|
HC HEP B ADMINISTRATION
|
Facility
|
IP
|
$34.17
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
77100008
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.21 |
| Max. Negotiated Rate |
$34.17 |
| Rate for Payer: Aetna Commercial |
$30.75
|
| Rate for Payer: ASR ASR |
$33.14
|
| Rate for Payer: ASR Commercial |
$33.14
|
| Rate for Payer: BCBS Trust/PPO |
$27.85
|
| Rate for Payer: BCN Commercial |
$26.49
|
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Cofinity Commercial |
$32.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.34
|
| Rate for Payer: Healthscope Commercial |
$34.17
|
| Rate for Payer: Healthscope Whirlpool |
$33.14
|
| Rate for Payer: Mclaren Commercial |
$30.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.04
|
| Rate for Payer: Nomi Health Commercial |
$28.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.07
|
|
|
HC HEP B ADMINISTRATION
|
Facility
|
OP
|
$34.17
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
77100008
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.21 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$30.75
|
| Rate for Payer: Aetna Medicare |
$45.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.51
|
| Rate for Payer: ASR ASR |
$33.14
|
| Rate for Payer: ASR Commercial |
$33.14
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS MAPPO |
$45.21
|
| Rate for Payer: BCBS Trust/PPO |
$27.98
|
| Rate for Payer: BCN Commercial |
$26.49
|
| Rate for Payer: BCN Medicare Advantage |
$45.21
|
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Cofinity Commercial |
$32.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.21
|
| Rate for Payer: Healthscope Commercial |
$34.17
|
| Rate for Payer: Healthscope Whirlpool |
$33.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$45.21
|
| Rate for Payer: Mclaren Commercial |
$30.75
|
| Rate for Payer: Mclaren Medicaid |
$24.23
|
| Rate for Payer: Mclaren Medicare |
$45.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.47
|
| Rate for Payer: Meridian Medicaid |
$25.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.04
|
| Rate for Payer: Nomi Health Commercial |
$28.02
|
| Rate for Payer: PACE Medicare |
$42.95
|
| Rate for Payer: PACE SWMI |
$45.21
|
| Rate for Payer: PHP Commercial |
$49.73
|
| Rate for Payer: PHP Medicaid |
$24.23
|
| Rate for Payer: PHP Medicare Advantage |
$45.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.94
|
| Rate for Payer: Priority Health Medicare |
$45.21
|
| Rate for Payer: Priority Health Narrow Network |
$23.95
|
| Rate for Payer: Railroad Medicare Medicare |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.21
|
| Rate for Payer: UHC Exchange |
$70.08
|
| Rate for Payer: UHC Medicare Advantage |
$45.21
|
| Rate for Payer: UHCCP DNSP |
$45.21
|
| Rate for Payer: UHCCP Medicaid |
$24.23
|
| Rate for Payer: VA VA |
$45.21
|
|
|
HC HEP B CORE AB TOTAL.
|
Facility
|
IP
|
$99.96
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200293
|
|
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 HEP B CORE AB TOTAL.
|
Facility
|
OP
|
$99.96
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200293
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$99.96 |
| Rate for Payer: Aetna Commercial |
$89.96
|
| 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 |
$96.96
|
| Rate for Payer: ASR Commercial |
$96.96
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$81.86
|
| Rate for Payer: BCN Commercial |
$77.50
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| 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 |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$99.96
|
| Rate for Payer: Healthscope Whirlpool |
$96.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$89.96
|
| 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 |
$84.97
|
| Rate for Payer: Nomi Health Commercial |
$81.97
|
| 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 |
$64.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.62
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$41.30
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.96
|
| 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 HEP B SURFACE ANTIGEN CONFIRMATION
|
Facility
|
OP
|
$45.93
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600140
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| 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 |
$44.55
|
| Rate for Payer: ASR Commercial |
$44.55
|
| Rate for Payer: BCBS Complete |
$5.81
|
| Rate for Payer: BCBS MAPPO |
$10.33
|
| Rate for Payer: BCBS Trust/PPO |
$37.61
|
| Rate for Payer: BCN Commercial |
$35.61
|
| Rate for Payer: BCN Medicare Advantage |
$10.33
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cofinity Commercial |
$43.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.33
|
| Rate for Payer: Healthscope Commercial |
$45.93
|
| Rate for Payer: Healthscope Whirlpool |
$44.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.33
|
| Rate for Payer: Mclaren Commercial |
$41.34
|
| Rate for Payer: Mclaren Medicaid |
$5.54
|
| 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 |
$5.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.04
|
| Rate for Payer: Nomi Health Commercial |
$37.66
|
| 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 |
$5.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.54
|
| Rate for Payer: Priority Health Medicare |
$10.33
|
| Rate for Payer: Priority Health Narrow Network |
$31.63
|
| Rate for Payer: Railroad Medicare Medicare |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.33
|
| Rate for Payer: UHC Exchange |
$16.01
|
| Rate for Payer: UHC Medicare Advantage |
$10.33
|
| Rate for Payer: UHCCP DNSP |
$10.33
|
| Rate for Payer: UHCCP Medicaid |
$5.54
|
| Rate for Payer: VA VA |
$10.33
|
|
|
HC HEP B SURFACE ANTIGEN CONFIRMATION
|
Facility
|
IP
|
$45.93
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600140
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$41.34
|
| Rate for Payer: ASR ASR |
$44.55
|
| Rate for Payer: ASR Commercial |
$44.55
|
| Rate for Payer: BCBS Trust/PPO |
$37.43
|
| Rate for Payer: BCN Commercial |
$35.61
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cofinity Commercial |
$43.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.74
|
| Rate for Payer: Healthscope Commercial |
$45.93
|
| Rate for Payer: Healthscope Whirlpool |
$44.55
|
| Rate for Payer: Mclaren Commercial |
$41.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.04
|
| Rate for Payer: Nomi Health Commercial |
$37.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.42
|
|
|
HC HEP B VACC 2 DOSE ADULT IM
|
Facility
|
IP
|
$332.93
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
63600181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$216.40 |
| Max. Negotiated Rate |
$332.93 |
| Rate for Payer: Aetna Commercial |
$299.64
|
| Rate for Payer: ASR ASR |
$322.94
|
| Rate for Payer: ASR Commercial |
$322.94
|
| Rate for Payer: BCBS Trust/PPO |
$271.30
|
| Rate for Payer: BCN Commercial |
$258.12
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cofinity Commercial |
$312.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.34
|
| Rate for Payer: Healthscope Commercial |
$332.93
|
| Rate for Payer: Healthscope Whirlpool |
$322.94
|
| Rate for Payer: Mclaren Commercial |
$299.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.99
|
| Rate for Payer: Nomi Health Commercial |
$273.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.98
|
|
|
HC HEP B VACC 2 DOSE ADULT IM
|
Facility
|
OP
|
$332.93
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
63600181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$332.93 |
| Rate for Payer: Aetna Commercial |
$299.64
|
| Rate for Payer: Aetna Medicare |
$166.46
|
| Rate for Payer: ASR ASR |
$322.94
|
| Rate for Payer: ASR Commercial |
$322.94
|
| Rate for Payer: BCBS Complete |
$133.17
|
| Rate for Payer: BCBS Trust/PPO |
$272.64
|
| Rate for Payer: BCN Commercial |
$258.12
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cofinity Commercial |
$312.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.34
|
| Rate for Payer: Healthscope Commercial |
$332.93
|
| Rate for Payer: Healthscope Whirlpool |
$322.94
|
| Rate for Payer: Mclaren Commercial |
$299.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.99
|
| Rate for Payer: Nomi Health Commercial |
$273.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.40
|
| Rate for Payer: 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 |
$292.98
|
|
|
HC HEP C GENO SUBTYPES
|
Facility
|
OP
|
$421.13
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600256
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$137.99 |
| Max. Negotiated Rate |
$796.06 |
| Rate for Payer: Aetna Commercial |
$379.02
|
| 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 |
$408.50
|
| Rate for Payer: ASR Commercial |
$408.50
|
| Rate for Payer: BCBS Complete |
$144.89
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCBS Trust/PPO |
$344.86
|
| Rate for Payer: BCN Commercial |
$326.50
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cofinity Commercial |
$395.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Healthscope Commercial |
$421.13
|
| Rate for Payer: Healthscope Whirlpool |
$408.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$257.45
|
| Rate for Payer: Mclaren Commercial |
$379.02
|
| Rate for Payer: Mclaren Medicaid |
$137.99
|
| 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 |
$144.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.96
|
| Rate for Payer: Nomi Health Commercial |
$345.33
|
| Rate for Payer: PACE Medicare |
$244.58
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PHP Commercial |
$283.20
|
| Rate for Payer: PHP Medicaid |
$137.99
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$796.06
|
| Rate for Payer: Priority Health Medicare |
$257.45
|
| Rate for Payer: Priority Health Narrow Network |
$636.85
|
| Rate for Payer: Railroad Medicare Medicare |
$257.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.45
|
| Rate for Payer: UHC Exchange |
$399.05
|
| Rate for Payer: UHC Medicare Advantage |
$257.45
|
| Rate for Payer: UHCCP DNSP |
$257.45
|
| Rate for Payer: UHCCP Medicaid |
$137.99
|
| Rate for Payer: VA VA |
$257.45
|
|
|
HC HEP C GENO SUBTYPES
|
Facility
|
IP
|
$421.13
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600256
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$273.73 |
| Max. Negotiated Rate |
$421.13 |
| Rate for Payer: Aetna Commercial |
$379.02
|
| Rate for Payer: ASR ASR |
$408.50
|
| Rate for Payer: ASR Commercial |
$408.50
|
| Rate for Payer: BCBS Trust/PPO |
$343.18
|
| Rate for Payer: BCN Commercial |
$326.50
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cofinity Commercial |
$395.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.90
|
| Rate for Payer: Healthscope Commercial |
$421.13
|
| Rate for Payer: Healthscope Whirlpool |
$408.50
|
| Rate for Payer: Mclaren Commercial |
$379.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.96
|
| Rate for Payer: Nomi Health Commercial |
$345.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.59
|
|
|
HC HER2 DUAL ISH
|
Facility
|
IP
|
$312.12
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000065
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$202.88 |
| Max. Negotiated Rate |
$312.12 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: ASR ASR |
$302.76
|
| Rate for Payer: ASR Commercial |
$302.76
|
| Rate for Payer: BCBS Trust/PPO |
$254.35
|
| Rate for Payer: BCN Commercial |
$241.99
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$293.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Healthscope Commercial |
$312.12
|
| Rate for Payer: Healthscope Whirlpool |
$302.76
|
| Rate for Payer: Mclaren Commercial |
$280.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.67
|
|
|
HC HER2 DUAL ISH
|
Facility
|
OP
|
$312.12
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000065
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$138.78 |
| Max. Negotiated Rate |
$546.30 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: Aetna Medicare |
$352.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$440.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$440.56
|
| Rate for Payer: ASR ASR |
$302.76
|
| Rate for Payer: ASR Commercial |
$302.76
|
| Rate for Payer: BCBS Complete |
$198.36
|
| Rate for Payer: BCBS MAPPO |
$352.45
|
| Rate for Payer: BCBS Trust/PPO |
$255.60
|
| Rate for Payer: BCCCP Commercial |
$138.78
|
| Rate for Payer: BCN Commercial |
$241.99
|
| Rate for Payer: BCN Medicare Advantage |
$352.45
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$293.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.45
|
| Rate for Payer: Healthscope Commercial |
$312.12
|
| Rate for Payer: Healthscope Whirlpool |
$302.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$352.45
|
| Rate for Payer: Mclaren Commercial |
$280.91
|
| Rate for Payer: Mclaren Medicaid |
$188.91
|
| Rate for Payer: Mclaren Medicare |
$352.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$370.07
|
| Rate for Payer: Meridian Medicaid |
$198.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$405.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: PACE Medicare |
$334.83
|
| Rate for Payer: PACE SWMI |
$352.45
|
| Rate for Payer: PHP Commercial |
$387.70
|
| Rate for Payer: PHP Medicaid |
$188.91
|
| Rate for Payer: PHP Medicare Advantage |
$352.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.48
|
| Rate for Payer: Priority Health Medicare |
$352.45
|
| Rate for Payer: Priority Health Narrow Network |
$218.80
|
| Rate for Payer: Railroad Medicare Medicare |
$352.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.45
|
| Rate for Payer: UHC Exchange |
$546.30
|
| Rate for Payer: UHC Medicare Advantage |
$352.45
|
| Rate for Payer: UHCCP DNSP |
$352.45
|
| Rate for Payer: UHCCP Medicaid |
$188.91
|
| Rate for Payer: VA VA |
$352.45
|
|
|
HC HER2 DUAL ISH CMPT
|
Facility
|
OP
|
$312.12
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000066
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$138.78 |
| Max. Negotiated Rate |
$546.30 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: Aetna Medicare |
$352.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$440.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$440.56
|
| Rate for Payer: ASR ASR |
$302.76
|
| Rate for Payer: ASR Commercial |
$302.76
|
| Rate for Payer: BCBS Complete |
$198.36
|
| Rate for Payer: BCBS MAPPO |
$352.45
|
| Rate for Payer: BCBS Trust/PPO |
$255.60
|
| Rate for Payer: BCCCP Commercial |
$138.78
|
| Rate for Payer: BCN Commercial |
$241.99
|
| Rate for Payer: BCN Medicare Advantage |
$352.45
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$293.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.45
|
| Rate for Payer: Healthscope Commercial |
$312.12
|
| Rate for Payer: Healthscope Whirlpool |
$302.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$352.45
|
| Rate for Payer: Mclaren Commercial |
$280.91
|
| Rate for Payer: Mclaren Medicaid |
$188.91
|
| Rate for Payer: Mclaren Medicare |
$352.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$370.07
|
| Rate for Payer: Meridian Medicaid |
$198.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$405.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: PACE Medicare |
$334.83
|
| Rate for Payer: PACE SWMI |
$352.45
|
| Rate for Payer: PHP Commercial |
$387.70
|
| Rate for Payer: PHP Medicaid |
$188.91
|
| Rate for Payer: PHP Medicare Advantage |
$352.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.48
|
| Rate for Payer: Priority Health Medicare |
$352.45
|
| Rate for Payer: Priority Health Narrow Network |
$218.80
|
| Rate for Payer: Railroad Medicare Medicare |
$352.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.45
|
| Rate for Payer: UHC Exchange |
$546.30
|
| Rate for Payer: UHC Medicare Advantage |
$352.45
|
| Rate for Payer: UHCCP DNSP |
$352.45
|
| Rate for Payer: UHCCP Medicaid |
$188.91
|
| Rate for Payer: VA VA |
$352.45
|
|
|
HC HER2 DUAL ISH CMPT
|
Facility
|
IP
|
$312.12
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000066
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$202.88 |
| Max. Negotiated Rate |
$312.12 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: ASR ASR |
$302.76
|
| Rate for Payer: ASR Commercial |
$302.76
|
| Rate for Payer: BCBS Trust/PPO |
$254.35
|
| Rate for Payer: BCN Commercial |
$241.99
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$293.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Healthscope Commercial |
$312.12
|
| Rate for Payer: Healthscope Whirlpool |
$302.76
|
| Rate for Payer: Mclaren Commercial |
$280.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.67
|
|
|
HC HER-2 NEU QUANTITATIVE
|
Facility
|
IP
|
$248.88
|
|
|
Service Code
|
CPT 83950
|
| Hospital Charge Code |
30100382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$161.77 |
| Max. Negotiated Rate |
$248.88 |
| Rate for Payer: Aetna Commercial |
$223.99
|
| Rate for Payer: ASR ASR |
$241.41
|
| Rate for Payer: ASR Commercial |
$241.41
|
| Rate for Payer: BCBS Trust/PPO |
$202.81
|
| Rate for Payer: BCN Commercial |
$192.96
|
| Rate for Payer: Cash Price |
$199.10
|
| Rate for Payer: Cofinity Commercial |
$233.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.10
|
| Rate for Payer: Healthscope Commercial |
$248.88
|
| Rate for Payer: Healthscope Whirlpool |
$241.41
|
| Rate for Payer: Mclaren Commercial |
$223.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.55
|
| Rate for Payer: Nomi Health Commercial |
$204.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.01
|
|
|
HC HER-2 NEU QUANTITATIVE
|
Facility
|
OP
|
$248.88
|
|
|
Service Code
|
CPT 83950
|
| Hospital Charge Code |
30100382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.52 |
| Max. Negotiated Rate |
$248.88 |
| Rate for Payer: Aetna Commercial |
$223.99
|
| Rate for Payer: Aetna Medicare |
$64.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.51
|
| Rate for Payer: ASR ASR |
$241.41
|
| Rate for Payer: ASR Commercial |
$241.41
|
| Rate for Payer: BCBS Complete |
$36.25
|
| Rate for Payer: BCBS MAPPO |
$64.41
|
| Rate for Payer: BCBS Trust/PPO |
$203.81
|
| Rate for Payer: BCN Commercial |
$192.96
|
| Rate for Payer: BCN Medicare Advantage |
$64.41
|
| Rate for Payer: Cash Price |
$199.10
|
| Rate for Payer: Cash Price |
$199.10
|
| Rate for Payer: Cofinity Commercial |
$233.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.41
|
| Rate for Payer: Healthscope Commercial |
$248.88
|
| Rate for Payer: Healthscope Whirlpool |
$241.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$64.41
|
| Rate for Payer: Mclaren Commercial |
$223.99
|
| Rate for Payer: Mclaren Medicaid |
$34.52
|
| Rate for Payer: Mclaren Medicare |
$64.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.63
|
| Rate for Payer: Meridian Medicaid |
$36.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.55
|
| Rate for Payer: Nomi Health Commercial |
$204.08
|
| Rate for Payer: PACE Medicare |
$61.19
|
| Rate for Payer: PACE SWMI |
$64.41
|
| Rate for Payer: PHP Commercial |
$70.85
|
| Rate for Payer: PHP Medicaid |
$34.52
|
| Rate for Payer: PHP Medicare Advantage |
$64.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.07
|
| Rate for Payer: Priority Health Medicare |
$64.41
|
| Rate for Payer: Priority Health Narrow Network |
$174.46
|
| Rate for Payer: Railroad Medicare Medicare |
$64.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.41
|
| Rate for Payer: UHC Exchange |
$99.84
|
| Rate for Payer: UHC Medicare Advantage |
$64.41
|
| Rate for Payer: UHCCP DNSP |
$64.41
|
| Rate for Payer: UHCCP Medicaid |
$34.52
|
| Rate for Payer: VA VA |
$64.41
|
|
|
HC HERPES PCR
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600211
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.34 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: ASR ASR |
$70.65
|
| Rate for Payer: ASR Commercial |
$70.65
|
| Rate for Payer: BCBS Trust/PPO |
$59.35
|
| Rate for Payer: BCN Commercial |
$56.47
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$68.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$72.83
|
| Rate for Payer: Healthscope Whirlpool |
$70.65
|
| Rate for Payer: Mclaren Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.09
|
|
|
HC HERPES PCR
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600211
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$70.65
|
| Rate for Payer: ASR Commercial |
$70.65
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$59.64
|
| Rate for Payer: BCN Commercial |
$56.47
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$68.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$72.83
|
| Rate for Payer: Healthscope Whirlpool |
$70.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$65.55
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.81
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$51.05
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HERPES PCR COMPONENT
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600212
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.34 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: ASR ASR |
$70.65
|
| Rate for Payer: ASR Commercial |
$70.65
|
| Rate for Payer: BCBS Trust/PPO |
$59.35
|
| Rate for Payer: BCN Commercial |
$56.47
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$68.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$72.83
|
| Rate for Payer: Healthscope Whirlpool |
$70.65
|
| Rate for Payer: Mclaren Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.09
|
|
|
HC HERPES PCR COMPONENT
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600212
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: ASR ASR |
$70.65
|
| Rate for Payer: ASR Commercial |
$70.65
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$59.64
|
| Rate for Payer: BCN Commercial |
$56.47
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$68.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$72.83
|
| Rate for Payer: Healthscope Whirlpool |
$70.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.09
|
| Rate for Payer: Mclaren Commercial |
$65.55
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$38.60
|
| Rate for Payer: PHP Medicaid |
$18.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.81
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow Network |
$51.05
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP DNSP |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$18.81
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HERPES SIMPLEX IGG TYPE 1
|
Facility
|
IP
|
$49.95
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200281
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.47 |
| Max. Negotiated Rate |
$49.95 |
| Rate for Payer: Aetna Commercial |
$44.96
|
| Rate for Payer: ASR ASR |
$48.45
|
| Rate for Payer: ASR Commercial |
$48.45
|
| Rate for Payer: BCBS Trust/PPO |
$40.70
|
| Rate for Payer: BCN Commercial |
$38.73
|
| Rate for Payer: Cash Price |
$39.96
|
| Rate for Payer: Cofinity Commercial |
$46.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.96
|
| Rate for Payer: Healthscope Commercial |
$49.95
|
| Rate for Payer: Healthscope Whirlpool |
$48.45
|
| Rate for Payer: Mclaren Commercial |
$44.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.46
|
| Rate for Payer: Nomi Health Commercial |
$40.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.96
|
|
|
HC HERPES SIMPLEX IGG TYPE 1
|
Facility
|
OP
|
$49.95
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200281
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$49.95 |
| Rate for Payer: Aetna Commercial |
$44.96
|
| Rate for Payer: Aetna Medicare |
$13.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: ASR ASR |
$48.45
|
| Rate for Payer: ASR Commercial |
$48.45
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$40.90
|
| Rate for Payer: BCN Commercial |
$38.73
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$39.96
|
| Rate for Payer: Cash Price |
$39.96
|
| Rate for Payer: Cofinity Commercial |
$46.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$49.95
|
| Rate for Payer: Healthscope Whirlpool |
$48.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.19
|
| Rate for Payer: Mclaren Commercial |
$44.96
|
| Rate for Payer: Mclaren Medicaid |
$7.07
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$7.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.46
|
| Rate for Payer: Nomi Health Commercial |
$40.96
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$14.51
|
| Rate for Payer: PHP Medicaid |
$7.07
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.93
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$26.34
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.19
|
| Rate for Payer: UHC Exchange |
$20.44
|
| Rate for Payer: UHC Medicare Advantage |
$13.19
|
| Rate for Payer: UHCCP DNSP |
$13.19
|
| Rate for Payer: UHCCP Medicaid |
$7.07
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC HERPES SIMPLEX IGG TYPE 2
|
Facility
|
IP
|
$73.29
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200283
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.64 |
| Max. Negotiated Rate |
$73.29 |
| Rate for Payer: Aetna Commercial |
$65.96
|
| Rate for Payer: ASR ASR |
$71.09
|
| Rate for Payer: ASR Commercial |
$71.09
|
| Rate for Payer: BCBS Trust/PPO |
$59.72
|
| Rate for Payer: BCN Commercial |
$56.82
|
| Rate for Payer: Cash Price |
$58.63
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.63
|
| Rate for Payer: Healthscope Commercial |
$73.29
|
| Rate for Payer: Healthscope Whirlpool |
$71.09
|
| Rate for Payer: Mclaren Commercial |
$65.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.30
|
| Rate for Payer: Nomi Health Commercial |
$60.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.50
|
|
|
HC HERPES SIMPLEX IGG TYPE 2
|
Facility
|
OP
|
$73.29
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200283
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$73.29 |
| Rate for Payer: Aetna Commercial |
$65.96
|
| Rate for Payer: Aetna Medicare |
$19.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: ASR ASR |
$71.09
|
| Rate for Payer: ASR Commercial |
$71.09
|
| Rate for Payer: BCBS Complete |
$10.89
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$60.02
|
| Rate for Payer: BCN Commercial |
$56.82
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$58.63
|
| Rate for Payer: Cash Price |
$58.63
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$73.29
|
| Rate for Payer: Healthscope Whirlpool |
$71.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.35
|
| Rate for Payer: Mclaren Commercial |
$65.96
|
| Rate for Payer: Mclaren Medicaid |
$10.37
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: Meridian Medicaid |
$10.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.30
|
| Rate for Payer: Nomi Health Commercial |
$60.10
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$21.28
|
| Rate for Payer: PHP Medicaid |
$10.37
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.37
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health Narrow Network |
$57.10
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.35
|
| Rate for Payer: UHC Exchange |
$29.99
|
| Rate for Payer: UHC Medicare Advantage |
$19.35
|
| Rate for Payer: UHCCP DNSP |
$19.35
|
| Rate for Payer: UHCCP Medicaid |
$10.37
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC HERPES SIMPLEX IGM TYPE 1&2
|
Facility
|
OP
|
$48.90
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200278
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$59.30 |
| Rate for Payer: Aetna Commercial |
$44.01
|
| Rate for Payer: Aetna Medicare |
$14.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: ASR ASR |
$47.43
|
| Rate for Payer: ASR Commercial |
$47.43
|
| Rate for Payer: BCBS Complete |
$8.10
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$40.04
|
| Rate for Payer: BCN Commercial |
$37.91
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Commercial |
$45.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$48.90
|
| Rate for Payer: Healthscope Whirlpool |
$47.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.39
|
| Rate for Payer: Mclaren Commercial |
$44.01
|
| Rate for Payer: Mclaren Medicaid |
$7.71
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: Meridian Medicaid |
$8.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: Nomi Health Commercial |
$40.10
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$15.83
|
| Rate for Payer: PHP Medicaid |
$7.71
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.30
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.39
|
| Rate for Payer: UHC Exchange |
$22.30
|
| Rate for Payer: UHC Medicare Advantage |
$14.39
|
| Rate for Payer: UHCCP DNSP |
$14.39
|
| Rate for Payer: UHCCP Medicaid |
$7.71
|
| Rate for Payer: VA VA |
$14.39
|
|
