|
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 |
$2,643.71 |
| Max. Negotiated Rate |
$7,145.15 |
| Rate for Payer: Aetna Commercial |
$6,430.64
|
| Rate for Payer: Aetna Medicare |
$2,643.71
|
| Rate for Payer: ASR ASR |
$6,930.80
|
| Rate for Payer: BCBS Complete |
$2,858.06
|
| Rate for Payer: BCBS Trust/PPO |
$5,891.18
|
| Rate for Payer: BCN Commercial |
$5,891.18
|
| Rate for Payer: Cash Price |
$5,716.12
|
| Rate for Payer: Cofinity Commercial |
$6,716.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,716.12
|
| Rate for Payer: Healthscope Commercial |
$6,930.80
|
| Rate for Payer: Healthscope Whirlpool |
$7,145.15
|
| Rate for Payer: Mclaren Commercial |
$6,430.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,716.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,073.38
|
| Rate for Payer: Nomi Health Commercial |
$5,859.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,358.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6,260.58
|
| Rate for Payer: Priority Health Narrow Network |
$5,008.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,287.73
|
|
|
HC THROMBO EMBO CATHETER LVL 71
|
Facility
|
IP
|
$7,145.15
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,358.86 |
| Max. Negotiated Rate |
$7,145.15 |
| Rate for Payer: Aetna Commercial |
$6,430.64
|
| Rate for Payer: ASR ASR |
$6,930.80
|
| Rate for Payer: BCBS Trust/PPO |
$5,867.60
|
| Rate for Payer: BCN Commercial |
$5,867.60
|
| Rate for Payer: Cash Price |
$5,716.12
|
| Rate for Payer: Cofinity Commercial |
$6,716.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,716.12
|
| Rate for Payer: Healthscope Commercial |
$6,930.80
|
| Rate for Payer: Healthscope Whirlpool |
$7,145.15
|
| Rate for Payer: Mclaren Commercial |
$6,430.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,073.38
|
| Rate for Payer: Nomi Health Commercial |
$5,859.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,358.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,287.73
|
|
|
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 |
$6,607.50 |
| Max. Negotiated Rate |
$8,810.00 |
| Rate for Payer: Aetna Commercial |
$7,929.00
|
| Rate for Payer: ASR ASR |
$8,545.70
|
| Rate for Payer: BCBS Trust/PPO |
$7,234.77
|
| Rate for Payer: BCN Commercial |
$7,234.77
|
| Rate for Payer: Cash Price |
$7,048.00
|
| Rate for Payer: Cofinity Commercial |
$8,281.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,048.00
|
| Rate for Payer: Healthscope Commercial |
$8,545.70
|
| Rate for Payer: Healthscope Whirlpool |
$8,810.00
|
| Rate for Payer: Mclaren Commercial |
$7,929.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,488.50
|
| Rate for Payer: Nomi Health Commercial |
$7,224.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,607.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,752.80
|
|
|
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 |
$3,259.70 |
| Max. Negotiated Rate |
$8,810.00 |
| Rate for Payer: Aetna Commercial |
$7,929.00
|
| Rate for Payer: Aetna Medicare |
$3,259.70
|
| Rate for Payer: ASR ASR |
$8,545.70
|
| Rate for Payer: BCBS Complete |
$3,524.00
|
| Rate for Payer: BCBS Trust/PPO |
$7,263.85
|
| Rate for Payer: BCN Commercial |
$7,263.85
|
| Rate for Payer: Cash Price |
$7,048.00
|
| Rate for Payer: Cofinity Commercial |
$8,281.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,048.00
|
| Rate for Payer: Healthscope Commercial |
$8,545.70
|
| Rate for Payer: Healthscope Whirlpool |
$8,810.00
|
| Rate for Payer: Mclaren Commercial |
$7,929.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,048.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,488.50
|
| Rate for Payer: Nomi Health Commercial |
$7,224.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,607.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,719.32
|
| Rate for Payer: Priority Health Narrow Network |
$6,175.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,752.80
|
|
|
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 |
$5,239.14 |
| Max. Negotiated Rate |
$14,159.85 |
| Rate for Payer: Aetna Commercial |
$12,743.86
|
| Rate for Payer: Aetna Medicare |
$5,239.14
|
| Rate for Payer: ASR ASR |
$13,735.05
|
| Rate for Payer: BCBS Complete |
$5,663.94
|
| Rate for Payer: BCBS Trust/PPO |
$11,674.80
|
| Rate for Payer: BCN Commercial |
$11,674.80
|
| Rate for Payer: Cash Price |
$11,327.88
|
| Rate for Payer: Cofinity Commercial |
$13,310.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,327.88
|
| Rate for Payer: Healthscope Commercial |
$13,735.05
|
| Rate for Payer: Healthscope Whirlpool |
$14,159.85
|
| Rate for Payer: Mclaren Commercial |
$12,743.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,327.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,035.87
|
| Rate for Payer: Nomi Health Commercial |
$11,611.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,619.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12,406.86
|
| Rate for Payer: Priority Health Narrow Network |
$9,926.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,460.67
|
|
|
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 |
$10,619.89 |
| Max. Negotiated Rate |
$14,159.85 |
| Rate for Payer: Aetna Commercial |
$12,743.86
|
| Rate for Payer: ASR ASR |
$13,735.05
|
| Rate for Payer: BCBS Trust/PPO |
$11,628.07
|
| Rate for Payer: BCN Commercial |
$11,628.07
|
| Rate for Payer: Cash Price |
$11,327.88
|
| Rate for Payer: Cofinity Commercial |
$13,310.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,327.88
|
| Rate for Payer: Healthscope Commercial |
$13,735.05
|
| Rate for Payer: Healthscope Whirlpool |
$14,159.85
|
| Rate for Payer: Mclaren Commercial |
$12,743.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,035.87
|
| Rate for Payer: Nomi Health Commercial |
$11,611.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,619.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,460.67
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
IP
|
$530.20
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$397.65 |
| Max. Negotiated Rate |
$530.20 |
| Rate for Payer: Aetna Commercial |
$477.18
|
| Rate for Payer: ASR ASR |
$514.29
|
| Rate for Payer: BCBS Trust/PPO |
$435.40
|
| Rate for Payer: BCN Commercial |
$435.40
|
| Rate for Payer: Cash Price |
$424.16
|
| Rate for Payer: Cofinity Commercial |
$498.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.16
|
| Rate for Payer: Healthscope Commercial |
$514.29
|
| Rate for Payer: Healthscope Whirlpool |
$530.20
|
| Rate for Payer: Mclaren Commercial |
$477.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$450.67
|
| Rate for Payer: Nomi Health Commercial |
$434.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$466.58
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
OP
|
$530.20
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$530.20 |
| Rate for Payer: Aetna Commercial |
$477.18
|
| Rate for Payer: Aetna Medicare |
$329.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$411.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$411.40
|
| Rate for Payer: ASR ASR |
$514.29
|
| Rate for Payer: BCBS Complete |
$180.75
|
| Rate for Payer: BCBS MAPPO |
$329.12
|
| Rate for Payer: BCBS Trust/PPO |
$437.15
|
| Rate for Payer: BCN Commercial |
$437.15
|
| Rate for Payer: BCN Medicare Advantage |
$329.12
|
| Rate for Payer: Cash Price |
$424.16
|
| Rate for Payer: Cash Price |
$424.16
|
| Rate for Payer: Cofinity Commercial |
$498.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.12
|
| Rate for Payer: Healthscope Commercial |
$514.29
|
| Rate for Payer: Healthscope Whirlpool |
$530.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$329.12
|
| Rate for Payer: Mclaren Commercial |
$477.18
|
| Rate for Payer: Mclaren Medicaid |
$329.12
|
| Rate for Payer: Mclaren Medicare |
$329.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.58
|
| Rate for Payer: Meridian Medicaid |
$180.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$362.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$450.67
|
| Rate for Payer: Nomi Health Commercial |
$434.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.65
|
| Rate for Payer: PACE Medicare |
$312.66
|
| Rate for Payer: PACE SWMI |
$329.12
|
| Rate for Payer: PHP Commercial |
$362.03
|
| Rate for Payer: PHP Medicaid |
$176.41
|
| Rate for Payer: PHP Medicare Advantage |
$329.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$391.00
|
| Rate for Payer: Priority Health Medicare |
$329.12
|
| Rate for Payer: Priority Health Narrow Network |
$312.80
|
| Rate for Payer: Railroad Medicare Medicare |
$329.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$466.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$329.12
|
| Rate for Payer: UHC Exchange |
$510.14
|
| Rate for Payer: UHC Medicaid |
$172.13
|
| Rate for Payer: UHCCP DNSP |
$329.12
|
| Rate for Payer: UHCCP Medicaid |
$172.13
|
| Rate for Payer: VA VA |
$329.12
|
|
|
HC THROMBOLYSIS CESSATION
|
Facility
|
IP
|
$4,737.42
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
36100374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,553.07 |
| Max. Negotiated Rate |
$4,737.42 |
| Rate for Payer: Aetna Commercial |
$4,263.68
|
| Rate for Payer: ASR ASR |
$4,595.30
|
| Rate for Payer: BCBS Trust/PPO |
$3,890.37
|
| Rate for Payer: BCN Commercial |
$3,890.37
|
| Rate for Payer: Cash Price |
$3,789.94
|
| Rate for Payer: Cofinity Commercial |
$4,453.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,789.94
|
| Rate for Payer: Healthscope Commercial |
$4,595.30
|
| Rate for Payer: Healthscope Whirlpool |
$4,737.42
|
| Rate for Payer: Mclaren Commercial |
$4,263.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,026.81
|
| Rate for Payer: Nomi Health Commercial |
$3,884.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,553.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,168.93
|
|
|
HC THROMBOLYSIS CESSATION
|
Facility
|
OP
|
$4,737.42
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
36100374
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$4,876.50 |
| Rate for Payer: Aetna Commercial |
$4,263.68
|
| Rate for Payer: Aetna Medicare |
$3,146.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: ASR ASR |
$4,595.30
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,906.00
|
| Rate for Payer: BCN Commercial |
$3,906.00
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,789.94
|
| Rate for Payer: Cash Price |
$3,789.94
|
| Rate for Payer: Cofinity Commercial |
$4,453.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,789.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$4,595.30
|
| Rate for Payer: Healthscope Whirlpool |
$4,737.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,146.13
|
| Rate for Payer: Mclaren Commercial |
$4,263.68
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$1,727.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,026.81
|
| Rate for Payer: Nomi Health Commercial |
$3,884.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,553.07
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,460.74
|
| Rate for Payer: PHP Medicaid |
$1,686.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,214.11
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,771.29
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,168.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Exchange |
$4,876.50
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP DNSP |
$3,146.13
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC THSD7
|
Facility
|
IP
|
$387.97
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200493
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$290.98 |
| Max. Negotiated Rate |
$387.97 |
| Rate for Payer: Aetna Commercial |
$349.17
|
| Rate for Payer: ASR ASR |
$376.33
|
| Rate for Payer: BCBS Trust/PPO |
$318.60
|
| Rate for Payer: BCN Commercial |
$318.60
|
| Rate for Payer: Cash Price |
$310.38
|
| Rate for Payer: Cofinity Commercial |
$364.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.38
|
| Rate for Payer: Healthscope Commercial |
$376.33
|
| Rate for Payer: Healthscope Whirlpool |
$387.97
|
| Rate for Payer: Mclaren Commercial |
$349.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.77
|
| Rate for Payer: Nomi Health Commercial |
$318.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$341.41
|
|
|
HC THSD7
|
Facility
|
OP
|
$387.97
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200493
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$387.97 |
| Rate for Payer: Aetna Commercial |
$349.17
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$376.33
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$319.88
|
| Rate for Payer: BCN Commercial |
$319.88
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$310.38
|
| Rate for Payer: Cash Price |
$310.38
|
| Rate for Payer: Cofinity Commercial |
$364.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$376.33
|
| Rate for Payer: Healthscope Whirlpool |
$387.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$349.17
|
| Rate for Payer: Mclaren Medicaid |
$12.05
|
| 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 |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.77
|
| Rate for Payer: Nomi Health Commercial |
$318.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.98
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$250.58
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$200.47
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$341.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC THYROGLOBULIN
|
Facility
|
OP
|
$59.05
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
30100434
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$66.58 |
| Rate for Payer: Aetna Commercial |
$53.15
|
| Rate for Payer: Aetna Medicare |
$16.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.07
|
| Rate for Payer: ASR ASR |
$57.28
|
| Rate for Payer: BCBS Complete |
$8.82
|
| Rate for Payer: BCBS MAPPO |
$16.06
|
| Rate for Payer: BCBS Trust/PPO |
$48.69
|
| Rate for Payer: BCN Commercial |
$48.69
|
| Rate for Payer: BCN Medicare Advantage |
$16.06
|
| Rate for Payer: Cash Price |
$47.24
|
| Rate for Payer: Cash Price |
$47.24
|
| Rate for Payer: Cofinity Commercial |
$55.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$57.28
|
| Rate for Payer: Healthscope Whirlpool |
$59.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.06
|
| Rate for Payer: Mclaren Commercial |
$53.15
|
| Rate for Payer: Mclaren Medicaid |
$16.06
|
| 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 |
$8.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.19
|
| Rate for Payer: Nomi Health Commercial |
$48.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.29
|
| Rate for Payer: PACE Medicare |
$15.26
|
| Rate for Payer: PACE SWMI |
$16.06
|
| Rate for Payer: PHP Commercial |
$17.67
|
| Rate for Payer: PHP Medicaid |
$8.61
|
| Rate for Payer: PHP Medicare Advantage |
$16.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$66.58
|
| Rate for Payer: Priority Health Medicare |
$16.06
|
| Rate for Payer: Priority Health Narrow Network |
$53.26
|
| Rate for Payer: Railroad Medicare Medicare |
$16.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.06
|
| Rate for Payer: UHC Exchange |
$24.89
|
| Rate for Payer: UHC Medicaid |
$8.40
|
| Rate for Payer: UHCCP DNSP |
$16.06
|
| Rate for Payer: UHCCP Medicaid |
$8.40
|
| Rate for Payer: VA VA |
$16.06
|
|
|
HC THYROGLOBULIN
|
Facility
|
IP
|
$59.05
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
30100434
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$59.05 |
| Rate for Payer: Aetna Commercial |
$53.15
|
| Rate for Payer: ASR ASR |
$57.28
|
| Rate for Payer: BCBS Trust/PPO |
$48.49
|
| Rate for Payer: BCN Commercial |
$48.49
|
| Rate for Payer: Cash Price |
$47.24
|
| Rate for Payer: Cofinity Commercial |
$55.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.24
|
| Rate for Payer: Healthscope Commercial |
$57.28
|
| Rate for Payer: Healthscope Whirlpool |
$59.05
|
| Rate for Payer: Mclaren Commercial |
$53.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.19
|
| Rate for Payer: Nomi Health Commercial |
$48.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.96
|
|
|
HC THYROGLOBULIN CMPT
|
Facility
|
OP
|
$61.44
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
30200335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$66.58 |
| Rate for Payer: Aetna Commercial |
$55.30
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.89
|
| Rate for Payer: ASR ASR |
$59.60
|
| Rate for Payer: BCBS Complete |
$8.74
|
| Rate for Payer: BCBS MAPPO |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$50.66
|
| Rate for Payer: BCN Commercial |
$50.66
|
| Rate for Payer: BCN Medicare Advantage |
$15.91
|
| Rate for Payer: Cash Price |
$49.15
|
| Rate for Payer: Cash Price |
$49.15
|
| Rate for Payer: Cofinity Commercial |
$57.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.91
|
| Rate for Payer: Healthscope Commercial |
$59.60
|
| Rate for Payer: Healthscope Whirlpool |
$61.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.91
|
| Rate for Payer: Mclaren Commercial |
$55.30
|
| Rate for Payer: Mclaren Medicaid |
$15.91
|
| 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 |
$8.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.22
|
| Rate for Payer: Nomi Health Commercial |
$50.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.08
|
| Rate for Payer: PACE Medicare |
$15.11
|
| Rate for Payer: PACE SWMI |
$15.91
|
| Rate for Payer: PHP Commercial |
$17.50
|
| Rate for Payer: PHP Medicaid |
$8.53
|
| Rate for Payer: PHP Medicare Advantage |
$15.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$66.58
|
| Rate for Payer: Priority Health Medicare |
$15.91
|
| Rate for Payer: Priority Health Narrow Network |
$53.26
|
| Rate for Payer: Railroad Medicare Medicare |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.91
|
| Rate for Payer: UHC Exchange |
$24.66
|
| Rate for Payer: UHC Medicaid |
$8.32
|
| Rate for Payer: UHCCP DNSP |
$15.91
|
| Rate for Payer: UHCCP Medicaid |
$8.32
|
| Rate for Payer: VA VA |
$15.91
|
|
|
HC THYROGLOBULIN CMPT
|
Facility
|
IP
|
$61.44
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
30200335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$55.30
|
| Rate for Payer: ASR ASR |
$59.60
|
| Rate for Payer: BCBS Trust/PPO |
$50.45
|
| Rate for Payer: BCN Commercial |
$50.45
|
| Rate for Payer: Cash Price |
$49.15
|
| Rate for Payer: Cofinity Commercial |
$57.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.15
|
| Rate for Payer: Healthscope Commercial |
$59.60
|
| Rate for Payer: Healthscope Whirlpool |
$61.44
|
| Rate for Payer: Mclaren Commercial |
$55.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.22
|
| Rate for Payer: Nomi Health Commercial |
$50.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.07
|
|
|
HC THYROID IMAGING W VASC FLOW
|
Facility
|
OP
|
$595.08
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
34100075
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$151.51 |
| Max. Negotiated Rate |
$617.41 |
| Rate for Payer: Aetna Commercial |
$535.57
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$577.23
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$490.64
|
| Rate for Payer: BCN Commercial |
$490.64
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$476.06
|
| Rate for Payer: Cash Price |
$476.06
|
| Rate for Payer: Cofinity Commercial |
$559.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$577.23
|
| Rate for Payer: Healthscope Whirlpool |
$595.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$535.57
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.82
|
| Rate for Payer: Nomi Health Commercial |
$487.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.31
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$189.39
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$151.51
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC THYROID IMAGING W VASC FLOW
|
Facility
|
IP
|
$595.08
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
34100075
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$446.31 |
| Max. Negotiated Rate |
$595.08 |
| Rate for Payer: Aetna Commercial |
$535.57
|
| Rate for Payer: ASR ASR |
$577.23
|
| Rate for Payer: BCBS Trust/PPO |
$488.68
|
| Rate for Payer: BCN Commercial |
$488.68
|
| Rate for Payer: Cash Price |
$476.06
|
| Rate for Payer: Cofinity Commercial |
$559.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.06
|
| Rate for Payer: Healthscope Commercial |
$577.23
|
| Rate for Payer: Healthscope Whirlpool |
$595.08
|
| Rate for Payer: Mclaren Commercial |
$535.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.82
|
| Rate for Payer: Nomi Health Commercial |
$487.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.67
|
|
|
HC THYROID IMAG W VASC FLOW SNGL OR MULTI
|
Facility
|
OP
|
$1,250.15
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
34100076
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,250.15 |
| Rate for Payer: Aetna Commercial |
$1,125.13
|
| Rate for Payer: Aetna Medicare |
$398.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: ASR ASR |
$1,212.65
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,030.75
|
| Rate for Payer: BCN Commercial |
$1,030.75
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,000.12
|
| Rate for Payer: Cash Price |
$1,000.12
|
| Rate for Payer: Cofinity Commercial |
$1,175.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,212.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,250.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$1,125.13
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$218.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,062.63
|
| Rate for Payer: Nomi Health Commercial |
$1,025.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$937.61
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$438.16
|
| Rate for Payer: PHP Medicaid |
$213.50
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$294.04
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$235.23
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,100.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$617.41
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP DNSP |
$398.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC THYROID IMAG W VASC FLOW SNGL OR MULTI
|
Facility
|
IP
|
$1,250.15
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
34100076
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$937.61 |
| Max. Negotiated Rate |
$1,250.15 |
| Rate for Payer: Aetna Commercial |
$1,125.13
|
| Rate for Payer: ASR ASR |
$1,212.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,026.62
|
| Rate for Payer: BCN Commercial |
$1,026.62
|
| Rate for Payer: Cash Price |
$1,000.12
|
| Rate for Payer: Cofinity Commercial |
$1,175.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.12
|
| Rate for Payer: Healthscope Commercial |
$1,212.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,250.15
|
| Rate for Payer: Mclaren Commercial |
$1,125.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,062.63
|
| Rate for Payer: Nomi Health Commercial |
$1,025.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$937.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,100.13
|
|
|
HC THYROID PEROXIDASE ANTIBODY
|
Facility
|
IP
|
$87.29
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200209
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$65.47 |
| Max. Negotiated Rate |
$87.29 |
| Rate for Payer: Aetna Commercial |
$78.56
|
| Rate for Payer: ASR ASR |
$84.67
|
| Rate for Payer: BCBS Trust/PPO |
$71.68
|
| Rate for Payer: BCN Commercial |
$71.68
|
| Rate for Payer: Cash Price |
$69.83
|
| Rate for Payer: Cofinity Commercial |
$82.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.83
|
| Rate for Payer: Healthscope Commercial |
$84.67
|
| Rate for Payer: Healthscope Whirlpool |
$87.29
|
| Rate for Payer: Mclaren Commercial |
$78.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.20
|
| Rate for Payer: Nomi Health Commercial |
$71.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.82
|
|
|
HC THYROID PEROXIDASE ANTIBODY
|
Facility
|
OP
|
$87.29
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200209
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$87.29 |
| Rate for Payer: Aetna Commercial |
$78.56
|
| 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 |
$84.67
|
| Rate for Payer: BCBS Complete |
$7.99
|
| Rate for Payer: BCBS MAPPO |
$14.55
|
| Rate for Payer: BCBS Trust/PPO |
$71.97
|
| Rate for Payer: BCN Commercial |
$71.97
|
| Rate for Payer: BCN Medicare Advantage |
$14.55
|
| Rate for Payer: Cash Price |
$69.83
|
| Rate for Payer: Cash Price |
$69.83
|
| Rate for Payer: Cofinity Commercial |
$82.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.55
|
| Rate for Payer: Healthscope Commercial |
$84.67
|
| Rate for Payer: Healthscope Whirlpool |
$87.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.55
|
| Rate for Payer: Mclaren Commercial |
$78.56
|
| Rate for Payer: Mclaren Medicaid |
$14.55
|
| 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 |
$7.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.20
|
| Rate for Payer: Nomi Health Commercial |
$71.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.47
|
| Rate for Payer: PACE Medicare |
$13.82
|
| Rate for Payer: PACE SWMI |
$14.55
|
| Rate for Payer: PHP Commercial |
$16.00
|
| Rate for Payer: PHP Medicaid |
$7.80
|
| Rate for Payer: PHP Medicare Advantage |
$14.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49.62
|
| Rate for Payer: Priority Health Medicare |
$14.55
|
| Rate for Payer: Priority Health Narrow Network |
$39.70
|
| Rate for Payer: Railroad Medicare Medicare |
$14.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.55
|
| Rate for Payer: UHC Exchange |
$22.55
|
| Rate for Payer: UHC Medicaid |
$7.61
|
| Rate for Payer: UHCCP DNSP |
$14.55
|
| Rate for Payer: UHCCP Medicaid |
$7.61
|
| Rate for Payer: VA VA |
$14.55
|
|
|
HC THYROID STIMULATING IMMUNOGLOB
|
Facility
|
OP
|
$91.06
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
30100439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$453.96 |
| Rate for Payer: Aetna Commercial |
$81.95
|
| 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 |
$88.33
|
| Rate for Payer: BCBS Complete |
$27.93
|
| Rate for Payer: BCBS MAPPO |
$50.86
|
| Rate for Payer: BCBS Trust/PPO |
$75.08
|
| Rate for Payer: BCN Commercial |
$75.08
|
| Rate for Payer: BCN Medicare Advantage |
$50.86
|
| Rate for Payer: Cash Price |
$72.85
|
| Rate for Payer: Cash Price |
$72.85
|
| Rate for Payer: Cofinity Commercial |
$85.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.86
|
| Rate for Payer: Healthscope Commercial |
$88.33
|
| Rate for Payer: Healthscope Whirlpool |
$91.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$50.86
|
| Rate for Payer: Mclaren Commercial |
$81.95
|
| Rate for Payer: Mclaren Medicaid |
$50.86
|
| 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 |
$27.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$55.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.40
|
| Rate for Payer: Nomi Health Commercial |
$74.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.30
|
| Rate for Payer: PACE Medicare |
$48.32
|
| Rate for Payer: PACE SWMI |
$50.86
|
| Rate for Payer: PHP Commercial |
$55.95
|
| Rate for Payer: PHP Medicaid |
$27.26
|
| Rate for Payer: PHP Medicare Advantage |
$50.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$453.96
|
| Rate for Payer: Priority Health Medicare |
$50.86
|
| Rate for Payer: Priority Health Narrow Network |
$363.17
|
| Rate for Payer: Railroad Medicare Medicare |
$50.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$50.86
|
| Rate for Payer: UHC Exchange |
$78.83
|
| Rate for Payer: UHC Medicaid |
$26.60
|
| Rate for Payer: UHCCP DNSP |
$50.86
|
| Rate for Payer: UHCCP Medicaid |
$26.60
|
| Rate for Payer: VA VA |
$50.86
|
|
|
HC THYROID STIMULATING IMMUNOGLOB
|
Facility
|
IP
|
$91.06
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
30100439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.30 |
| Max. Negotiated Rate |
$91.06 |
| Rate for Payer: Aetna Commercial |
$81.95
|
| Rate for Payer: ASR ASR |
$88.33
|
| Rate for Payer: BCBS Trust/PPO |
$74.78
|
| Rate for Payer: BCN Commercial |
$74.78
|
| Rate for Payer: Cash Price |
$72.85
|
| Rate for Payer: Cofinity Commercial |
$85.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.85
|
| Rate for Payer: Healthscope Commercial |
$88.33
|
| Rate for Payer: Healthscope Whirlpool |
$91.06
|
| Rate for Payer: Mclaren Commercial |
$81.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.40
|
| Rate for Payer: Nomi Health Commercial |
$74.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.13
|
|
|
HC THYROID TC 99M PER STUDY
|
Facility
|
OP
|
$146.06
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300021
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$54.04 |
| Max. Negotiated Rate |
$304.46 |
| Rate for Payer: Aetna Commercial |
$131.45
|
| Rate for Payer: Aetna Medicare |
$54.04
|
| Rate for Payer: ASR ASR |
$141.68
|
| Rate for Payer: BCBS Complete |
$58.42
|
| Rate for Payer: BCBS Trust/PPO |
$120.43
|
| Rate for Payer: BCN Commercial |
$120.43
|
| Rate for Payer: Cash Price |
$116.85
|
| Rate for Payer: Cash Price |
$116.85
|
| Rate for Payer: Cofinity Commercial |
$137.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.85
|
| Rate for Payer: Healthscope Commercial |
$141.68
|
| Rate for Payer: Healthscope Whirlpool |
$146.06
|
| Rate for Payer: Mclaren Commercial |
$131.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.15
|
| Rate for Payer: Nomi Health Commercial |
$119.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$304.46
|
| Rate for Payer: Priority Health Narrow Network |
$243.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.53
|
|
