|
HC THROMBO EMBO LVL 141
|
Facility
|
IP
|
$14,159.85
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
27200225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,920.71 |
| Max. Negotiated Rate |
$12,743.86 |
| Rate for Payer: Aetna Commercial |
$12,035.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,203.90
|
| Rate for Payer: Cash Price |
$11,327.88
|
| Rate for Payer: Cofinity Commercial |
$12,177.47
|
| Rate for Payer: Cofinity Commercial |
$9,911.90
|
| Rate for Payer: Healthscope Commercial |
$12,743.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,035.87
|
| Rate for Payer: PHP Commercial |
$12,035.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,911.90
|
| Rate for Payer: Priority Health SBD |
$8,920.71
|
|
|
HC THROMBO EMBO LVL 141
|
Facility
|
OP
|
$14,159.85
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
27200225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,663.94 |
| Max. Negotiated Rate |
$12,743.86 |
| Rate for Payer: Aetna Commercial |
$12,035.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,203.90
|
| Rate for Payer: BCBS Complete |
$5,663.94
|
| Rate for Payer: Cash Price |
$11,327.88
|
| Rate for Payer: Cofinity Commercial |
$12,177.47
|
| Rate for Payer: Cofinity Commercial |
$9,911.90
|
| Rate for Payer: Healthscope Commercial |
$12,743.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,035.87
|
| Rate for Payer: PHP Commercial |
$12,035.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,911.90
|
| Rate for Payer: Priority Health SBD |
$8,920.71
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
IP
|
$509.61
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.05 |
| Max. Negotiated Rate |
$458.65 |
| Rate for Payer: Aetna Commercial |
$433.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.25
|
| Rate for Payer: Cash Price |
$407.69
|
| Rate for Payer: Cofinity Commercial |
$356.73
|
| Rate for Payer: Cofinity Commercial |
$438.26
|
| Rate for Payer: Healthscope Commercial |
$458.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$433.17
|
| Rate for Payer: PHP Commercial |
$433.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$356.73
|
| Rate for Payer: Priority Health SBD |
$321.05
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
OP
|
$509.61
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.47 |
| Max. Negotiated Rate |
$947.66 |
| Rate for Payer: Aetna Commercial |
$433.17
|
| Rate for Payer: Aetna Medicare |
$313.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$376.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$376.68
|
| Rate for Payer: BCBS Complete |
$173.09
|
| Rate for Payer: BCBS MAPPO |
$301.34
|
| Rate for Payer: BCBS Trust/PPO |
$145.47
|
| Rate for Payer: BCN Medicare Advantage |
$301.34
|
| Rate for Payer: Cash Price |
$407.69
|
| Rate for Payer: Cash Price |
$407.69
|
| Rate for Payer: Cofinity Commercial |
$438.26
|
| Rate for Payer: Cofinity Commercial |
$356.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.34
|
| Rate for Payer: Healthscope Commercial |
$458.65
|
| Rate for Payer: Mclaren Medicaid |
$164.83
|
| Rate for Payer: Mclaren Medicare |
$301.34
|
| Rate for Payer: Meridian Medicaid |
$173.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$316.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$433.17
|
| Rate for Payer: PACE Medicare |
$286.27
|
| Rate for Payer: PACE SWMI |
$301.34
|
| Rate for Payer: PHP Commercial |
$433.17
|
| Rate for Payer: PHP Medicare Advantage |
$301.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$356.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$947.66
|
| Rate for Payer: Priority Health Medicare |
$301.34
|
| Rate for Payer: Priority Health Narrow Network |
$758.13
|
| Rate for Payer: Priority Health SBD |
$321.05
|
| Rate for Payer: Railroad Medicare Medicare |
$301.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$301.34
|
| Rate for Payer: UHC Medicare Advantage |
$310.38
|
| Rate for Payer: VA VA |
$301.34
|
|
|
HC THROMBOLYSIS CESSATION
|
Facility
|
IP
|
$4,553.46
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
36100374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,868.68 |
| Max. Negotiated Rate |
$4,098.11 |
| Rate for Payer: Aetna Commercial |
$3,870.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,959.75
|
| Rate for Payer: Cash Price |
$3,642.77
|
| Rate for Payer: Cofinity Commercial |
$3,187.42
|
| Rate for Payer: Cofinity Commercial |
$3,915.98
|
| Rate for Payer: Healthscope Commercial |
$4,098.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,870.44
|
| Rate for Payer: PHP Commercial |
$3,870.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,187.42
|
| Rate for Payer: Priority Health SBD |
$2,868.68
|
|
|
HC THROMBOLYSIS CESSATION
|
Facility
|
OP
|
$4,553.46
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
36100374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.24 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$3,870.44
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,959.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$356.11
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$3,642.77
|
| Rate for Payer: Cash Price |
$3,642.77
|
| Rate for Payer: Cofinity Commercial |
$3,187.42
|
| Rate for Payer: Cofinity Commercial |
$3,915.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$4,098.11
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,870.44
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$3,870.44
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,187.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Priority Health SBD |
$2,868.68
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.86
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$116.24
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC THSD7
|
Facility
|
IP
|
$372.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200493
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$234.93 |
| Max. Negotiated Rate |
$335.61 |
| Rate for Payer: Aetna Commercial |
$316.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.38
|
| Rate for Payer: Cash Price |
$298.32
|
| Rate for Payer: Cofinity Commercial |
$261.03
|
| Rate for Payer: Cofinity Commercial |
$320.69
|
| Rate for Payer: Healthscope Commercial |
$335.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.96
|
| Rate for Payer: PHP Commercial |
$316.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.03
|
| Rate for Payer: Priority Health SBD |
$234.93
|
|
|
HC THSD7
|
Facility
|
OP
|
$372.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200493
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$335.61 |
| Rate for Payer: Aetna Commercial |
$316.96
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$7.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$298.32
|
| Rate for Payer: Cash Price |
$298.32
|
| Rate for Payer: Cofinity Commercial |
$320.69
|
| Rate for Payer: Cofinity Commercial |
$261.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$335.61
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.96
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$316.96
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.03
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$234.93
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$20.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC THYROGLOBULIN
|
Facility
|
OP
|
$56.75
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
30100434
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$51.08 |
| Rate for Payer: Aetna Commercial |
$48.24
|
| Rate for Payer: Aetna Medicare |
$16.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.08
|
| Rate for Payer: BCBS Complete |
$9.22
|
| Rate for Payer: BCBS MAPPO |
$16.06
|
| Rate for Payer: BCBS Trust/PPO |
$12.58
|
| Rate for Payer: BCN Medicare Advantage |
$16.06
|
| Rate for Payer: Cash Price |
$45.40
|
| Rate for Payer: Cash Price |
$45.40
|
| Rate for Payer: Cofinity Commercial |
$39.72
|
| Rate for Payer: Cofinity Commercial |
$48.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$51.08
|
| Rate for Payer: Mclaren Medicaid |
$8.78
|
| Rate for Payer: Mclaren Medicare |
$16.06
|
| Rate for Payer: Meridian Medicaid |
$9.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.24
|
| Rate for Payer: PACE Medicare |
$15.26
|
| Rate for Payer: PACE SWMI |
$16.06
|
| Rate for Payer: PHP Commercial |
$48.24
|
| Rate for Payer: PHP Medicare Advantage |
$16.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.72
|
| Rate for Payer: Priority Health Medicare |
$16.06
|
| Rate for Payer: Priority Health SBD |
$35.75
|
| Rate for Payer: Railroad Medicare Medicare |
$16.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.27
|
| Rate for Payer: UHC Core |
$27.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.06
|
| Rate for Payer: UHC Exchange |
$16.06
|
| Rate for Payer: UHC Medicare Advantage |
$16.54
|
| Rate for Payer: VA VA |
$16.06
|
|
|
HC THYROGLOBULIN
|
Facility
|
IP
|
$56.75
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
30100434
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$51.08 |
| Rate for Payer: Aetna Commercial |
$48.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.89
|
| Rate for Payer: Cash Price |
$45.40
|
| Rate for Payer: Cofinity Commercial |
$39.72
|
| Rate for Payer: Cofinity Commercial |
$48.80
|
| Rate for Payer: Healthscope Commercial |
$51.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.24
|
| Rate for Payer: PHP Commercial |
$48.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.72
|
| Rate for Payer: Priority Health SBD |
$35.75
|
|
|
HC THYROGLOBULIN CMPT
|
Facility
|
OP
|
$59.06
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
30200335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$53.15 |
| Rate for Payer: Aetna Commercial |
$50.20
|
| Rate for Payer: Aetna Medicare |
$16.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.89
|
| Rate for Payer: BCBS Complete |
$9.14
|
| Rate for Payer: BCBS MAPPO |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$12.46
|
| Rate for Payer: BCN Medicare Advantage |
$15.91
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cofinity Commercial |
$41.34
|
| Rate for Payer: Cofinity Commercial |
$50.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.91
|
| Rate for Payer: Healthscope Commercial |
$53.15
|
| Rate for Payer: Mclaren Medicaid |
$8.70
|
| Rate for Payer: Mclaren Medicare |
$15.91
|
| Rate for Payer: Meridian Medicaid |
$9.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.20
|
| Rate for Payer: PACE Medicare |
$15.11
|
| Rate for Payer: PACE SWMI |
$15.91
|
| Rate for Payer: PHP Commercial |
$50.20
|
| Rate for Payer: PHP Medicare Advantage |
$15.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.34
|
| Rate for Payer: Priority Health Medicare |
$15.91
|
| Rate for Payer: Priority Health SBD |
$37.21
|
| Rate for Payer: Railroad Medicare Medicare |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.09
|
| Rate for Payer: UHC Core |
$27.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.91
|
| Rate for Payer: UHC Exchange |
$15.91
|
| Rate for Payer: UHC Medicare Advantage |
$16.39
|
| Rate for Payer: VA VA |
$15.91
|
|
|
HC THYROGLOBULIN CMPT
|
Facility
|
IP
|
$59.06
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
30200335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.21 |
| Max. Negotiated Rate |
$53.15 |
| Rate for Payer: Aetna Commercial |
$50.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.39
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cofinity Commercial |
$41.34
|
| Rate for Payer: Cofinity Commercial |
$50.79
|
| Rate for Payer: Healthscope Commercial |
$53.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.20
|
| Rate for Payer: PHP Commercial |
$50.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.34
|
| Rate for Payer: Priority Health SBD |
$37.21
|
|
|
HC THYROID IMAGING W VASC FLOW
|
Facility
|
IP
|
$571.97
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
34100075
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$360.34 |
| Max. Negotiated Rate |
$514.77 |
| Rate for Payer: Aetna Commercial |
$486.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.78
|
| Rate for Payer: Cash Price |
$457.58
|
| Rate for Payer: Cofinity Commercial |
$400.38
|
| Rate for Payer: Cofinity Commercial |
$491.89
|
| Rate for Payer: Healthscope Commercial |
$514.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.17
|
| Rate for Payer: PHP Commercial |
$486.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.38
|
| Rate for Payer: Priority Health SBD |
$360.34
|
|
|
HC THYROID IMAGING W VASC FLOW
|
Facility
|
OP
|
$571.97
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
34100075
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$168.31 |
| Max. Negotiated Rate |
$514.77 |
| Rate for Payer: Aetna Commercial |
$486.17
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCBS Trust/PPO |
$265.87
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$457.58
|
| Rate for Payer: Cash Price |
$457.58
|
| Rate for Payer: Cofinity Commercial |
$491.89
|
| Rate for Payer: Cofinity Commercial |
$400.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$514.77
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.17
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$486.17
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.38
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$360.34
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Exchange |
$168.31
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC THYROID IMAG W VASC FLOW SNGL OR MULTI
|
Facility
|
IP
|
$1,201.61
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
34100076
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$757.01 |
| Max. Negotiated Rate |
$1,081.45 |
| Rate for Payer: Aetna Commercial |
$1,021.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$781.05
|
| Rate for Payer: Cash Price |
$961.29
|
| Rate for Payer: Cofinity Commercial |
$841.13
|
| Rate for Payer: Cofinity Commercial |
$1,033.38
|
| Rate for Payer: Healthscope Commercial |
$1,081.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,021.37
|
| Rate for Payer: PHP Commercial |
$1,021.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.13
|
| Rate for Payer: Priority Health SBD |
$757.01
|
|
|
HC THYROID IMAG W VASC FLOW SNGL OR MULTI
|
Facility
|
OP
|
$1,201.61
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
34100076
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.74 |
| Max. Negotiated Rate |
$1,081.45 |
| Rate for Payer: Aetna Commercial |
$1,021.37
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$781.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCBS Trust/PPO |
$329.31
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$961.29
|
| Rate for Payer: Cash Price |
$961.29
|
| Rate for Payer: Cofinity Commercial |
$1,033.38
|
| Rate for Payer: Cofinity Commercial |
$841.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$1,081.45
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,021.37
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$1,021.37
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.13
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$757.01
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Exchange |
$213.82
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC THYROID PEROXIDASE ANTIBODY
|
Facility
|
OP
|
$83.90
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200209
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$75.51 |
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: Aetna Medicare |
$15.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.19
|
| Rate for Payer: BCBS Complete |
$8.36
|
| Rate for Payer: BCBS MAPPO |
$14.55
|
| Rate for Payer: BCBS Trust/PPO |
$11.39
|
| Rate for Payer: BCN Medicare Advantage |
$14.55
|
| Rate for Payer: Cash Price |
$67.12
|
| Rate for Payer: Cash Price |
$67.12
|
| Rate for Payer: Cofinity Commercial |
$58.73
|
| Rate for Payer: Cofinity Commercial |
$72.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.55
|
| Rate for Payer: Healthscope Commercial |
$75.51
|
| Rate for Payer: Mclaren Medicaid |
$7.96
|
| Rate for Payer: Mclaren Medicare |
$14.55
|
| Rate for Payer: Meridian Medicaid |
$8.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.32
|
| Rate for Payer: PACE Medicare |
$13.82
|
| Rate for Payer: PACE SWMI |
$14.55
|
| Rate for Payer: PHP Commercial |
$71.32
|
| Rate for Payer: PHP Medicare Advantage |
$14.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.73
|
| Rate for Payer: Priority Health Medicare |
$14.55
|
| Rate for Payer: Priority Health SBD |
$52.86
|
| Rate for Payer: Railroad Medicare Medicare |
$14.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.46
|
| Rate for Payer: UHC Core |
$24.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.55
|
| Rate for Payer: UHC Exchange |
$14.55
|
| Rate for Payer: UHC Medicare Advantage |
$14.99
|
| Rate for Payer: VA VA |
$14.55
|
|
|
HC THYROID PEROXIDASE ANTIBODY
|
Facility
|
IP
|
$83.90
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200209
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.86 |
| Max. Negotiated Rate |
$75.51 |
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.54
|
| Rate for Payer: Cash Price |
$67.12
|
| Rate for Payer: Cofinity Commercial |
$58.73
|
| Rate for Payer: Cofinity Commercial |
$72.15
|
| Rate for Payer: Healthscope Commercial |
$75.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.32
|
| Rate for Payer: PHP Commercial |
$71.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.73
|
| Rate for Payer: Priority Health SBD |
$52.86
|
|
|
HC THYROID STIMULATING IMMUNOGLOB
|
Facility
|
OP
|
$83.95
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
30100439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$86.42 |
| Rate for Payer: Aetna Commercial |
$71.36
|
| Rate for Payer: Aetna Medicare |
$52.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.58
|
| Rate for Payer: BCBS Complete |
$29.21
|
| Rate for Payer: BCBS MAPPO |
$50.86
|
| Rate for Payer: BCBS Trust/PPO |
$39.83
|
| Rate for Payer: BCN Medicare Advantage |
$50.86
|
| Rate for Payer: Cash Price |
$67.16
|
| Rate for Payer: Cash Price |
$67.16
|
| Rate for Payer: Cofinity Commercial |
$72.20
|
| Rate for Payer: Cofinity Commercial |
$58.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.86
|
| Rate for Payer: Healthscope Commercial |
$75.56
|
| Rate for Payer: Mclaren Medicaid |
$27.82
|
| Rate for Payer: Mclaren Medicare |
$50.86
|
| Rate for Payer: Meridian Medicaid |
$29.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.36
|
| Rate for Payer: PACE Medicare |
$48.32
|
| Rate for Payer: PACE SWMI |
$50.86
|
| Rate for Payer: PHP Commercial |
$71.36
|
| Rate for Payer: PHP Medicare Advantage |
$50.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.76
|
| Rate for Payer: Priority Health Medicare |
$50.86
|
| Rate for Payer: Priority Health SBD |
$52.89
|
| Rate for Payer: Railroad Medicare Medicare |
$50.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.03
|
| Rate for Payer: UHC Core |
$86.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.86
|
| Rate for Payer: UHC Exchange |
$50.86
|
| Rate for Payer: UHC Medicare Advantage |
$52.39
|
| Rate for Payer: VA VA |
$50.86
|
|
|
HC THYROID STIMULATING IMMUNOGLOB
|
Facility
|
IP
|
$83.95
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
30100439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.89 |
| Max. Negotiated Rate |
$75.56 |
| Rate for Payer: Aetna Commercial |
$71.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.57
|
| Rate for Payer: Cash Price |
$67.16
|
| Rate for Payer: Cofinity Commercial |
$58.76
|
| Rate for Payer: Cofinity Commercial |
$72.20
|
| Rate for Payer: Healthscope Commercial |
$75.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.36
|
| Rate for Payer: PHP Commercial |
$71.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.76
|
| Rate for Payer: Priority Health SBD |
$52.89
|
|
|
HC THYROID TC 99M PER STUDY
|
Facility
|
IP
|
$140.39
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300021
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$88.45 |
| Max. Negotiated Rate |
$126.35 |
| Rate for Payer: Aetna Commercial |
$119.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.25
|
| Rate for Payer: Cash Price |
$112.31
|
| Rate for Payer: Cofinity Commercial |
$120.74
|
| Rate for Payer: Cofinity Commercial |
$98.27
|
| Rate for Payer: Healthscope Commercial |
$126.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.33
|
| Rate for Payer: PHP Commercial |
$119.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.27
|
| Rate for Payer: Priority Health SBD |
$88.45
|
|
|
HC THYROID TC 99M PER STUDY
|
Facility
|
OP
|
$140.39
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300021
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$56.16 |
| Max. Negotiated Rate |
$133.75 |
| Rate for Payer: Aetna Commercial |
$119.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.25
|
| Rate for Payer: BCBS Complete |
$56.16
|
| Rate for Payer: BCBS Trust/PPO |
$133.75
|
| Rate for Payer: Cash Price |
$112.31
|
| Rate for Payer: Cash Price |
$112.31
|
| Rate for Payer: Cofinity Commercial |
$120.74
|
| Rate for Payer: Cofinity Commercial |
$98.27
|
| Rate for Payer: Healthscope Commercial |
$126.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.33
|
| Rate for Payer: PHP Commercial |
$119.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.27
|
| Rate for Payer: Priority Health SBD |
$88.45
|
|
|
HC THYROID UPTK SNGL OR MULTI DETER
|
Facility
|
IP
|
$1,035.91
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
34100074
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$652.62 |
| Max. Negotiated Rate |
$932.32 |
| Rate for Payer: Aetna Commercial |
$880.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.34
|
| Rate for Payer: Cash Price |
$828.73
|
| Rate for Payer: Cofinity Commercial |
$725.14
|
| Rate for Payer: Cofinity Commercial |
$890.88
|
| Rate for Payer: Healthscope Commercial |
$932.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$880.52
|
| Rate for Payer: PHP Commercial |
$880.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$725.14
|
| Rate for Payer: Priority Health SBD |
$652.62
|
|
|
HC THYROID UPTK SNGL OR MULTI DETER
|
Facility
|
OP
|
$1,035.91
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
34100074
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$79.57 |
| Max. Negotiated Rate |
$932.32 |
| Rate for Payer: Aetna Commercial |
$880.52
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCBS Trust/PPO |
$119.14
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$828.73
|
| Rate for Payer: Cash Price |
$828.73
|
| Rate for Payer: Cofinity Commercial |
$725.14
|
| Rate for Payer: Cofinity Commercial |
$890.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$932.32
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$880.52
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$880.52
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$725.14
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$652.62
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Exchange |
$79.57
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC THYROXINE BINDING GLOBULIN
|
Facility
|
IP
|
$65.10
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
30100437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.01 |
| Max. Negotiated Rate |
$58.59 |
| Rate for Payer: Aetna Commercial |
$55.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.32
|
| Rate for Payer: Cash Price |
$52.08
|
| Rate for Payer: Cofinity Commercial |
$45.57
|
| Rate for Payer: Cofinity Commercial |
$55.99
|
| Rate for Payer: Healthscope Commercial |
$58.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.34
|
| Rate for Payer: PHP Commercial |
$55.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.57
|
| Rate for Payer: Priority Health SBD |
$41.01
|
|
