|
HC ESOPHAGOSCOPY
|
Facility
|
IP
|
$1,404.77
|
|
| Hospital Charge Code |
36000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$885.01 |
| Max. Negotiated Rate |
$1,264.29 |
| Rate for Payer: Aetna Commercial |
$1,194.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$913.10
|
| Rate for Payer: Cash Price |
$1,123.82
|
| Rate for Payer: Cofinity Advantage |
$983.34
|
| Rate for Payer: Cofinity Commercial |
$1,208.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.82
|
| Rate for Payer: Healthscope Commercial |
$1,264.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,194.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,053.58
|
| Rate for Payer: PHP Commercial |
$1,194.05
|
| Rate for Payer: Priority Health SBD |
$885.01
|
|
|
HC ESOPHGL FUNC G-ESOP RFLX IMPD ELTRD PROLNG
|
Facility
|
OP
|
$2,439.74
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
76100426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$2,195.77 |
| Rate for Payer: Aetna Commercial |
$2,073.78
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,585.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,474.55
|
| Rate for Payer: BCN Commercial |
$1,474.55
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$1,951.79
|
| Rate for Payer: Cash Price |
$1,951.79
|
| Rate for Payer: Cofinity Advantage |
$1,707.82
|
| Rate for Payer: Cofinity Commercial |
$2,098.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,951.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$2,195.77
|
| Rate for Payer: Mclaren Medicaid |
$194.46
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,073.78
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,829.81
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$2,073.78
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$1,537.04
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,585.83
|
| Rate for Payer: UHC Core |
$1,271.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$958.82
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC ESOPHGL FUNC G-ESOP RFLX IMPD ELTRD PROLNG
|
Facility
|
IP
|
$2,439.74
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
76100426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,537.04 |
| Max. Negotiated Rate |
$2,195.77 |
| Rate for Payer: Aetna Commercial |
$2,073.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,585.83
|
| Rate for Payer: Cash Price |
$1,951.79
|
| Rate for Payer: Cofinity Advantage |
$1,707.82
|
| Rate for Payer: Cofinity Commercial |
$2,098.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,951.79
|
| Rate for Payer: Healthscope Commercial |
$2,195.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,073.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,829.81
|
| Rate for Payer: PHP Commercial |
$2,073.78
|
| Rate for Payer: Priority Health SBD |
$1,537.04
|
|
|
HC ESOPH IMPEDENCE MONITOR/MANOMETRY
|
Facility
|
IP
|
$1,480.45
|
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$932.68 |
| Max. Negotiated Rate |
$1,332.40 |
| Rate for Payer: Aetna Commercial |
$1,258.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$962.29
|
| Rate for Payer: Cash Price |
$1,184.36
|
| Rate for Payer: Cofinity Advantage |
$1,036.32
|
| Rate for Payer: Cofinity Commercial |
$1,273.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,184.36
|
| Rate for Payer: Healthscope Commercial |
$1,332.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,258.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,110.34
|
| Rate for Payer: PHP Commercial |
$1,258.38
|
| Rate for Payer: Priority Health SBD |
$932.68
|
|
|
HC ESOPH IMPEDENCE MONITOR/MANOMETRY
|
Facility
|
OP
|
$1,480.45
|
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$592.18 |
| Max. Negotiated Rate |
$1,332.40 |
| Rate for Payer: Aetna Commercial |
$1,258.38
|
| Rate for Payer: Aetna Medicare |
$740.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$962.29
|
| Rate for Payer: BCBS Complete |
$592.18
|
| Rate for Payer: Cash Price |
$1,184.36
|
| Rate for Payer: Cofinity Advantage |
$1,036.32
|
| Rate for Payer: Cofinity Commercial |
$1,273.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,184.36
|
| Rate for Payer: Healthscope Commercial |
$1,332.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,184.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,258.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,110.34
|
| Rate for Payer: PHP Commercial |
$1,258.38
|
| Rate for Payer: Priority Health SBD |
$932.68
|
|
|
HC ESOSURE ESOPHAGEAL DEVICE
|
Facility
|
IP
|
$1,257.53
|
|
| Hospital Charge Code |
27200326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$792.24 |
| Max. Negotiated Rate |
$1,131.78 |
| Rate for Payer: Aetna Commercial |
$1,068.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$817.39
|
| Rate for Payer: Cash Price |
$1,006.02
|
| Rate for Payer: Cofinity Advantage |
$880.27
|
| Rate for Payer: Cofinity Commercial |
$1,081.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,006.02
|
| Rate for Payer: Healthscope Commercial |
$1,131.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,068.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$943.15
|
| Rate for Payer: PHP Commercial |
$1,068.90
|
| Rate for Payer: Priority Health SBD |
$792.24
|
|
|
HC ESOSURE ESOPHAGEAL DEVICE
|
Facility
|
OP
|
$1,257.53
|
|
| Hospital Charge Code |
27200326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$494.21 |
| Max. Negotiated Rate |
$1,131.78 |
| Rate for Payer: Aetna Commercial |
$1,068.90
|
| Rate for Payer: Aetna Medicare |
$628.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$817.39
|
| Rate for Payer: BCBS Complete |
$503.01
|
| Rate for Payer: Cash Price |
$1,006.02
|
| Rate for Payer: Cofinity Advantage |
$880.27
|
| Rate for Payer: Cofinity Commercial |
$1,081.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,006.02
|
| Rate for Payer: Healthscope Commercial |
$1,131.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,006.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,068.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$943.15
|
| Rate for Payer: PHP Commercial |
$1,068.90
|
| Rate for Payer: Priority Health SBD |
$792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$817.39
|
| Rate for Payer: UHC Core |
$655.17
|
| Rate for Payer: UHC Exchange |
$494.21
|
|
|
HC E- STIM ATTENDED PER 15 MIN
|
Facility
|
OP
|
$108.24
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$92.00
|
| Rate for Payer: Aetna Medicare |
$54.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.36
|
| Rate for Payer: BCBS Complete |
$43.30
|
| Rate for Payer: BCBS Trust/PPO |
$13.40
|
| Rate for Payer: BCN Commercial |
$13.40
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cofinity Advantage |
$75.77
|
| Rate for Payer: Cofinity Commercial |
$93.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.59
|
| Rate for Payer: Healthscope Commercial |
$97.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.00
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.18
|
| Rate for Payer: PHP Commercial |
$92.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.00
|
| Rate for Payer: Priority Health SBD |
$68.19
|
| Rate for Payer: Priority Health Tiered Network |
$12.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.36
|
| Rate for Payer: UHC Core |
$56.39
|
| Rate for Payer: UHC Exchange |
$42.54
|
|
|
HC E- STIM ATTENDED PER 15 MIN
|
Facility
|
IP
|
$108.24
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.19 |
| Max. Negotiated Rate |
$97.42 |
| Rate for Payer: Aetna Commercial |
$92.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.36
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cofinity Advantage |
$75.77
|
| Rate for Payer: Cofinity Commercial |
$93.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.59
|
| Rate for Payer: Healthscope Commercial |
$97.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.18
|
| Rate for Payer: PHP Commercial |
$92.00
|
| Rate for Payer: Priority Health SBD |
$68.19
|
|
|
HC ESTRADIAL, MASS SPEC, S
|
Facility
|
IP
|
$56.18
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.39 |
| Max. Negotiated Rate |
$50.56 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.52
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Advantage |
$39.33
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.13
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: Priority Health SBD |
$35.39
|
|
|
HC ESTRADIAL, MASS SPEC, S
|
Facility
|
OP
|
$56.18
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$50.56 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$29.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.92
|
| Rate for Payer: BCBS Complete |
$15.34
|
| Rate for Payer: BCBS MAPPO |
$27.94
|
| Rate for Payer: BCBS Trust/PPO |
$29.80
|
| Rate for Payer: BCN Commercial |
$29.80
|
| Rate for Payer: BCN Medicare Advantage |
$27.94
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Advantage |
$39.33
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: Mclaren Medicaid |
$14.61
|
| Rate for Payer: Mclaren Medicare |
$27.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.34
|
| Rate for Payer: Meridian Medicaid |
$29.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: Nomi Health Commercial |
$41.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.13
|
| Rate for Payer: PACE Medicare |
$26.54
|
| Rate for Payer: PACE SWMI |
$27.94
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: PHP Medicare Advantage |
$27.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27.94
|
| Rate for Payer: Priority Health Medicare |
$27.94
|
| Rate for Payer: Priority Health SBD |
$35.39
|
| Rate for Payer: Priority Health Tiered Network |
$22.35
|
| Rate for Payer: Railroad Medicare Medicare |
$27.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.91
|
| Rate for Payer: UHC Core |
$41.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.94
|
| Rate for Payer: UHC Exchange |
$41.91
|
| Rate for Payer: UHC Medicaid |
$14.61
|
| Rate for Payer: UHCCP Medicaid |
$14.61
|
| Rate for Payer: VA VA |
$27.94
|
|
|
HC ESTRADIOL LEVEL
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: Priority Health SBD |
$50.14
|
|
|
HC ESTRADIOL LEVEL
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna Medicare |
$29.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.92
|
| Rate for Payer: BCBS Complete |
$15.34
|
| Rate for Payer: BCBS MAPPO |
$27.94
|
| Rate for Payer: BCBS Trust/PPO |
$29.80
|
| Rate for Payer: BCN Commercial |
$29.80
|
| Rate for Payer: BCN Medicare Advantage |
$27.94
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Mclaren Medicaid |
$14.61
|
| Rate for Payer: Mclaren Medicare |
$27.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.34
|
| Rate for Payer: Meridian Medicaid |
$29.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$41.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Medicare |
$26.54
|
| Rate for Payer: PACE SWMI |
$27.94
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: PHP Medicare Advantage |
$27.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27.94
|
| Rate for Payer: Priority Health Medicare |
$27.94
|
| Rate for Payer: Priority Health SBD |
$50.14
|
| Rate for Payer: Priority Health Tiered Network |
$22.35
|
| Rate for Payer: Railroad Medicare Medicare |
$27.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.91
|
| Rate for Payer: UHC Core |
$41.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.94
|
| Rate for Payer: UHC Exchange |
$41.91
|
| Rate for Payer: UHC Medicaid |
$14.61
|
| Rate for Payer: UHCCP Medicaid |
$14.61
|
| Rate for Payer: VA VA |
$27.94
|
|
|
HC ESTRIOL
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
30100195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna Commercial |
$44.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Advantage |
$36.40
|
| Rate for Payer: Cofinity Commercial |
$44.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.60
|
| Rate for Payer: Healthscope Commercial |
$46.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: PHP Commercial |
$44.20
|
| Rate for Payer: Priority Health SBD |
$32.76
|
|
|
HC ESTRIOL
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
30100195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna Commercial |
$44.20
|
| Rate for Payer: Aetna Medicare |
$25.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.23
|
| Rate for Payer: BCBS Complete |
$13.28
|
| Rate for Payer: BCBS MAPPO |
$24.18
|
| Rate for Payer: BCBS Trust/PPO |
$25.79
|
| Rate for Payer: BCN Commercial |
$25.79
|
| Rate for Payer: BCN Medicare Advantage |
$24.18
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Advantage |
$36.40
|
| Rate for Payer: Cofinity Commercial |
$44.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.18
|
| Rate for Payer: Healthscope Commercial |
$46.80
|
| Rate for Payer: Mclaren Medicaid |
$12.65
|
| Rate for Payer: Mclaren Medicare |
$24.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.39
|
| Rate for Payer: Meridian Medicaid |
$25.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.20
|
| Rate for Payer: Nomi Health Commercial |
$36.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: PACE Medicare |
$22.97
|
| Rate for Payer: PACE SWMI |
$24.18
|
| Rate for Payer: PHP Commercial |
$44.20
|
| Rate for Payer: PHP Medicare Advantage |
$24.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.18
|
| Rate for Payer: Priority Health Medicare |
$24.18
|
| Rate for Payer: Priority Health SBD |
$32.76
|
| Rate for Payer: Priority Health Tiered Network |
$19.34
|
| Rate for Payer: Railroad Medicare Medicare |
$24.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.27
|
| Rate for Payer: UHC Core |
$36.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.18
|
| Rate for Payer: UHC Exchange |
$36.27
|
| Rate for Payer: UHC Medicaid |
$12.65
|
| Rate for Payer: UHCCP Medicaid |
$12.65
|
| Rate for Payer: VA VA |
$24.18
|
|
|
HC ESTROGEN FRACTIONATED E1 & E2
|
Facility
|
IP
|
$51.85
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
30100527
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.67 |
| Max. Negotiated Rate |
$46.66 |
| Rate for Payer: Aetna Commercial |
$44.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.70
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cofinity Advantage |
$36.30
|
| Rate for Payer: Cofinity Commercial |
$44.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.48
|
| Rate for Payer: Healthscope Commercial |
$46.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.89
|
| Rate for Payer: PHP Commercial |
$44.07
|
| Rate for Payer: Priority Health SBD |
$32.67
|
|
|
HC ESTROGEN FRACTIONATED E1 & E2
|
Facility
|
OP
|
$51.85
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
30100527
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Aetna Commercial |
$44.07
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.38
|
| Rate for Payer: BCBS Complete |
$17.74
|
| Rate for Payer: BCBS MAPPO |
$32.30
|
| Rate for Payer: BCBS Trust/PPO |
$34.45
|
| Rate for Payer: BCN Commercial |
$34.45
|
| Rate for Payer: BCN Medicare Advantage |
$32.30
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cofinity Advantage |
$36.30
|
| Rate for Payer: Cofinity Commercial |
$44.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.30
|
| Rate for Payer: Healthscope Commercial |
$46.66
|
| Rate for Payer: Mclaren Medicaid |
$16.89
|
| Rate for Payer: Mclaren Medicare |
$32.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.91
|
| Rate for Payer: Meridian Medicaid |
$33.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.07
|
| Rate for Payer: Nomi Health Commercial |
$48.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.89
|
| Rate for Payer: PACE Medicare |
$30.68
|
| Rate for Payer: PACE SWMI |
$32.30
|
| Rate for Payer: PHP Commercial |
$44.07
|
| Rate for Payer: PHP Medicare Advantage |
$32.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$32.30
|
| Rate for Payer: Priority Health Medicare |
$32.30
|
| Rate for Payer: Priority Health SBD |
$32.67
|
| Rate for Payer: Priority Health Tiered Network |
$25.84
|
| Rate for Payer: Railroad Medicare Medicare |
$32.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.45
|
| Rate for Payer: UHC Core |
$48.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32.30
|
| Rate for Payer: UHC Exchange |
$48.45
|
| Rate for Payer: UHC Medicaid |
$16.89
|
| Rate for Payer: UHCCP Medicaid |
$16.89
|
| Rate for Payer: VA VA |
$32.30
|
|
|
HC ESTROGEN RECEPTOR
|
Facility
|
OP
|
$120.55
|
|
|
Service Code
|
CPT 84233
|
| Hospital Charge Code |
30100416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.96 |
| Max. Negotiated Rate |
$131.82 |
| Rate for Payer: Aetna Commercial |
$102.47
|
| Rate for Payer: Aetna Medicare |
$91.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.85
|
| Rate for Payer: BCBS Complete |
$48.26
|
| Rate for Payer: BCBS MAPPO |
$87.88
|
| Rate for Payer: BCBS Trust/PPO |
$93.70
|
| Rate for Payer: BCN Commercial |
$93.70
|
| Rate for Payer: BCN Medicare Advantage |
$87.88
|
| Rate for Payer: Cash Price |
$96.44
|
| Rate for Payer: Cash Price |
$96.44
|
| Rate for Payer: Cofinity Advantage |
$84.39
|
| Rate for Payer: Cofinity Commercial |
$103.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.88
|
| Rate for Payer: Healthscope Commercial |
$108.50
|
| Rate for Payer: Mclaren Medicaid |
$45.96
|
| Rate for Payer: Mclaren Medicare |
$87.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.27
|
| Rate for Payer: Meridian Medicaid |
$92.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$96.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.47
|
| Rate for Payer: Nomi Health Commercial |
$131.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.41
|
| Rate for Payer: PACE Medicare |
$83.49
|
| Rate for Payer: PACE SWMI |
$87.88
|
| Rate for Payer: PHP Commercial |
$102.47
|
| Rate for Payer: PHP Medicare Advantage |
$87.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$87.88
|
| Rate for Payer: Priority Health Medicare |
$87.88
|
| Rate for Payer: Priority Health SBD |
$75.95
|
| Rate for Payer: Priority Health Tiered Network |
$70.30
|
| Rate for Payer: Railroad Medicare Medicare |
$87.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.82
|
| Rate for Payer: UHC Core |
$131.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$87.88
|
| Rate for Payer: UHC Exchange |
$131.82
|
| Rate for Payer: UHC Medicaid |
$45.96
|
| Rate for Payer: UHCCP Medicaid |
$45.96
|
| Rate for Payer: VA VA |
$87.88
|
|
|
HC ESTROGEN RECEPTOR
|
Facility
|
IP
|
$120.55
|
|
|
Service Code
|
CPT 84233
|
| Hospital Charge Code |
30100416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.95 |
| Max. Negotiated Rate |
$108.50 |
| Rate for Payer: Aetna Commercial |
$102.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.36
|
| Rate for Payer: Cash Price |
$96.44
|
| Rate for Payer: Cofinity Advantage |
$84.39
|
| Rate for Payer: Cofinity Commercial |
$103.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.44
|
| Rate for Payer: Healthscope Commercial |
$108.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.41
|
| Rate for Payer: PHP Commercial |
$102.47
|
| Rate for Payer: Priority Health SBD |
$75.95
|
|
|
HC ESTROGEN RECEPTOR-PROGESTERONE
|
Facility
|
OP
|
$121.40
|
|
|
Service Code
|
CPT 84234
|
| Hospital Charge Code |
30100417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$109.26 |
| Rate for Payer: Aetna Commercial |
$103.19
|
| Rate for Payer: Aetna Medicare |
$67.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.10
|
| Rate for Payer: BCBS Complete |
$35.63
|
| Rate for Payer: BCBS MAPPO |
$64.88
|
| Rate for Payer: BCBS Trust/PPO |
$69.18
|
| Rate for Payer: BCN Commercial |
$69.18
|
| Rate for Payer: BCN Medicare Advantage |
$64.88
|
| Rate for Payer: Cash Price |
$97.12
|
| Rate for Payer: Cash Price |
$97.12
|
| Rate for Payer: Cofinity Advantage |
$84.98
|
| Rate for Payer: Cofinity Commercial |
$104.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.88
|
| Rate for Payer: Healthscope Commercial |
$109.26
|
| Rate for Payer: Mclaren Medicaid |
$33.93
|
| Rate for Payer: Mclaren Medicare |
$64.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.12
|
| Rate for Payer: Meridian Medicaid |
$68.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.19
|
| Rate for Payer: Nomi Health Commercial |
$97.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.05
|
| Rate for Payer: PACE Medicare |
$61.64
|
| Rate for Payer: PACE SWMI |
$64.88
|
| Rate for Payer: PHP Commercial |
$103.19
|
| Rate for Payer: PHP Medicare Advantage |
$64.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$64.88
|
| Rate for Payer: Priority Health Medicare |
$64.88
|
| Rate for Payer: Priority Health SBD |
$76.48
|
| Rate for Payer: Priority Health Tiered Network |
$51.90
|
| Rate for Payer: Railroad Medicare Medicare |
$64.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.32
|
| Rate for Payer: UHC Core |
$97.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$64.88
|
| Rate for Payer: UHC Exchange |
$97.32
|
| Rate for Payer: UHC Medicaid |
$33.93
|
| Rate for Payer: UHCCP Medicaid |
$33.93
|
| Rate for Payer: VA VA |
$64.88
|
|
|
HC ESTROGEN RECEPTOR-PROGESTERONE
|
Facility
|
IP
|
$121.40
|
|
|
Service Code
|
CPT 84234
|
| Hospital Charge Code |
30100417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.48 |
| Max. Negotiated Rate |
$109.26 |
| Rate for Payer: Aetna Commercial |
$103.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.91
|
| Rate for Payer: Cash Price |
$97.12
|
| Rate for Payer: Cofinity Advantage |
$84.98
|
| Rate for Payer: Cofinity Commercial |
$104.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.12
|
| Rate for Payer: Healthscope Commercial |
$109.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.05
|
| Rate for Payer: PHP Commercial |
$103.19
|
| Rate for Payer: Priority Health SBD |
$76.48
|
|
|
HC ESTRONE
|
Facility
|
IP
|
$67.92
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
30100196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.79 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: Aetna Commercial |
$57.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.15
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cofinity Advantage |
$47.54
|
| Rate for Payer: Cofinity Commercial |
$58.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.34
|
| Rate for Payer: Healthscope Commercial |
$61.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.94
|
| Rate for Payer: PHP Commercial |
$57.73
|
| Rate for Payer: Priority Health SBD |
$42.79
|
|
|
HC ESTRONE
|
Facility
|
OP
|
$67.92
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
30100196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: Aetna Commercial |
$57.73
|
| Rate for Payer: Aetna Medicare |
$25.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.19
|
| Rate for Payer: BCBS Complete |
$13.70
|
| Rate for Payer: BCBS MAPPO |
$24.95
|
| Rate for Payer: BCBS Trust/PPO |
$26.60
|
| Rate for Payer: BCN Commercial |
$26.60
|
| Rate for Payer: BCN Medicare Advantage |
$24.95
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cofinity Advantage |
$47.54
|
| Rate for Payer: Cofinity Commercial |
$58.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.95
|
| Rate for Payer: Healthscope Commercial |
$61.13
|
| Rate for Payer: Mclaren Medicaid |
$13.05
|
| Rate for Payer: Mclaren Medicare |
$24.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.20
|
| Rate for Payer: Meridian Medicaid |
$26.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.73
|
| Rate for Payer: Nomi Health Commercial |
$37.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.94
|
| Rate for Payer: PACE Medicare |
$23.70
|
| Rate for Payer: PACE SWMI |
$24.95
|
| Rate for Payer: PHP Commercial |
$57.73
|
| Rate for Payer: PHP Medicare Advantage |
$24.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.95
|
| Rate for Payer: Priority Health Medicare |
$24.95
|
| Rate for Payer: Priority Health SBD |
$42.79
|
| Rate for Payer: Priority Health Tiered Network |
$19.96
|
| Rate for Payer: Railroad Medicare Medicare |
$24.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.43
|
| Rate for Payer: UHC Core |
$37.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.95
|
| Rate for Payer: UHC Exchange |
$37.43
|
| Rate for Payer: UHC Medicaid |
$13.05
|
| Rate for Payer: UHCCP Medicaid |
$13.05
|
| Rate for Payer: VA VA |
$24.95
|
|
|
HC ETHANOL CONFIRM URINE
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.42 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna Medicare |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: BCBS Complete |
$62.42
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Advantage |
$109.24
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health SBD |
$98.32
|
|
|
HC ETHANOL CONFIRM URINE
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$98.32 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Advantage |
$109.24
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health SBD |
$98.32
|
|
