| Rate for Payer: BCN Commercial |
$68.01
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$82.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$87.72
|
| Rate for Payer: Healthscope Whirlpool |
$85.09
|
| Rate for Payer: Mclaren Commercial |
$78.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.19
|
|
|
HC HIV QUANTITATIVE
|
Facility
|
IP
|
$140.80
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
30600299
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$98.56 |
| Max. Negotiated Rate |
$140.80 |
| Rate for Payer: Aetna Commercial |
$126.72
|
| Rate for Payer: ASR ASR |
$136.58
|
| Rate for Payer: BCBS Trust/PPO |
$109.16
|
| Rate for Payer: BCN Commercial |
$109.16
|
| Rate for Payer: Cash Price |
$112.64
|
| Rate for Payer: Cofinity Commercial |
$132.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.64
|
| Rate for Payer: Healthscope Commercial |
$140.80
|
| Rate for Payer: Healthscope Whirlpool |
$136.58
|
| Rate for Payer: Mclaren Commercial |
$126.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.90
|
|
|
HC HIV QUANTITATIVE
|
Facility
|
OP
|
$140.80
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
30600299
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.55 |
| Max. Negotiated Rate |
$316.07 |
| Rate for Payer: Aetna Commercial |
$126.72
|
| Rate for Payer: Aetna Medicare |
$85.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.38
|
| Rate for Payer: ASR ASR |
$136.58
|
| Rate for Payer: BCBS Complete |
$48.88
|
| Rate for Payer: BCBS MAPPO |
$85.10
|
| Rate for Payer: BCBS Trust/PPO |
$109.16
|
| Rate for Payer: BCN Commercial |
$109.16
|
| Rate for Payer: BCN Medicare Advantage |
$85.10
|
| Rate for Payer: Cash Price |
$112.64
|
| Rate for Payer: Cash Price |
$112.64
|
| Rate for Payer: Cofinity Commercial |
$132.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.10
|
| Rate for Payer: Healthscope Commercial |
$140.80
|
| Rate for Payer: Healthscope Whirlpool |
$136.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.10
|
| Rate for Payer: Mclaren Commercial |
$126.72
|
| Rate for Payer: Mclaren Medicaid |
$46.55
|
| Rate for Payer: Mclaren Medicare |
$85.10
|
| Rate for Payer: Meridian Medicaid |
$48.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.68
|
| Rate for Payer: PACE Medicare |
$80.84
|
| Rate for Payer: PACE SWMI |
$85.10
|
| Rate for Payer: PHP Commercial |
$93.61
|
| Rate for Payer: PHP Medicaid |
$46.55
|
| Rate for Payer: PHP Medicare Advantage |
$85.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$316.07
|
| Rate for Payer: Priority Health Medicare |
$85.10
|
| Rate for Payer: Priority Health Narrow Network |
$252.86
|
| Rate for Payer: Railroad Medicare Medicare |
$85.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.90
|
| Rate for Payer: UHC Medicare Advantage |
$87.65
|
| Rate for Payer: VA VA |
$85.10
|
|
|
HC HIV RNA BY PCR
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
30600160
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: ASR ASR |
$197.88
|
| Rate for Payer: BCBS Trust/PPO |
$158.16
|
| Rate for Payer: BCN Commercial |
$158.16
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$191.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Healthscope Commercial |
$204.00
|
| Rate for Payer: Healthscope Whirlpool |
$197.88
|
| Rate for Payer: Mclaren Commercial |
$183.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.52
|
|
|
HC HIV RNA BY PCR
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
30600160
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.55 |
| Max. Negotiated Rate |
$316.07 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Medicare |
$85.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.38
|
| Rate for Payer: ASR ASR |
$197.88
|
| Rate for Payer: BCBS Complete |
$48.88
|
| Rate for Payer: BCBS MAPPO |
$85.10
|
| Rate for Payer: BCBS Trust/PPO |
$158.16
|
| Rate for Payer: BCN Commercial |
$158.16
|
| Rate for Payer: BCN Medicare Advantage |
$85.10
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$191.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.10
|
| Rate for Payer: Healthscope Commercial |
$204.00
|
| Rate for Payer: Healthscope Whirlpool |
$197.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.10
|
| Rate for Payer: Mclaren Commercial |
$183.60
|
| Rate for Payer: Mclaren Medicaid |
$46.55
|
| Rate for Payer: Mclaren Medicare |
$85.10
|
| Rate for Payer: Meridian Medicaid |
$48.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.40
|
| Rate for Payer: PACE Medicare |
$80.84
|
| Rate for Payer: PACE SWMI |
$85.10
|
| Rate for Payer: PHP Commercial |
$93.61
|
| Rate for Payer: PHP Medicaid |
$46.55
|
| Rate for Payer: PHP Medicare Advantage |
$85.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$316.07
|
| Rate for Payer: Priority Health Medicare |
$85.10
|
| Rate for Payer: Priority Health Narrow Network |
$252.86
|
| Rate for Payer: Railroad Medicare Medicare |
$85.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.52
|
| Rate for Payer: UHC Medicare Advantage |
$87.65
|
| Rate for Payer: VA VA |
$85.10
|
|
|
HC HIV RNA QUANT REFLEX GENOTYPE
|
Facility
|
IP
|
$130.56
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
30600161
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$91.39 |
| Max. Negotiated Rate |
$130.56 |
| Rate for Payer: Aetna Commercial |
$117.50
|
| Rate for Payer: ASR ASR |
$126.64
|
| Rate for Payer: BCBS Trust/PPO |
$101.22
|
| Rate for Payer: BCN Commercial |
$101.22
|
| Rate for Payer: Cash Price |
$104.45
|
| Rate for Payer: Cofinity Commercial |
$122.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.45
|
| Rate for Payer: Healthscope Commercial |
$130.56
|
| Rate for Payer: Healthscope Whirlpool |
$126.64
|
| Rate for Payer: Mclaren Commercial |
$117.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.89
|
|
|
HC HIV RNA QUANT REFLEX GENOTYPE
|
Facility
|
OP
|
$130.56
|
|
|
Service Code
|
CPT 87536
|
| Hospital Charge Code |
30600161
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.55 |
| Max. Negotiated Rate |
$316.07 |
| Rate for Payer: Aetna Commercial |
$117.50
|
| Rate for Payer: Aetna Medicare |
$85.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.38
|
| Rate for Payer: ASR ASR |
$126.64
|
| Rate for Payer: BCBS Complete |
$48.88
|
| Rate for Payer: BCBS MAPPO |
$85.10
|
| Rate for Payer: BCBS Trust/PPO |
$101.22
|
| Rate for Payer: BCN Commercial |
$101.22
|
| Rate for Payer: BCN Medicare Advantage |
$85.10
|
| Rate for Payer: Cash Price |
$104.45
|
| Rate for Payer: Cash Price |
$104.45
|
| Rate for Payer: Cofinity Commercial |
$122.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.10
|
| Rate for Payer: Healthscope Commercial |
$130.56
|
| Rate for Payer: Healthscope Whirlpool |
$126.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$85.10
|
| Rate for Payer: Mclaren Commercial |
$117.50
|
| Rate for Payer: Mclaren Medicaid |
$46.55
|
| Rate for Payer: Mclaren Medicare |
$85.10
|
| Rate for Payer: Meridian Medicaid |
$48.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.98
|
| Rate for Payer: PACE Medicare |
$80.84
|
| Rate for Payer: PACE SWMI |
$85.10
|
| Rate for Payer: PHP Commercial |
$93.61
|
| Rate for Payer: PHP Medicaid |
$46.55
|
| Rate for Payer: PHP Medicare Advantage |
$85.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$316.07
|
| Rate for Payer: Priority Health Medicare |
$85.10
|
| Rate for Payer: Priority Health Narrow Network |
$252.86
|
| Rate for Payer: Railroad Medicare Medicare |
$85.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.89
|
| Rate for Payer: UHC Medicare Advantage |
$87.65
|
| Rate for Payer: VA VA |
$85.10
|
|
|
HC HIV TYPE 1 AB IFA
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200275
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Medicare |
$19.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: ASR ASR |
$97.97
|
| Rate for Payer: BCBS Complete |
$11.11
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$78.31
|
| Rate for Payer: BCN Commercial |
$78.31
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$94.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$101.00
|
| Rate for Payer: Healthscope Whirlpool |
$97.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.35
|
| Rate for Payer: Mclaren Commercial |
$90.90
|
| Rate for Payer: Mclaren Medicaid |
$10.58
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Medicaid |
$11.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.85
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$21.28
|
| Rate for Payer: PHP Medicaid |
$10.58
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.91
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health Narrow Network |
$71.71
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.88
|
| Rate for Payer: UHC Medicare Advantage |
$19.93
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC HIV TYPE 1 AB IFA
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200275
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.70 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: ASR ASR |
$97.97
|
| Rate for Payer: BCBS Trust/PPO |
$78.31
|
| Rate for Payer: BCN Commercial |
$78.31
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$94.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.80
|
| Rate for Payer: Healthscope Commercial |
$101.00
|
| Rate for Payer: Healthscope Whirlpool |
$97.97
|
| Rate for Payer: Mclaren Commercial |
$90.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.88
|
|
|
HC HIV TYPE 2 AB IMMUNOBLOT
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200274
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: ASR ASR |
$101.85
|
| Rate for Payer: BCBS Trust/PPO |
$81.41
|
| Rate for Payer: BCN Commercial |
$81.41
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$105.00
|
| Rate for Payer: Healthscope Whirlpool |
$101.85
|
| Rate for Payer: Mclaren Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.40
|
|
|
HC HIV TYPE 2 AB IMMUNOBLOT
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200274
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Medicare |
$19.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: ASR ASR |
$101.85
|
| Rate for Payer: BCBS Complete |
$11.11
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$81.41
|
| Rate for Payer: BCN Commercial |
$81.41
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$105.00
|
| Rate for Payer: Healthscope Whirlpool |
$101.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.35
|
| Rate for Payer: Mclaren Commercial |
$94.50
|
| Rate for Payer: Mclaren Medicaid |
$10.58
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Medicaid |
$11.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$21.28
|
| Rate for Payer: PHP Medicaid |
$10.58
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.55
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health Narrow Network |
$74.55
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.40
|
| Rate for Payer: UHC Medicare Advantage |
$19.93
|
| Rate for Payer: VA VA |
$19.35
|
|
