|
HC THSD7
|
Facility
|
IP
|
$387.97
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200493
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$244.42 |
| Max. Negotiated Rate |
$349.17 |
| Rate for Payer: Aetna Commercial |
$329.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.18
|
| Rate for Payer: Cash Price |
$310.38
|
| Rate for Payer: Cofinity Advantage |
$271.58
|
| Rate for Payer: Cofinity Commercial |
$333.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.38
|
| Rate for Payer: Healthscope Commercial |
$349.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.98
|
| Rate for Payer: PHP Commercial |
$329.77
|
| Rate for Payer: Priority Health SBD |
$244.42
|
|
|
HC THYROGLOBULIN
|
Facility
|
OP
|
$59.05
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
30100434
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$53.15 |
| Rate for Payer: Aetna Commercial |
$50.19
|
| Rate for Payer: Aetna Medicare |
$16.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.07
|
| Rate for Payer: BCBS Complete |
$8.82
|
| Rate for Payer: BCBS MAPPO |
$16.06
|
| Rate for Payer: BCBS Trust/PPO |
$17.13
|
| Rate for Payer: BCN Commercial |
$17.13
|
| Rate for Payer: BCN Medicare Advantage |
$16.06
|
| Rate for Payer: Cash Price |
$47.24
|
| Rate for Payer: Cash Price |
$47.24
|
| Rate for Payer: Cofinity Advantage |
$41.34
|
| Rate for Payer: Cofinity Commercial |
$50.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$53.15
|
| Rate for Payer: Mclaren Medicaid |
$8.40
|
| Rate for Payer: Mclaren Medicare |
$16.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.86
|
| Rate for Payer: Meridian Medicaid |
$16.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.19
|
| Rate for Payer: Nomi Health Commercial |
$24.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.29
|
| Rate for Payer: PACE Medicare |
$15.26
|
| Rate for Payer: PACE SWMI |
$16.06
|
| Rate for Payer: PHP Commercial |
$50.19
|
| Rate for Payer: PHP Medicare Advantage |
$16.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.06
|
| Rate for Payer: Priority Health Medicare |
$16.06
|
| Rate for Payer: Priority Health SBD |
$37.20
|
| Rate for Payer: Priority Health Tiered Network |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$16.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.09
|
| Rate for Payer: UHC Core |
$24.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.06
|
| Rate for Payer: UHC Exchange |
$24.09
|
| Rate for Payer: UHC Medicaid |
$8.40
|
| Rate for Payer: UHCCP Medicaid |
$8.40
|
| Rate for Payer: VA VA |
$16.06
|
|
|
HC THYROGLOBULIN
|
Facility
|
IP
|
$59.05
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
30100434
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$53.15 |
| Rate for Payer: Aetna Commercial |
$50.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.38
|
| Rate for Payer: Cash Price |
$47.24
|
| Rate for Payer: Cofinity Advantage |
$41.34
|
| Rate for Payer: Cofinity Commercial |
$50.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.24
|
| Rate for Payer: Healthscope Commercial |
$53.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.29
|
| Rate for Payer: PHP Commercial |
$50.19
|
| Rate for Payer: Priority Health SBD |
$37.20
|
|
|
HC THYROGLOBULIN CMPT
|
Facility
|
IP
|
$61.44
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
30200335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$55.30 |
| Rate for Payer: Aetna Commercial |
$52.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.94
|
| Rate for Payer: Cash Price |
$49.15
|
| Rate for Payer: Cofinity Advantage |
$43.01
|
| Rate for Payer: Cofinity Commercial |
$52.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.15
|
| Rate for Payer: Healthscope Commercial |
$55.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.08
|
| Rate for Payer: PHP Commercial |
$52.22
|
| Rate for Payer: Priority Health SBD |
$38.71
|
|
|
HC THYROGLOBULIN CMPT
|
Facility
|
OP
|
$61.44
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
30200335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$55.30 |
| Rate for Payer: Aetna Commercial |
$52.22
|
| Rate for Payer: Aetna Medicare |
$16.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.94
|
| 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 |
$8.74
|
| Rate for Payer: BCBS MAPPO |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.96
|
| Rate for Payer: BCN Medicare Advantage |
$15.91
|
| Rate for Payer: Cash Price |
$49.15
|
| Rate for Payer: Cash Price |
$49.15
|
| Rate for Payer: Cofinity Advantage |
$43.01
|
| Rate for Payer: Cofinity Commercial |
$52.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.91
|
| Rate for Payer: Healthscope Commercial |
$55.30
|
| Rate for Payer: Mclaren Medicaid |
$8.32
|
| Rate for Payer: Mclaren Medicare |
$15.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.71
|
| Rate for Payer: Meridian Medicaid |
$16.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.22
|
| Rate for Payer: Nomi Health Commercial |
$23.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.08
|
| Rate for Payer: PACE Medicare |
$15.11
|
| Rate for Payer: PACE SWMI |
$15.91
|
| Rate for Payer: PHP Commercial |
$52.22
|
| Rate for Payer: PHP Medicare Advantage |
$15.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15.91
|
| Rate for Payer: Priority Health Medicare |
$15.91
|
| Rate for Payer: Priority Health SBD |
$38.71
|
| Rate for Payer: Priority Health Tiered Network |
$12.73
|
| Rate for Payer: Railroad Medicare Medicare |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.87
|
| Rate for Payer: UHC Core |
$23.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.91
|
| Rate for Payer: UHC Exchange |
$23.87
|
| Rate for Payer: UHC Medicaid |
$8.32
|
| Rate for Payer: UHCCP Medicaid |
$8.32
|
| Rate for Payer: VA VA |
$15.91
|
|
|
HC THYROID IMAGING W VASC FLOW
|
Facility
|
IP
|
$595.08
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
34100075
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$374.90 |
| Max. Negotiated Rate |
$535.57 |
| Rate for Payer: Aetna Commercial |
$505.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.80
|
| Rate for Payer: Cash Price |
$476.06
|
| Rate for Payer: Cofinity Advantage |
$416.56
|
| Rate for Payer: Cofinity Commercial |
$511.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.06
|
| Rate for Payer: Healthscope Commercial |
$535.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.31
|
| Rate for Payer: PHP Commercial |
$505.82
|
| Rate for Payer: Priority Health SBD |
$374.90
|
|
|
HC THYROID IMAGING W VASC FLOW
|
Facility
|
OP
|
$595.08
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
34100075
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna Commercial |
$505.82
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$343.74
|
| Rate for Payer: BCN Commercial |
$343.74
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$476.06
|
| Rate for Payer: Cash Price |
$476.06
|
| Rate for Payer: Cofinity Advantage |
$416.56
|
| Rate for Payer: Cofinity Commercial |
$511.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$535.57
|
| Rate for Payer: Mclaren Medicaid |
$208.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.82
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.31
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$505.82
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$374.90
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.80
|
| Rate for Payer: UHC Core |
$310.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$233.87
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC THYROID IMAG W VASC FLOW SNGL OR MULTI
|
Facility
|
IP
|
$1,250.15
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
34100076
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$787.59 |
| Max. Negotiated Rate |
$1,125.13 |
| Rate for Payer: Aetna Commercial |
$1,062.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$812.60
|
| Rate for Payer: Cash Price |
$1,000.12
|
| Rate for Payer: Cofinity Advantage |
$875.11
|
| Rate for Payer: Cofinity Commercial |
$1,075.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.12
|
| Rate for Payer: Healthscope Commercial |
$1,125.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,062.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$937.61
|
| Rate for Payer: PHP Commercial |
$1,062.63
|
| Rate for Payer: Priority Health SBD |
$787.59
|
|
|
HC THYROID IMAG W VASC FLOW SNGL OR MULTI
|
Facility
|
OP
|
$1,250.15
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
34100076
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna Commercial |
$1,062.63
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$812.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$433.09
|
| Rate for Payer: BCN Commercial |
$433.09
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,000.12
|
| Rate for Payer: Cash Price |
$1,000.12
|
| Rate for Payer: Cofinity Advantage |
$875.11
|
| Rate for Payer: Cofinity Commercial |
$1,075.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,125.13
|
| Rate for Payer: Mclaren Medicaid |
$208.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,062.63
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$937.61
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$1,062.63
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$787.59
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$812.60
|
| Rate for Payer: UHC Core |
$651.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$491.31
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC THYROID PEROXIDASE ANTIBODY
|
Facility
|
IP
|
$87.29
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200209
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.99 |
| Max. Negotiated Rate |
$78.56 |
| Rate for Payer: Aetna Commercial |
$74.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.74
|
| Rate for Payer: Cash Price |
$69.83
|
| Rate for Payer: Cofinity Advantage |
$61.10
|
| Rate for Payer: Cofinity Commercial |
$75.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.83
|
| Rate for Payer: Healthscope Commercial |
$78.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.47
|
| Rate for Payer: PHP Commercial |
$74.20
|
| Rate for Payer: Priority Health SBD |
$54.99
|
|
|
HC THYROID PEROXIDASE ANTIBODY
|
Facility
|
OP
|
$87.29
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200209
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$78.56 |
| Rate for Payer: Aetna Commercial |
$74.20
|
| Rate for Payer: Aetna Medicare |
$15.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.74
|
| 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 |
$7.99
|
| Rate for Payer: BCBS MAPPO |
$14.55
|
| Rate for Payer: BCBS Trust/PPO |
$15.51
|
| Rate for Payer: BCN Commercial |
$15.51
|
| Rate for Payer: BCN Medicare Advantage |
$14.55
|
| Rate for Payer: Cash Price |
$69.83
|
| Rate for Payer: Cash Price |
$69.83
|
| Rate for Payer: Cofinity Advantage |
$61.10
|
| Rate for Payer: Cofinity Commercial |
$75.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.55
|
| Rate for Payer: Healthscope Commercial |
$78.56
|
| Rate for Payer: Mclaren Medicaid |
$7.61
|
| Rate for Payer: Mclaren Medicare |
$14.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.28
|
| Rate for Payer: Meridian Medicaid |
$15.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.20
|
| Rate for Payer: Nomi Health Commercial |
$21.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.47
|
| Rate for Payer: PACE Medicare |
$13.82
|
| Rate for Payer: PACE SWMI |
$14.55
|
| Rate for Payer: PHP Commercial |
$74.20
|
| Rate for Payer: PHP Medicare Advantage |
$14.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.55
|
| Rate for Payer: Priority Health Medicare |
$14.55
|
| Rate for Payer: Priority Health SBD |
$54.99
|
| Rate for Payer: Priority Health Tiered Network |
$11.64
|
| Rate for Payer: Railroad Medicare Medicare |
$14.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.83
|
| Rate for Payer: UHC Core |
$21.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.55
|
| Rate for Payer: UHC Exchange |
$21.83
|
| Rate for Payer: UHC Medicaid |
$7.61
|
| Rate for Payer: UHCCP Medicaid |
$7.61
|
| Rate for Payer: VA VA |
$14.55
|
|
|
HC THYROID STIMULATING IMMUNOGLOB
|
Facility
|
IP
|
$91.06
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
30100439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.37 |
| Max. Negotiated Rate |
$81.95 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.19
|
| Rate for Payer: Cash Price |
$72.85
|
| Rate for Payer: Cofinity Advantage |
$63.74
|
| Rate for Payer: Cofinity Commercial |
$78.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.85
|
| Rate for Payer: Healthscope Commercial |
$81.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.30
|
| Rate for Payer: PHP Commercial |
$77.40
|
| Rate for Payer: Priority Health SBD |
$57.37
|
|
|
HC THYROID STIMULATING IMMUNOGLOB
|
Facility
|
OP
|
$91.06
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
30100439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$81.95 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Medicare |
$52.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.19
|
| 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 |
$27.93
|
| Rate for Payer: BCBS MAPPO |
$50.86
|
| Rate for Payer: BCBS Trust/PPO |
$54.23
|
| Rate for Payer: BCN Commercial |
$54.23
|
| Rate for Payer: BCN Medicare Advantage |
$50.86
|
| Rate for Payer: Cash Price |
$72.85
|
| Rate for Payer: Cash Price |
$72.85
|
| Rate for Payer: Cofinity Advantage |
$63.74
|
| Rate for Payer: Cofinity Commercial |
$78.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.86
|
| Rate for Payer: Healthscope Commercial |
$81.95
|
| Rate for Payer: Mclaren Medicaid |
$26.60
|
| Rate for Payer: Mclaren Medicare |
$50.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.40
|
| Rate for Payer: Meridian Medicaid |
$53.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$55.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.40
|
| Rate for Payer: Nomi Health Commercial |
$76.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.30
|
| Rate for Payer: PACE Medicare |
$48.32
|
| Rate for Payer: PACE SWMI |
$50.86
|
| Rate for Payer: PHP Commercial |
$77.40
|
| Rate for Payer: PHP Medicare Advantage |
$50.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$50.86
|
| Rate for Payer: Priority Health Medicare |
$50.86
|
| Rate for Payer: Priority Health SBD |
$57.37
|
| Rate for Payer: Priority Health Tiered Network |
$40.69
|
| Rate for Payer: Railroad Medicare Medicare |
$50.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.29
|
| Rate for Payer: UHC Core |
$76.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$50.86
|
| Rate for Payer: UHC Exchange |
$76.29
|
| Rate for Payer: UHC Medicaid |
$26.60
|
| Rate for Payer: UHCCP Medicaid |
$26.60
|
| Rate for Payer: VA VA |
$50.86
|
|
|
HC THYROID TC 99M PER STUDY
|
Facility
|
IP
|
$146.06
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300021
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$92.02 |
| Max. Negotiated Rate |
$131.45 |
| Rate for Payer: Aetna Commercial |
$124.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.94
|
| Rate for Payer: Cash Price |
$116.85
|
| Rate for Payer: Cofinity Advantage |
$102.24
|
| Rate for Payer: Cofinity Commercial |
$125.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.85
|
| Rate for Payer: Healthscope Commercial |
$131.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.55
|
| Rate for Payer: PHP Commercial |
$124.15
|
| Rate for Payer: Priority Health SBD |
$92.02
|
|
|
HC THYROID TC 99M PER STUDY
|
Facility
|
OP
|
$146.06
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300021
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$743.46 |
| Rate for Payer: Aetna Commercial |
$124.15
|
| Rate for Payer: Aetna Medicare |
$73.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.94
|
| Rate for Payer: BCBS Complete |
$58.42
|
| Rate for Payer: BCBS Trust/PPO |
$182.11
|
| Rate for Payer: BCN Commercial |
$182.11
|
| Rate for Payer: Cash Price |
$116.85
|
| Rate for Payer: Cash Price |
$116.85
|
| Rate for Payer: Cofinity Advantage |
$102.24
|
| Rate for Payer: Cofinity Commercial |
$125.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.85
|
| Rate for Payer: Healthscope Commercial |
$131.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.55
|
| Rate for Payer: PHP Commercial |
$124.15
|
| Rate for Payer: Priority Health SBD |
$92.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$743.46
|
| Rate for Payer: UHC Core |
$743.46
|
| Rate for Payer: UHC Exchange |
$743.46
|
|
|
HC THYROID UPTK SNGL OR MULTI DETER
|
Facility
|
OP
|
$1,077.76
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
34100074
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$164.29 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna Commercial |
$916.10
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$700.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$164.29
|
| Rate for Payer: BCN Commercial |
$164.29
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$862.21
|
| Rate for Payer: Cash Price |
$862.21
|
| Rate for Payer: Cofinity Advantage |
$754.43
|
| Rate for Payer: Cofinity Commercial |
$926.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$862.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$969.98
|
| Rate for Payer: Mclaren Medicaid |
$208.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$916.10
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$808.32
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$916.10
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$678.99
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$700.54
|
| Rate for Payer: UHC Core |
$561.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$423.56
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC THYROID UPTK SNGL OR MULTI DETER
|
Facility
|
IP
|
$1,077.76
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
34100074
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$678.99 |
| Max. Negotiated Rate |
$969.98 |
| Rate for Payer: Aetna Commercial |
$916.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$700.54
|
| Rate for Payer: Cash Price |
$862.21
|
| Rate for Payer: Cofinity Advantage |
$754.43
|
| Rate for Payer: Cofinity Commercial |
$926.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$862.21
|
| Rate for Payer: Healthscope Commercial |
$969.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$916.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$808.32
|
| Rate for Payer: PHP Commercial |
$916.10
|
| Rate for Payer: Priority Health SBD |
$678.99
|
|
|
HC THYROXINE BINDING GLOBULIN
|
Facility
|
IP
|
$67.73
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
30100437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.67 |
| Max. Negotiated Rate |
$60.96 |
| Rate for Payer: Aetna Commercial |
$57.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.02
|
| Rate for Payer: Cash Price |
$54.18
|
| Rate for Payer: Cofinity Advantage |
$47.41
|
| Rate for Payer: Cofinity Commercial |
$58.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.18
|
| Rate for Payer: Healthscope Commercial |
$60.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.80
|
| Rate for Payer: PHP Commercial |
$57.57
|
| Rate for Payer: Priority Health SBD |
$42.67
|
|
|
HC THYROXINE BINDING GLOBULIN
|
Facility
|
OP
|
$67.73
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
30100437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.73 |
| Max. Negotiated Rate |
$60.96 |
| Rate for Payer: Aetna Commercial |
$57.57
|
| Rate for Payer: Aetna Medicare |
$15.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.48
|
| Rate for Payer: BCBS Complete |
$8.12
|
| Rate for Payer: BCBS MAPPO |
$14.78
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: BCN Medicare Advantage |
$14.78
|
| Rate for Payer: Cash Price |
$54.18
|
| Rate for Payer: Cash Price |
$54.18
|
| Rate for Payer: Cofinity Advantage |
$47.41
|
| Rate for Payer: Cofinity Commercial |
$58.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.78
|
| Rate for Payer: Healthscope Commercial |
$60.96
|
| Rate for Payer: Mclaren Medicaid |
$7.73
|
| Rate for Payer: Mclaren Medicare |
$14.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.52
|
| Rate for Payer: Meridian Medicaid |
$15.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.57
|
| Rate for Payer: Nomi Health Commercial |
$22.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.80
|
| Rate for Payer: PACE Medicare |
$14.04
|
| Rate for Payer: PACE SWMI |
$14.78
|
| Rate for Payer: PHP Commercial |
$57.57
|
| Rate for Payer: PHP Medicare Advantage |
$14.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.78
|
| Rate for Payer: Priority Health Medicare |
$14.78
|
| Rate for Payer: Priority Health SBD |
$42.67
|
| Rate for Payer: Priority Health Tiered Network |
$11.82
|
| Rate for Payer: Railroad Medicare Medicare |
$14.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.17
|
| Rate for Payer: UHC Core |
$22.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.78
|
| Rate for Payer: UHC Exchange |
$22.17
|
| Rate for Payer: UHC Medicaid |
$7.73
|
| Rate for Payer: UHCCP Medicaid |
$7.73
|
| Rate for Payer: VA VA |
$14.78
|
|
|
HC THYROXINE FREE T4
|
Facility
|
IP
|
$117.57
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
30100436
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.07 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna Commercial |
$99.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.42
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Advantage |
$82.30
|
| Rate for Payer: Cofinity Commercial |
$101.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Healthscope Commercial |
$105.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PHP Commercial |
$99.93
|
| Rate for Payer: Priority Health SBD |
$74.07
|
|
|
HC THYROXINE FREE T4
|
Facility
|
OP
|
$117.57
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
30100436
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna Commercial |
$99.93
|
| Rate for Payer: Aetna Medicare |
$9.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.28
|
| Rate for Payer: BCBS Complete |
$4.95
|
| Rate for Payer: BCBS MAPPO |
$9.02
|
| Rate for Payer: BCBS Trust/PPO |
$9.62
|
| Rate for Payer: BCN Commercial |
$9.62
|
| Rate for Payer: BCN Medicare Advantage |
$9.02
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Advantage |
$82.30
|
| Rate for Payer: Cofinity Commercial |
$101.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.02
|
| Rate for Payer: Healthscope Commercial |
$105.81
|
| Rate for Payer: Mclaren Medicaid |
$4.72
|
| Rate for Payer: Mclaren Medicare |
$9.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.47
|
| Rate for Payer: Meridian Medicaid |
$9.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$13.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PACE Medicare |
$8.57
|
| Rate for Payer: PACE SWMI |
$9.02
|
| Rate for Payer: PHP Commercial |
$99.93
|
| Rate for Payer: PHP Medicare Advantage |
$9.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.02
|
| Rate for Payer: Priority Health Medicare |
$9.02
|
| Rate for Payer: Priority Health SBD |
$74.07
|
| Rate for Payer: Priority Health Tiered Network |
$7.22
|
| Rate for Payer: Railroad Medicare Medicare |
$9.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.53
|
| Rate for Payer: UHC Core |
$13.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.02
|
| Rate for Payer: UHC Exchange |
$13.53
|
| Rate for Payer: UHC Medicaid |
$4.72
|
| Rate for Payer: UHCCP Medicaid |
$4.72
|
| Rate for Payer: VA VA |
$9.02
|
|
|
HC TIAGABINE LEVEL
|
Facility
|
IP
|
$118.25
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
30100058
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.50 |
| Max. Negotiated Rate |
$106.42 |
| Rate for Payer: Aetna Commercial |
$100.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.86
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cofinity Advantage |
$82.78
|
| Rate for Payer: Cofinity Commercial |
$101.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.60
|
| Rate for Payer: Healthscope Commercial |
$106.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.69
|
| Rate for Payer: PHP Commercial |
$100.51
|
| Rate for Payer: Priority Health SBD |
$74.50
|
|
|
HC TIAGABINE LEVEL
|
Facility
|
OP
|
$118.25
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
30100058
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$106.42 |
| Rate for Payer: Aetna Commercial |
$100.51
|
| Rate for Payer: Aetna Medicare |
$28.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.89
|
| Rate for Payer: BCBS Complete |
$14.89
|
| Rate for Payer: BCBS MAPPO |
$27.11
|
| Rate for Payer: BCBS Trust/PPO |
$28.90
|
| Rate for Payer: BCN Commercial |
$28.90
|
| Rate for Payer: BCN Medicare Advantage |
$27.11
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cofinity Advantage |
$82.78
|
| Rate for Payer: Cofinity Commercial |
$101.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.11
|
| Rate for Payer: Healthscope Commercial |
$106.42
|
| Rate for Payer: Mclaren Medicaid |
$14.18
|
| Rate for Payer: Mclaren Medicare |
$27.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.47
|
| Rate for Payer: Meridian Medicaid |
$28.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.51
|
| Rate for Payer: Nomi Health Commercial |
$40.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.69
|
| Rate for Payer: PACE Medicare |
$25.75
|
| Rate for Payer: PACE SWMI |
$27.11
|
| Rate for Payer: PHP Commercial |
$100.51
|
| Rate for Payer: PHP Medicare Advantage |
$27.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27.11
|
| Rate for Payer: Priority Health Medicare |
$27.11
|
| Rate for Payer: Priority Health SBD |
$74.50
|
| Rate for Payer: Priority Health Tiered Network |
$21.69
|
| Rate for Payer: Railroad Medicare Medicare |
$27.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.67
|
| Rate for Payer: UHC Core |
$40.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.11
|
| Rate for Payer: UHC Exchange |
$40.67
|
| Rate for Payer: UHC Medicaid |
$14.18
|
| Rate for Payer: UHCCP Medicaid |
$14.18
|
| Rate for Payer: VA VA |
$27.11
|
|
|
HC TICK-BORNE AB CMPT 2
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
30200521
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$28.90
|
| Rate for Payer: Aetna Medicare |
$12.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.49
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$12.39
|
| Rate for Payer: BCBS Trust/PPO |
$13.21
|
| Rate for Payer: BCN Commercial |
$13.21
|
| Rate for Payer: BCN Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Advantage |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$29.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.39
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Mclaren Medicaid |
$6.48
|
| Rate for Payer: Mclaren Medicare |
$12.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.01
|
| Rate for Payer: Meridian Medicaid |
$13.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.90
|
| Rate for Payer: Nomi Health Commercial |
$18.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: PACE Medicare |
$11.77
|
| Rate for Payer: PACE SWMI |
$12.39
|
| Rate for Payer: PHP Commercial |
$28.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.39
|
| Rate for Payer: Priority Health Medicare |
$12.39
|
| Rate for Payer: Priority Health SBD |
$21.42
|
| Rate for Payer: Priority Health Tiered Network |
$9.91
|
| Rate for Payer: Railroad Medicare Medicare |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.59
|
| Rate for Payer: UHC Core |
$18.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.39
|
| Rate for Payer: UHC Exchange |
$18.59
|
| Rate for Payer: UHC Medicaid |
$6.48
|
| Rate for Payer: UHCCP Medicaid |
$6.48
|
| Rate for Payer: VA VA |
$12.39
|
|
|
HC TICK-BORNE AB CMPT 2
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
30200521
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna Commercial |
$28.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.10
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Advantage |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$29.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.20
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: PHP Commercial |
$28.90
|
| Rate for Payer: Priority Health SBD |
$21.42
|
|
