|
HC LVDS PLT PHER LEUKO RED
|
Facility
|
IP
|
$2,244.05
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000087
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,683.04 |
| Max. Negotiated Rate |
$2,244.05 |
| Rate for Payer: Aetna Commercial |
$2,019.64
|
| Rate for Payer: ASR ASR |
$2,176.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,842.81
|
| Rate for Payer: BCN Commercial |
$1,842.81
|
| Rate for Payer: Cash Price |
$1,795.24
|
| Rate for Payer: Cofinity Commercial |
$2,109.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,795.24
|
| Rate for Payer: Healthscope Commercial |
$2,176.73
|
| Rate for Payer: Healthscope Whirlpool |
$2,244.05
|
| Rate for Payer: Mclaren Commercial |
$2,019.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,907.44
|
| Rate for Payer: Nomi Health Commercial |
$1,840.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,683.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,974.76
|
|
|
HC LVDS PLT PHER LEUKO RED
|
Facility
|
OP
|
$2,244.05
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000087
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$260.95 |
| Max. Negotiated Rate |
$2,244.05 |
| Rate for Payer: Aetna Commercial |
$2,019.64
|
| Rate for Payer: Aetna Medicare |
$498.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.67
|
| Rate for Payer: ASR ASR |
$2,176.73
|
| Rate for Payer: BCBS Complete |
$274.02
|
| Rate for Payer: BCBS MAPPO |
$498.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,850.22
|
| Rate for Payer: BCN Commercial |
$1,850.22
|
| Rate for Payer: BCN Medicare Advantage |
$498.94
|
| Rate for Payer: Cash Price |
$1,795.24
|
| Rate for Payer: Cash Price |
$1,795.24
|
| Rate for Payer: Cofinity Commercial |
$2,109.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,795.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.94
|
| Rate for Payer: Healthscope Commercial |
$2,176.73
|
| Rate for Payer: Healthscope Whirlpool |
$2,244.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$498.94
|
| Rate for Payer: Mclaren Commercial |
$2,019.64
|
| Rate for Payer: Mclaren Medicaid |
$498.94
|
| Rate for Payer: Mclaren Medicare |
$498.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.89
|
| Rate for Payer: Meridian Medicaid |
$274.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$548.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,907.44
|
| Rate for Payer: Nomi Health Commercial |
$1,840.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,683.04
|
| Rate for Payer: PACE Medicare |
$473.99
|
| Rate for Payer: PACE SWMI |
$498.94
|
| Rate for Payer: PHP Commercial |
$548.83
|
| Rate for Payer: PHP Medicaid |
$267.43
|
| Rate for Payer: PHP Medicare Advantage |
$498.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$962.40
|
| Rate for Payer: Priority Health Medicare |
$498.94
|
| Rate for Payer: Priority Health Narrow Network |
$769.92
|
| Rate for Payer: Railroad Medicare Medicare |
$498.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,974.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$498.94
|
| Rate for Payer: UHC Exchange |
$773.36
|
| Rate for Payer: UHC Medicaid |
$260.95
|
| Rate for Payer: UHCCP DNSP |
$498.94
|
| Rate for Payer: UHCCP Medicaid |
$260.95
|
| Rate for Payer: VA VA |
$498.94
|
|
|
HC LV LEAD PLACEMENT
|
Facility
|
OP
|
$9,737.48
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
36100070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,602.87 |
| Max. Negotiated Rate |
$9,737.48 |
| Rate for Payer: Aetna Commercial |
$8,763.73
|
| Rate for Payer: Aetna Medicare |
$3,602.87
|
| Rate for Payer: ASR ASR |
$9,445.36
|
| Rate for Payer: BCBS Complete |
$3,894.99
|
| Rate for Payer: BCBS Trust/PPO |
$8,028.55
|
| Rate for Payer: BCN Commercial |
$8,028.55
|
| Rate for Payer: Cash Price |
$7,789.98
|
| Rate for Payer: Cofinity Commercial |
$9,153.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,789.98
|
| Rate for Payer: Healthscope Commercial |
$9,445.36
|
| Rate for Payer: Healthscope Whirlpool |
$9,737.48
|
| Rate for Payer: Mclaren Commercial |
$8,763.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,789.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,276.86
|
| Rate for Payer: Nomi Health Commercial |
$7,984.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,303.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8,531.98
|
| Rate for Payer: Priority Health Narrow Network |
$6,825.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,568.98
|
|
|
HC LV LEAD PLACEMENT
|
Facility
|
IP
|
$9,737.48
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
36100070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,303.11 |
| Max. Negotiated Rate |
$9,737.48 |
| Rate for Payer: Aetna Commercial |
$8,763.73
|
| Rate for Payer: ASR ASR |
$9,445.36
|
| Rate for Payer: BCBS Trust/PPO |
$7,996.42
|
| Rate for Payer: BCN Commercial |
$7,996.42
|
| Rate for Payer: Cash Price |
$7,789.98
|
| Rate for Payer: Cofinity Commercial |
$9,153.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,789.98
|
| Rate for Payer: Healthscope Commercial |
$9,445.36
|
| Rate for Payer: Healthscope Whirlpool |
$9,737.48
|
| Rate for Payer: Mclaren Commercial |
$8,763.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,276.86
|
| Rate for Payer: Nomi Health Commercial |
$7,984.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,303.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8,568.98
|
|
|
HC LV LEAD REPOSITIONING
|
Facility
|
IP
|
$3,660.20
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
36100071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,745.15 |
| Max. Negotiated Rate |
$3,660.20 |
| Rate for Payer: Aetna Commercial |
$3,294.18
|
| Rate for Payer: ASR ASR |
$3,550.39
|
| Rate for Payer: BCBS Trust/PPO |
$3,005.76
|
| Rate for Payer: BCN Commercial |
$3,005.76
|
| Rate for Payer: Cash Price |
$2,928.16
|
| Rate for Payer: Cofinity Commercial |
$3,440.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,928.16
|
| Rate for Payer: Healthscope Commercial |
$3,550.39
|
| Rate for Payer: Healthscope Whirlpool |
$3,660.20
|
| Rate for Payer: Mclaren Commercial |
$3,294.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,111.17
|
| Rate for Payer: Nomi Health Commercial |
$3,001.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,745.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,220.98
|
|
|
HC LV LEAD REPOSITIONING
|
Facility
|
OP
|
$3,660.20
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
36100071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$4,876.50 |
| Rate for Payer: Aetna Commercial |
$3,294.18
|
| Rate for Payer: Aetna Medicare |
$3,146.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: ASR ASR |
$3,550.39
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,017.83
|
| Rate for Payer: BCN Commercial |
$3,017.83
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$2,928.16
|
| Rate for Payer: Cash Price |
$2,928.16
|
| Rate for Payer: Cofinity Commercial |
$3,440.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,928.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,550.39
|
| Rate for Payer: Healthscope Whirlpool |
$3,660.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,146.13
|
| Rate for Payer: Mclaren Commercial |
$3,294.18
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$1,727.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,111.17
|
| Rate for Payer: Nomi Health Commercial |
$3,001.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,745.15
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,460.74
|
| Rate for Payer: PHP Medicaid |
$1,686.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,207.07
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,565.80
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,220.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$4,876.50
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP DNSP |
$3,146.13
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC LYME AB CONFIRMATION CMPT
|
Facility
|
IP
|
$35.02
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
30200232
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$35.02 |
| Rate for Payer: Aetna Commercial |
$31.52
|
| Rate for Payer: ASR ASR |
$33.97
|
| Rate for Payer: BCBS Trust/PPO |
$28.76
|
| Rate for Payer: BCN Commercial |
$28.76
|
| Rate for Payer: Cash Price |
$28.02
|
| Rate for Payer: Cofinity Commercial |
$32.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.02
|
| Rate for Payer: Healthscope Commercial |
$33.97
|
| Rate for Payer: Healthscope Whirlpool |
$35.02
|
| Rate for Payer: Mclaren Commercial |
$31.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.77
|
| Rate for Payer: Nomi Health Commercial |
$28.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.82
|
|
|
HC LYME AB CONFIRMATION CMPT
|
Facility
|
OP
|
$35.02
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
30200232
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$37.53 |
| Rate for Payer: Aetna Commercial |
$31.52
|
| 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 |
$33.97
|
| Rate for Payer: BCBS Complete |
$8.51
|
| Rate for Payer: BCBS MAPPO |
$15.49
|
| Rate for Payer: BCBS Trust/PPO |
$28.87
|
| Rate for Payer: BCN Commercial |
$28.87
|
| Rate for Payer: BCN Medicare Advantage |
$15.49
|
| Rate for Payer: Cash Price |
$28.02
|
| Rate for Payer: Cash Price |
$28.02
|
| Rate for Payer: Cofinity Commercial |
$32.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$33.97
|
| Rate for Payer: Healthscope Whirlpool |
$35.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.49
|
| Rate for Payer: Mclaren Commercial |
$31.52
|
| 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 |
$29.77
|
| Rate for Payer: Nomi Health Commercial |
$28.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.27
|
| 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 |
$37.53
|
| Rate for Payer: Priority Health Medicare |
$15.49
|
| Rate for Payer: Priority Health Narrow Network |
$30.02
|
| Rate for Payer: Railroad Medicare Medicare |
$15.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.82
|
| 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 LYME CSF COMPONENT 1
|
Facility
|
IP
|
$61.38
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100669
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$61.38 |
| Rate for Payer: Aetna Commercial |
$55.24
|
| Rate for Payer: ASR ASR |
$59.54
|
| Rate for Payer: BCBS Trust/PPO |
$50.41
|
| Rate for Payer: BCN Commercial |
$50.41
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cofinity Commercial |
$57.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.10
|
| Rate for Payer: Healthscope Commercial |
$59.54
|
| Rate for Payer: Healthscope Whirlpool |
$61.38
|
| Rate for Payer: Mclaren Commercial |
$55.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.17
|
| Rate for Payer: Nomi Health Commercial |
$50.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.01
|
|
|
HC LYME CSF COMPONENT 1
|
Facility
|
OP
|
$61.38
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100669
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$61.38 |
| Rate for Payer: Aetna Commercial |
$55.24
|
| Rate for Payer: Aetna Medicare |
$7.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.72
|
| Rate for Payer: ASR ASR |
$59.54
|
| Rate for Payer: BCBS Complete |
$4.27
|
| Rate for Payer: BCBS MAPPO |
$7.78
|
| Rate for Payer: BCBS Trust/PPO |
$50.61
|
| Rate for Payer: BCN Commercial |
$50.61
|
| Rate for Payer: BCN Medicare Advantage |
$7.78
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cofinity Commercial |
$57.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$59.54
|
| Rate for Payer: Healthscope Whirlpool |
$61.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.78
|
| Rate for Payer: Mclaren Commercial |
$55.24
|
| Rate for Payer: Mclaren Medicaid |
$7.78
|
| Rate for Payer: Mclaren Medicare |
$7.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.17
|
| Rate for Payer: Meridian Medicaid |
$4.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.17
|
| Rate for Payer: Nomi Health Commercial |
$50.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.03
|
| Rate for Payer: PACE Medicare |
$7.39
|
| Rate for Payer: PACE SWMI |
$7.78
|
| Rate for Payer: PHP Commercial |
$8.56
|
| Rate for Payer: PHP Medicaid |
$4.17
|
| Rate for Payer: PHP Medicare Advantage |
$7.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$53.78
|
| Rate for Payer: Priority Health Medicare |
$7.78
|
| Rate for Payer: Priority Health Narrow Network |
$43.03
|
| Rate for Payer: Railroad Medicare Medicare |
$7.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.78
|
| Rate for Payer: UHC Exchange |
$12.06
|
| Rate for Payer: UHC Medicaid |
$4.07
|
| Rate for Payer: UHCCP DNSP |
$7.78
|
| Rate for Payer: UHCCP Medicaid |
$4.07
|
| Rate for Payer: VA VA |
$7.78
|
|
|
HC LYME CSF COMPONENT 2
|
Facility
|
OP
|
$165.42
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$165.42 |
| Rate for Payer: Aetna Commercial |
$148.88
|
| Rate for Payer: Aetna Medicare |
$17.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.29
|
| Rate for Payer: ASR ASR |
$160.46
|
| Rate for Payer: BCBS Complete |
$9.35
|
| Rate for Payer: BCBS MAPPO |
$17.03
|
| Rate for Payer: BCBS Trust/PPO |
$136.39
|
| Rate for Payer: BCN Commercial |
$136.39
|
| Rate for Payer: BCN Medicare Advantage |
$17.03
|
| Rate for Payer: Cash Price |
$132.34
|
| Rate for Payer: Cash Price |
$132.34
|
| Rate for Payer: Cofinity Commercial |
$155.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.03
|
| Rate for Payer: Healthscope Commercial |
$160.46
|
| Rate for Payer: Healthscope Whirlpool |
$165.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.03
|
| Rate for Payer: Mclaren Commercial |
$148.88
|
| Rate for Payer: Mclaren Medicaid |
$17.03
|
| Rate for Payer: Mclaren Medicare |
$17.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.88
|
| Rate for Payer: Meridian Medicaid |
$9.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.61
|
| Rate for Payer: Nomi Health Commercial |
$135.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.06
|
| Rate for Payer: PACE Medicare |
$16.18
|
| Rate for Payer: PACE SWMI |
$17.03
|
| Rate for Payer: PHP Commercial |
$18.73
|
| Rate for Payer: PHP Medicaid |
$9.13
|
| Rate for Payer: PHP Medicare Advantage |
$17.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$58.11
|
| Rate for Payer: Priority Health Medicare |
$17.03
|
| Rate for Payer: Priority Health Narrow Network |
$46.49
|
| Rate for Payer: Railroad Medicare Medicare |
$17.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.03
|
| Rate for Payer: UHC Exchange |
$26.40
|
| Rate for Payer: UHC Medicaid |
$8.91
|
| Rate for Payer: UHCCP DNSP |
$17.03
|
| Rate for Payer: UHCCP Medicaid |
$8.91
|
| Rate for Payer: VA VA |
$17.03
|
|
|
HC LYME CSF COMPONENT 2
|
Facility
|
IP
|
$165.42
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$124.06 |
| Max. Negotiated Rate |
$165.42 |
| Rate for Payer: Aetna Commercial |
$148.88
|
| Rate for Payer: ASR ASR |
$160.46
|
| Rate for Payer: BCBS Trust/PPO |
$135.84
|
| Rate for Payer: BCN Commercial |
$135.84
|
| Rate for Payer: Cash Price |
$132.34
|
| Rate for Payer: Cofinity Commercial |
$155.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.34
|
| Rate for Payer: Healthscope Commercial |
$160.46
|
| Rate for Payer: Healthscope Whirlpool |
$165.42
|
| Rate for Payer: Mclaren Commercial |
$148.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.61
|
| Rate for Payer: Nomi Health Commercial |
$135.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.57
|
|
|
HC LYME CSF COMPONENT 3
|
Facility
|
OP
|
$90.51
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$90.51 |
| Rate for Payer: Aetna Commercial |
$81.46
|
| Rate for Payer: Aetna Medicare |
$9.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.62
|
| Rate for Payer: ASR ASR |
$87.79
|
| Rate for Payer: BCBS Complete |
$5.11
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$74.63
|
| Rate for Payer: BCN Commercial |
$74.63
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Cofinity Commercial |
$85.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$87.79
|
| Rate for Payer: Healthscope Whirlpool |
$90.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.30
|
| Rate for Payer: Mclaren Commercial |
$81.46
|
| Rate for Payer: Mclaren Medicaid |
$9.30
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.77
|
| Rate for Payer: Meridian Medicaid |
$5.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.93
|
| Rate for Payer: Nomi Health Commercial |
$74.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.88
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$10.23
|
| Rate for Payer: PHP Medicaid |
$4.98
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$58.11
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health Narrow Network |
$46.49
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.30
|
| Rate for Payer: UHC Exchange |
$14.41
|
| Rate for Payer: UHC Medicaid |
$4.86
|
| Rate for Payer: UHCCP DNSP |
$9.30
|
| Rate for Payer: UHCCP Medicaid |
$4.86
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC LYME CSF COMPONENT 3
|
Facility
|
IP
|
$90.51
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$90.51 |
| Rate for Payer: Aetna Commercial |
$81.46
|
| Rate for Payer: ASR ASR |
$87.79
|
| Rate for Payer: BCBS Trust/PPO |
$74.33
|
| Rate for Payer: BCN Commercial |
$74.33
|
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Cofinity Commercial |
$85.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.41
|
| Rate for Payer: Healthscope Commercial |
$87.79
|
| Rate for Payer: Healthscope Whirlpool |
$90.51
|
| Rate for Payer: Mclaren Commercial |
$81.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.93
|
| Rate for Payer: Nomi Health Commercial |
$74.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.65
|
|
|
HC LYME CSF IGG AB INDEX
|
Facility
|
OP
|
$73.87
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna Commercial |
$66.48
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: ASR ASR |
$71.65
|
| Rate for Payer: BCBS Complete |
$2.72
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS Trust/PPO |
$60.91
|
| Rate for Payer: BCN Commercial |
$60.91
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$69.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Healthscope Commercial |
$71.65
|
| Rate for Payer: Healthscope Whirlpool |
$73.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.95
|
| Rate for Payer: Mclaren Commercial |
$66.48
|
| Rate for Payer: Mclaren Medicaid |
$4.95
|
| Rate for Payer: Mclaren Medicare |
$4.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Medicaid |
$2.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.40
|
| Rate for Payer: PACE Medicare |
$4.70
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PHP Commercial |
$5.45
|
| Rate for Payer: PHP Medicaid |
$2.65
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.76
|
| Rate for Payer: Priority Health Medicare |
$4.95
|
| Rate for Payer: Priority Health Narrow Network |
$15.01
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.95
|
| Rate for Payer: UHC Exchange |
$7.67
|
| Rate for Payer: UHC Medicaid |
$2.59
|
| Rate for Payer: UHCCP DNSP |
$4.95
|
| Rate for Payer: UHCCP Medicaid |
$2.59
|
| Rate for Payer: VA VA |
$4.95
|
|
|
HC LYME CSF IGG AB INDEX
|
Facility
|
IP
|
$73.87
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.40 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna Commercial |
$66.48
|
| Rate for Payer: ASR ASR |
$71.65
|
| Rate for Payer: BCBS Trust/PPO |
$60.66
|
| Rate for Payer: BCN Commercial |
$60.66
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$69.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Healthscope Commercial |
$71.65
|
| Rate for Payer: Healthscope Whirlpool |
$73.87
|
| Rate for Payer: Mclaren Commercial |
$66.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.01
|
|
|
HC LYME DISEASE ANTIBODY
|
Facility
|
OP
|
$47.76
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$58.11 |
| Rate for Payer: Aetna Commercial |
$42.98
|
| Rate for Payer: Aetna Medicare |
$17.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.29
|
| Rate for Payer: ASR ASR |
$46.33
|
| Rate for Payer: BCBS Complete |
$9.35
|
| Rate for Payer: BCBS MAPPO |
$17.03
|
| Rate for Payer: BCBS Trust/PPO |
$39.38
|
| Rate for Payer: BCN Commercial |
$39.38
|
| Rate for Payer: BCN Medicare Advantage |
$17.03
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.03
|
| Rate for Payer: Healthscope Commercial |
$46.33
|
| Rate for Payer: Healthscope Whirlpool |
$47.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.03
|
| Rate for Payer: Mclaren Commercial |
$42.98
|
| Rate for Payer: Mclaren Medicaid |
$17.03
|
| Rate for Payer: Mclaren Medicare |
$17.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.88
|
| Rate for Payer: Meridian Medicaid |
$9.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$39.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: PACE Medicare |
$16.18
|
| Rate for Payer: PACE SWMI |
$17.03
|
| Rate for Payer: PHP Commercial |
$18.73
|
| Rate for Payer: PHP Medicaid |
$9.13
|
| Rate for Payer: PHP Medicare Advantage |
$17.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$58.11
|
| Rate for Payer: Priority Health Medicare |
$17.03
|
| Rate for Payer: Priority Health Narrow Network |
$46.49
|
| Rate for Payer: Railroad Medicare Medicare |
$17.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.03
|
| Rate for Payer: UHC Exchange |
$26.40
|
| Rate for Payer: UHC Medicaid |
$8.91
|
| Rate for Payer: UHCCP DNSP |
$17.03
|
| Rate for Payer: UHCCP Medicaid |
$8.91
|
| Rate for Payer: VA VA |
$17.03
|
|
|
HC LYME DISEASE ANTIBODY
|
Facility
|
IP
|
$47.76
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$47.76 |
| Rate for Payer: Aetna Commercial |
$42.98
|
| Rate for Payer: ASR ASR |
$46.33
|
| Rate for Payer: BCBS Trust/PPO |
$39.22
|
| Rate for Payer: BCN Commercial |
$39.22
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Healthscope Commercial |
$46.33
|
| Rate for Payer: Healthscope Whirlpool |
$47.76
|
| Rate for Payer: Mclaren Commercial |
$42.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$39.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.03
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS
|
Facility
|
IP
|
$264.91
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200472
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$198.68 |
| Max. Negotiated Rate |
$264.91 |
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: ASR ASR |
$256.96
|
| Rate for Payer: BCBS Trust/PPO |
$217.54
|
| Rate for Payer: BCN Commercial |
$217.54
|
| Rate for Payer: Cash Price |
$211.93
|
| Rate for Payer: Cofinity Commercial |
$249.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.93
|
| Rate for Payer: Healthscope Commercial |
$256.96
|
| Rate for Payer: Healthscope Whirlpool |
$264.91
|
| Rate for Payer: Mclaren Commercial |
$238.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.17
|
| Rate for Payer: Nomi Health Commercial |
$217.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.12
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS
|
Facility
|
OP
|
$264.91
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200472
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$264.91 |
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna Medicare |
$49.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: ASR ASR |
$256.96
|
| Rate for Payer: BCBS Complete |
$26.93
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$218.42
|
| Rate for Payer: BCN Commercial |
$218.42
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$211.93
|
| Rate for Payer: Cash Price |
$211.93
|
| Rate for Payer: Cofinity Commercial |
$249.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$256.96
|
| Rate for Payer: Healthscope Whirlpool |
$264.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.03
|
| Rate for Payer: Mclaren Commercial |
$238.42
|
| Rate for Payer: Mclaren Medicaid |
$49.03
|
| Rate for Payer: Mclaren Medicare |
$49.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.48
|
| Rate for Payer: Meridian Medicaid |
$26.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.17
|
| Rate for Payer: Nomi Health Commercial |
$217.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.68
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: PHP Medicaid |
$26.28
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$232.11
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health Narrow Network |
$185.70
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.03
|
| Rate for Payer: UHC Exchange |
$76.00
|
| Rate for Payer: UHC Medicaid |
$25.64
|
| Rate for Payer: UHCCP DNSP |
$49.03
|
| Rate for Payer: UHCCP Medicaid |
$25.64
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS CMPT
|
Facility
|
IP
|
$285.69
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200475
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$214.27 |
| Max. Negotiated Rate |
$285.69 |
| Rate for Payer: Aetna Commercial |
$257.12
|
| Rate for Payer: ASR ASR |
$277.12
|
| Rate for Payer: BCBS Trust/PPO |
$234.61
|
| Rate for Payer: BCN Commercial |
$234.61
|
| Rate for Payer: Cash Price |
$228.55
|
| Rate for Payer: Cofinity Commercial |
$268.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.55
|
| Rate for Payer: Healthscope Commercial |
$277.12
|
| Rate for Payer: Healthscope Whirlpool |
$285.69
|
| Rate for Payer: Mclaren Commercial |
$257.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.84
|
| Rate for Payer: Nomi Health Commercial |
$234.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.41
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS CMPT
|
Facility
|
OP
|
$285.69
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200475
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$285.69 |
| Rate for Payer: Aetna Commercial |
$257.12
|
| Rate for Payer: Aetna Medicare |
$49.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: ASR ASR |
$277.12
|
| Rate for Payer: BCBS Complete |
$26.93
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$235.55
|
| Rate for Payer: BCN Commercial |
$235.55
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$228.55
|
| Rate for Payer: Cash Price |
$228.55
|
| Rate for Payer: Cofinity Commercial |
$268.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$277.12
|
| Rate for Payer: Healthscope Whirlpool |
$285.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.03
|
| Rate for Payer: Mclaren Commercial |
$257.12
|
| Rate for Payer: Mclaren Medicaid |
$49.03
|
| Rate for Payer: Mclaren Medicare |
$49.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.48
|
| Rate for Payer: Meridian Medicaid |
$26.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.84
|
| Rate for Payer: Nomi Health Commercial |
$234.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.27
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: PHP Medicaid |
$26.28
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$250.32
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health Narrow Network |
$200.27
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.03
|
| Rate for Payer: UHC Exchange |
$76.00
|
| Rate for Payer: UHC Medicaid |
$25.64
|
| Rate for Payer: UHCCP DNSP |
$49.03
|
| Rate for Payer: UHCCP Medicaid |
$25.64
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION MITOGEN
|
Facility
|
IP
|
$240.33
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$180.25 |
| Max. Negotiated Rate |
$240.33 |
| Rate for Payer: Aetna Commercial |
$216.30
|
| Rate for Payer: ASR ASR |
$233.12
|
| Rate for Payer: BCBS Trust/PPO |
$197.36
|
| Rate for Payer: BCN Commercial |
$197.36
|
| Rate for Payer: Cash Price |
$192.26
|
| Rate for Payer: Cofinity Commercial |
$225.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.26
|
| Rate for Payer: Healthscope Commercial |
$233.12
|
| Rate for Payer: Healthscope Whirlpool |
$240.33
|
| Rate for Payer: Mclaren Commercial |
$216.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.28
|
| Rate for Payer: Nomi Health Commercial |
$197.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.49
|
|
|
HC LYMPHOCYTE PROLIFERATION MITOGEN
|
Facility
|
OP
|
$240.33
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$240.33 |
| Rate for Payer: Aetna Commercial |
$216.30
|
| Rate for Payer: Aetna Medicare |
$49.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: ASR ASR |
$233.12
|
| Rate for Payer: BCBS Complete |
$26.93
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$198.15
|
| Rate for Payer: BCN Commercial |
$198.15
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$192.26
|
| Rate for Payer: Cash Price |
$192.26
|
| Rate for Payer: Cofinity Commercial |
$225.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$233.12
|
| Rate for Payer: Healthscope Whirlpool |
$240.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.03
|
| Rate for Payer: Mclaren Commercial |
$216.30
|
| Rate for Payer: Mclaren Medicaid |
$49.03
|
| Rate for Payer: Mclaren Medicare |
$49.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.48
|
| Rate for Payer: Meridian Medicaid |
$26.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.28
|
| Rate for Payer: Nomi Health Commercial |
$197.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.25
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: PHP Medicaid |
$26.28
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$210.58
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health Narrow Network |
$168.47
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.03
|
| Rate for Payer: UHC Exchange |
$76.00
|
| Rate for Payer: UHC Medicaid |
$25.64
|
| Rate for Payer: UHCCP DNSP |
$49.03
|
| Rate for Payer: UHCCP Medicaid |
$25.64
|
| Rate for Payer: VA VA |
$49.03
|
|
|
HC LYMPHOCYTE PROLIFERATION, MITOGENS
|
Facility
|
OP
|
$264.91
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200473
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$264.91 |
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna Medicare |
$49.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.29
|
| Rate for Payer: ASR ASR |
$256.96
|
| Rate for Payer: BCBS Complete |
$26.93
|
| Rate for Payer: BCBS MAPPO |
$49.03
|
| Rate for Payer: BCBS Trust/PPO |
$218.42
|
| Rate for Payer: BCN Commercial |
$218.42
|
| Rate for Payer: BCN Medicare Advantage |
$49.03
|
| Rate for Payer: Cash Price |
$211.93
|
| Rate for Payer: Cash Price |
$211.93
|
| Rate for Payer: Cofinity Commercial |
$249.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.03
|
| Rate for Payer: Healthscope Commercial |
$256.96
|
| Rate for Payer: Healthscope Whirlpool |
$264.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$49.03
|
| Rate for Payer: Mclaren Commercial |
$238.42
|
| Rate for Payer: Mclaren Medicaid |
$49.03
|
| Rate for Payer: Mclaren Medicare |
$49.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.48
|
| Rate for Payer: Meridian Medicaid |
$26.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.17
|
| Rate for Payer: Nomi Health Commercial |
$217.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.68
|
| Rate for Payer: PACE Medicare |
$46.58
|
| Rate for Payer: PACE SWMI |
$49.03
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: PHP Medicaid |
$26.28
|
| Rate for Payer: PHP Medicare Advantage |
$49.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$232.11
|
| Rate for Payer: Priority Health Medicare |
$49.03
|
| Rate for Payer: Priority Health Narrow Network |
$185.70
|
| Rate for Payer: Railroad Medicare Medicare |
$49.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.03
|
| Rate for Payer: UHC Exchange |
$76.00
|
| Rate for Payer: UHC Medicaid |
$25.64
|
| Rate for Payer: UHCCP DNSP |
$49.03
|
| Rate for Payer: UHCCP Medicaid |
$25.64
|
| Rate for Payer: VA VA |
$49.03
|
|
