|
HC HEPATITIS ABC PANEL
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
30100017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: ASR ASR |
$296.82
|
| Rate for Payer: ASR Commercial |
$296.82
|
| Rate for Payer: BCBS Trust/PPO |
$249.36
|
| Rate for Payer: BCN Commercial |
$237.24
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$287.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Healthscope Commercial |
$306.00
|
| Rate for Payer: Healthscope Whirlpool |
$296.82
|
| Rate for Payer: Mclaren Commercial |
$275.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.10
|
| Rate for Payer: Nomi Health Commercial |
$250.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$269.28
|
|
|
HC HEPATITIS ABC PANEL
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
30100017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.53 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: Aetna Medicare |
$47.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.54
|
| Rate for Payer: ASR ASR |
$296.82
|
| Rate for Payer: ASR Commercial |
$296.82
|
| Rate for Payer: BCBS Complete |
$26.81
|
| Rate for Payer: BCBS MAPPO |
$47.63
|
| Rate for Payer: BCBS Trust/PPO |
$250.58
|
| Rate for Payer: BCN Commercial |
$237.24
|
| Rate for Payer: BCN Medicare Advantage |
$47.63
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$287.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.63
|
| Rate for Payer: Healthscope Commercial |
$306.00
|
| Rate for Payer: Healthscope Whirlpool |
$296.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$47.63
|
| Rate for Payer: Mclaren Commercial |
$275.40
|
| Rate for Payer: Mclaren Medicaid |
$25.53
|
| Rate for Payer: Mclaren Medicare |
$47.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.01
|
| Rate for Payer: Meridian Medicaid |
$26.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.10
|
| Rate for Payer: Nomi Health Commercial |
$250.92
|
| Rate for Payer: PACE Medicare |
$45.25
|
| Rate for Payer: PACE SWMI |
$47.63
|
| Rate for Payer: PHP Commercial |
$52.39
|
| Rate for Payer: PHP Medicaid |
$25.53
|
| Rate for Payer: PHP Medicare Advantage |
$47.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.12
|
| Rate for Payer: Priority Health Medicare |
$47.63
|
| Rate for Payer: Priority Health Narrow Network |
$214.51
|
| Rate for Payer: Railroad Medicare Medicare |
$47.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$269.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.63
|
| Rate for Payer: UHC Exchange |
$73.83
|
| Rate for Payer: UHC Medicare Advantage |
$47.63
|
| Rate for Payer: UHCCP DNSP |
$47.63
|
| Rate for Payer: UHCCP Medicaid |
$25.53
|
| Rate for Payer: VA VA |
$47.63
|
|
|
HC HEPATITIS A IGG
|
Facility
|
OP
|
$43.70
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna Commercial |
$39.33
|
| Rate for Payer: Aetna Medicare |
$12.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.49
|
| Rate for Payer: ASR ASR |
$42.39
|
| Rate for Payer: ASR Commercial |
$42.39
|
| Rate for Payer: BCBS Complete |
$6.97
|
| Rate for Payer: BCBS MAPPO |
$12.39
|
| Rate for Payer: BCBS Trust/PPO |
$35.79
|
| Rate for Payer: BCN Commercial |
$33.88
|
| Rate for Payer: BCN Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$41.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.39
|
| Rate for Payer: Healthscope Commercial |
$43.70
|
| Rate for Payer: Healthscope Whirlpool |
$42.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.39
|
| Rate for Payer: Mclaren Commercial |
$39.33
|
| Rate for Payer: Mclaren Medicaid |
$6.64
|
| Rate for Payer: Mclaren Medicare |
$12.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.01
|
| Rate for Payer: Meridian Medicaid |
$6.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Nomi Health Commercial |
$35.83
|
| Rate for Payer: PACE Medicare |
$11.77
|
| Rate for Payer: PACE SWMI |
$12.39
|
| Rate for Payer: PHP Commercial |
$13.63
|
| Rate for Payer: PHP Medicaid |
$6.64
|
| Rate for Payer: PHP Medicare Advantage |
$12.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.29
|
| Rate for Payer: Priority Health Medicare |
$12.39
|
| Rate for Payer: Priority Health Narrow Network |
$30.63
|
| Rate for Payer: Railroad Medicare Medicare |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.39
|
| Rate for Payer: UHC Exchange |
$19.20
|
| Rate for Payer: UHC Medicare Advantage |
$12.39
|
| Rate for Payer: UHCCP DNSP |
$12.39
|
| Rate for Payer: UHCCP Medicaid |
$6.64
|
| Rate for Payer: VA VA |
$12.39
|
|
|
HC HEPATITIS A IGG
|
Facility
|
IP
|
$43.70
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.41 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna Commercial |
$39.33
|
| Rate for Payer: ASR ASR |
$42.39
|
| Rate for Payer: ASR Commercial |
$42.39
|
| Rate for Payer: BCBS Trust/PPO |
$35.61
|
| Rate for Payer: BCN Commercial |
$33.88
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$41.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$43.70
|
| Rate for Payer: Healthscope Whirlpool |
$42.39
|
| Rate for Payer: Mclaren Commercial |
$39.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Nomi Health Commercial |
$35.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.46
|
|
|
HC HEPATITIS A TOTAL ANTIBODY
|
Facility
|
IP
|
$47.86
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200298
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.11 |
| Max. Negotiated Rate |
$47.86 |
| Rate for Payer: Aetna Commercial |
$43.07
|
| Rate for Payer: ASR ASR |
$46.42
|
| Rate for Payer: ASR Commercial |
$46.42
|
| Rate for Payer: BCBS Trust/PPO |
$39.00
|
| Rate for Payer: BCN Commercial |
$37.11
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cofinity Commercial |
$44.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.29
|
| Rate for Payer: Healthscope Commercial |
$47.86
|
| Rate for Payer: Healthscope Whirlpool |
$46.42
|
| Rate for Payer: Mclaren Commercial |
$43.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.68
|
| Rate for Payer: Nomi Health Commercial |
$39.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.12
|
|
|
HC HEPATITIS A TOTAL ANTIBODY
|
Facility
|
OP
|
$47.86
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200298
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$47.86 |
| Rate for Payer: Aetna Commercial |
$43.07
|
| Rate for Payer: Aetna Medicare |
$12.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.49
|
| Rate for Payer: ASR ASR |
$46.42
|
| Rate for Payer: ASR Commercial |
$46.42
|
| Rate for Payer: BCBS Complete |
$6.97
|
| Rate for Payer: BCBS MAPPO |
$12.39
|
| Rate for Payer: BCBS Trust/PPO |
$39.19
|
| Rate for Payer: BCN Commercial |
$37.11
|
| Rate for Payer: BCN Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cofinity Commercial |
$44.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.39
|
| Rate for Payer: Healthscope Commercial |
$47.86
|
| Rate for Payer: Healthscope Whirlpool |
$46.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.39
|
| Rate for Payer: Mclaren Commercial |
$43.07
|
| Rate for Payer: Mclaren Medicaid |
$6.64
|
| Rate for Payer: Mclaren Medicare |
$12.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.01
|
| Rate for Payer: Meridian Medicaid |
$6.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.68
|
| Rate for Payer: Nomi Health Commercial |
$39.25
|
| Rate for Payer: PACE Medicare |
$11.77
|
| Rate for Payer: PACE SWMI |
$12.39
|
| Rate for Payer: PHP Commercial |
$13.63
|
| Rate for Payer: PHP Medicaid |
$6.64
|
| Rate for Payer: PHP Medicare Advantage |
$12.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.93
|
| Rate for Payer: Priority Health Medicare |
$12.39
|
| Rate for Payer: Priority Health Narrow Network |
$33.55
|
| Rate for Payer: Railroad Medicare Medicare |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.39
|
| Rate for Payer: UHC Exchange |
$19.20
|
| Rate for Payer: UHC Medicare Advantage |
$12.39
|
| Rate for Payer: UHCCP DNSP |
$12.39
|
| Rate for Payer: UHCCP Medicaid |
$6.64
|
| Rate for Payer: VA VA |
$12.39
|
|
|
HC HEPATITIS A VACCINE (HEPA) ADULT IM
|
Facility
|
OP
|
$91.56
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
63600067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$91.56 |
| Rate for Payer: Aetna Commercial |
$82.40
|
| Rate for Payer: Aetna Medicare |
$45.78
|
| Rate for Payer: ASR ASR |
$88.81
|
| Rate for Payer: ASR Commercial |
$88.81
|
| Rate for Payer: BCBS Complete |
$36.62
|
| Rate for Payer: BCBS Trust/PPO |
$74.98
|
| Rate for Payer: BCN Commercial |
$70.99
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$91.56
|
| Rate for Payer: Healthscope Whirlpool |
$88.81
|
| Rate for Payer: Mclaren Commercial |
$82.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.22
|
| Rate for Payer: Priority Health Narrow Network |
$64.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.57
|
|
|
HC HEPATITIS A VACCINE (HEPA) ADULT IM
|
Facility
|
IP
|
$91.56
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
63600067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$91.56 |
| Rate for Payer: Aetna Commercial |
$82.40
|
| Rate for Payer: ASR ASR |
$88.81
|
| Rate for Payer: ASR Commercial |
$88.81
|
| Rate for Payer: BCBS Trust/PPO |
$74.61
|
| Rate for Payer: BCN Commercial |
$70.99
|
| Rate for Payer: Cash Price |
$73.25
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$91.56
|
| Rate for Payer: Healthscope Whirlpool |
$88.81
|
| Rate for Payer: Mclaren Commercial |
$82.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.57
|
|
|
HC HEPATITIS A VAC (HEPA) PEDI/ADOLESCENT DOSAGE-2 DOSE SCHEDULE IM
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
63600068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC HEPATITIS A VAC (HEPA) PEDI/ADOLESCENT DOSAGE-2 DOSE SCHEDULE IM
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
63600068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$26.01
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
IP
|
$99.96
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
30200295
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$99.96 |
| Rate for Payer: Aetna Commercial |
$89.96
|
| Rate for Payer: ASR ASR |
$96.96
|
| Rate for Payer: ASR Commercial |
$96.96
|
| Rate for Payer: BCBS Trust/PPO |
$81.46
|
| Rate for Payer: BCN Commercial |
$77.50
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$93.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Healthscope Commercial |
$99.96
|
| Rate for Payer: Healthscope Whirlpool |
$96.96
|
| Rate for Payer: Mclaren Commercial |
$89.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.97
|
| Rate for Payer: Nomi Health Commercial |
$81.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.96
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
OP
|
$99.96
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
30200295
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$99.96 |
| Rate for Payer: Aetna Commercial |
$89.96
|
| Rate for Payer: Aetna Medicare |
$11.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.71
|
| Rate for Payer: ASR ASR |
$96.96
|
| Rate for Payer: ASR Commercial |
$96.96
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.77
|
| Rate for Payer: BCBS Trust/PPO |
$81.86
|
| Rate for Payer: BCN Commercial |
$77.50
|
| Rate for Payer: BCN Medicare Advantage |
$11.77
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$93.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.77
|
| Rate for Payer: Healthscope Commercial |
$99.96
|
| Rate for Payer: Healthscope Whirlpool |
$96.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.77
|
| Rate for Payer: Mclaren Commercial |
$89.96
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.36
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.97
|
| Rate for Payer: Nomi Health Commercial |
$81.97
|
| Rate for Payer: PACE Medicare |
$11.18
|
| Rate for Payer: PACE SWMI |
$11.77
|
| Rate for Payer: PHP Commercial |
$12.95
|
| Rate for Payer: PHP Medicaid |
$6.31
|
| Rate for Payer: PHP Medicare Advantage |
$11.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.58
|
| Rate for Payer: Priority Health Medicare |
$11.77
|
| Rate for Payer: Priority Health Narrow Network |
$70.07
|
| Rate for Payer: Railroad Medicare Medicare |
$11.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.77
|
| Rate for Payer: UHC Exchange |
$18.24
|
| Rate for Payer: UHC Medicare Advantage |
$11.77
|
| Rate for Payer: UHCCP DNSP |
$11.77
|
| Rate for Payer: UHCCP Medicaid |
$6.31
|
| Rate for Payer: VA VA |
$11.77
|
|
|
HC HEPATITIS B CORE AB TOTAL.
|
Facility
|
IP
|
$48.80
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200294
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.72 |
| Max. Negotiated Rate |
$48.80 |
| Rate for Payer: Aetna Commercial |
$43.92
|
| Rate for Payer: ASR ASR |
$47.34
|
| Rate for Payer: ASR Commercial |
$47.34
|
| Rate for Payer: BCBS Trust/PPO |
$39.77
|
| Rate for Payer: BCN Commercial |
$37.83
|
| Rate for Payer: Cash Price |
$39.04
|
| Rate for Payer: Cofinity Commercial |
$45.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.04
|
| Rate for Payer: Healthscope Commercial |
$48.80
|
| Rate for Payer: Healthscope Whirlpool |
$47.34
|
| Rate for Payer: Mclaren Commercial |
$43.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.48
|
| Rate for Payer: Nomi Health Commercial |
$40.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.94
|
|
|
HC HEPATITIS B CORE AB TOTAL.
|
Facility
|
OP
|
$48.80
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200294
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$48.80 |
| Rate for Payer: Aetna Commercial |
$43.92
|
| 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 |
$47.34
|
| Rate for Payer: ASR Commercial |
$47.34
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$39.96
|
| Rate for Payer: BCN Commercial |
$37.83
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$39.04
|
| Rate for Payer: Cash Price |
$39.04
|
| Rate for Payer: Cofinity Commercial |
$45.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$48.80
|
| Rate for Payer: Healthscope Whirlpool |
$47.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$43.92
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| 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 |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.48
|
| Rate for Payer: Nomi Health Commercial |
$40.02
|
| 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 |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.76
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$34.21
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC HEPATITIS B CORE ANTIBODY TOTAL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200511
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: ASR ASR |
$48.50
|
| Rate for Payer: ASR Commercial |
$48.50
|
| Rate for Payer: BCBS Trust/PPO |
$40.74
|
| Rate for Payer: BCN Commercial |
$38.77
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$47.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$50.00
|
| Rate for Payer: Healthscope Whirlpool |
$48.50
|
| Rate for Payer: Mclaren Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.50
|
| Rate for Payer: Nomi Health Commercial |
$41.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.00
|
|
|
HC HEPATITIS B CORE ANTIBODY TOTAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200511
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| 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 |
$48.50
|
| Rate for Payer: ASR Commercial |
$48.50
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$40.95
|
| Rate for Payer: BCN Commercial |
$38.77
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$47.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$50.00
|
| Rate for Payer: Healthscope Whirlpool |
$48.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$45.00
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| 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 |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.50
|
| Rate for Payer: Nomi Health Commercial |
$41.00
|
| 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 |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.81
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$35.05
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC HEPATITIS B DNA QUANTITATION
|
Facility
|
OP
|
$176.87
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
30600154
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$176.87 |
| Rate for Payer: Aetna Commercial |
$159.18
|
| 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 |
$171.56
|
| Rate for Payer: ASR Commercial |
$171.56
|
| Rate for Payer: BCBS Complete |
$24.11
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$144.84
|
| Rate for Payer: BCN Commercial |
$137.13
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cofinity Commercial |
$166.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$176.87
|
| Rate for Payer: Healthscope Whirlpool |
$171.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$42.84
|
| Rate for Payer: Mclaren Commercial |
$159.18
|
| Rate for Payer: Mclaren Medicaid |
$22.96
|
| 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 |
$24.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.34
|
| Rate for Payer: Nomi Health Commercial |
$145.03
|
| 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 |
$22.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.97
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health Narrow Network |
$123.99
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.84
|
| Rate for Payer: UHC Exchange |
$66.40
|
| Rate for Payer: UHC Medicare Advantage |
$42.84
|
| Rate for Payer: UHCCP DNSP |
$42.84
|
| Rate for Payer: UHCCP Medicaid |
$22.96
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC HEPATITIS B DNA QUANTITATION
|
Facility
|
IP
|
$176.87
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
30600154
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$114.97 |
| Max. Negotiated Rate |
$176.87 |
| Rate for Payer: Aetna Commercial |
$159.18
|
| Rate for Payer: ASR ASR |
$171.56
|
| Rate for Payer: ASR Commercial |
$171.56
|
| Rate for Payer: BCBS Trust/PPO |
$144.13
|
| Rate for Payer: BCN Commercial |
$137.13
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cofinity Commercial |
$166.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.50
|
| Rate for Payer: Healthscope Commercial |
$176.87
|
| Rate for Payer: Healthscope Whirlpool |
$171.56
|
| Rate for Payer: Mclaren Commercial |
$159.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.34
|
| Rate for Payer: Nomi Health Commercial |
$145.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.65
|
|
|
HC HEPATITIS BE ANTIBODY
|
Facility
|
IP
|
$47.86
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
30200297
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.11 |
| Max. Negotiated Rate |
$47.86 |
| Rate for Payer: Aetna Commercial |
$43.07
|
| Rate for Payer: ASR ASR |
$46.42
|
| Rate for Payer: ASR Commercial |
$46.42
|
| Rate for Payer: BCBS Trust/PPO |
$39.00
|
| Rate for Payer: BCN Commercial |
$37.11
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cofinity Commercial |
$44.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.29
|
| Rate for Payer: Healthscope Commercial |
$47.86
|
| Rate for Payer: Healthscope Whirlpool |
$46.42
|
| Rate for Payer: Mclaren Commercial |
$43.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.68
|
| Rate for Payer: Nomi Health Commercial |
$39.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.12
|
|
|
HC HEPATITIS BE ANTIBODY
|
Facility
|
OP
|
$47.86
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
30200297
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$47.86 |
| Rate for Payer: Aetna Commercial |
$43.07
|
| Rate for Payer: Aetna Medicare |
$11.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.46
|
| Rate for Payer: ASR ASR |
$46.42
|
| Rate for Payer: ASR Commercial |
$46.42
|
| Rate for Payer: BCBS Complete |
$6.51
|
| Rate for Payer: BCBS MAPPO |
$11.57
|
| Rate for Payer: BCBS Trust/PPO |
$39.19
|
| Rate for Payer: BCN Commercial |
$37.11
|
| Rate for Payer: BCN Medicare Advantage |
$11.57
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cofinity Commercial |
$44.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.57
|
| Rate for Payer: Healthscope Commercial |
$47.86
|
| Rate for Payer: Healthscope Whirlpool |
$46.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.57
|
| Rate for Payer: Mclaren Commercial |
$43.07
|
| Rate for Payer: Mclaren Medicaid |
$6.20
|
| Rate for Payer: Mclaren Medicare |
$11.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.15
|
| Rate for Payer: Meridian Medicaid |
$6.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.68
|
| Rate for Payer: Nomi Health Commercial |
$39.25
|
| Rate for Payer: PACE Medicare |
$10.99
|
| Rate for Payer: PACE SWMI |
$11.57
|
| Rate for Payer: PHP Commercial |
$12.73
|
| Rate for Payer: PHP Medicaid |
$6.20
|
| Rate for Payer: PHP Medicare Advantage |
$11.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.93
|
| Rate for Payer: Priority Health Medicare |
$11.57
|
| Rate for Payer: Priority Health Narrow Network |
$33.55
|
| Rate for Payer: Railroad Medicare Medicare |
$11.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.57
|
| Rate for Payer: UHC Exchange |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$11.57
|
| Rate for Payer: UHCCP DNSP |
$11.57
|
| Rate for Payer: UHCCP Medicaid |
$6.20
|
| Rate for Payer: VA VA |
$11.57
|
|
|
HC HEPATITIS BE ANTIGEN
|
Facility
|
OP
|
$87.72
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
30600142
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Aetna Commercial |
$78.95
|
| 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 |
$85.09
|
| Rate for Payer: ASR Commercial |
$85.09
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$71.83
|
| Rate for Payer: BCN Commercial |
$68.01
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| 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 |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$87.72
|
| Rate for Payer: Healthscope Whirlpool |
$85.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$78.95
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.56
|
| Rate for Payer: Nomi Health Commercial |
$71.93
|
| 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 |
$6.18
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.86
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$61.49
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP DNSP |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC HEPATITIS BE ANTIGEN
|
Facility
|
IP
|
$87.72
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
30600142
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$87.72 |
| Rate for Payer: Aetna Commercial |
$78.95
|
| Rate for Payer: ASR ASR |
$85.09
|
| Rate for Payer: ASR Commercial |
$85.09
|
| Rate for Payer: BCBS Trust/PPO |
$71.48
|
| 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 Commercial |
$74.56
|
| Rate for Payer: Nomi Health Commercial |
$71.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.19
|
|
|
HC HEPATITIS B SURFACE ANTIBODY
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
30200296
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$10.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.43
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Complete |
$6.04
|
| Rate for Payer: BCBS MAPPO |
$10.74
|
| Rate for Payer: BCBS Trust/PPO |
$42.60
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: BCN Medicare Advantage |
$10.74
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.74
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.74
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$5.76
|
| Rate for Payer: Mclaren Medicare |
$10.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.28
|
| Rate for Payer: Meridian Medicaid |
$6.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Medicare |
$10.20
|
| Rate for Payer: PACE SWMI |
$10.74
|
| Rate for Payer: PHP Commercial |
$11.81
|
| Rate for Payer: PHP Medicaid |
$5.76
|
| Rate for Payer: PHP Medicare Advantage |
$10.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.58
|
| Rate for Payer: Priority Health Medicare |
$10.74
|
| Rate for Payer: Priority Health Narrow Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$10.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.74
|
| Rate for Payer: UHC Exchange |
$16.65
|
| Rate for Payer: UHC Medicare Advantage |
$10.74
|
| Rate for Payer: UHCCP DNSP |
$10.74
|
| Rate for Payer: UHCCP Medicaid |
$5.76
|
| Rate for Payer: VA VA |
$10.74
|
|
|
HC HEPATITIS B SURFACE ANTIBODY
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
30200296
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$52.02 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: ASR ASR |
$50.46
|
| Rate for Payer: ASR Commercial |
$50.46
|
| Rate for Payer: BCBS Trust/PPO |
$42.39
|
| Rate for Payer: BCN Commercial |
$40.33
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Whirlpool |
$50.46
|
| Rate for Payer: Mclaren Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.78
|
|
|
HC HEPATITIS B SURFACE ANTIGEN
|
Facility
|
IP
|
$38.85
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600139
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$38.85 |
| Rate for Payer: Aetna Commercial |
$34.97
|
| Rate for Payer: ASR ASR |
$37.68
|
| Rate for Payer: ASR Commercial |
$37.68
|
| Rate for Payer: BCBS Trust/PPO |
$31.66
|
| Rate for Payer: BCN Commercial |
$30.12
|
| Rate for Payer: Cash Price |
$31.08
|
| Rate for Payer: Cofinity Commercial |
$36.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.08
|
| Rate for Payer: Healthscope Commercial |
$38.85
|
| Rate for Payer: Healthscope Whirlpool |
$37.68
|
| Rate for Payer: Mclaren Commercial |
$34.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.02
|
| Rate for Payer: Nomi Health Commercial |
$31.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.19
|
|
