|
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 |
$417.10 |
| 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 |
$417.10
|
| 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 |
$41.16 |
| Max. Negotiated Rate |
$481.80 |
| Rate for Payer: Aetna Commercial |
$393.93
|
| Rate for Payer: Aetna Medicare |
$159.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$48.75
|
| Rate for Payer: BCN Commercial |
$48.75
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| 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 |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$417.10
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.93
|
| Rate for Payer: Nomi Health Commercial |
$459.90
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$393.93
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.80
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$385.44
|
| Rate for Payer: Priority Health SBD |
$291.97
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$342.95
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$86.31
|
| Rate for Payer: VA VA |
$153.30
|
|
|
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 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: BCBS Trust/PPO |
$17.37
|
| Rate for Payer: BCN Commercial |
$17.37
|
| 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: Nomi Health Commercial |
$29.44
|
| 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 HMO/PPO/Tiered Network |
$19.63
|
| Rate for Payer: Priority Health Medicare |
$19.63
|
| Rate for Payer: Priority Health Narrow Network |
$15.70
|
| Rate for Payer: Priority Health SBD |
$149.08
|
| Rate for Payer: Railroad Medicare Medicare |
$19.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.56
|
| 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, 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 |
$36.72 |
| 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: BCBS Trust/PPO |
$17.37
|
| Rate for Payer: BCN Commercial |
$17.37
|
| 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: Nomi Health Commercial |
$29.44
|
| 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 HMO/PPO/Tiered Network |
$19.63
|
| Rate for Payer: Priority Health Medicare |
$19.63
|
| Rate for Payer: Priority Health Narrow Network |
$15.70
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: Railroad Medicare Medicare |
$19.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.56
|
| 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: BCBS Trust/PPO |
$107.67
|
| Rate for Payer: BCN Commercial |
$107.67
|
| 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 |
$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: 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: Nomi Health Commercial |
$364.89
|
| 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 HMO/PPO/Tiered Network |
$125.13
|
| Rate for Payer: Priority Health Medicare |
$121.63
|
| Rate for Payer: Priority Health Narrow Network |
$100.10
|
| Rate for Payer: Priority Health SBD |
$424.14
|
| Rate for Payer: Railroad Medicare Medicare |
$121.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.96
|
| Rate for Payer: UHC Core |
$113.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.63
|
| Rate for Payer: UHC Exchange |
$113.38
|
| 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 |
$47.13 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$111.87
|
| Rate for Payer: Aetna Medicare |
$65.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.55
|
| Rate for Payer: BCBS Complete |
$52.64
|
| Rate for Payer: BCBS Trust/PPO |
$52.03
|
| Rate for Payer: BCN Commercial |
$52.03
|
| Rate for Payer: Cash Price |
$105.29
|
| 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 HMO/PPO/Tiered Network |
$58.91
|
| Rate for Payer: Priority Health Narrow Network |
$47.13
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| 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) |
$31.78
|
| 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 |
$31.78
|
| 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 |
$44.01 |
| Rate for Payer: Aetna Commercial |
$41.56
|
| Rate for Payer: Aetna Medicare |
$21.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.78
|
| 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: BCBS Trust/PPO |
$18.42
|
| Rate for Payer: BCN Commercial |
$18.42
|
| 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: Nomi Health Commercial |
$31.22
|
| 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 |
$31.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.41
|
| Rate for Payer: Priority Health Medicare |
$20.81
|
| Rate for Payer: Priority Health Narrow Network |
$17.13
|
| Rate for Payer: Priority Health SBD |
$30.81
|
| Rate for Payer: Railroad Medicare Medicare |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.97
|
| 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 |
$41.20 |
| 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: BCBS Trust/PPO |
$18.42
|
| Rate for Payer: BCN Commercial |
$18.42
|
| 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: Nomi Health Commercial |
$31.22
|
| 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 HMO/PPO/Tiered Network |
$21.41
|
| Rate for Payer: Priority Health Medicare |
$20.81
|
| Rate for Payer: Priority Health Narrow Network |
$17.13
|
| Rate for Payer: Priority Health SBD |
$28.84
|
| Rate for Payer: Railroad Medicare Medicare |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.97
|
| 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 |
$37.08 |
| 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: BCBS Trust/PPO |
$18.42
|
| Rate for Payer: BCN Commercial |
$18.42
|
| 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: Nomi Health Commercial |
$31.22
|
| 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 HMO/PPO/Tiered Network |
$21.41
|
| Rate for Payer: Priority Health Medicare |
$20.81
|
| Rate for Payer: Priority Health Narrow Network |
$17.13
|
| Rate for Payer: Priority Health SBD |
$25.96
|
| Rate for Payer: Railroad Medicare Medicare |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.97
|
| 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 CANDIDA ALBICANS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200077
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC CANDIDA ALBICANS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200077
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.63
|
| Rate for Payer: BCN Commercial |
$4.63
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC CANNABINOID URIN
|
Facility
|
IP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.05 |
| Max. Negotiated Rate |
$91.49 |
| Rate for Payer: Aetna Commercial |
$86.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.08
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$71.16
|
| Rate for Payer: Cofinity Commercial |
$87.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health SBD |
$64.05
|
|
|
HC CANNABINOID URIN
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$93.21 |
| Rate for Payer: Aetna Commercial |
$86.41
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$55.01
|
| Rate for Payer: BCN Commercial |
$55.01
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$87.43
|
| Rate for Payer: Cofinity Commercial |
$71.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$49.71
|
| Rate for Payer: Priority Health SBD |
$64.05
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$34.98
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC CANN/INTRO FEM ART 17,19,21 FR
|
Facility
|
OP
|
$884.34
|
|
| Hospital Charge Code |
27000274
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$353.74 |
| Max. Negotiated Rate |
$795.91 |
| Rate for Payer: Aetna Commercial |
$751.69
|
| Rate for Payer: Aetna Medicare |
$442.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$574.82
|
| Rate for Payer: BCBS Complete |
$353.74
|
| Rate for Payer: Cash Price |
$707.47
|
| Rate for Payer: Cofinity Commercial |
$619.04
|
| Rate for Payer: Cofinity Commercial |
$760.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$619.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$707.47
|
| Rate for Payer: Healthscope Commercial |
$795.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$751.69
|
| Rate for Payer: PHP Commercial |
$751.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.82
|
| Rate for Payer: Priority Health SBD |
$557.13
|
|
|
HC CANN/INTRO FEM ART 17,19,21 FR
|
Facility
|
IP
|
$884.34
|
|
| Hospital Charge Code |
27000274
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$557.13 |
| Max. Negotiated Rate |
$795.91 |
| Rate for Payer: Aetna Commercial |
$751.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$574.82
|
| Rate for Payer: Cash Price |
$707.47
|
| Rate for Payer: Cofinity Commercial |
$619.04
|
| Rate for Payer: Cofinity Commercial |
$760.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$619.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$707.47
|
| Rate for Payer: Healthscope Commercial |
$795.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$751.69
|
| Rate for Payer: PHP Commercial |
$751.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.82
|
| Rate for Payer: Priority Health SBD |
$557.13
|
|
|
HC CANN RT ANG BALLOON 4-6MM
|
Facility
|
OP
|
$302.94
|
|
| Hospital Charge Code |
27000446
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$121.18 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: Aetna Medicare |
$151.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.91
|
| Rate for Payer: BCBS Complete |
$121.18
|
| Rate for Payer: Cash Price |
$242.35
|
| Rate for Payer: Cofinity Commercial |
$212.06
|
| Rate for Payer: Cofinity Commercial |
$260.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.35
|
| Rate for Payer: Healthscope Commercial |
$272.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.50
|
| Rate for Payer: PHP Commercial |
$257.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.91
|
| Rate for Payer: Priority Health SBD |
$190.85
|
|
|
HC CANN RT ANG BALLOON 4-6MM
|
Facility
|
IP
|
$302.94
|
|
| Hospital Charge Code |
27000446
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$190.85 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.91
|
| Rate for Payer: Cash Price |
$242.35
|
| Rate for Payer: Cofinity Commercial |
$212.06
|
| Rate for Payer: Cofinity Commercial |
$260.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.35
|
| Rate for Payer: Healthscope Commercial |
$272.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.50
|
| Rate for Payer: PHP Commercial |
$257.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.91
|
| Rate for Payer: Priority Health SBD |
$190.85
|
|
|
HC CANNULA ARTERIAL 21, 24 FR
|
Facility
|
OP
|
$116.28
|
|
| Hospital Charge Code |
27000449
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.51 |
| Max. Negotiated Rate |
$104.65 |
| Rate for Payer: Aetna Commercial |
$98.84
|
| Rate for Payer: Aetna Medicare |
$58.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.58
|
| Rate for Payer: BCBS Complete |
$46.51
|
| Rate for Payer: Cash Price |
$93.02
|
| Rate for Payer: Cofinity Commercial |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$81.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.02
|
| Rate for Payer: Healthscope Commercial |
$104.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.84
|
| Rate for Payer: PHP Commercial |
$98.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.58
|
| Rate for Payer: Priority Health SBD |
$73.26
|
|
