|
HC ERYTHROPOIETIN
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
30100191
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health SBD |
$26.22
|
|
|
HC ESCHERICHIA COLI K1
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$98.77 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$19.76
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC ESCHERICHIA COLI K1
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC ESOPHAGOSCOPY
|
Facility
|
IP
|
$1,377.23
|
|
| Hospital Charge Code |
36000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$867.65 |
| Max. Negotiated Rate |
$1,239.51 |
| Rate for Payer: Aetna Commercial |
$1,170.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$895.20
|
| Rate for Payer: Cash Price |
$1,101.78
|
| Rate for Payer: Cofinity Commercial |
$1,184.42
|
| Rate for Payer: Cofinity Commercial |
$964.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$964.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.78
|
| Rate for Payer: Healthscope Commercial |
$1,239.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.65
|
| Rate for Payer: PHP Commercial |
$1,170.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.20
|
| Rate for Payer: Priority Health SBD |
$867.65
|
|
|
HC ESOPHAGOSCOPY
|
Facility
|
OP
|
$1,377.23
|
|
| Hospital Charge Code |
36000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$550.89 |
| Max. Negotiated Rate |
$1,239.51 |
| Rate for Payer: Aetna Commercial |
$1,170.65
|
| Rate for Payer: Aetna Medicare |
$688.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$895.20
|
| Rate for Payer: BCBS Complete |
$550.89
|
| Rate for Payer: Cash Price |
$1,101.78
|
| Rate for Payer: Cofinity Commercial |
$1,184.42
|
| Rate for Payer: Cofinity Commercial |
$964.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$964.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.78
|
| Rate for Payer: Healthscope Commercial |
$1,239.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.65
|
| Rate for Payer: PHP Commercial |
$1,170.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.20
|
| Rate for Payer: Priority Health SBD |
$867.65
|
|
|
HC ESOPHGL FUNC G-ESOP RFLX IMPD ELTRD PROLNG
|
Facility
|
IP
|
$2,391.90
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
76100426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,506.90 |
| Max. Negotiated Rate |
$2,152.71 |
| Rate for Payer: Aetna Commercial |
$2,033.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,554.73
|
| Rate for Payer: Cash Price |
$1,913.52
|
| Rate for Payer: Cofinity Commercial |
$1,674.33
|
| Rate for Payer: Cofinity Commercial |
$2,057.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,674.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,913.52
|
| Rate for Payer: Healthscope Commercial |
$2,152.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,033.12
|
| Rate for Payer: PHP Commercial |
$2,033.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,554.73
|
| Rate for Payer: Priority Health SBD |
$1,506.90
|
|
|
HC ESOPHGL FUNC G-ESOP RFLX IMPD ELTRD PROLNG
|
Facility
|
OP
|
$2,391.90
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
76100426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$2,152.71 |
| Rate for Payer: Aetna Commercial |
$2,033.12
|
| Rate for Payer: Aetna Medicare |
$538.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,554.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$1,913.52
|
| Rate for Payer: Cash Price |
$1,913.52
|
| Rate for Payer: Cofinity Commercial |
$2,057.03
|
| Rate for Payer: Cofinity Commercial |
$1,674.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,674.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,913.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$2,152.71
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,033.12
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$2,033.12
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,554.73
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health SBD |
$1,506.90
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$291.34
|
| Rate for Payer: VA VA |
$517.48
|
|
|
HC ESOPH IMPEDENCE MONITOR/MANOMETRY
|
Facility
|
IP
|
$1,451.42
|
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$914.39 |
| Max. Negotiated Rate |
$1,306.28 |
| Rate for Payer: Aetna Commercial |
$1,233.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$943.42
|
| Rate for Payer: Cash Price |
$1,161.14
|
| Rate for Payer: Cofinity Commercial |
$1,015.99
|
| Rate for Payer: Cofinity Commercial |
$1,248.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,015.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,161.14
|
| Rate for Payer: Healthscope Commercial |
$1,306.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,233.71
|
| Rate for Payer: PHP Commercial |
$1,233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$943.42
|
| Rate for Payer: Priority Health SBD |
$914.39
|
|
|
HC ESOPH IMPEDENCE MONITOR/MANOMETRY
|
Facility
|
OP
|
$1,451.42
|
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$580.57 |
| Max. Negotiated Rate |
$1,306.28 |
| Rate for Payer: Aetna Commercial |
$1,233.71
|
| Rate for Payer: Aetna Medicare |
$725.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$943.42
|
| Rate for Payer: BCBS Complete |
$580.57
|
| Rate for Payer: Cash Price |
$1,161.14
|
| Rate for Payer: Cofinity Commercial |
$1,015.99
|
| Rate for Payer: Cofinity Commercial |
$1,248.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,015.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,161.14
|
| Rate for Payer: Healthscope Commercial |
$1,306.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,233.71
|
| Rate for Payer: PHP Commercial |
$1,233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$943.42
|
| Rate for Payer: Priority Health SBD |
$914.39
|
|
|
HC ESOSURE ESOPHAGEAL DEVICE
|
Facility
|
OP
|
$1,232.87
|
|
| Hospital Charge Code |
27200326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.15 |
| Max. Negotiated Rate |
$1,109.58 |
| Rate for Payer: Aetna Commercial |
$1,047.94
|
| Rate for Payer: Aetna Medicare |
$616.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$801.37
|
| Rate for Payer: BCBS Complete |
$493.15
|
| Rate for Payer: Cash Price |
$986.30
|
| Rate for Payer: Cofinity Commercial |
$1,060.27
|
| Rate for Payer: Cofinity Commercial |
$863.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$863.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$986.30
|
| Rate for Payer: Healthscope Commercial |
$1,109.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,047.94
|
| Rate for Payer: PHP Commercial |
$1,047.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$801.37
|
| Rate for Payer: Priority Health SBD |
$776.71
|
|
|
HC ESOSURE ESOPHAGEAL DEVICE
|
Facility
|
IP
|
$1,232.87
|
|
| Hospital Charge Code |
27200326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$776.71 |
| Max. Negotiated Rate |
$1,109.58 |
| Rate for Payer: Aetna Commercial |
$1,047.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$801.37
|
| Rate for Payer: Cash Price |
$986.30
|
| Rate for Payer: Cofinity Commercial |
$1,060.27
|
| Rate for Payer: Cofinity Commercial |
$863.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$863.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$986.30
|
| Rate for Payer: Healthscope Commercial |
$1,109.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,047.94
|
| Rate for Payer: PHP Commercial |
$1,047.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$801.37
|
| Rate for Payer: Priority Health SBD |
$776.71
|
|
|
HC E- STIM ATTENDED PER 15 MIN
|
Facility
|
IP
|
$106.12
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$66.86 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.98
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$74.28
|
| Rate for Payer: Cofinity Commercial |
$91.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$95.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: PHP Commercial |
$90.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.98
|
| Rate for Payer: Priority Health SBD |
$66.86
|
|
|
HC E- STIM ATTENDED PER 15 MIN
|
Facility
|
OP
|
$106.12
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: Aetna Medicare |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.98
|
| Rate for Payer: BCBS Complete |
$42.45
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$91.26
|
| Rate for Payer: Cofinity Commercial |
$74.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$95.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$90.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.98
|
| Rate for Payer: Priority Health SBD |
$66.86
|
| Rate for Payer: UHC Core |
$78.53
|
| Rate for Payer: UHC Exchange |
$78.53
|
|
|
HC ESTRADIAL, MASS SPEC, S
|
Facility
|
OP
|
$55.08
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$29.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.80
|
| 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 |
$15.72
|
| Rate for Payer: BCBS MAPPO |
$27.94
|
| Rate for Payer: BCN Medicare Advantage |
$27.94
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$47.37
|
| Rate for Payer: Cofinity Commercial |
$38.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$49.57
|
| Rate for Payer: Mclaren Medicaid |
$14.98
|
| 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 |
$15.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.82
|
| Rate for Payer: PACE Medicare |
$26.54
|
| Rate for Payer: PACE SWMI |
$27.94
|
| Rate for Payer: PHP Commercial |
$46.82
|
| Rate for Payer: PHP Medicare Advantage |
$27.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health Medicare |
$27.94
|
| Rate for Payer: Priority Health SBD |
$34.70
|
| Rate for Payer: Railroad Medicare Medicare |
$27.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.94
|
| Rate for Payer: UHC Medicare Advantage |
$27.94
|
| Rate for Payer: UHCCP Medicaid |
$15.73
|
| Rate for Payer: VA VA |
$27.94
|
|
|
HC ESTRADIAL, MASS SPEC, S
|
Facility
|
IP
|
$55.08
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.80
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$38.56
|
| Rate for Payer: Cofinity Commercial |
$47.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$49.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.82
|
| Rate for Payer: PHP Commercial |
$46.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health SBD |
$34.70
|
|
|
HC ESTRADIOL LEVEL
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$29.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| 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 |
$15.72
|
| Rate for Payer: BCBS MAPPO |
$27.94
|
| Rate for Payer: BCN Medicare Advantage |
$27.94
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.94
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$14.98
|
| 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 |
$15.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PACE Medicare |
$26.54
|
| Rate for Payer: PACE SWMI |
$27.94
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$27.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health Medicare |
$27.94
|
| Rate for Payer: Priority Health SBD |
$49.16
|
| Rate for Payer: Railroad Medicare Medicare |
$27.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.94
|
| Rate for Payer: UHC Medicare Advantage |
$27.94
|
| Rate for Payer: UHCCP Medicaid |
$15.73
|
| Rate for Payer: VA VA |
$27.94
|
|
|
HC ESTRADIOL LEVEL
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health SBD |
$49.16
|
|
|
HC ESTRIOL
|
Facility
|
IP
|
$50.98
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
30100195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health SBD |
$32.12
|
|
|
HC ESTRIOL
|
Facility
|
OP
|
$50.98
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
30100195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$68.06 |
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna Medicare |
$25.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| 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 |
$13.61
|
| Rate for Payer: BCBS MAPPO |
$24.18
|
| Rate for Payer: BCN Medicare Advantage |
$24.18
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.18
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Mclaren Medicaid |
$12.96
|
| 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 |
$13.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: PACE Medicare |
$22.97
|
| Rate for Payer: PACE SWMI |
$24.18
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: PHP Medicare Advantage |
$24.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health Medicare |
$24.18
|
| Rate for Payer: Priority Health SBD |
$32.12
|
| Rate for Payer: Railroad Medicare Medicare |
$24.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.18
|
| Rate for Payer: UHC Medicare Advantage |
$24.18
|
| Rate for Payer: UHCCP Medicaid |
$13.61
|
| Rate for Payer: VA VA |
$24.18
|
|
|
HC ESTROGEN RECEPTOR
|
Facility
|
OP
|
$118.19
|
|
|
Service Code
|
CPT 84233
|
| Hospital Charge Code |
30100416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.10 |
| Max. Negotiated Rate |
$247.37 |
| Rate for Payer: Aetna Commercial |
$100.46
|
| Rate for Payer: Aetna Medicare |
$91.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.82
|
| 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 |
$49.46
|
| Rate for Payer: BCBS MAPPO |
$87.88
|
| Rate for Payer: BCN Medicare Advantage |
$87.88
|
| Rate for Payer: Cash Price |
$94.55
|
| Rate for Payer: Cash Price |
$94.55
|
| Rate for Payer: Cofinity Commercial |
$82.73
|
| Rate for Payer: Cofinity Commercial |
$101.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.88
|
| Rate for Payer: Healthscope Commercial |
$106.37
|
| Rate for Payer: Mclaren Medicaid |
$47.10
|
| 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 |
$49.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.46
|
| Rate for Payer: PACE Medicare |
$83.49
|
| Rate for Payer: PACE SWMI |
$87.88
|
| Rate for Payer: PHP Commercial |
$100.46
|
| Rate for Payer: PHP Medicare Advantage |
$87.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.82
|
| Rate for Payer: Priority Health Medicare |
$87.88
|
| Rate for Payer: Priority Health SBD |
$74.46
|
| Rate for Payer: Railroad Medicare Medicare |
$87.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.88
|
| Rate for Payer: UHC Medicare Advantage |
$87.88
|
| Rate for Payer: UHCCP Medicaid |
$49.48
|
| Rate for Payer: VA VA |
$87.88
|
|
|
HC ESTROGEN RECEPTOR
|
Facility
|
IP
|
$118.19
|
|
|
Service Code
|
CPT 84233
|
| Hospital Charge Code |
30100416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.46 |
| Max. Negotiated Rate |
$106.37 |
| Rate for Payer: Aetna Commercial |
$100.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.82
|
| Rate for Payer: Cash Price |
$94.55
|
| Rate for Payer: Cofinity Commercial |
$101.64
|
| Rate for Payer: Cofinity Commercial |
$82.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.55
|
| Rate for Payer: Healthscope Commercial |
$106.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.46
|
| Rate for Payer: PHP Commercial |
$100.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.82
|
| Rate for Payer: Priority Health SBD |
$74.46
|
|
|
HC ESTROGEN RECEPTOR-PROGESTERONE
|
Facility
|
IP
|
$119.02
|
|
|
Service Code
|
CPT 84234
|
| Hospital Charge Code |
30100417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$107.12 |
| Rate for Payer: Aetna Commercial |
$101.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.36
|
| Rate for Payer: Cash Price |
$95.22
|
| Rate for Payer: Cofinity Commercial |
$102.36
|
| Rate for Payer: Cofinity Commercial |
$83.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.22
|
| Rate for Payer: Healthscope Commercial |
$107.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.17
|
| Rate for Payer: PHP Commercial |
$101.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.36
|
| Rate for Payer: Priority Health SBD |
$74.98
|
|
|
HC ESTROGEN RECEPTOR-PROGESTERONE
|
Facility
|
OP
|
$119.02
|
|
|
Service Code
|
CPT 84234
|
| Hospital Charge Code |
30100417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$182.63 |
| Rate for Payer: Aetna Commercial |
$101.17
|
| Rate for Payer: Aetna Medicare |
$67.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.36
|
| 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 |
$36.51
|
| Rate for Payer: BCBS MAPPO |
$64.88
|
| Rate for Payer: BCN Medicare Advantage |
$64.88
|
| Rate for Payer: Cash Price |
$95.22
|
| Rate for Payer: Cash Price |
$95.22
|
| Rate for Payer: Cofinity Commercial |
$83.31
|
| Rate for Payer: Cofinity Commercial |
$102.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.88
|
| Rate for Payer: Healthscope Commercial |
$107.12
|
| Rate for Payer: Mclaren Medicaid |
$34.78
|
| 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 |
$36.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.17
|
| Rate for Payer: PACE Medicare |
$61.64
|
| Rate for Payer: PACE SWMI |
$64.88
|
| Rate for Payer: PHP Commercial |
$101.17
|
| Rate for Payer: PHP Medicare Advantage |
$64.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.36
|
| Rate for Payer: Priority Health Medicare |
$64.88
|
| Rate for Payer: Priority Health SBD |
$74.98
|
| Rate for Payer: Railroad Medicare Medicare |
$64.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.88
|
| Rate for Payer: UHC Medicare Advantage |
$64.88
|
| Rate for Payer: UHCCP Medicaid |
$36.53
|
| Rate for Payer: VA VA |
$64.88
|
|
|
HC ESTRONE
|
Facility
|
OP
|
$66.59
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
30100196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna Medicare |
$25.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.28
|
| 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 |
$14.04
|
| Rate for Payer: BCBS MAPPO |
$24.95
|
| Rate for Payer: BCN Medicare Advantage |
$24.95
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Cofinity Commercial |
$46.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.95
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: Mclaren Medicaid |
$13.37
|
| 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 |
$14.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: PACE Medicare |
$23.70
|
| Rate for Payer: PACE SWMI |
$24.95
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: PHP Medicare Advantage |
$24.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.28
|
| Rate for Payer: Priority Health Medicare |
$24.95
|
| Rate for Payer: Priority Health SBD |
$41.95
|
| Rate for Payer: Railroad Medicare Medicare |
$24.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.95
|
| Rate for Payer: UHC Medicare Advantage |
$24.95
|
| Rate for Payer: UHCCP Medicaid |
$14.05
|
| Rate for Payer: VA VA |
$24.95
|
|
|
HC ESTRONE
|
Facility
|
IP
|
$66.59
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
30100196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.95 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.28
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.28
|
| Rate for Payer: Priority Health SBD |
$41.95
|
|
