|
HC CALCIUM ALGINATE AG ROPE
|
Facility
|
IP
|
$18.88
|
|
| Hospital Charge Code |
27000462
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$16.99 |
| Rate for Payer: Aetna Commercial |
$16.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.27
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$16.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$16.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.05
|
| Rate for Payer: PHP Commercial |
$16.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.27
|
| Rate for Payer: Priority Health SBD |
$11.89
|
|
|
HC CALCIUM LEVEL, TOTAL
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
30100129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.45
|
| Rate for Payer: BCBS Complete |
$2.90
|
| Rate for Payer: BCBS MAPPO |
$5.16
|
| Rate for Payer: BCN Medicare Advantage |
$5.16
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.16
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$2.77
|
| Rate for Payer: Mclaren Medicare |
$5.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.42
|
| Rate for Payer: Meridian Medicaid |
$2.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PACE Medicare |
$4.90
|
| Rate for Payer: PACE SWMI |
$5.16
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health Medicare |
$5.16
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: Railroad Medicare Medicare |
$5.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.16
|
| Rate for Payer: UHC Medicare Advantage |
$5.16
|
| Rate for Payer: UHCCP Medicaid |
$2.91
|
| Rate for Payer: VA VA |
$5.16
|
|
|
HC CALCIUM LEVEL, TOTAL
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
30100129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
|
|
HC CALCIUM URINE
|
Facility
|
OP
|
$53.86
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
30100131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$48.47 |
| Rate for Payer: Aetna Commercial |
$45.78
|
| Rate for Payer: Aetna Medicare |
$6.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.54
|
| Rate for Payer: BCBS Complete |
$3.39
|
| Rate for Payer: BCBS MAPPO |
$6.03
|
| Rate for Payer: BCN Medicare Advantage |
$6.03
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$46.32
|
| Rate for Payer: Cofinity Commercial |
$37.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.03
|
| Rate for Payer: Healthscope Commercial |
$48.47
|
| Rate for Payer: Mclaren Medicaid |
$3.23
|
| Rate for Payer: Mclaren Medicare |
$6.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.33
|
| Rate for Payer: Meridian Medicaid |
$3.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.78
|
| Rate for Payer: PACE Medicare |
$5.73
|
| Rate for Payer: PACE SWMI |
$6.03
|
| Rate for Payer: PHP Commercial |
$45.78
|
| Rate for Payer: PHP Medicare Advantage |
$6.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.01
|
| Rate for Payer: Priority Health Medicare |
$6.03
|
| Rate for Payer: Priority Health SBD |
$33.93
|
| Rate for Payer: Railroad Medicare Medicare |
$6.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.03
|
| Rate for Payer: UHC Medicare Advantage |
$6.03
|
| Rate for Payer: UHCCP Medicaid |
$3.39
|
| Rate for Payer: VA VA |
$6.03
|
|
|
HC CALCIUM URINE
|
Facility
|
IP
|
$53.86
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
30100131
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$48.47 |
| Rate for Payer: Aetna Commercial |
$45.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.01
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$37.70
|
| Rate for Payer: Cofinity Commercial |
$46.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.09
|
| Rate for Payer: Healthscope Commercial |
$48.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.78
|
| Rate for Payer: PHP Commercial |
$45.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.01
|
| Rate for Payer: Priority Health SBD |
$33.93
|
|
|
HC CALCULI
|
Facility
|
OP
|
$42.66
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
30100132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$38.39 |
| Rate for Payer: Aetna Commercial |
$36.26
|
| Rate for Payer: Aetna Medicare |
$13.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.12
|
| Rate for Payer: BCBS Complete |
$7.26
|
| Rate for Payer: BCBS MAPPO |
$12.90
|
| Rate for Payer: BCN Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cofinity Commercial |
$36.69
|
| Rate for Payer: Cofinity Commercial |
$29.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.90
|
| Rate for Payer: Healthscope Commercial |
$38.39
|
| Rate for Payer: Mclaren Medicaid |
$6.91
|
| Rate for Payer: Mclaren Medicare |
$12.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.54
|
| Rate for Payer: Meridian Medicaid |
$7.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.26
|
| Rate for Payer: PACE Medicare |
$12.26
|
| Rate for Payer: PACE SWMI |
$12.90
|
| Rate for Payer: PHP Commercial |
$36.26
|
| Rate for Payer: PHP Medicare Advantage |
$12.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.73
|
| Rate for Payer: Priority Health Medicare |
$12.90
|
| Rate for Payer: Priority Health SBD |
$26.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.90
|
| Rate for Payer: UHC Medicare Advantage |
$12.90
|
| Rate for Payer: UHCCP Medicaid |
$7.26
|
| Rate for Payer: VA VA |
$12.90
|
|
|
HC CALCULI
|
Facility
|
IP
|
$42.66
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
30100132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$38.39 |
| Rate for Payer: Aetna Commercial |
$36.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.73
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cofinity Commercial |
$29.86
|
| Rate for Payer: Cofinity Commercial |
$36.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.13
|
| Rate for Payer: Healthscope Commercial |
$38.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.26
|
| Rate for Payer: PHP Commercial |
$36.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.73
|
| Rate for Payer: Priority Health SBD |
$26.88
|
|
|
HC CALORIC VESTIBULAR BILATERAL MONOTHERMAL
|
Facility
|
OP
|
$463.45
|
|
|
Service Code
|
HCPCS 92538
|
| Hospital Charge Code |
47100007
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$429.53 |
| Rate for Payer: Aetna Commercial |
$393.93
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cofinity Commercial |
$398.57
|
| Rate for Payer: Cofinity Commercial |
$324.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$417.11
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.93
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$393.93
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.24
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$291.97
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Core |
$342.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$342.95
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$85.91
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC CALORIC VESTIBULAR BILATERAL MONOTHERMAL
|
Facility
|
IP
|
$463.45
|
|
|
Service Code
|
HCPCS 92538
|
| Hospital Charge Code |
47100007
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$291.97 |
| Max. Negotiated Rate |
$417.11 |
| Rate for Payer: Aetna Commercial |
$393.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.24
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cofinity Commercial |
$324.42
|
| Rate for Payer: Cofinity Commercial |
$398.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.76
|
| Rate for Payer: Healthscope Commercial |
$417.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.93
|
| Rate for Payer: PHP Commercial |
$393.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.24
|
| Rate for Payer: Priority Health SBD |
$291.97
|
|
|
HC CALORIC VESTIBULAR TEST BILAT BITHERMAL
|
Facility
|
IP
|
$463.45
|
|
|
Service Code
|
HCPCS 92537
|
| Hospital Charge Code |
47100006
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$291.97 |
| Max. Negotiated Rate |
$417.11 |
| Rate for Payer: Aetna Commercial |
$393.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.24
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cofinity Commercial |
$324.42
|
| Rate for Payer: Cofinity Commercial |
$398.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.76
|
| Rate for Payer: Healthscope Commercial |
$417.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.93
|
| Rate for Payer: PHP Commercial |
$393.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.24
|
| Rate for Payer: Priority Health SBD |
$291.97
|
|
|
HC CALORIC VESTIBULAR TEST BILAT BITHERMAL
|
Facility
|
OP
|
$463.45
|
|
|
Service Code
|
HCPCS 92537
|
| Hospital Charge Code |
47100006
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$429.53 |
| Rate for Payer: Aetna Commercial |
$393.93
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cofinity Commercial |
$398.57
|
| Rate for Payer: Cofinity Commercial |
$324.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$417.11
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.93
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$393.93
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.24
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$291.97
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Core |
$342.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Exchange |
$342.95
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$85.91
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC CALPROTECTIN FECAL
|
Facility
|
OP
|
$236.64
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
30100638
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$212.98 |
| Rate for Payer: Aetna Commercial |
$201.14
|
| Rate for Payer: Aetna Medicare |
$20.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.54
|
| Rate for Payer: BCBS Complete |
$11.05
|
| Rate for Payer: BCBS MAPPO |
$19.63
|
| Rate for Payer: BCN Medicare Advantage |
$19.63
|
| Rate for Payer: Cash Price |
$189.31
|
| Rate for Payer: Cash Price |
$189.31
|
| Rate for Payer: Cofinity Commercial |
$203.51
|
| Rate for Payer: Cofinity Commercial |
$165.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.63
|
| Rate for Payer: Healthscope Commercial |
$212.98
|
| Rate for Payer: Mclaren Medicaid |
$10.52
|
| Rate for Payer: Mclaren Medicare |
$19.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.61
|
| Rate for Payer: Meridian Medicaid |
$11.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.14
|
| Rate for Payer: PACE Medicare |
$18.65
|
| Rate for Payer: PACE SWMI |
$19.63
|
| Rate for Payer: PHP Commercial |
$201.14
|
| Rate for Payer: PHP Medicare Advantage |
$19.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.82
|
| Rate for Payer: Priority Health Medicare |
$19.63
|
| Rate for Payer: Priority Health SBD |
$149.08
|
| Rate for Payer: Railroad Medicare Medicare |
$19.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.63
|
| Rate for Payer: UHC Medicare Advantage |
$19.63
|
| Rate for Payer: UHCCP Medicaid |
$11.05
|
| Rate for Payer: VA VA |
$19.63
|
|
|
HC CALPROTECTIN FECAL
|
Facility
|
IP
|
$236.64
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
30100638
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$149.08 |
| Max. Negotiated Rate |
$212.98 |
| Rate for Payer: Aetna Commercial |
$201.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.82
|
| Rate for Payer: Cash Price |
$189.31
|
| Rate for Payer: Cofinity Commercial |
$165.65
|
| Rate for Payer: Cofinity Commercial |
$203.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.31
|
| Rate for Payer: Healthscope Commercial |
$212.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.14
|
| Rate for Payer: PHP Commercial |
$201.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.82
|
| Rate for Payer: Priority Health SBD |
$149.08
|
|
|
HC CALPROTECTIN, FECES
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
30100741
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health SBD |
$25.70
|
|
|
HC CALPROTECTIN, FECES
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
30100741
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$55.26 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$20.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.54
|
| Rate for Payer: BCBS Complete |
$11.05
|
| Rate for Payer: BCBS MAPPO |
$19.63
|
| Rate for Payer: BCN Medicare Advantage |
$19.63
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.63
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$10.52
|
| Rate for Payer: Mclaren Medicare |
$19.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.61
|
| Rate for Payer: Meridian Medicaid |
$11.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: PACE Medicare |
$18.65
|
| Rate for Payer: PACE SWMI |
$19.63
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$19.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health Medicare |
$19.63
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: Railroad Medicare Medicare |
$19.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.63
|
| Rate for Payer: UHC Medicare Advantage |
$19.63
|
| Rate for Payer: UHCCP Medicaid |
$11.05
|
| Rate for Payer: VA VA |
$19.63
|
|
|
HC CALR, GENE MUTATION, EXON 9, REFLEX
|
Facility
|
IP
|
$673.24
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
30000108
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$424.14 |
| Max. Negotiated Rate |
$605.92 |
| Rate for Payer: Aetna Commercial |
$572.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.61
|
| Rate for Payer: Cash Price |
$538.59
|
| Rate for Payer: Cofinity Commercial |
$471.27
|
| Rate for Payer: Cofinity Commercial |
$578.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$471.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.59
|
| Rate for Payer: Healthscope Commercial |
$605.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.25
|
| Rate for Payer: PHP Commercial |
$572.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.61
|
| Rate for Payer: Priority Health SBD |
$424.14
|
|
|
HC CALR, GENE MUTATION, EXON 9, REFLEX
|
Facility
|
OP
|
$673.24
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
30000108
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.19 |
| Max. Negotiated Rate |
$605.92 |
| Rate for Payer: Aetna Commercial |
$572.25
|
| Rate for Payer: Aetna Medicare |
$126.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.04
|
| Rate for Payer: BCBS Complete |
$68.45
|
| Rate for Payer: BCBS MAPPO |
$121.63
|
| Rate for Payer: BCN Medicare Advantage |
$121.63
|
| Rate for Payer: Cash Price |
$538.59
|
| Rate for Payer: Cash Price |
$538.59
|
| Rate for Payer: Cofinity Commercial |
$578.99
|
| Rate for Payer: Cofinity Commercial |
$471.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$471.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.63
|
| Rate for Payer: Healthscope Commercial |
$605.92
|
| Rate for Payer: Mclaren Medicaid |
$65.19
|
| Rate for Payer: Mclaren Medicare |
$121.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.71
|
| Rate for Payer: Meridian Medicaid |
$68.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.25
|
| Rate for Payer: PACE Medicare |
$115.55
|
| Rate for Payer: PACE SWMI |
$121.63
|
| Rate for Payer: PHP Commercial |
$572.25
|
| Rate for Payer: PHP Medicare Advantage |
$121.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.61
|
| Rate for Payer: Priority Health Medicare |
$121.63
|
| Rate for Payer: Priority Health SBD |
$424.14
|
| Rate for Payer: Railroad Medicare Medicare |
$121.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.63
|
| Rate for Payer: UHC Medicare Advantage |
$121.63
|
| Rate for Payer: UHCCP Medicaid |
$68.48
|
| Rate for Payer: VA VA |
$121.63
|
|
|
HC CANALITH REPOSITIONING
|
Facility
|
OP
|
$131.61
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
42000008
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.64 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$111.87
|
| Rate for Payer: Aetna Medicare |
$65.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.55
|
| Rate for Payer: BCBS Complete |
$52.64
|
| Rate for Payer: Cash Price |
$105.29
|
| Rate for Payer: Cash Price |
$105.29
|
| Rate for Payer: Cofinity Commercial |
$92.13
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.29
|
| Rate for Payer: Healthscope Commercial |
$118.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.87
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$111.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.55
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UHC Core |
$97.39
|
| Rate for Payer: UHC Exchange |
$97.39
|
|
|
HC CANALITH REPOSITIONING
|
Facility
|
IP
|
$131.61
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
42000008
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$82.91 |
| Max. Negotiated Rate |
$118.45 |
| Rate for Payer: Aetna Commercial |
$111.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.55
|
| Rate for Payer: Cash Price |
$105.29
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Cofinity Commercial |
$92.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.29
|
| Rate for Payer: Healthscope Commercial |
$118.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.87
|
| Rate for Payer: PHP Commercial |
$111.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.55
|
| Rate for Payer: Priority Health SBD |
$82.91
|
|
|
HC CANCER ANTIGEN 15-3
|
Facility
|
IP
|
$48.90
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
30200182
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.81 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$41.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.79
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Cofinity Commercial |
$42.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Healthscope Commercial |
$44.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: PHP Commercial |
$41.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.79
|
| Rate for Payer: Priority Health SBD |
$30.81
|
|
|
HC CANCER ANTIGEN 15-3
|
Facility
|
OP
|
$48.90
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
30200182
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$58.58 |
| Rate for Payer: Aetna Commercial |
$41.56
|
| Rate for Payer: Aetna Medicare |
$21.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.01
|
| Rate for Payer: BCBS Complete |
$11.71
|
| Rate for Payer: BCBS MAPPO |
$20.81
|
| Rate for Payer: BCN Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Commercial |
$42.05
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$44.01
|
| Rate for Payer: Mclaren Medicaid |
$11.15
|
| Rate for Payer: Mclaren Medicare |
$20.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.85
|
| Rate for Payer: Meridian Medicaid |
$11.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: PACE Medicare |
$19.77
|
| Rate for Payer: PACE SWMI |
$20.81
|
| Rate for Payer: PHP Commercial |
$41.56
|
| Rate for Payer: PHP Medicare Advantage |
$20.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.79
|
| Rate for Payer: Priority Health Medicare |
$20.81
|
| Rate for Payer: Priority Health SBD |
$30.81
|
| Rate for Payer: Railroad Medicare Medicare |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.81
|
| Rate for Payer: UHC Medicare Advantage |
$20.81
|
| Rate for Payer: UHCCP Medicaid |
$11.72
|
| Rate for Payer: VA VA |
$20.81
|
|
|
HC CANCER ANTIGEN 19-9
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
30200184
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$58.58 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna Medicare |
$21.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.01
|
| Rate for Payer: BCBS Complete |
$11.71
|
| Rate for Payer: BCBS MAPPO |
$20.81
|
| Rate for Payer: BCN Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Cofinity Commercial |
$32.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Mclaren Medicaid |
$11.15
|
| Rate for Payer: Mclaren Medicare |
$20.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.85
|
| Rate for Payer: Meridian Medicaid |
$11.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: PACE Medicare |
$19.77
|
| Rate for Payer: PACE SWMI |
$20.81
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: PHP Medicare Advantage |
$20.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health Medicare |
$20.81
|
| Rate for Payer: Priority Health SBD |
$28.84
|
| Rate for Payer: Railroad Medicare Medicare |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.81
|
| Rate for Payer: UHC Medicare Advantage |
$20.81
|
| Rate for Payer: UHCCP Medicaid |
$11.72
|
| Rate for Payer: VA VA |
$20.81
|
|
|
HC CANCER ANTIGEN 19-9
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
30200184
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.76
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$32.05
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health SBD |
$28.84
|
|
|
HC CANCER ANTIGEN 2729
|
Facility
|
IP
|
$41.20
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
30200183
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.96 |
| Max. Negotiated Rate |
$37.08 |
| Rate for Payer: Aetna Commercial |
$35.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.78
|
| Rate for Payer: Cash Price |
$32.96
|
| Rate for Payer: Cofinity Commercial |
$28.84
|
| Rate for Payer: Cofinity Commercial |
$35.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.96
|
| Rate for Payer: Healthscope Commercial |
$37.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.02
|
| Rate for Payer: PHP Commercial |
$35.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.78
|
| Rate for Payer: Priority Health SBD |
$25.96
|
|
|
HC CANCER ANTIGEN 2729
|
Facility
|
OP
|
$41.20
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
30200183
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$58.58 |
| Rate for Payer: Aetna Commercial |
$35.02
|
| Rate for Payer: Aetna Medicare |
$21.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.01
|
| Rate for Payer: BCBS Complete |
$11.71
|
| Rate for Payer: BCBS MAPPO |
$20.81
|
| Rate for Payer: BCN Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$32.96
|
| Rate for Payer: Cash Price |
$32.96
|
| Rate for Payer: Cofinity Commercial |
$35.43
|
| Rate for Payer: Cofinity Commercial |
$28.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$37.08
|
| Rate for Payer: Mclaren Medicaid |
$11.15
|
| Rate for Payer: Mclaren Medicare |
$20.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.85
|
| Rate for Payer: Meridian Medicaid |
$11.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.02
|
| Rate for Payer: PACE Medicare |
$19.77
|
| Rate for Payer: PACE SWMI |
$20.81
|
| Rate for Payer: PHP Commercial |
$35.02
|
| Rate for Payer: PHP Medicare Advantage |
$20.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.78
|
| Rate for Payer: Priority Health Medicare |
$20.81
|
| Rate for Payer: Priority Health SBD |
$25.96
|
| Rate for Payer: Railroad Medicare Medicare |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.81
|
| Rate for Payer: UHC Medicare Advantage |
$20.81
|
| Rate for Payer: UHCCP Medicaid |
$11.72
|
| Rate for Payer: VA VA |
$20.81
|
|
