|
HC HEPATITIS B VIRUS SURFACE ANTIGEN, SERUM
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600350
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$43.60 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| 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 |
$39.58
|
| Rate for Payer: BCBS Complete |
$5.67
|
| Rate for Payer: BCBS MAPPO |
$10.33
|
| Rate for Payer: BCBS Trust/PPO |
$33.64
|
| Rate for Payer: BCN Commercial |
$33.64
|
| Rate for Payer: BCN Medicare Advantage |
$10.33
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.33
|
| Rate for Payer: Healthscope Commercial |
$39.58
|
| Rate for Payer: Healthscope Whirlpool |
$40.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.33
|
| Rate for Payer: Mclaren Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$10.33
|
| Rate for Payer: Mclaren Medicare |
$10.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.85
|
| Rate for Payer: Meridian Medicaid |
$5.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: Nomi Health Commercial |
$33.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.60
|
| 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 |
$5.54
|
| Rate for Payer: PHP Medicare Advantage |
$10.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$43.60
|
| Rate for Payer: Priority Health Medicare |
$10.33
|
| Rate for Payer: Priority Health Narrow Network |
$34.88
|
| Rate for Payer: Railroad Medicare Medicare |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.33
|
| Rate for Payer: UHC Exchange |
$16.01
|
| Rate for Payer: UHC Medicaid |
$5.40
|
| Rate for Payer: UHCCP DNSP |
$10.33
|
| Rate for Payer: UHCCP Medicaid |
$5.40
|
| Rate for Payer: VA VA |
$10.33
|
|
|
HC HEPATITIS C ANTIBODY
|
Facility
|
IP
|
$50.21
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
30200336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$50.21 |
| Rate for Payer: Aetna Commercial |
$45.19
|
| Rate for Payer: ASR ASR |
$48.70
|
| Rate for Payer: BCBS Trust/PPO |
$41.23
|
| Rate for Payer: BCN Commercial |
$41.23
|
| Rate for Payer: Cash Price |
$40.17
|
| Rate for Payer: Cofinity Commercial |
$47.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.17
|
| Rate for Payer: Healthscope Commercial |
$48.70
|
| Rate for Payer: Healthscope Whirlpool |
$50.21
|
| Rate for Payer: Mclaren Commercial |
$45.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.68
|
| Rate for Payer: Nomi Health Commercial |
$41.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.18
|
|
|
HC HEPATITIS C ANTIBODY
|
Facility
|
OP
|
$50.21
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
30200336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$54.47 |
| Rate for Payer: Aetna Commercial |
$45.19
|
| Rate for Payer: Aetna Medicare |
$14.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.84
|
| Rate for Payer: ASR ASR |
$48.70
|
| Rate for Payer: BCBS Complete |
$7.84
|
| Rate for Payer: BCBS MAPPO |
$14.27
|
| Rate for Payer: BCBS Trust/PPO |
$41.40
|
| Rate for Payer: BCN Commercial |
$41.40
|
| Rate for Payer: BCN Medicare Advantage |
$14.27
|
| Rate for Payer: Cash Price |
$40.17
|
| Rate for Payer: Cash Price |
$40.17
|
| Rate for Payer: Cofinity Commercial |
$47.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.27
|
| Rate for Payer: Healthscope Commercial |
$48.70
|
| Rate for Payer: Healthscope Whirlpool |
$50.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.27
|
| Rate for Payer: Mclaren Commercial |
$45.19
|
| Rate for Payer: Mclaren Medicaid |
$14.27
|
| Rate for Payer: Mclaren Medicare |
$14.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.98
|
| Rate for Payer: Meridian Medicaid |
$7.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.68
|
| Rate for Payer: Nomi Health Commercial |
$41.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.66
|
| Rate for Payer: PACE Medicare |
$13.56
|
| Rate for Payer: PACE SWMI |
$14.27
|
| Rate for Payer: PHP Commercial |
$15.70
|
| Rate for Payer: PHP Medicaid |
$7.65
|
| Rate for Payer: PHP Medicare Advantage |
$14.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.47
|
| Rate for Payer: Priority Health Medicare |
$14.27
|
| Rate for Payer: Priority Health Narrow Network |
$43.58
|
| Rate for Payer: Railroad Medicare Medicare |
$14.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.27
|
| Rate for Payer: UHC Exchange |
$22.12
|
| Rate for Payer: UHC Medicaid |
$7.46
|
| Rate for Payer: UHCCP DNSP |
$14.27
|
| Rate for Payer: UHCCP Medicaid |
$7.46
|
| Rate for Payer: VA VA |
$14.27
|
|
|
HC HEPATITIS C ANTIBODY BY RIBA
|
Facility
|
OP
|
$84.27
|
|
|
Service Code
|
CPT 86804
|
| Hospital Charge Code |
30200337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$84.27 |
| Rate for Payer: Aetna Commercial |
$75.84
|
| Rate for Payer: Aetna Medicare |
$15.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.36
|
| Rate for Payer: ASR ASR |
$81.74
|
| Rate for Payer: BCBS Complete |
$8.51
|
| Rate for Payer: BCBS MAPPO |
$15.49
|
| Rate for Payer: BCBS Trust/PPO |
$69.48
|
| Rate for Payer: BCN Commercial |
$69.48
|
| Rate for Payer: BCN Medicare Advantage |
$15.49
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$79.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$81.74
|
| Rate for Payer: Healthscope Whirlpool |
$84.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.49
|
| Rate for Payer: Mclaren Commercial |
$75.84
|
| Rate for Payer: Mclaren Medicaid |
$15.49
|
| Rate for Payer: Mclaren Medicare |
$15.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.26
|
| Rate for Payer: Meridian Medicaid |
$8.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.63
|
| Rate for Payer: Nomi Health Commercial |
$69.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.20
|
| Rate for Payer: PACE Medicare |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.49
|
| Rate for Payer: PHP Commercial |
$17.04
|
| Rate for Payer: PHP Medicaid |
$8.30
|
| Rate for Payer: PHP Medicare Advantage |
$15.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$73.84
|
| Rate for Payer: Priority Health Medicare |
$15.49
|
| Rate for Payer: Priority Health Narrow Network |
$59.07
|
| Rate for Payer: Railroad Medicare Medicare |
$15.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.49
|
| Rate for Payer: UHC Exchange |
$24.01
|
| Rate for Payer: UHC Medicaid |
$8.10
|
| Rate for Payer: UHCCP DNSP |
$15.49
|
| Rate for Payer: UHCCP Medicaid |
$8.10
|
| Rate for Payer: VA VA |
$15.49
|
|
|
HC HEPATITIS C ANTIBODY BY RIBA
|
Facility
|
IP
|
$84.27
|
|
|
Service Code
|
CPT 86804
|
| Hospital Charge Code |
30200337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$84.27 |
| Rate for Payer: Aetna Commercial |
$75.84
|
| Rate for Payer: ASR ASR |
$81.74
|
| Rate for Payer: BCBS Trust/PPO |
$69.20
|
| Rate for Payer: BCN Commercial |
$69.20
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$79.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.42
|
| Rate for Payer: Healthscope Commercial |
$81.74
|
| Rate for Payer: Healthscope Whirlpool |
$84.27
|
| Rate for Payer: Mclaren Commercial |
$75.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.63
|
| Rate for Payer: Nomi Health Commercial |
$69.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.16
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANT
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600295
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.41 |
| Max. Negotiated Rate |
$272.38 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| 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 |
$151.32
|
| Rate for Payer: BCBS Complete |
$23.53
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$128.62
|
| Rate for Payer: BCN Commercial |
$128.62
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$146.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$151.32
|
| Rate for Payer: Healthscope Whirlpool |
$156.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.84
|
| Rate for Payer: Mclaren Commercial |
$140.40
|
| Rate for Payer: Mclaren Medicaid |
$42.84
|
| Rate for Payer: Mclaren Medicare |
$42.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.98
|
| Rate for Payer: Meridian Medicaid |
$23.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.60
|
| Rate for Payer: Nomi Health Commercial |
$127.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.00
|
| 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 |
$22.96
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$272.38
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health Narrow Network |
$217.90
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.84
|
| Rate for Payer: UHC Exchange |
$66.40
|
| Rate for Payer: UHC Medicaid |
$22.41
|
| Rate for Payer: UHCCP DNSP |
$42.84
|
| Rate for Payer: UHCCP Medicaid |
$22.41
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANT
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600295
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: ASR ASR |
$151.32
|
| Rate for Payer: BCBS Trust/PPO |
$128.11
|
| Rate for Payer: BCN Commercial |
$128.11
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$146.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.80
|
| Rate for Payer: Healthscope Commercial |
$151.32
|
| Rate for Payer: Healthscope Whirlpool |
$156.00
|
| Rate for Payer: Mclaren Commercial |
$140.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.60
|
| Rate for Payer: Nomi Health Commercial |
$127.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.28
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANTIFICATION
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600157
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.41 |
| Max. Negotiated Rate |
$272.38 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| 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 |
$151.32
|
| Rate for Payer: BCBS Complete |
$23.53
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$128.62
|
| Rate for Payer: BCN Commercial |
$128.62
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$146.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$151.32
|
| Rate for Payer: Healthscope Whirlpool |
$156.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.84
|
| Rate for Payer: Mclaren Commercial |
$140.40
|
| Rate for Payer: Mclaren Medicaid |
$42.84
|
| Rate for Payer: Mclaren Medicare |
$42.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.98
|
| Rate for Payer: Meridian Medicaid |
$23.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.60
|
| Rate for Payer: Nomi Health Commercial |
$127.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.00
|
| 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 |
$22.96
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$272.38
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health Narrow Network |
$217.90
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.84
|
| Rate for Payer: UHC Exchange |
$66.40
|
| Rate for Payer: UHC Medicaid |
$22.41
|
| Rate for Payer: UHCCP DNSP |
$42.84
|
| Rate for Payer: UHCCP Medicaid |
$22.41
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANTIFICATION
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600157
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: ASR ASR |
$151.32
|
| Rate for Payer: BCBS Trust/PPO |
$128.11
|
| Rate for Payer: BCN Commercial |
$128.11
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$146.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.80
|
| Rate for Payer: Healthscope Commercial |
$151.32
|
| Rate for Payer: Healthscope Whirlpool |
$156.00
|
| Rate for Payer: Mclaren Commercial |
$140.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.60
|
| Rate for Payer: Nomi Health Commercial |
$127.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.28
|
|
|
HC HEPATITS B VACCINE (HEPB), PEDIATRIC/ADOLESCENT, 3 DOSE IM
|
Facility
|
IP
|
$37.14
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
63600086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$37.14 |
| Rate for Payer: Aetna Commercial |
$33.43
|
| Rate for Payer: ASR ASR |
$36.03
|
| Rate for Payer: BCBS Trust/PPO |
$30.50
|
| Rate for Payer: BCN Commercial |
$30.50
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$34.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Healthscope Commercial |
$36.03
|
| Rate for Payer: Healthscope Whirlpool |
$37.14
|
| Rate for Payer: Mclaren Commercial |
$33.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.68
|
|
|
HC HEPATITS B VACCINE (HEPB), PEDIATRIC/ADOLESCENT, 3 DOSE IM
|
Facility
|
OP
|
$37.14
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
63600086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$37.14 |
| Rate for Payer: Aetna Commercial |
$33.43
|
| Rate for Payer: Aetna Medicare |
$13.74
|
| Rate for Payer: ASR ASR |
$36.03
|
| Rate for Payer: BCBS Complete |
$14.86
|
| Rate for Payer: BCBS Trust/PPO |
$30.62
|
| Rate for Payer: BCN Commercial |
$30.62
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$34.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Healthscope Commercial |
$36.03
|
| Rate for Payer: Healthscope Whirlpool |
$37.14
|
| Rate for Payer: Mclaren Commercial |
$33.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$33.20
|
| Rate for Payer: Priority Health Narrow Network |
$26.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.68
|
|
|
HC HEP B ADMINISTRATION
|
Facility
|
IP
|
$34.85
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
77100008
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$26.14 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: Aetna Commercial |
$31.36
|
| Rate for Payer: ASR ASR |
$33.80
|
| Rate for Payer: BCBS Trust/PPO |
$28.62
|
| Rate for Payer: BCN Commercial |
$28.62
|
| Rate for Payer: Cash Price |
$27.88
|
| Rate for Payer: Cofinity Commercial |
$32.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.88
|
| Rate for Payer: Healthscope Commercial |
$33.80
|
| Rate for Payer: Healthscope Whirlpool |
$34.85
|
| Rate for Payer: Mclaren Commercial |
$31.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.62
|
| Rate for Payer: Nomi Health Commercial |
$28.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.67
|
|
|
HC HEP B ADMINISTRATION
|
Facility
|
OP
|
$34.85
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
77100008
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$72.32 |
| Rate for Payer: Aetna Commercial |
$31.36
|
| Rate for Payer: Aetna Medicare |
$46.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.33
|
| Rate for Payer: ASR ASR |
$33.80
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS MAPPO |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$28.73
|
| Rate for Payer: BCN Commercial |
$28.73
|
| Rate for Payer: BCN Medicare Advantage |
$46.66
|
| Rate for Payer: Cash Price |
$27.88
|
| Rate for Payer: Cash Price |
$27.88
|
| Rate for Payer: Cofinity Commercial |
$32.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.66
|
| Rate for Payer: Healthscope Commercial |
$33.80
|
| Rate for Payer: Healthscope Whirlpool |
$34.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$46.66
|
| Rate for Payer: Mclaren Commercial |
$31.36
|
| Rate for Payer: Mclaren Medicaid |
$46.66
|
| Rate for Payer: Mclaren Medicare |
$46.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.99
|
| Rate for Payer: Meridian Medicaid |
$25.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.62
|
| Rate for Payer: Nomi Health Commercial |
$28.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.14
|
| Rate for Payer: PACE Medicare |
$44.33
|
| Rate for Payer: PACE SWMI |
$46.66
|
| Rate for Payer: PHP Commercial |
$51.33
|
| Rate for Payer: PHP Medicaid |
$25.01
|
| Rate for Payer: PHP Medicare Advantage |
$46.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30.54
|
| Rate for Payer: Priority Health Medicare |
$46.66
|
| Rate for Payer: Priority Health Narrow Network |
$24.43
|
| Rate for Payer: Railroad Medicare Medicare |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.66
|
| Rate for Payer: UHC Exchange |
$72.32
|
| Rate for Payer: UHC Medicaid |
$24.40
|
| Rate for Payer: UHCCP DNSP |
$46.66
|
| Rate for Payer: UHCCP Medicaid |
$24.40
|
| Rate for Payer: VA VA |
$46.66
|
|
|
HC HEP B CORE AB TOTAL.
|
Facility
|
OP
|
$101.96
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200293
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$101.96 |
| Rate for Payer: Aetna Commercial |
$91.76
|
| 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 |
$98.90
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$84.07
|
| Rate for Payer: BCN Commercial |
$84.07
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$95.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$98.90
|
| Rate for Payer: Healthscope Whirlpool |
$101.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$91.76
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$83.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.47
|
| 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 |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$56.91
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$45.53
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC HEP B CORE AB TOTAL.
|
Facility
|
IP
|
$101.96
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200293
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$76.47 |
| Max. Negotiated Rate |
$101.96 |
| Rate for Payer: Aetna Commercial |
$91.76
|
| Rate for Payer: ASR ASR |
$98.90
|
| Rate for Payer: BCBS Trust/PPO |
$83.73
|
| Rate for Payer: BCN Commercial |
$83.73
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$95.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Healthscope Commercial |
$98.90
|
| Rate for Payer: Healthscope Whirlpool |
$101.96
|
| Rate for Payer: Mclaren Commercial |
$91.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$83.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.72
|
|
|
HC HEP B SURFACE ANTIGEN CONFIRMATION
|
Facility
|
IP
|
$46.85
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600140
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.14 |
| Max. Negotiated Rate |
$46.85 |
| Rate for Payer: Aetna Commercial |
$42.16
|
| Rate for Payer: ASR ASR |
$45.44
|
| Rate for Payer: BCBS Trust/PPO |
$38.47
|
| Rate for Payer: BCN Commercial |
$38.47
|
| Rate for Payer: Cash Price |
$37.48
|
| Rate for Payer: Cofinity Commercial |
$44.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.48
|
| Rate for Payer: Healthscope Commercial |
$45.44
|
| Rate for Payer: Healthscope Whirlpool |
$46.85
|
| Rate for Payer: Mclaren Commercial |
$42.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.82
|
| Rate for Payer: Nomi Health Commercial |
$38.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.23
|
|
|
HC HEP B SURFACE ANTIGEN CONFIRMATION
|
Facility
|
OP
|
$46.85
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600140
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$46.85 |
| Rate for Payer: Aetna Commercial |
$42.16
|
| 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 |
$45.44
|
| Rate for Payer: BCBS Complete |
$5.67
|
| Rate for Payer: BCBS MAPPO |
$10.33
|
| Rate for Payer: BCBS Trust/PPO |
$38.63
|
| Rate for Payer: BCN Commercial |
$38.63
|
| Rate for Payer: BCN Medicare Advantage |
$10.33
|
| Rate for Payer: Cash Price |
$37.48
|
| Rate for Payer: Cash Price |
$37.48
|
| Rate for Payer: Cofinity Commercial |
$44.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.33
|
| Rate for Payer: Healthscope Commercial |
$45.44
|
| Rate for Payer: Healthscope Whirlpool |
$46.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.33
|
| Rate for Payer: Mclaren Commercial |
$42.16
|
| Rate for Payer: Mclaren Medicaid |
$10.33
|
| Rate for Payer: Mclaren Medicare |
$10.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.85
|
| Rate for Payer: Meridian Medicaid |
$5.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.82
|
| Rate for Payer: Nomi Health Commercial |
$38.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.14
|
| 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 |
$5.54
|
| Rate for Payer: PHP Medicare Advantage |
$10.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$43.60
|
| Rate for Payer: Priority Health Medicare |
$10.33
|
| Rate for Payer: Priority Health Narrow Network |
$34.88
|
| Rate for Payer: Railroad Medicare Medicare |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.33
|
| Rate for Payer: UHC Exchange |
$16.01
|
| Rate for Payer: UHC Medicaid |
$5.40
|
| Rate for Payer: UHCCP DNSP |
$10.33
|
| Rate for Payer: UHCCP Medicaid |
$5.40
|
| Rate for Payer: VA VA |
$10.33
|
|
|
HC HEP B VACC 2 DOSE ADULT IM
|
Facility
|
IP
|
$339.59
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
63600181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$254.69 |
| Max. Negotiated Rate |
$339.59 |
| Rate for Payer: Aetna Commercial |
$305.63
|
| Rate for Payer: ASR ASR |
$329.40
|
| Rate for Payer: BCBS Trust/PPO |
$278.87
|
| Rate for Payer: BCN Commercial |
$278.87
|
| Rate for Payer: Cash Price |
$271.67
|
| Rate for Payer: Cofinity Commercial |
$319.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.67
|
| Rate for Payer: Healthscope Commercial |
$329.40
|
| Rate for Payer: Healthscope Whirlpool |
$339.59
|
| Rate for Payer: Mclaren Commercial |
$305.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.65
|
| Rate for Payer: Nomi Health Commercial |
$278.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.84
|
|
|
HC HEP B VACC 2 DOSE ADULT IM
|
Facility
|
OP
|
$339.59
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
63600181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$339.59 |
| Rate for Payer: Aetna Commercial |
$305.63
|
| Rate for Payer: Aetna Medicare |
$125.65
|
| Rate for Payer: ASR ASR |
$329.40
|
| Rate for Payer: BCBS Complete |
$135.84
|
| Rate for Payer: BCBS Trust/PPO |
$279.99
|
| Rate for Payer: BCN Commercial |
$279.99
|
| Rate for Payer: Cash Price |
$271.67
|
| Rate for Payer: Cash Price |
$271.67
|
| Rate for Payer: Cofinity Commercial |
$319.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.67
|
| Rate for Payer: Healthscope Commercial |
$329.40
|
| Rate for Payer: Healthscope Whirlpool |
$339.59
|
| Rate for Payer: Mclaren Commercial |
$305.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.65
|
| Rate for Payer: Nomi Health Commercial |
$278.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.84
|
|
|
HC HEP C GENO SUBTYPES
|
Facility
|
OP
|
$460.87
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600256
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$134.65 |
| Max. Negotiated Rate |
$877.65 |
| Rate for Payer: Aetna Commercial |
$414.78
|
| 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 |
$447.04
|
| Rate for Payer: BCBS Complete |
$141.39
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCBS Trust/PPO |
$379.99
|
| Rate for Payer: BCN Commercial |
$379.99
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$368.70
|
| Rate for Payer: Cash Price |
$368.70
|
| Rate for Payer: Cofinity Commercial |
$433.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Healthscope Commercial |
$447.04
|
| Rate for Payer: Healthscope Whirlpool |
$460.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$257.45
|
| Rate for Payer: Mclaren Commercial |
$414.78
|
| Rate for Payer: Mclaren Medicaid |
$257.45
|
| Rate for Payer: Mclaren Medicare |
$257.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.32
|
| Rate for Payer: Meridian Medicaid |
$141.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$283.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.74
|
| Rate for Payer: Nomi Health Commercial |
$377.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.65
|
| Rate for Payer: PACE Medicare |
$244.58
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PHP Commercial |
$283.19
|
| Rate for Payer: PHP Medicaid |
$137.99
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$877.65
|
| Rate for Payer: Priority Health Medicare |
$257.45
|
| Rate for Payer: Priority Health Narrow Network |
$702.12
|
| Rate for Payer: Railroad Medicare Medicare |
$257.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$405.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$257.45
|
| Rate for Payer: UHC Exchange |
$399.05
|
| Rate for Payer: UHC Medicaid |
$134.65
|
| Rate for Payer: UHCCP DNSP |
$257.45
|
| Rate for Payer: UHCCP Medicaid |
$134.65
|
| Rate for Payer: VA VA |
$257.45
|
|
|
HC HEP C GENO SUBTYPES
|
Facility
|
IP
|
$460.87
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600256
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$345.65 |
| Max. Negotiated Rate |
$460.87 |
| Rate for Payer: Aetna Commercial |
$414.78
|
| Rate for Payer: ASR ASR |
$447.04
|
| Rate for Payer: BCBS Trust/PPO |
$378.47
|
| Rate for Payer: BCN Commercial |
$378.47
|
| Rate for Payer: Cash Price |
$368.70
|
| Rate for Payer: Cofinity Commercial |
$433.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.70
|
| Rate for Payer: Healthscope Commercial |
$447.04
|
| Rate for Payer: Healthscope Whirlpool |
$460.87
|
| Rate for Payer: Mclaren Commercial |
$414.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.74
|
| Rate for Payer: Nomi Health Commercial |
$377.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$405.57
|
|
|
HC HER2 DUAL ISH
|
Facility
|
OP
|
$318.36
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000065
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$138.78 |
| Max. Negotiated Rate |
$553.60 |
| Rate for Payer: Aetna Commercial |
$286.52
|
| Rate for Payer: Aetna Medicare |
$357.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.45
|
| Rate for Payer: ASR ASR |
$308.81
|
| Rate for Payer: BCBS Complete |
$196.15
|
| Rate for Payer: BCBS MAPPO |
$357.16
|
| Rate for Payer: BCBS Trust/PPO |
$262.49
|
| Rate for Payer: BCCCP Commercial |
$138.78
|
| Rate for Payer: BCN Commercial |
$262.49
|
| Rate for Payer: BCN Medicare Advantage |
$357.16
|
| Rate for Payer: Cash Price |
$254.69
|
| Rate for Payer: Cash Price |
$254.69
|
| Rate for Payer: Cofinity Commercial |
$299.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.16
|
| Rate for Payer: Healthscope Commercial |
$308.81
|
| Rate for Payer: Healthscope Whirlpool |
$318.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$357.16
|
| Rate for Payer: Mclaren Commercial |
$286.52
|
| Rate for Payer: Mclaren Medicaid |
$357.16
|
| Rate for Payer: Mclaren Medicare |
$357.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.02
|
| Rate for Payer: Meridian Medicaid |
$196.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$392.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.61
|
| Rate for Payer: Nomi Health Commercial |
$261.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.77
|
| Rate for Payer: PACE Medicare |
$339.30
|
| Rate for Payer: PACE SWMI |
$357.16
|
| Rate for Payer: PHP Commercial |
$392.88
|
| Rate for Payer: PHP Medicaid |
$191.44
|
| Rate for Payer: PHP Medicare Advantage |
$357.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$278.95
|
| Rate for Payer: Priority Health Medicare |
$357.16
|
| Rate for Payer: Priority Health Narrow Network |
$223.17
|
| Rate for Payer: Railroad Medicare Medicare |
$357.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$280.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$357.16
|
| Rate for Payer: UHC Exchange |
$553.60
|
| Rate for Payer: UHC Medicaid |
$186.79
|
| Rate for Payer: UHCCP DNSP |
$357.16
|
| Rate for Payer: UHCCP Medicaid |
$186.79
|
| Rate for Payer: VA VA |
$357.16
|
|
|
HC HER2 DUAL ISH
|
Facility
|
IP
|
$318.36
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000065
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$238.77 |
| Max. Negotiated Rate |
$318.36 |
| Rate for Payer: Aetna Commercial |
$286.52
|
| Rate for Payer: ASR ASR |
$308.81
|
| Rate for Payer: BCBS Trust/PPO |
$261.44
|
| Rate for Payer: BCN Commercial |
$261.44
|
| Rate for Payer: Cash Price |
$254.69
|
| Rate for Payer: Cofinity Commercial |
$299.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.69
|
| Rate for Payer: Healthscope Commercial |
$308.81
|
| Rate for Payer: Healthscope Whirlpool |
$318.36
|
| Rate for Payer: Mclaren Commercial |
$286.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.61
|
| Rate for Payer: Nomi Health Commercial |
$261.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$280.16
|
|
|
HC HER2 DUAL ISH CMPT
|
Facility
|
OP
|
$318.36
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000066
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$138.78 |
| Max. Negotiated Rate |
$553.60 |
| Rate for Payer: Aetna Commercial |
$286.52
|
| Rate for Payer: Aetna Medicare |
$357.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.45
|
| Rate for Payer: ASR ASR |
$308.81
|
| Rate for Payer: BCBS Complete |
$196.15
|
| Rate for Payer: BCBS MAPPO |
$357.16
|
| Rate for Payer: BCBS Trust/PPO |
$262.49
|
| Rate for Payer: BCCCP Commercial |
$138.78
|
| Rate for Payer: BCN Commercial |
$262.49
|
| Rate for Payer: BCN Medicare Advantage |
$357.16
|
| Rate for Payer: Cash Price |
$254.69
|
| Rate for Payer: Cash Price |
$254.69
|
| Rate for Payer: Cofinity Commercial |
$299.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.16
|
| Rate for Payer: Healthscope Commercial |
$308.81
|
| Rate for Payer: Healthscope Whirlpool |
$318.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$357.16
|
| Rate for Payer: Mclaren Commercial |
$286.52
|
| Rate for Payer: Mclaren Medicaid |
$357.16
|
| Rate for Payer: Mclaren Medicare |
$357.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.02
|
| Rate for Payer: Meridian Medicaid |
$196.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$392.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.61
|
| Rate for Payer: Nomi Health Commercial |
$261.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.77
|
| Rate for Payer: PACE Medicare |
$339.30
|
| Rate for Payer: PACE SWMI |
$357.16
|
| Rate for Payer: PHP Commercial |
$392.88
|
| Rate for Payer: PHP Medicaid |
$191.44
|
| Rate for Payer: PHP Medicare Advantage |
$357.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$278.95
|
| Rate for Payer: Priority Health Medicare |
$357.16
|
| Rate for Payer: Priority Health Narrow Network |
$223.17
|
| Rate for Payer: Railroad Medicare Medicare |
$357.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$280.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$357.16
|
| Rate for Payer: UHC Exchange |
$553.60
|
| Rate for Payer: UHC Medicaid |
$186.79
|
| Rate for Payer: UHCCP DNSP |
$357.16
|
| Rate for Payer: UHCCP Medicaid |
$186.79
|
| Rate for Payer: VA VA |
$357.16
|
|
|
HC HER2 DUAL ISH CMPT
|
Facility
|
IP
|
$318.36
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000066
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$238.77 |
| Max. Negotiated Rate |
$318.36 |
| Rate for Payer: Aetna Commercial |
$286.52
|
| Rate for Payer: ASR ASR |
$308.81
|
| Rate for Payer: BCBS Trust/PPO |
$261.44
|
| Rate for Payer: BCN Commercial |
$261.44
|
| Rate for Payer: Cash Price |
$254.69
|
| Rate for Payer: Cofinity Commercial |
$299.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.69
|
| Rate for Payer: Healthscope Commercial |
$308.81
|
| Rate for Payer: Healthscope Whirlpool |
$318.36
|
| Rate for Payer: Mclaren Commercial |
$286.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.61
|
| Rate for Payer: Nomi Health Commercial |
$261.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$280.16
|
|
