|
HC THYROID UPTK SNGL OR MULTI DETER
|
Facility
|
OP
|
$1,056.63
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
34100074
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,103.16 |
| Rate for Payer: Aetna Commercial |
$898.14
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$686.81
|
| 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 |
$845.30
|
| Rate for Payer: Cash Price |
$845.30
|
| Rate for Payer: Cofinity Commercial |
$908.70
|
| Rate for Payer: Cofinity Commercial |
$739.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$739.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$845.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$950.97
|
| 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 |
$898.14
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$898.14
|
| 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 |
$686.81
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$665.68
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$781.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$781.91
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC THYROID UPTK SNGL OR MULTI DETER
|
Facility
|
IP
|
$1,056.63
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
34100074
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$665.68 |
| Max. Negotiated Rate |
$950.97 |
| Rate for Payer: Aetna Commercial |
$898.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$686.81
|
| Rate for Payer: Cash Price |
$845.30
|
| Rate for Payer: Cofinity Commercial |
$739.64
|
| Rate for Payer: Cofinity Commercial |
$908.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$739.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$845.30
|
| Rate for Payer: Healthscope Commercial |
$950.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$898.14
|
| Rate for Payer: PHP Commercial |
$898.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.81
|
| Rate for Payer: Priority Health SBD |
$665.68
|
|
|
HC THYROXINE BINDING GLOBULIN
|
Facility
|
OP
|
$66.40
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
30100437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$59.76 |
| Rate for Payer: Aetna Commercial |
$56.44
|
| Rate for Payer: Aetna Medicare |
$15.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.16
|
| 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 |
$8.32
|
| Rate for Payer: BCBS MAPPO |
$14.78
|
| Rate for Payer: BCN Medicare Advantage |
$14.78
|
| Rate for Payer: Cash Price |
$53.12
|
| Rate for Payer: Cash Price |
$53.12
|
| Rate for Payer: Cofinity Commercial |
$57.10
|
| Rate for Payer: Cofinity Commercial |
$46.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.78
|
| Rate for Payer: Healthscope Commercial |
$59.76
|
| Rate for Payer: Mclaren Medicaid |
$7.92
|
| 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 |
$8.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.44
|
| Rate for Payer: PACE Medicare |
$14.04
|
| Rate for Payer: PACE SWMI |
$14.78
|
| Rate for Payer: PHP Commercial |
$56.44
|
| Rate for Payer: PHP Medicare Advantage |
$14.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.16
|
| Rate for Payer: Priority Health Medicare |
$14.78
|
| Rate for Payer: Priority Health SBD |
$41.83
|
| Rate for Payer: Railroad Medicare Medicare |
$14.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.78
|
| Rate for Payer: UHC Medicare Advantage |
$14.78
|
| Rate for Payer: UHCCP Medicaid |
$8.32
|
| Rate for Payer: VA VA |
$14.78
|
|
|
HC THYROXINE BINDING GLOBULIN
|
Facility
|
IP
|
$66.40
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
30100437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.83 |
| Max. Negotiated Rate |
$59.76 |
| Rate for Payer: Aetna Commercial |
$56.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.16
|
| Rate for Payer: Cash Price |
$53.12
|
| Rate for Payer: Cofinity Commercial |
$46.48
|
| Rate for Payer: Cofinity Commercial |
$57.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.12
|
| Rate for Payer: Healthscope Commercial |
$59.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.44
|
| Rate for Payer: PHP Commercial |
$56.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.16
|
| Rate for Payer: Priority Health SBD |
$41.83
|
|
|
HC THYROXINE FREE T4
|
Facility
|
IP
|
$115.26
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
30100436
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.61 |
| Max. Negotiated Rate |
$103.73 |
| Rate for Payer: Aetna Commercial |
$97.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.92
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cofinity Commercial |
$80.68
|
| Rate for Payer: Cofinity Commercial |
$99.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.21
|
| Rate for Payer: Healthscope Commercial |
$103.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.97
|
| Rate for Payer: PHP Commercial |
$97.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.92
|
| Rate for Payer: Priority Health SBD |
$72.61
|
|
|
HC THYROXINE FREE T4
|
Facility
|
OP
|
$115.26
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
30100436
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$103.73 |
| Rate for Payer: Aetna Commercial |
$97.97
|
| Rate for Payer: Aetna Medicare |
$9.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.92
|
| 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 |
$5.08
|
| Rate for Payer: BCBS MAPPO |
$9.02
|
| Rate for Payer: BCN Medicare Advantage |
$9.02
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cofinity Commercial |
$99.12
|
| Rate for Payer: Cofinity Commercial |
$80.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.02
|
| Rate for Payer: Healthscope Commercial |
$103.73
|
| Rate for Payer: Mclaren Medicaid |
$4.83
|
| 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 |
$5.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.97
|
| Rate for Payer: PACE Medicare |
$8.57
|
| Rate for Payer: PACE SWMI |
$9.02
|
| Rate for Payer: PHP Commercial |
$97.97
|
| Rate for Payer: PHP Medicare Advantage |
$9.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.92
|
| Rate for Payer: Priority Health Medicare |
$9.02
|
| Rate for Payer: Priority Health SBD |
$72.61
|
| Rate for Payer: Railroad Medicare Medicare |
$9.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.02
|
| Rate for Payer: UHC Medicare Advantage |
$9.02
|
| Rate for Payer: UHCCP Medicaid |
$5.08
|
| Rate for Payer: VA VA |
$9.02
|
|
|
HC TIAGABINE LEVEL
|
Facility
|
OP
|
$115.93
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
30100058
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$104.34 |
| Rate for Payer: Aetna Commercial |
$98.54
|
| Rate for Payer: Aetna Medicare |
$28.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.35
|
| 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 |
$15.26
|
| Rate for Payer: BCBS MAPPO |
$27.11
|
| Rate for Payer: BCN Medicare Advantage |
$27.11
|
| Rate for Payer: Cash Price |
$92.74
|
| Rate for Payer: Cash Price |
$92.74
|
| Rate for Payer: Cofinity Commercial |
$99.70
|
| Rate for Payer: Cofinity Commercial |
$81.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.11
|
| Rate for Payer: Healthscope Commercial |
$104.34
|
| Rate for Payer: Mclaren Medicaid |
$14.53
|
| 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 |
$15.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.54
|
| Rate for Payer: PACE Medicare |
$25.75
|
| Rate for Payer: PACE SWMI |
$27.11
|
| Rate for Payer: PHP Commercial |
$98.54
|
| Rate for Payer: PHP Medicare Advantage |
$27.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.35
|
| Rate for Payer: Priority Health Medicare |
$27.11
|
| Rate for Payer: Priority Health SBD |
$73.04
|
| Rate for Payer: Railroad Medicare Medicare |
$27.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.11
|
| Rate for Payer: UHC Medicare Advantage |
$27.11
|
| Rate for Payer: UHCCP Medicaid |
$15.26
|
| Rate for Payer: VA VA |
$27.11
|
|
|
HC TIAGABINE LEVEL
|
Facility
|
IP
|
$115.93
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
30100058
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.04 |
| Max. Negotiated Rate |
$104.34 |
| Rate for Payer: Aetna Commercial |
$98.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.35
|
| Rate for Payer: Cash Price |
$92.74
|
| Rate for Payer: Cofinity Commercial |
$81.15
|
| Rate for Payer: Cofinity Commercial |
$99.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.74
|
| Rate for Payer: Healthscope Commercial |
$104.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.54
|
| Rate for Payer: PHP Commercial |
$98.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.35
|
| Rate for Payer: Priority Health SBD |
$73.04
|
|
|
HC TIER 1 MAJOR TRAUMA RESUSCITATION
|
Facility
|
IP
|
$6,022.01
|
|
| Hospital Charge Code |
68100001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$3,793.87 |
| Max. Negotiated Rate |
$5,419.81 |
| Rate for Payer: Aetna Commercial |
$5,118.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,914.31
|
| Rate for Payer: Cash Price |
$4,817.61
|
| Rate for Payer: Cofinity Commercial |
$4,215.41
|
| Rate for Payer: Cofinity Commercial |
$5,178.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,215.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,817.61
|
| Rate for Payer: Healthscope Commercial |
$5,419.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,118.71
|
| Rate for Payer: PHP Commercial |
$5,118.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,914.31
|
| Rate for Payer: Priority Health SBD |
$3,793.87
|
|
|
HC TIER 1 MAJOR TRAUMA RESUSCITATION
|
Facility
|
OP
|
$6,022.01
|
|
| Hospital Charge Code |
68100001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,408.80 |
| Max. Negotiated Rate |
$5,419.81 |
| Rate for Payer: Aetna Commercial |
$5,118.71
|
| Rate for Payer: Aetna Medicare |
$3,011.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,914.31
|
| Rate for Payer: BCBS Complete |
$2,408.80
|
| Rate for Payer: Cash Price |
$4,817.61
|
| Rate for Payer: Cofinity Commercial |
$4,215.41
|
| Rate for Payer: Cofinity Commercial |
$5,178.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,215.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,817.61
|
| Rate for Payer: Healthscope Commercial |
$5,419.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,118.71
|
| Rate for Payer: PHP Commercial |
$5,118.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,914.31
|
| Rate for Payer: Priority Health SBD |
$3,793.87
|
|
|
HC TIER 2 TRAUMA RESUSCITATION
|
Facility
|
OP
|
$4,592.66
|
|
| Hospital Charge Code |
68200001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,837.06 |
| Max. Negotiated Rate |
$4,133.39 |
| Rate for Payer: Aetna Commercial |
$3,903.76
|
| Rate for Payer: Aetna Medicare |
$2,296.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,985.23
|
| Rate for Payer: BCBS Complete |
$1,837.06
|
| Rate for Payer: Cash Price |
$3,674.13
|
| Rate for Payer: Cofinity Commercial |
$3,214.86
|
| Rate for Payer: Cofinity Commercial |
$3,949.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,214.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,674.13
|
| Rate for Payer: Healthscope Commercial |
$4,133.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,903.76
|
| Rate for Payer: PHP Commercial |
$3,903.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,985.23
|
| Rate for Payer: Priority Health SBD |
$2,893.38
|
|
|
HC TIER 2 TRAUMA RESUSCITATION
|
Facility
|
IP
|
$4,592.66
|
|
| Hospital Charge Code |
68200001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,893.38 |
| Max. Negotiated Rate |
$4,133.39 |
| Rate for Payer: Aetna Commercial |
$3,903.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,985.23
|
| Rate for Payer: Cash Price |
$3,674.13
|
| Rate for Payer: Cofinity Commercial |
$3,214.86
|
| Rate for Payer: Cofinity Commercial |
$3,949.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,214.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,674.13
|
| Rate for Payer: Healthscope Commercial |
$4,133.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,903.76
|
| Rate for Payer: PHP Commercial |
$3,903.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,985.23
|
| Rate for Payer: Priority Health SBD |
$2,893.38
|
|
|
HC TIER 3 TRAUMA CONSULT
|
Facility
|
OP
|
$3,503.03
|
|
| Hospital Charge Code |
68100002
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,401.21 |
| Max. Negotiated Rate |
$3,152.73 |
| Rate for Payer: Aetna Commercial |
$2,977.58
|
| Rate for Payer: Aetna Medicare |
$1,751.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,276.97
|
| Rate for Payer: BCBS Complete |
$1,401.21
|
| Rate for Payer: Cash Price |
$2,802.42
|
| Rate for Payer: Cofinity Commercial |
$2,452.12
|
| Rate for Payer: Cofinity Commercial |
$3,012.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,452.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,802.42
|
| Rate for Payer: Healthscope Commercial |
$3,152.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,977.58
|
| Rate for Payer: PHP Commercial |
$2,977.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,276.97
|
| Rate for Payer: Priority Health SBD |
$2,206.91
|
|
|
HC TIER 3 TRAUMA CONSULT
|
Facility
|
IP
|
$3,503.03
|
|
| Hospital Charge Code |
68100002
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,206.91 |
| Max. Negotiated Rate |
$3,152.73 |
| Rate for Payer: Aetna Commercial |
$2,977.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,276.97
|
| Rate for Payer: Cash Price |
$2,802.42
|
| Rate for Payer: Cofinity Commercial |
$2,452.12
|
| Rate for Payer: Cofinity Commercial |
$3,012.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,452.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,802.42
|
| Rate for Payer: Healthscope Commercial |
$3,152.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,977.58
|
| Rate for Payer: PHP Commercial |
$2,977.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,276.97
|
| Rate for Payer: Priority Health SBD |
$2,206.91
|
|
|
HC TIER 4 TRAUMA CONSULT
|
Facility
|
IP
|
$2,672.79
|
|
| Hospital Charge Code |
68100003
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,683.86 |
| Max. Negotiated Rate |
$2,405.51 |
| Rate for Payer: Aetna Commercial |
$2,271.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,737.31
|
| Rate for Payer: Cash Price |
$2,138.23
|
| Rate for Payer: Cofinity Commercial |
$1,870.95
|
| Rate for Payer: Cofinity Commercial |
$2,298.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,870.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,138.23
|
| Rate for Payer: Healthscope Commercial |
$2,405.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,271.87
|
| Rate for Payer: PHP Commercial |
$2,271.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,737.31
|
| Rate for Payer: Priority Health SBD |
$1,683.86
|
|
|
HC TIER 4 TRAUMA CONSULT
|
Facility
|
OP
|
$2,672.79
|
|
| Hospital Charge Code |
68100003
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,069.12 |
| Max. Negotiated Rate |
$2,405.51 |
| Rate for Payer: Aetna Commercial |
$2,271.87
|
| Rate for Payer: Aetna Medicare |
$1,336.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,737.31
|
| Rate for Payer: BCBS Complete |
$1,069.12
|
| Rate for Payer: Cash Price |
$2,138.23
|
| Rate for Payer: Cofinity Commercial |
$1,870.95
|
| Rate for Payer: Cofinity Commercial |
$2,298.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,870.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,138.23
|
| Rate for Payer: Healthscope Commercial |
$2,405.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,271.87
|
| Rate for Payer: PHP Commercial |
$2,271.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,737.31
|
| Rate for Payer: Priority Health SBD |
$1,683.86
|
|
|
HC TILT TABLE STRESS
|
Facility
|
OP
|
$1,122.86
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$1,456.65 |
| Rate for Payer: Aetna Commercial |
$954.43
|
| Rate for Payer: Aetna Medicare |
$538.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$898.29
|
| Rate for Payer: Cash Price |
$898.29
|
| Rate for Payer: Cofinity Commercial |
$965.66
|
| Rate for Payer: Cofinity Commercial |
$786.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$786.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$1,010.57
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.43
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$954.43
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.86
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health SBD |
$707.40
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.65
|
| Rate for Payer: UHC Core |
$830.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$830.92
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$291.34
|
| Rate for Payer: VA VA |
$517.48
|
|
|
HC TILT TABLE STRESS
|
Facility
|
IP
|
$1,122.86
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$707.40 |
| Max. Negotiated Rate |
$1,010.57 |
| Rate for Payer: Aetna Commercial |
$954.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.86
|
| Rate for Payer: Cash Price |
$898.29
|
| Rate for Payer: Cofinity Commercial |
$786.00
|
| Rate for Payer: Cofinity Commercial |
$965.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$786.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.29
|
| Rate for Payer: Healthscope Commercial |
$1,010.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.43
|
| Rate for Payer: PHP Commercial |
$954.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.86
|
| Rate for Payer: Priority Health SBD |
$707.40
|
|
|
HC TIMOTHY GRASS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC TIMOTHY GRASS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC TIP PUMP SUCTION
|
Facility
|
IP
|
$42.84
|
|
| Hospital Charge Code |
27000111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health SBD |
$26.99
|
|
|
HC TIP PUMP SUCTION
|
Facility
|
OP
|
$42.84
|
|
| Hospital Charge Code |
27000111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health SBD |
$26.99
|
|
|
HC TISSUE IN SITU HYB QUANT EA ADD
|
Facility
|
OP
|
$269.46
|
|
|
Service Code
|
CPT 88369
|
| Hospital Charge Code |
31000123
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$107.78 |
| Max. Negotiated Rate |
$242.51 |
| Rate for Payer: Aetna Commercial |
$229.04
|
| Rate for Payer: Aetna Medicare |
$134.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.15
|
| Rate for Payer: BCBS Complete |
$107.78
|
| Rate for Payer: Cash Price |
$215.57
|
| Rate for Payer: Cofinity Commercial |
$188.62
|
| Rate for Payer: Cofinity Commercial |
$231.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.57
|
| Rate for Payer: Healthscope Commercial |
$242.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.04
|
| Rate for Payer: PHP Commercial |
$229.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.15
|
| Rate for Payer: Priority Health SBD |
$169.76
|
|
|
HC TISSUE IN SITU HYB QUANT EA ADD
|
Facility
|
IP
|
$269.46
|
|
|
Service Code
|
CPT 88369
|
| Hospital Charge Code |
31000123
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$169.76 |
| Max. Negotiated Rate |
$242.51 |
| Rate for Payer: Aetna Commercial |
$229.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.15
|
| Rate for Payer: Cash Price |
$215.57
|
| Rate for Payer: Cofinity Commercial |
$188.62
|
| Rate for Payer: Cofinity Commercial |
$231.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.57
|
| Rate for Payer: Healthscope Commercial |
$242.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.04
|
| Rate for Payer: PHP Commercial |
$229.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.15
|
| Rate for Payer: Priority Health SBD |
$169.76
|
|
|
HC TISSUE IN SITU HYBRIDIZATION
|
Facility
|
IP
|
$355.46
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
31000060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$223.94 |
| Max. Negotiated Rate |
$319.91 |
| Rate for Payer: Aetna Commercial |
$302.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.05
|
| Rate for Payer: Cash Price |
$284.37
|
| Rate for Payer: Cofinity Commercial |
$248.82
|
| Rate for Payer: Cofinity Commercial |
$305.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.37
|
| Rate for Payer: Healthscope Commercial |
$319.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.14
|
| Rate for Payer: PHP Commercial |
$302.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.05
|
| Rate for Payer: Priority Health SBD |
$223.94
|
|
