|
HC THROMBO EMBO CATHETER LVL 71
|
Facility
|
OP
|
$7,145.15
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,858.06 |
| Max. Negotiated Rate |
$6,430.64 |
| Rate for Payer: Aetna Commercial |
$6,073.38
|
| Rate for Payer: Aetna Medicare |
$3,572.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,644.35
|
| Rate for Payer: BCBS Complete |
$2,858.06
|
| Rate for Payer: Cash Price |
$5,716.12
|
| Rate for Payer: Cofinity Commercial |
$5,001.60
|
| Rate for Payer: Cofinity Commercial |
$6,144.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,001.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,716.12
|
| Rate for Payer: Healthscope Commercial |
$6,430.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,073.38
|
| Rate for Payer: PHP Commercial |
$6,073.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,644.35
|
| Rate for Payer: Priority Health SBD |
$4,501.44
|
|
|
HC THROMBO EMBO CATHETER LVL 88
|
Facility
|
OP
|
$8,810.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,524.00 |
| Max. Negotiated Rate |
$7,929.00 |
| Rate for Payer: Aetna Commercial |
$7,488.50
|
| Rate for Payer: Aetna Medicare |
$4,405.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,726.50
|
| Rate for Payer: BCBS Complete |
$3,524.00
|
| Rate for Payer: Cash Price |
$7,048.00
|
| Rate for Payer: Cofinity Commercial |
$6,167.00
|
| Rate for Payer: Cofinity Commercial |
$7,576.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,167.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,048.00
|
| Rate for Payer: Healthscope Commercial |
$7,929.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,488.50
|
| Rate for Payer: PHP Commercial |
$7,488.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,726.50
|
| Rate for Payer: Priority Health SBD |
$5,550.30
|
|
|
HC THROMBO EMBO CATHETER LVL 88
|
Facility
|
IP
|
$8,810.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,550.30 |
| Max. Negotiated Rate |
$7,929.00 |
| Rate for Payer: Aetna Commercial |
$7,488.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,726.50
|
| Rate for Payer: Cash Price |
$7,048.00
|
| Rate for Payer: Cofinity Commercial |
$6,167.00
|
| Rate for Payer: Cofinity Commercial |
$7,576.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,167.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,048.00
|
| Rate for Payer: Healthscope Commercial |
$7,929.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,488.50
|
| Rate for Payer: PHP Commercial |
$7,488.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,726.50
|
| Rate for Payer: Priority Health SBD |
$5,550.30
|
|
|
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: Cofinity Medicare Advantage |
$9,911.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,327.88
|
| Rate for Payer: Healthscope Commercial |
$12,743.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,035.87
|
| Rate for Payer: PHP Commercial |
$12,035.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,203.90
|
| 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 Medicare |
$7,079.93
|
| 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: Cofinity Medicare Advantage |
$9,911.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,327.88
|
| Rate for Payer: Healthscope Commercial |
$12,743.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,035.87
|
| Rate for Payer: PHP Commercial |
$12,035.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,203.90
|
| Rate for Payer: Priority Health SBD |
$8,920.71
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
IP
|
$519.80
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$327.47 |
| Max. Negotiated Rate |
$467.82 |
| Rate for Payer: Aetna Commercial |
$441.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.87
|
| Rate for Payer: Cash Price |
$415.84
|
| Rate for Payer: Cofinity Commercial |
$363.86
|
| Rate for Payer: Cofinity Commercial |
$447.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$363.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.84
|
| Rate for Payer: Healthscope Commercial |
$467.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.83
|
| Rate for Payer: PHP Commercial |
$441.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.87
|
| Rate for Payer: Priority Health SBD |
$327.47
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
OP
|
$519.80
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.39 |
| Max. Negotiated Rate |
$910.59 |
| Rate for Payer: Aetna Commercial |
$441.83
|
| Rate for Payer: Aetna Medicare |
$336.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$404.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$404.36
|
| Rate for Payer: BCBS Complete |
$182.06
|
| Rate for Payer: BCBS MAPPO |
$323.49
|
| Rate for Payer: BCN Medicare Advantage |
$323.49
|
| Rate for Payer: Cash Price |
$415.84
|
| Rate for Payer: Cash Price |
$415.84
|
| Rate for Payer: Cofinity Commercial |
$447.03
|
| Rate for Payer: Cofinity Commercial |
$363.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$363.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$323.49
|
| Rate for Payer: Healthscope Commercial |
$467.82
|
| Rate for Payer: Mclaren Medicaid |
$173.39
|
| Rate for Payer: Mclaren Medicare |
$323.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$339.66
|
| Rate for Payer: Meridian Medicaid |
$182.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.83
|
| Rate for Payer: PACE Medicare |
$307.32
|
| Rate for Payer: PACE SWMI |
$323.49
|
| Rate for Payer: PHP Commercial |
$441.83
|
| Rate for Payer: PHP Medicare Advantage |
$323.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.87
|
| Rate for Payer: Priority Health Medicare |
$323.49
|
| Rate for Payer: Priority Health SBD |
$327.47
|
| Rate for Payer: Railroad Medicare Medicare |
$323.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$910.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$323.49
|
| Rate for Payer: UHC Medicare Advantage |
$323.49
|
| Rate for Payer: UHCCP Medicaid |
$182.12
|
| Rate for Payer: VA VA |
$323.49
|
|
|
HC THROMBOLYSIS CESSATION
|
Facility
|
OP
|
$4,644.53
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
36100374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Commercial |
$3,947.85
|
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,018.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$3,715.62
|
| Rate for Payer: Cash Price |
$3,715.62
|
| Rate for Payer: Cofinity Commercial |
$3,994.30
|
| Rate for Payer: Cofinity Commercial |
$3,251.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,251.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,715.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$4,180.08
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,947.85
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$3,947.85
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,018.94
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health SBD |
$2,926.05
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,728.24
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC THROMBOLYSIS CESSATION
|
Facility
|
IP
|
$4,644.53
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
36100374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,926.05 |
| Max. Negotiated Rate |
$4,180.08 |
| Rate for Payer: Aetna Commercial |
$3,947.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,018.94
|
| Rate for Payer: Cash Price |
$3,715.62
|
| Rate for Payer: Cofinity Commercial |
$3,251.17
|
| Rate for Payer: Cofinity Commercial |
$3,994.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,251.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,715.62
|
| Rate for Payer: Healthscope Commercial |
$4,180.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,947.85
|
| Rate for Payer: PHP Commercial |
$3,947.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,018.94
|
| Rate for Payer: Priority Health SBD |
$2,926.05
|
|
|
HC THSD7
|
Facility
|
IP
|
$380.36
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200493
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$239.63 |
| Max. Negotiated Rate |
$342.32 |
| Rate for Payer: Aetna Commercial |
$323.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.23
|
| Rate for Payer: Cash Price |
$304.29
|
| Rate for Payer: Cofinity Commercial |
$266.25
|
| Rate for Payer: Cofinity Commercial |
$327.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.29
|
| Rate for Payer: Healthscope Commercial |
$342.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.31
|
| Rate for Payer: PHP Commercial |
$323.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.23
|
| Rate for Payer: Priority Health SBD |
$239.63
|
|
|
HC THSD7
|
Facility
|
OP
|
$380.36
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200493
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$342.32 |
| Rate for Payer: Aetna Commercial |
$323.31
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.23
|
| 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 |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$304.29
|
| Rate for Payer: Cash Price |
$304.29
|
| Rate for Payer: Cofinity Commercial |
$327.11
|
| Rate for Payer: Cofinity Commercial |
$266.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$342.32
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.31
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$323.31
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.23
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$239.63
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC THYROGLOBULIN
|
Facility
|
OP
|
$57.89
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
30100434
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$52.10 |
| Rate for Payer: Aetna Commercial |
$49.21
|
| Rate for Payer: Aetna Medicare |
$16.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.63
|
| 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 |
$9.04
|
| Rate for Payer: BCBS MAPPO |
$16.06
|
| Rate for Payer: BCN Medicare Advantage |
$16.06
|
| Rate for Payer: Cash Price |
$46.31
|
| Rate for Payer: Cash Price |
$46.31
|
| Rate for Payer: Cofinity Commercial |
$49.79
|
| Rate for Payer: Cofinity Commercial |
$40.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$52.10
|
| Rate for Payer: Mclaren Medicaid |
$8.61
|
| 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 |
$9.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.21
|
| Rate for Payer: PACE Medicare |
$15.26
|
| Rate for Payer: PACE SWMI |
$16.06
|
| Rate for Payer: PHP Commercial |
$49.21
|
| Rate for Payer: PHP Medicare Advantage |
$16.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.63
|
| Rate for Payer: Priority Health Medicare |
$16.06
|
| Rate for Payer: Priority Health SBD |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$16.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.06
|
| Rate for Payer: UHC Medicare Advantage |
$16.06
|
| Rate for Payer: UHCCP Medicaid |
$9.04
|
| Rate for Payer: VA VA |
$16.06
|
|
|
HC THYROGLOBULIN
|
Facility
|
IP
|
$57.89
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
30100434
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.47 |
| Max. Negotiated Rate |
$52.10 |
| Rate for Payer: Aetna Commercial |
$49.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.63
|
| Rate for Payer: Cash Price |
$46.31
|
| Rate for Payer: Cofinity Commercial |
$40.52
|
| Rate for Payer: Cofinity Commercial |
$49.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.31
|
| Rate for Payer: Healthscope Commercial |
$52.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.21
|
| Rate for Payer: PHP Commercial |
$49.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.63
|
| Rate for Payer: Priority Health SBD |
$36.47
|
|
|
HC THYROGLOBULIN CMPT
|
Facility
|
OP
|
$60.24
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
30200335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$54.22 |
| Rate for Payer: Aetna Commercial |
$51.20
|
| Rate for Payer: Aetna Medicare |
$16.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.16
|
| 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 |
$8.95
|
| Rate for Payer: BCBS MAPPO |
$15.91
|
| Rate for Payer: BCN Medicare Advantage |
$15.91
|
| Rate for Payer: Cash Price |
$48.19
|
| Rate for Payer: Cash Price |
$48.19
|
| Rate for Payer: Cofinity Commercial |
$51.81
|
| Rate for Payer: Cofinity Commercial |
$42.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.91
|
| Rate for Payer: Healthscope Commercial |
$54.22
|
| Rate for Payer: Mclaren Medicaid |
$8.53
|
| 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 |
$8.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.20
|
| Rate for Payer: PACE Medicare |
$15.11
|
| Rate for Payer: PACE SWMI |
$15.91
|
| Rate for Payer: PHP Commercial |
$51.20
|
| Rate for Payer: PHP Medicare Advantage |
$15.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.16
|
| Rate for Payer: Priority Health Medicare |
$15.91
|
| Rate for Payer: Priority Health SBD |
$37.95
|
| Rate for Payer: Railroad Medicare Medicare |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.91
|
| Rate for Payer: UHC Medicare Advantage |
$15.91
|
| Rate for Payer: UHCCP Medicaid |
$8.96
|
| Rate for Payer: VA VA |
$15.91
|
|
|
HC THYROGLOBULIN CMPT
|
Facility
|
IP
|
$60.24
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
30200335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$54.22 |
| Rate for Payer: Aetna Commercial |
$51.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.16
|
| Rate for Payer: Cash Price |
$48.19
|
| Rate for Payer: Cofinity Commercial |
$42.17
|
| Rate for Payer: Cofinity Commercial |
$51.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.19
|
| Rate for Payer: Healthscope Commercial |
$54.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.20
|
| Rate for Payer: PHP Commercial |
$51.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.16
|
| Rate for Payer: Priority Health SBD |
$37.95
|
|
|
HC THYROID IMAGING W VASC FLOW
|
Facility
|
IP
|
$583.41
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
34100075
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$367.55 |
| Max. Negotiated Rate |
$525.07 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.22
|
| Rate for Payer: Cash Price |
$466.73
|
| Rate for Payer: Cofinity Commercial |
$408.39
|
| Rate for Payer: Cofinity Commercial |
$501.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$408.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.73
|
| Rate for Payer: Healthscope Commercial |
$525.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.90
|
| Rate for Payer: PHP Commercial |
$495.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.22
|
| Rate for Payer: Priority Health SBD |
$367.55
|
|
|
HC THYROID IMAGING W VASC FLOW
|
Facility
|
OP
|
$583.41
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
34100075
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,103.16 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$466.73
|
| Rate for Payer: Cash Price |
$466.73
|
| Rate for Payer: Cofinity Commercial |
$501.73
|
| Rate for Payer: Cofinity Commercial |
$408.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$408.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$525.07
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.90
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$495.90
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.22
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$367.55
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$431.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$431.72
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC THYROID IMAG W VASC FLOW SNGL OR MULTI
|
Facility
|
IP
|
$1,225.64
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
34100076
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$772.15 |
| Max. Negotiated Rate |
$1,103.08 |
| Rate for Payer: Aetna Commercial |
$1,041.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$796.67
|
| Rate for Payer: Cash Price |
$980.51
|
| Rate for Payer: Cofinity Commercial |
$1,054.05
|
| Rate for Payer: Cofinity Commercial |
$857.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$857.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$980.51
|
| Rate for Payer: Healthscope Commercial |
$1,103.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,041.79
|
| Rate for Payer: PHP Commercial |
$1,041.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.67
|
| Rate for Payer: Priority Health SBD |
$772.15
|
|
|
HC THYROID IMAG W VASC FLOW SNGL OR MULTI
|
Facility
|
OP
|
$1,225.64
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
34100076
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,103.16 |
| Rate for Payer: Aetna Commercial |
$1,041.79
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$796.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$980.51
|
| Rate for Payer: Cash Price |
$980.51
|
| Rate for Payer: Cofinity Commercial |
$857.95
|
| Rate for Payer: Cofinity Commercial |
$1,054.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$857.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$980.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,103.08
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,041.79
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$1,041.79
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.67
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$772.15
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$906.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$906.97
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC THYROID PEROXIDASE ANTIBODY
|
Facility
|
OP
|
$85.58
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200209
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$77.02 |
| Rate for Payer: Aetna Commercial |
$72.74
|
| Rate for Payer: Aetna Medicare |
$15.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.63
|
| 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 |
$8.19
|
| Rate for Payer: BCBS MAPPO |
$14.55
|
| Rate for Payer: BCN Medicare Advantage |
$14.55
|
| Rate for Payer: Cash Price |
$68.46
|
| Rate for Payer: Cash Price |
$68.46
|
| Rate for Payer: Cofinity Commercial |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$59.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.55
|
| Rate for Payer: Healthscope Commercial |
$77.02
|
| Rate for Payer: Mclaren Medicaid |
$7.80
|
| 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 |
$8.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.74
|
| Rate for Payer: PACE Medicare |
$13.82
|
| Rate for Payer: PACE SWMI |
$14.55
|
| Rate for Payer: PHP Commercial |
$72.74
|
| Rate for Payer: PHP Medicare Advantage |
$14.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.63
|
| Rate for Payer: Priority Health Medicare |
$14.55
|
| Rate for Payer: Priority Health SBD |
$53.92
|
| Rate for Payer: Railroad Medicare Medicare |
$14.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.55
|
| Rate for Payer: UHC Medicare Advantage |
$14.55
|
| Rate for Payer: UHCCP Medicaid |
$8.19
|
| Rate for Payer: VA VA |
$14.55
|
|
|
HC THYROID PEROXIDASE ANTIBODY
|
Facility
|
IP
|
$85.58
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200209
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.92 |
| Max. Negotiated Rate |
$77.02 |
| Rate for Payer: Aetna Commercial |
$72.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.63
|
| Rate for Payer: Cash Price |
$68.46
|
| Rate for Payer: Cofinity Commercial |
$59.91
|
| Rate for Payer: Cofinity Commercial |
$73.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.46
|
| Rate for Payer: Healthscope Commercial |
$77.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.74
|
| Rate for Payer: PHP Commercial |
$72.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.63
|
| Rate for Payer: Priority Health SBD |
$53.92
|
|
|
HC THYROID STIMULATING IMMUNOGLOB
|
Facility
|
IP
|
$85.63
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
30100439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.95 |
| Max. Negotiated Rate |
$77.07 |
| Rate for Payer: Aetna Commercial |
$72.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.66
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cofinity Commercial |
$59.94
|
| Rate for Payer: Cofinity Commercial |
$73.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.50
|
| Rate for Payer: Healthscope Commercial |
$77.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.79
|
| Rate for Payer: PHP Commercial |
$72.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.66
|
| Rate for Payer: Priority Health SBD |
$53.95
|
|
|
HC THYROID STIMULATING IMMUNOGLOB
|
Facility
|
OP
|
$85.63
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
30100439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.26 |
| Max. Negotiated Rate |
$143.17 |
| Rate for Payer: Aetna Commercial |
$72.79
|
| Rate for Payer: Aetna Medicare |
$52.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.66
|
| 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 |
$28.62
|
| Rate for Payer: BCBS MAPPO |
$50.86
|
| Rate for Payer: BCN Medicare Advantage |
$50.86
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cofinity Commercial |
$73.64
|
| Rate for Payer: Cofinity Commercial |
$59.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.86
|
| Rate for Payer: Healthscope Commercial |
$77.07
|
| Rate for Payer: Mclaren Medicaid |
$27.26
|
| 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 |
$28.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.79
|
| Rate for Payer: PACE Medicare |
$48.32
|
| Rate for Payer: PACE SWMI |
$50.86
|
| Rate for Payer: PHP Commercial |
$72.79
|
| Rate for Payer: PHP Medicare Advantage |
$50.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.66
|
| Rate for Payer: Priority Health Medicare |
$50.86
|
| Rate for Payer: Priority Health SBD |
$53.95
|
| Rate for Payer: Railroad Medicare Medicare |
$50.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.86
|
| Rate for Payer: UHC Medicare Advantage |
$50.86
|
| Rate for Payer: UHCCP Medicaid |
$28.63
|
| Rate for Payer: VA VA |
$50.86
|
|
|
HC THYROID TC 99M PER STUDY
|
Facility
|
OP
|
$143.20
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300021
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$57.28 |
| Max. Negotiated Rate |
$128.88 |
| Rate for Payer: Aetna Commercial |
$121.72
|
| Rate for Payer: Aetna Medicare |
$71.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.08
|
| Rate for Payer: BCBS Complete |
$57.28
|
| Rate for Payer: Cash Price |
$114.56
|
| Rate for Payer: Cofinity Commercial |
$100.24
|
| Rate for Payer: Cofinity Commercial |
$123.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.56
|
| Rate for Payer: Healthscope Commercial |
$128.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.72
|
| Rate for Payer: PHP Commercial |
$121.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.08
|
| Rate for Payer: Priority Health SBD |
$90.22
|
|
|
HC THYROID TC 99M PER STUDY
|
Facility
|
IP
|
$143.20
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300021
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$90.22 |
| Max. Negotiated Rate |
$128.88 |
| Rate for Payer: Aetna Commercial |
$121.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.08
|
| Rate for Payer: Cash Price |
$114.56
|
| Rate for Payer: Cofinity Commercial |
$100.24
|
| Rate for Payer: Cofinity Commercial |
$123.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.56
|
| Rate for Payer: Healthscope Commercial |
$128.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.72
|
| Rate for Payer: PHP Commercial |
$121.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.08
|
| Rate for Payer: Priority Health SBD |
$90.22
|
|
