|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100566
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100559
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100574
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100575
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100571
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100557
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100563
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100568
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100564
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100578
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100569
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100562
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100579
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100561
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100581
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100558
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IA INFECTIOUS AGENT AB
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
3100572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Community Health Alliance Commercial |
$18.70
|
| Rate for Payer: Priority Health Commercial |
$15.40
|
| Rate for Payer: Priority Health PPO |
$15.40
|
|
|
IAP
|
Facility
|
OP
|
$79.52
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
3005339
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$67.59 |
| Rate for Payer: BCBS BCN 65 |
$14.28
|
| Rate for Payer: Blue Care Network Medicare Advantage |
$14.28
|
| Rate for Payer: Cash Price |
$51.69
|
| Rate for Payer: Cash Price |
$51.69
|
| Rate for Payer: Community Health Alliance Commercial |
$67.59
|
| Rate for Payer: Meridian Health Plan Medicaid/Meridian MI Child |
$14.28
|
| Rate for Payer: Meridian Health Plan Medicare |
$14.28
|
| Rate for Payer: Priority Health Commercial |
$55.66
|
| Rate for Payer: Priority Health Medicaid |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$14.28
|
| Rate for Payer: Priority Health PPO |
$55.66
|
| Rate for Payer: United Health Care Medicaid |
$14.28
|
| Rate for Payer: United Health Care Medicare Advantage |
$6.28
|
|
|
IBD-1
|
Facility
|
OP
|
$32.47
|
|
| Hospital Charge Code |
3101550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.73 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Cash Price |
$21.11
|
| Rate for Payer: Community Health Alliance Commercial |
$27.60
|
| Rate for Payer: Priority Health Commercial |
$22.73
|
| Rate for Payer: Priority Health PPO |
$22.73
|
|