|
HC THYROID IMAGING W VASC FLOW
|
Facility
|
OP
|
$571.97
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
34100075
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$128.43 |
| Max. Negotiated Rate |
$571.97 |
| Rate for Payer: Aetna Commercial |
$514.77
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$554.81
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$443.45
|
| Rate for Payer: BCN Commercial |
$443.45
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$457.58
|
| Rate for Payer: Cash Price |
$457.58
|
| Rate for Payer: Cofinity Commercial |
$537.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$571.97
|
| Rate for Payer: Healthscope Whirlpool |
$554.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$514.77
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.17
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.54
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$128.43
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$503.33
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC THYROID IMAGING W VASC FLOW
|
Facility
|
IP
|
$571.97
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
34100075
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$400.38 |
| Max. Negotiated Rate |
$571.97 |
| Rate for Payer: Aetna Commercial |
$514.77
|
| Rate for Payer: ASR ASR |
$554.81
|
| Rate for Payer: BCBS Trust/PPO |
$443.45
|
| Rate for Payer: BCN Commercial |
$443.45
|
| Rate for Payer: Cash Price |
$457.58
|
| Rate for Payer: Cofinity Commercial |
$537.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.58
|
| Rate for Payer: Healthscope Commercial |
$571.97
|
| Rate for Payer: Healthscope Whirlpool |
$554.81
|
| Rate for Payer: Mclaren Commercial |
$514.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$503.33
|
|
|
HC THYROID IMAG W VASC FLOW SNGL OR MULTI
|
Facility
|
OP
|
$1,201.61
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
34100076
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$199.40 |
| Max. Negotiated Rate |
$1,201.61 |
| Rate for Payer: Aetna Commercial |
$1,081.45
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$1,165.56
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$931.61
|
| Rate for Payer: BCN Commercial |
$931.61
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$961.29
|
| Rate for Payer: Cash Price |
$961.29
|
| Rate for Payer: Cofinity Commercial |
$1,129.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$961.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,201.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,165.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$1,081.45
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,021.37
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$249.25
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$199.40
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,057.42
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC THYROID IMAG W VASC FLOW SNGL OR MULTI
|
Facility
|
IP
|
$1,201.61
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
34100076
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$841.13 |
| Max. Negotiated Rate |
$1,201.61 |
| Rate for Payer: Aetna Commercial |
$1,081.45
|
| Rate for Payer: ASR ASR |
$1,165.56
|
| Rate for Payer: BCBS Trust/PPO |
$931.61
|
| Rate for Payer: BCN Commercial |
$931.61
|
| Rate for Payer: Cash Price |
$961.29
|
| Rate for Payer: Cofinity Commercial |
$1,129.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$961.29
|
| Rate for Payer: Healthscope Commercial |
$1,201.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,165.56
|
| Rate for Payer: Mclaren Commercial |
$1,081.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,021.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,057.42
|
|
|
HC THYROID PEROXIDASE ANTIBODY
|
Facility
|
OP
|
$83.90
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200209
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$83.90 |
| Rate for Payer: Aetna Commercial |
$75.51
|
| Rate for Payer: Aetna Medicare |
$14.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.19
|
| Rate for Payer: ASR ASR |
$81.38
|
| Rate for Payer: BCBS Complete |
$8.36
|
| Rate for Payer: BCBS MAPPO |
$14.55
|
| Rate for Payer: BCBS Trust/PPO |
$65.05
|
| Rate for Payer: BCN Commercial |
$65.05
|
| Rate for Payer: BCN Medicare Advantage |
$14.55
|
| Rate for Payer: Cash Price |
$67.12
|
| Rate for Payer: Cash Price |
$67.12
|
| Rate for Payer: Cofinity Commercial |
$78.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.55
|
| Rate for Payer: Healthscope Commercial |
$83.90
|
| Rate for Payer: Healthscope Whirlpool |
$81.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.55
|
| Rate for Payer: Mclaren Commercial |
$75.51
|
| Rate for Payer: Mclaren Medicaid |
$7.96
|
| Rate for Payer: Mclaren Medicare |
$14.55
|
| Rate for Payer: Meridian Medicaid |
$8.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.32
|
| Rate for Payer: PACE Medicare |
$13.82
|
| Rate for Payer: PACE SWMI |
$14.55
|
| Rate for Payer: PHP Commercial |
$16.00
|
| Rate for Payer: PHP Medicaid |
$7.96
|
| Rate for Payer: PHP Medicare Advantage |
$14.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.07
|
| Rate for Payer: Priority Health Medicare |
$14.55
|
| Rate for Payer: Priority Health Narrow Network |
$33.66
|
| Rate for Payer: Railroad Medicare Medicare |
$14.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.83
|
| Rate for Payer: UHC Medicare Advantage |
$14.99
|
| Rate for Payer: VA VA |
$14.55
|
|
|
HC THYROID PEROXIDASE ANTIBODY
|
Facility
|
IP
|
$83.90
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200209
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.73 |
| Max. Negotiated Rate |
$83.90 |
| Rate for Payer: Aetna Commercial |
$75.51
|
| Rate for Payer: ASR ASR |
$81.38
|
| Rate for Payer: BCBS Trust/PPO |
$65.05
|
| Rate for Payer: BCN Commercial |
$65.05
|
| Rate for Payer: Cash Price |
$67.12
|
| Rate for Payer: Cofinity Commercial |
$78.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.12
|
| Rate for Payer: Healthscope Commercial |
$83.90
|
| Rate for Payer: Healthscope Whirlpool |
$81.38
|
| Rate for Payer: Mclaren Commercial |
$75.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.83
|
|
|
HC THYROID STIMULATING IMMUNOGLOB
|
Facility
|
IP
|
$83.95
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
30100439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.76 |
| Max. Negotiated Rate |
$83.95 |
| Rate for Payer: Aetna Commercial |
$75.56
|
| Rate for Payer: ASR ASR |
$81.43
|
| Rate for Payer: BCBS Trust/PPO |
$65.09
|
| Rate for Payer: BCN Commercial |
$65.09
|
| Rate for Payer: Cash Price |
$67.16
|
| Rate for Payer: Cofinity Commercial |
$78.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.16
|
| Rate for Payer: Healthscope Commercial |
$83.95
|
| Rate for Payer: Healthscope Whirlpool |
$81.43
|
| Rate for Payer: Mclaren Commercial |
$75.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.88
|
|
|
HC THYROID STIMULATING IMMUNOGLOB
|
Facility
|
OP
|
$83.95
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
30100439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$384.81 |
| Rate for Payer: Aetna Commercial |
$75.56
|
| Rate for Payer: Aetna Medicare |
$50.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.58
|
| Rate for Payer: ASR ASR |
$81.43
|
| Rate for Payer: BCBS Complete |
$29.21
|
| Rate for Payer: BCBS MAPPO |
$50.86
|
| Rate for Payer: BCBS Trust/PPO |
$65.09
|
| Rate for Payer: BCN Commercial |
$65.09
|
| Rate for Payer: BCN Medicare Advantage |
$50.86
|
| Rate for Payer: Cash Price |
$67.16
|
| Rate for Payer: Cash Price |
$67.16
|
| Rate for Payer: Cofinity Commercial |
$78.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.86
|
| Rate for Payer: Healthscope Commercial |
$83.95
|
| Rate for Payer: Healthscope Whirlpool |
$81.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$50.86
|
| Rate for Payer: Mclaren Commercial |
$75.56
|
| Rate for Payer: Mclaren Medicaid |
$27.82
|
| Rate for Payer: Mclaren Medicare |
$50.86
|
| Rate for Payer: Meridian Medicaid |
$29.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.36
|
| Rate for Payer: PACE Medicare |
$48.32
|
| Rate for Payer: PACE SWMI |
$50.86
|
| Rate for Payer: PHP Commercial |
$55.95
|
| Rate for Payer: PHP Medicaid |
$27.82
|
| Rate for Payer: PHP Medicare Advantage |
$50.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$384.81
|
| Rate for Payer: Priority Health Medicare |
$50.86
|
| Rate for Payer: Priority Health Narrow Network |
$307.85
|
| Rate for Payer: Railroad Medicare Medicare |
$50.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.88
|
| Rate for Payer: UHC Medicare Advantage |
$52.39
|
| Rate for Payer: VA VA |
$50.86
|
|
|
HC THYROID TC 99M PER STUDY
|
Facility
|
IP
|
$140.39
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300021
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$98.27 |
| Max. Negotiated Rate |
$140.39 |
| Rate for Payer: Aetna Commercial |
$126.35
|
| Rate for Payer: ASR ASR |
$136.18
|
| Rate for Payer: BCBS Trust/PPO |
$108.84
|
| Rate for Payer: BCN Commercial |
$108.84
|
| Rate for Payer: Cash Price |
$112.31
|
| Rate for Payer: Cofinity Commercial |
$131.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.31
|
| Rate for Payer: Healthscope Commercial |
$140.39
|
| Rate for Payer: Healthscope Whirlpool |
$136.18
|
| Rate for Payer: Mclaren Commercial |
$126.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.54
|
|
|
HC THYROID TC 99M PER STUDY
|
Facility
|
OP
|
$140.39
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300021
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$56.16 |
| Max. Negotiated Rate |
$258.08 |
| Rate for Payer: Aetna Commercial |
$126.35
|
| Rate for Payer: ASR ASR |
$136.18
|
| Rate for Payer: BCBS Complete |
$56.16
|
| Rate for Payer: BCBS Trust/PPO |
$108.84
|
| Rate for Payer: BCN Commercial |
$108.84
|
| Rate for Payer: Cash Price |
$112.31
|
| Rate for Payer: Cash Price |
$112.31
|
| Rate for Payer: Cofinity Commercial |
$131.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.31
|
| Rate for Payer: Healthscope Commercial |
$140.39
|
| Rate for Payer: Healthscope Whirlpool |
$136.18
|
| Rate for Payer: Mclaren Commercial |
$126.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$258.08
|
| Rate for Payer: Priority Health Narrow Network |
$206.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.54
|
|
|
HC THYROID UPTK SNGL OR MULTI DETER
|
Facility
|
OP
|
$1,035.91
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
34100074
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$97.61 |
| Max. Negotiated Rate |
$1,035.91 |
| Rate for Payer: Aetna Commercial |
$932.32
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$1,004.83
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$803.14
|
| Rate for Payer: BCN Commercial |
$803.14
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$828.73
|
| Rate for Payer: Cash Price |
$828.73
|
| Rate for Payer: Cofinity Commercial |
$973.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$828.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,035.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,004.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$932.32
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$880.52
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$725.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.01
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$97.61
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$911.60
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC THYROID UPTK SNGL OR MULTI DETER
|
Facility
|
IP
|
$1,035.91
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
34100074
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$725.14 |
| Max. Negotiated Rate |
$1,035.91 |
| Rate for Payer: Aetna Commercial |
$932.32
|
| Rate for Payer: ASR ASR |
$1,004.83
|
| Rate for Payer: BCBS Trust/PPO |
$803.14
|
| Rate for Payer: BCN Commercial |
$803.14
|
| Rate for Payer: Cash Price |
$828.73
|
| Rate for Payer: Cofinity Commercial |
$973.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$828.73
|
| Rate for Payer: Healthscope Commercial |
$1,035.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,004.83
|
| Rate for Payer: Mclaren Commercial |
$932.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$880.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$725.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$911.60
|
|
|
HC THYROXINE BINDING GLOBULIN
|
Facility
|
IP
|
$65.10
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
30100437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$65.10 |
| Rate for Payer: Aetna Commercial |
$58.59
|
| Rate for Payer: ASR ASR |
$63.15
|
| Rate for Payer: BCBS Trust/PPO |
$50.47
|
| Rate for Payer: BCN Commercial |
$50.47
|
| Rate for Payer: Cash Price |
$52.08
|
| Rate for Payer: Cofinity Commercial |
$61.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.08
|
| Rate for Payer: Healthscope Commercial |
$65.10
|
| Rate for Payer: Healthscope Whirlpool |
$63.15
|
| Rate for Payer: Mclaren Commercial |
$58.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.29
|
|
|
HC THYROXINE BINDING GLOBULIN
|
Facility
|
OP
|
$65.10
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
30100437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$65.10 |
| Rate for Payer: Aetna Commercial |
$58.59
|
| Rate for Payer: Aetna Medicare |
$14.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.48
|
| Rate for Payer: ASR ASR |
$63.15
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS MAPPO |
$14.78
|
| Rate for Payer: BCBS Trust/PPO |
$50.47
|
| Rate for Payer: BCN Commercial |
$50.47
|
| Rate for Payer: BCN Medicare Advantage |
$14.78
|
| Rate for Payer: Cash Price |
$52.08
|
| Rate for Payer: Cash Price |
$52.08
|
| Rate for Payer: Cofinity Commercial |
$61.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.78
|
| Rate for Payer: Healthscope Commercial |
$65.10
|
| Rate for Payer: Healthscope Whirlpool |
$63.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.78
|
| Rate for Payer: Mclaren Commercial |
$58.59
|
| Rate for Payer: Mclaren Medicaid |
$8.08
|
| Rate for Payer: Mclaren Medicare |
$14.78
|
| Rate for Payer: Meridian Medicaid |
$8.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.34
|
| Rate for Payer: PACE Medicare |
$14.04
|
| Rate for Payer: PACE SWMI |
$14.78
|
| Rate for Payer: PHP Commercial |
$16.26
|
| Rate for Payer: PHP Medicaid |
$8.08
|
| Rate for Payer: PHP Medicare Advantage |
$14.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.24
|
| Rate for Payer: Priority Health Medicare |
$14.78
|
| Rate for Payer: Priority Health Narrow Network |
$46.22
|
| Rate for Payer: Railroad Medicare Medicare |
$14.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.29
|
| Rate for Payer: UHC Medicare Advantage |
$15.22
|
| Rate for Payer: VA VA |
$14.78
|
|
|
HC THYROXINE FREE T4
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
30100436
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Medicare |
$9.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.28
|
| Rate for Payer: ASR ASR |
$109.61
|
| Rate for Payer: BCBS Complete |
$5.18
|
| Rate for Payer: BCBS MAPPO |
$9.02
|
| Rate for Payer: BCBS Trust/PPO |
$87.61
|
| Rate for Payer: BCN Commercial |
$87.61
|
| Rate for Payer: BCN Medicare Advantage |
$9.02
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$106.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.02
|
| Rate for Payer: Healthscope Commercial |
$113.00
|
| Rate for Payer: Healthscope Whirlpool |
$109.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.02
|
| Rate for Payer: Mclaren Commercial |
$101.70
|
| Rate for Payer: Mclaren Medicaid |
$4.93
|
| Rate for Payer: Mclaren Medicare |
$9.02
|
| Rate for Payer: Meridian Medicaid |
$5.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PACE Medicare |
$8.57
|
| Rate for Payer: PACE SWMI |
$9.02
|
| Rate for Payer: PHP Commercial |
$9.92
|
| Rate for Payer: PHP Medicaid |
$4.93
|
| Rate for Payer: PHP Medicare Advantage |
$9.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.74
|
| Rate for Payer: Priority Health Medicare |
$9.02
|
| Rate for Payer: Priority Health Narrow Network |
$38.99
|
| Rate for Payer: Railroad Medicare Medicare |
$9.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.44
|
| Rate for Payer: UHC Medicare Advantage |
$9.29
|
| Rate for Payer: VA VA |
$9.02
|
|
|
HC THYROXINE FREE T4
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
30100436
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: ASR ASR |
$109.61
|
| Rate for Payer: BCBS Trust/PPO |
$87.61
|
| Rate for Payer: BCN Commercial |
$87.61
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$106.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Healthscope Commercial |
$113.00
|
| Rate for Payer: Healthscope Whirlpool |
$109.61
|
| Rate for Payer: Mclaren Commercial |
$101.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.44
|
|
|
HC TIAGABINE LEVEL
|
Facility
|
OP
|
$113.66
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
30100058
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$113.66 |
| Rate for Payer: Aetna Commercial |
$102.29
|
| Rate for Payer: Aetna Medicare |
$27.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.89
|
| Rate for Payer: ASR ASR |
$110.25
|
| Rate for Payer: BCBS Complete |
$15.57
|
| Rate for Payer: BCBS MAPPO |
$27.11
|
| Rate for Payer: BCBS Trust/PPO |
$88.12
|
| Rate for Payer: BCN Commercial |
$88.12
|
| Rate for Payer: BCN Medicare Advantage |
$27.11
|
| Rate for Payer: Cash Price |
$90.93
|
| Rate for Payer: Cash Price |
$90.93
|
| Rate for Payer: Cofinity Commercial |
$106.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.11
|
| Rate for Payer: Healthscope Commercial |
$113.66
|
| Rate for Payer: Healthscope Whirlpool |
$110.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.11
|
| Rate for Payer: Mclaren Commercial |
$102.29
|
| Rate for Payer: Mclaren Medicaid |
$14.83
|
| Rate for Payer: Mclaren Medicare |
$27.11
|
| Rate for Payer: Meridian Medicaid |
$15.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.61
|
| Rate for Payer: PACE Medicare |
$25.75
|
| Rate for Payer: PACE SWMI |
$27.11
|
| Rate for Payer: PHP Commercial |
$29.82
|
| Rate for Payer: PHP Medicaid |
$14.83
|
| Rate for Payer: PHP Medicare Advantage |
$27.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.00
|
| Rate for Payer: Priority Health Medicare |
$27.11
|
| Rate for Payer: Priority Health Narrow Network |
$13.60
|
| Rate for Payer: Railroad Medicare Medicare |
$27.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.02
|
| Rate for Payer: UHC Medicare Advantage |
$27.92
|
| Rate for Payer: VA VA |
$27.11
|
|
|
HC TIAGABINE LEVEL
|
Facility
|
IP
|
$113.66
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
30100058
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$113.66 |
| Rate for Payer: Aetna Commercial |
$102.29
|
| Rate for Payer: ASR ASR |
$110.25
|
| Rate for Payer: BCBS Trust/PPO |
$88.12
|
| Rate for Payer: BCN Commercial |
$88.12
|
| Rate for Payer: Cash Price |
$90.93
|
| Rate for Payer: Cofinity Commercial |
$106.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.93
|
| Rate for Payer: Healthscope Commercial |
$113.66
|
| Rate for Payer: Healthscope Whirlpool |
$110.25
|
| Rate for Payer: Mclaren Commercial |
$102.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.02
|
|
|
HC TIER 1 MAJOR TRAUMA RESUSCITATION
|
Facility
|
IP
|
$5,903.93
|
|
| Hospital Charge Code |
68100001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$4,132.75 |
| Max. Negotiated Rate |
$5,903.93 |
| Rate for Payer: Aetna Commercial |
$5,313.54
|
| Rate for Payer: ASR ASR |
$5,726.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,577.32
|
| Rate for Payer: BCN Commercial |
$4,577.32
|
| Rate for Payer: Cash Price |
$4,723.14
|
| Rate for Payer: Cofinity Commercial |
$5,549.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,723.14
|
| Rate for Payer: Healthscope Commercial |
$5,903.93
|
| Rate for Payer: Healthscope Whirlpool |
$5,726.81
|
| Rate for Payer: Mclaren Commercial |
$5,313.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,018.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,132.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,195.46
|
|
|
HC TIER 1 MAJOR TRAUMA RESUSCITATION
|
Facility
|
OP
|
$5,903.93
|
|
| Hospital Charge Code |
68100001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,361.57 |
| Max. Negotiated Rate |
$5,903.93 |
| Rate for Payer: Aetna Commercial |
$5,313.54
|
| Rate for Payer: ASR ASR |
$5,726.81
|
| Rate for Payer: BCBS Complete |
$2,361.57
|
| Rate for Payer: BCBS Trust/PPO |
$4,577.32
|
| Rate for Payer: BCN Commercial |
$4,577.32
|
| Rate for Payer: Cash Price |
$4,723.14
|
| Rate for Payer: Cofinity Commercial |
$5,549.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,723.14
|
| Rate for Payer: Healthscope Commercial |
$5,903.93
|
| Rate for Payer: Healthscope Whirlpool |
$5,726.81
|
| Rate for Payer: Mclaren Commercial |
$5,313.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,018.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,132.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,372.58
|
| Rate for Payer: Priority Health Narrow Network |
$4,191.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,195.46
|
|
|
HC TIER 2 TRAUMA RESUSCITATION
|
Facility
|
IP
|
$4,502.61
|
|
| Hospital Charge Code |
68200001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$3,151.83 |
| Max. Negotiated Rate |
$4,502.61 |
| Rate for Payer: Aetna Commercial |
$4,052.35
|
| Rate for Payer: ASR ASR |
$4,367.53
|
| Rate for Payer: BCBS Trust/PPO |
$3,490.87
|
| Rate for Payer: BCN Commercial |
$3,490.87
|
| Rate for Payer: Cash Price |
$3,602.09
|
| Rate for Payer: Cofinity Commercial |
$4,232.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,602.09
|
| Rate for Payer: Healthscope Commercial |
$4,502.61
|
| Rate for Payer: Healthscope Whirlpool |
$4,367.53
|
| Rate for Payer: Mclaren Commercial |
$4,052.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,827.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,151.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,962.30
|
|
|
HC TIER 2 TRAUMA RESUSCITATION
|
Facility
|
OP
|
$4,502.61
|
|
| Hospital Charge Code |
68200001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,801.04 |
| Max. Negotiated Rate |
$4,502.61 |
| Rate for Payer: Aetna Commercial |
$4,052.35
|
| Rate for Payer: ASR ASR |
$4,367.53
|
| Rate for Payer: BCBS Complete |
$1,801.04
|
| Rate for Payer: BCBS Trust/PPO |
$3,490.87
|
| Rate for Payer: BCN Commercial |
$3,490.87
|
| Rate for Payer: Cash Price |
$3,602.09
|
| Rate for Payer: Cofinity Commercial |
$4,232.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,602.09
|
| Rate for Payer: Healthscope Commercial |
$4,502.61
|
| Rate for Payer: Healthscope Whirlpool |
$4,367.53
|
| Rate for Payer: Mclaren Commercial |
$4,052.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,827.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,151.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,097.38
|
| Rate for Payer: Priority Health Narrow Network |
$3,196.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,962.30
|
|
|
HC TIER 3 TRAUMA CONSULT
|
Facility
|
IP
|
$3,434.34
|
|
| Hospital Charge Code |
68100002
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,404.04 |
| Max. Negotiated Rate |
$3,434.34 |
| Rate for Payer: Aetna Commercial |
$3,090.91
|
| Rate for Payer: ASR ASR |
$3,331.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,662.64
|
| Rate for Payer: BCN Commercial |
$2,662.64
|
| Rate for Payer: Cash Price |
$2,747.47
|
| Rate for Payer: Cofinity Commercial |
$3,228.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,747.47
|
| Rate for Payer: Healthscope Commercial |
$3,434.34
|
| Rate for Payer: Healthscope Whirlpool |
$3,331.31
|
| Rate for Payer: Mclaren Commercial |
$3,090.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,919.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,404.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,022.22
|
|
|
HC TIER 3 TRAUMA CONSULT
|
Facility
|
OP
|
$3,434.34
|
|
| Hospital Charge Code |
68100002
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,373.74 |
| Max. Negotiated Rate |
$3,434.34 |
| Rate for Payer: Aetna Commercial |
$3,090.91
|
| Rate for Payer: ASR ASR |
$3,331.31
|
| Rate for Payer: BCBS Complete |
$1,373.74
|
| Rate for Payer: BCBS Trust/PPO |
$2,662.64
|
| Rate for Payer: BCN Commercial |
$2,662.64
|
| Rate for Payer: Cash Price |
$2,747.47
|
| Rate for Payer: Cofinity Commercial |
$3,228.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,747.47
|
| Rate for Payer: Healthscope Commercial |
$3,434.34
|
| Rate for Payer: Healthscope Whirlpool |
$3,331.31
|
| Rate for Payer: Mclaren Commercial |
$3,090.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,919.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,404.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,125.25
|
| Rate for Payer: Priority Health Narrow Network |
$2,438.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,022.22
|
|
|
HC TIER 4 TRAUMA CONSULT
|
Facility
|
IP
|
$2,620.38
|
|
| Hospital Charge Code |
68100003
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,834.27 |
| Max. Negotiated Rate |
$2,620.38 |
| Rate for Payer: Aetna Commercial |
$2,358.34
|
| Rate for Payer: ASR ASR |
$2,541.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,031.58
|
| Rate for Payer: BCN Commercial |
$2,031.58
|
| Rate for Payer: Cash Price |
$2,096.30
|
| Rate for Payer: Cofinity Commercial |
$2,463.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,096.30
|
| Rate for Payer: Healthscope Commercial |
$2,620.38
|
| Rate for Payer: Healthscope Whirlpool |
$2,541.77
|
| Rate for Payer: Mclaren Commercial |
$2,358.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,227.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,834.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,305.93
|
|
