|
HC IMMUNIZATION NASAL ORAL 1ST
|
Facility
|
OP
|
$36.80
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
77100005
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.76 |
| Max. Negotiated Rate |
$78.28 |
| Rate for Payer: Aetna Commercial |
$33.12
|
| Rate for Payer: Aetna Medicare |
$62.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.28
|
| Rate for Payer: ASR ASR |
$35.70
|
| Rate for Payer: BCBS Complete |
$35.97
|
| Rate for Payer: BCBS MAPPO |
$62.62
|
| Rate for Payer: BCBS Trust/PPO |
$28.53
|
| Rate for Payer: BCN Commercial |
$28.53
|
| Rate for Payer: BCN Medicare Advantage |
$62.62
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Cofinity Commercial |
$34.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.62
|
| Rate for Payer: Healthscope Commercial |
$36.80
|
| Rate for Payer: Healthscope Whirlpool |
$35.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.62
|
| Rate for Payer: Mclaren Commercial |
$33.12
|
| Rate for Payer: Mclaren Medicaid |
$34.25
|
| Rate for Payer: Mclaren Medicare |
$62.62
|
| Rate for Payer: Meridian Medicaid |
$35.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.28
|
| Rate for Payer: PACE Medicare |
$59.49
|
| Rate for Payer: PACE SWMI |
$62.62
|
| Rate for Payer: PHP Commercial |
$68.88
|
| Rate for Payer: PHP Medicaid |
$34.25
|
| Rate for Payer: PHP Medicare Advantage |
$62.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.49
|
| Rate for Payer: Priority Health Medicare |
$62.62
|
| Rate for Payer: Priority Health Narrow Network |
$26.13
|
| Rate for Payer: Railroad Medicare Medicare |
$62.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.38
|
| Rate for Payer: UHC Medicare Advantage |
$64.50
|
| Rate for Payer: VA VA |
$62.62
|
|
|
HC IMMUNIZATION NASAL ORAL 1ST
|
Facility
|
IP
|
$36.80
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
77100005
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.76 |
| Max. Negotiated Rate |
$36.80 |
| Rate for Payer: Aetna Commercial |
$33.12
|
| Rate for Payer: ASR ASR |
$35.70
|
| Rate for Payer: BCBS Trust/PPO |
$28.53
|
| Rate for Payer: BCN Commercial |
$28.53
|
| Rate for Payer: Cash Price |
$29.44
|
| Rate for Payer: Cofinity Commercial |
$34.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.44
|
| Rate for Payer: Healthscope Commercial |
$36.80
|
| Rate for Payer: Healthscope Whirlpool |
$35.70
|
| Rate for Payer: Mclaren Commercial |
$33.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.38
|
|
|
HC IMMUNIZATION ORAL/NASL EA ADD
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
77100006
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: ASR ASR |
$26.19
|
| Rate for Payer: BCBS Trust/PPO |
$20.93
|
| Rate for Payer: BCN Commercial |
$20.93
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$25.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.60
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Healthscope Whirlpool |
$26.19
|
| Rate for Payer: Mclaren Commercial |
$24.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.76
|
|
|
HC IMMUNIZATION ORAL/NASL EA ADD
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
77100006
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: ASR ASR |
$26.19
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$20.93
|
| Rate for Payer: BCN Commercial |
$20.93
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$25.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.60
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Healthscope Whirlpool |
$26.19
|
| Rate for Payer: Mclaren Commercial |
$24.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.57
|
| Rate for Payer: Priority Health Narrow Network |
$19.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.76
|
|
|
HC IMMUNOASSAY MULTI STEP
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100659
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$24.48 |
| Rate for Payer: Aetna Commercial |
$22.03
|
| Rate for Payer: ASR ASR |
$23.75
|
| Rate for Payer: BCBS Trust/PPO |
$18.98
|
| Rate for Payer: BCN Commercial |
$18.98
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$23.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$24.48
|
| Rate for Payer: Healthscope Whirlpool |
$23.75
|
| Rate for Payer: Mclaren Commercial |
$22.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.54
|
|
|
HC IMMUNOASSAY MULTI STEP
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100659
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$22.03
|
| 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 |
$23.75
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$18.98
|
| Rate for Payer: BCN Commercial |
$18.98
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$23.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$24.48
|
| Rate for Payer: Healthscope Whirlpool |
$23.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$22.03
|
| 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 |
$20.81
|
| 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 |
$17.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.03
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$157.62
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.54
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC IMMUNOASSAY MULTI STEP ADDITIONAL
|
Facility
|
IP
|
$38.25
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: ASR ASR |
$37.10
|
| Rate for Payer: BCBS Trust/PPO |
$29.66
|
| Rate for Payer: BCN Commercial |
$29.66
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cofinity Commercial |
$35.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.60
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Whirlpool |
$37.10
|
| Rate for Payer: Mclaren Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.66
|
|
|
HC IMMUNOASSAY MULTI STEP ADDITIONAL
|
Facility
|
OP
|
$38.25
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| 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 |
$37.10
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$29.66
|
| Rate for Payer: BCN Commercial |
$29.66
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cofinity Commercial |
$35.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Whirlpool |
$37.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$34.42
|
| 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 |
$32.51
|
| 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 |
$26.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.03
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$157.62
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.66
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC IMMUNOASSAY MULTI STEP FIRST
|
Facility
|
IP
|
$38.25
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: ASR ASR |
$37.10
|
| Rate for Payer: BCBS Trust/PPO |
$29.66
|
| Rate for Payer: BCN Commercial |
$29.66
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cofinity Commercial |
$35.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.60
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Whirlpool |
$37.10
|
| Rate for Payer: Mclaren Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.66
|
|
|
HC IMMUNOASSAY MULTI STEP FIRST
|
Facility
|
OP
|
$38.25
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| 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 |
$37.10
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$29.66
|
| Rate for Payer: BCN Commercial |
$29.66
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cofinity Commercial |
$35.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Whirlpool |
$37.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$34.42
|
| 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 |
$32.51
|
| 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 |
$26.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.03
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$157.62
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.66
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC IMMUNODIFFUSION
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 86329
|
| Hospital Charge Code |
30200191
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$153.93 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Medicare |
$14.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.56
|
| Rate for Payer: ASR ASR |
$119.31
|
| Rate for Payer: BCBS Complete |
$8.07
|
| Rate for Payer: BCBS MAPPO |
$14.05
|
| Rate for Payer: BCBS Trust/PPO |
$95.36
|
| Rate for Payer: BCN Commercial |
$95.36
|
| Rate for Payer: BCN Medicare Advantage |
$14.05
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$115.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.05
|
| Rate for Payer: Healthscope Commercial |
$123.00
|
| Rate for Payer: Healthscope Whirlpool |
$119.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.05
|
| Rate for Payer: Mclaren Commercial |
$110.70
|
| Rate for Payer: Mclaren Medicaid |
$7.69
|
| Rate for Payer: Mclaren Medicare |
$14.05
|
| Rate for Payer: Meridian Medicaid |
$8.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.55
|
| Rate for Payer: PACE Medicare |
$13.35
|
| Rate for Payer: PACE SWMI |
$14.05
|
| Rate for Payer: PHP Commercial |
$15.46
|
| Rate for Payer: PHP Medicaid |
$7.69
|
| Rate for Payer: PHP Medicare Advantage |
$14.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.93
|
| Rate for Payer: Priority Health Medicare |
$14.05
|
| Rate for Payer: Priority Health Narrow Network |
$123.14
|
| Rate for Payer: Railroad Medicare Medicare |
$14.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.24
|
| Rate for Payer: UHC Medicare Advantage |
$14.47
|
| Rate for Payer: VA VA |
$14.05
|
|
|
HC IMMUNODIFFUSION
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 86329
|
| Hospital Charge Code |
30200191
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$123.00 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: ASR ASR |
$119.31
|
| Rate for Payer: BCBS Trust/PPO |
$95.36
|
| Rate for Payer: BCN Commercial |
$95.36
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$115.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.40
|
| Rate for Payer: Healthscope Commercial |
$123.00
|
| Rate for Payer: Healthscope Whirlpool |
$119.31
|
| Rate for Payer: Mclaren Commercial |
$110.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.24
|
|
|
HC IMMUNODIFFUSION AB OR AG ADDITIONAL
|
Facility
|
OP
|
$77.52
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
30200402
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$77.52 |
| Rate for Payer: Aetna Commercial |
$69.77
|
| Rate for Payer: Aetna Medicare |
$11.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: ASR ASR |
$75.19
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$60.10
|
| Rate for Payer: BCN Commercial |
$60.10
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cofinity Commercial |
$72.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$77.52
|
| Rate for Payer: Healthscope Whirlpool |
$75.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.98
|
| Rate for Payer: Mclaren Commercial |
$69.77
|
| Rate for Payer: Mclaren Medicaid |
$6.55
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Medicaid |
$6.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.89
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$13.18
|
| Rate for Payer: PHP Medicaid |
$6.55
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.54
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow Network |
$55.04
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.22
|
| Rate for Payer: UHC Medicare Advantage |
$12.34
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC IMMUNODIFFUSION AB OR AG ADDITIONAL
|
Facility
|
IP
|
$77.52
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
30200402
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.26 |
| Max. Negotiated Rate |
$77.52 |
| Rate for Payer: Aetna Commercial |
$69.77
|
| Rate for Payer: ASR ASR |
$75.19
|
| Rate for Payer: BCBS Trust/PPO |
$60.10
|
| Rate for Payer: BCN Commercial |
$60.10
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cofinity Commercial |
$72.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.02
|
| Rate for Payer: Healthscope Commercial |
$77.52
|
| Rate for Payer: Healthscope Whirlpool |
$75.19
|
| Rate for Payer: Mclaren Commercial |
$69.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.22
|
|
|
HC IMMUNODIFFUSION AB OR AG FIRST
|
Facility
|
IP
|
$89.76
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
30200401
|
|
Hospital Revenue Code
|
302
|
| 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 IMMUNODIFFUSION AB OR AG FIRST
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
30200401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$89.76 |
| Rate for Payer: Aetna Commercial |
$80.78
|
| Rate for Payer: Aetna Medicare |
$11.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: ASR ASR |
$87.07
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$69.59
|
| Rate for Payer: BCN Commercial |
$69.59
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$71.81
|
| 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: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$89.76
|
| Rate for Payer: Healthscope Whirlpool |
$87.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.98
|
| Rate for Payer: Mclaren Commercial |
$80.78
|
| Rate for Payer: Mclaren Medicaid |
$6.55
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Medicaid |
$6.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$13.18
|
| Rate for Payer: PHP Medicaid |
$6.55
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.55
|
| 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 Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow Network |
$63.73
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.99
|
| Rate for Payer: UHC Medicare Advantage |
$12.34
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC IMMUNOFIXATION
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
30200195
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$114.93 |
| Rate for Payer: Aetna Commercial |
$80.78
|
| Rate for Payer: Aetna Medicare |
$22.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.92
|
| Rate for Payer: ASR ASR |
$87.07
|
| Rate for Payer: BCBS Complete |
$12.83
|
| Rate for Payer: BCBS MAPPO |
$22.34
|
| Rate for Payer: BCBS Trust/PPO |
$69.59
|
| Rate for Payer: BCN Commercial |
$69.59
|
| Rate for Payer: BCN Medicare Advantage |
$22.34
|
| Rate for Payer: Cash Price |
$71.81
|
| 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: Health Alliance Plan Medicare Advantage |
$22.34
|
| Rate for Payer: Healthscope Commercial |
$89.76
|
| Rate for Payer: Healthscope Whirlpool |
$87.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.34
|
| Rate for Payer: Mclaren Commercial |
$80.78
|
| Rate for Payer: Mclaren Medicaid |
$12.22
|
| Rate for Payer: Mclaren Medicare |
$22.34
|
| Rate for Payer: Meridian Medicaid |
$12.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: PACE Medicare |
$21.22
|
| Rate for Payer: PACE SWMI |
$22.34
|
| Rate for Payer: PHP Commercial |
$24.57
|
| Rate for Payer: PHP Medicaid |
$12.22
|
| Rate for Payer: PHP Medicare Advantage |
$22.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.93
|
| Rate for Payer: Priority Health Medicare |
$22.34
|
| Rate for Payer: Priority Health Narrow Network |
$91.94
|
| Rate for Payer: Railroad Medicare Medicare |
$22.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.99
|
| Rate for Payer: UHC Medicare Advantage |
$23.01
|
| Rate for Payer: VA VA |
$22.34
|
|
|
HC IMMUNOFIXATION
|
Facility
|
IP
|
$89.76
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
30200195
|
|
Hospital Revenue Code
|
302
|
| 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 IMMUNOFIXATION ELECTRO SERUM
|
Facility
|
OP
|
$165.80
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
30200194
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$165.80 |
| Rate for Payer: Aetna Commercial |
$149.22
|
| Rate for Payer: Aetna Medicare |
$22.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.92
|
| Rate for Payer: ASR ASR |
$160.83
|
| Rate for Payer: BCBS Complete |
$12.83
|
| Rate for Payer: BCBS MAPPO |
$22.34
|
| Rate for Payer: BCBS Trust/PPO |
$128.54
|
| Rate for Payer: BCN Commercial |
$128.54
|
| Rate for Payer: BCN Medicare Advantage |
$22.34
|
| Rate for Payer: Cash Price |
$132.64
|
| Rate for Payer: Cash Price |
$132.64
|
| Rate for Payer: Cofinity Commercial |
$155.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.34
|
| Rate for Payer: Healthscope Commercial |
$165.80
|
| Rate for Payer: Healthscope Whirlpool |
$160.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.34
|
| Rate for Payer: Mclaren Commercial |
$149.22
|
| Rate for Payer: Mclaren Medicaid |
$12.22
|
| Rate for Payer: Mclaren Medicare |
$22.34
|
| Rate for Payer: Meridian Medicaid |
$12.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.93
|
| Rate for Payer: PACE Medicare |
$21.22
|
| Rate for Payer: PACE SWMI |
$22.34
|
| Rate for Payer: PHP Commercial |
$24.57
|
| Rate for Payer: PHP Medicaid |
$12.22
|
| Rate for Payer: PHP Medicare Advantage |
$22.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.93
|
| Rate for Payer: Priority Health Medicare |
$22.34
|
| Rate for Payer: Priority Health Narrow Network |
$91.94
|
| Rate for Payer: Railroad Medicare Medicare |
$22.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.90
|
| Rate for Payer: UHC Medicare Advantage |
$23.01
|
| Rate for Payer: VA VA |
$22.34
|
|
|
HC IMMUNOFIXATION ELECTRO SERUM
|
Facility
|
IP
|
$165.80
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
30200194
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$116.06 |
| Max. Negotiated Rate |
$165.80 |
| Rate for Payer: Aetna Commercial |
$149.22
|
| Rate for Payer: ASR ASR |
$160.83
|
| Rate for Payer: BCBS Trust/PPO |
$128.54
|
| Rate for Payer: BCN Commercial |
$128.54
|
| Rate for Payer: Cash Price |
$132.64
|
| Rate for Payer: Cofinity Commercial |
$155.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.64
|
| Rate for Payer: Healthscope Commercial |
$165.80
|
| Rate for Payer: Healthscope Whirlpool |
$160.83
|
| Rate for Payer: Mclaren Commercial |
$149.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.90
|
|
|
HC IMMUNOFIXATION ELEC URINE/CSF
|
Facility
|
OP
|
$165.80
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
30200196
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$165.80 |
| Rate for Payer: Aetna Commercial |
$149.22
|
| Rate for Payer: Aetna Medicare |
$29.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.69
|
| Rate for Payer: ASR ASR |
$160.83
|
| Rate for Payer: BCBS Complete |
$16.86
|
| Rate for Payer: BCBS MAPPO |
$29.35
|
| Rate for Payer: BCBS Trust/PPO |
$128.54
|
| Rate for Payer: BCN Commercial |
$128.54
|
| Rate for Payer: BCN Medicare Advantage |
$29.35
|
| Rate for Payer: Cash Price |
$132.64
|
| Rate for Payer: Cash Price |
$132.64
|
| Rate for Payer: Cofinity Commercial |
$155.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.35
|
| Rate for Payer: Healthscope Commercial |
$165.80
|
| Rate for Payer: Healthscope Whirlpool |
$160.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$29.35
|
| Rate for Payer: Mclaren Commercial |
$149.22
|
| Rate for Payer: Mclaren Medicaid |
$16.05
|
| Rate for Payer: Mclaren Medicare |
$29.35
|
| Rate for Payer: Meridian Medicaid |
$16.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.93
|
| Rate for Payer: PACE Medicare |
$27.88
|
| Rate for Payer: PACE SWMI |
$29.35
|
| Rate for Payer: PHP Commercial |
$32.28
|
| Rate for Payer: PHP Medicaid |
$16.05
|
| Rate for Payer: PHP Medicare Advantage |
$29.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.02
|
| Rate for Payer: Priority Health Medicare |
$29.35
|
| Rate for Payer: Priority Health Narrow Network |
$63.22
|
| Rate for Payer: Railroad Medicare Medicare |
$29.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.90
|
| Rate for Payer: UHC Medicare Advantage |
$30.23
|
| Rate for Payer: VA VA |
$29.35
|
|
|
HC IMMUNOFIXATION ELEC URINE/CSF
|
Facility
|
IP
|
$165.80
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
30200196
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$116.06 |
| Max. Negotiated Rate |
$165.80 |
| Rate for Payer: Aetna Commercial |
$149.22
|
| Rate for Payer: ASR ASR |
$160.83
|
| Rate for Payer: BCBS Trust/PPO |
$128.54
|
| Rate for Payer: BCN Commercial |
$128.54
|
| Rate for Payer: Cash Price |
$132.64
|
| Rate for Payer: Cofinity Commercial |
$155.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.64
|
| Rate for Payer: Healthscope Commercial |
$165.80
|
| Rate for Payer: Healthscope Whirlpool |
$160.83
|
| Rate for Payer: Mclaren Commercial |
$149.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.90
|
|
|
HC IMMUNOGLOBULIN A IGA
|
Facility
|
IP
|
$75.40
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.78 |
| Max. Negotiated Rate |
$75.40 |
| Rate for Payer: Aetna Commercial |
$67.86
|
| Rate for Payer: ASR ASR |
$73.14
|
| Rate for Payer: BCBS Trust/PPO |
$58.46
|
| Rate for Payer: BCN Commercial |
$58.46
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$70.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.32
|
| Rate for Payer: Healthscope Commercial |
$75.40
|
| Rate for Payer: Healthscope Whirlpool |
$73.14
|
| Rate for Payer: Mclaren Commercial |
$67.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.35
|
|
|
HC IMMUNOGLOBULIN A IGA
|
Facility
|
OP
|
$75.40
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$75.40 |
| Rate for Payer: Aetna Commercial |
$67.86
|
| Rate for Payer: Aetna Medicare |
$9.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.62
|
| Rate for Payer: ASR ASR |
$73.14
|
| Rate for Payer: BCBS Complete |
$5.34
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$58.46
|
| Rate for Payer: BCN Commercial |
$58.46
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$70.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$75.40
|
| Rate for Payer: Healthscope Whirlpool |
$73.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.30
|
| Rate for Payer: Mclaren Commercial |
$67.86
|
| Rate for Payer: Mclaren Medicaid |
$5.09
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Medicaid |
$5.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$10.23
|
| Rate for Payer: PHP Medicaid |
$5.09
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.25
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health Narrow Network |
$39.40
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.35
|
| Rate for Payer: UHC Medicare Advantage |
$9.58
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC IMMUNOGLOBULIN A (IGA), S
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna Commercial |
$35.10
|
| Rate for Payer: ASR ASR |
$37.83
|
| Rate for Payer: BCBS Trust/PPO |
$30.24
|
| Rate for Payer: BCN Commercial |
$30.24
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$36.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.20
|
| Rate for Payer: Healthscope Commercial |
$39.00
|
| Rate for Payer: Healthscope Whirlpool |
$37.83
|
| Rate for Payer: Mclaren Commercial |
$35.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.32
|
|
