|
HC THYROID TC 99M PER STUDY
|
Facility
|
IP
|
$146.06
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300021
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$109.55 |
| Max. Negotiated Rate |
$146.06 |
| Rate for Payer: Aetna Commercial |
$131.45
|
| Rate for Payer: ASR ASR |
$141.68
|
| Rate for Payer: BCBS Trust/PPO |
$119.94
|
| Rate for Payer: BCN Commercial |
$119.94
|
| 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: 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: UHC All Payor (Choice/PPO) + Core |
$128.53
|
|
|
HC THYROID UPTK SNGL OR MULTI DETER
|
Facility
|
IP
|
$1,077.76
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
34100074
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$808.32 |
| Max. Negotiated Rate |
$1,077.76 |
| Rate for Payer: Aetna Commercial |
$969.98
|
| Rate for Payer: ASR ASR |
$1,045.43
|
| Rate for Payer: BCBS Trust/PPO |
$885.06
|
| Rate for Payer: BCN Commercial |
$885.06
|
| Rate for Payer: Cash Price |
$862.21
|
| Rate for Payer: Cofinity Commercial |
$1,013.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$862.21
|
| Rate for Payer: Healthscope Commercial |
$1,045.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,077.76
|
| Rate for Payer: Mclaren Commercial |
$969.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$916.10
|
| Rate for Payer: Nomi Health Commercial |
$883.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$808.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$948.43
|
|
|
HC THYROID UPTK SNGL OR MULTI DETER
|
Facility
|
OP
|
$1,077.76
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
34100074
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$115.15 |
| Max. Negotiated Rate |
$1,077.76 |
| Rate for Payer: Aetna Commercial |
$969.98
|
| 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 |
$1,045.43
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$888.61
|
| Rate for Payer: BCN Commercial |
$888.61
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$862.21
|
| Rate for Payer: Cash Price |
$862.21
|
| Rate for Payer: Cofinity Commercial |
$1,013.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$862.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,045.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,077.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$398.33
|
| Rate for Payer: Mclaren Commercial |
$969.98
|
| 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 |
$916.10
|
| Rate for Payer: Nomi Health Commercial |
$883.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$808.32
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$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 |
$143.93
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Narrow Network |
$115.15
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$948.43
|
| 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 THYROXINE BINDING GLOBULIN
|
Facility
|
OP
|
$67.73
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
30100437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.73 |
| Max. Negotiated Rate |
$67.73 |
| Rate for Payer: Aetna Commercial |
$60.96
|
| 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 |
$65.70
|
| Rate for Payer: BCBS Complete |
$8.12
|
| Rate for Payer: BCBS MAPPO |
$14.78
|
| Rate for Payer: BCBS Trust/PPO |
$55.84
|
| Rate for Payer: BCN Commercial |
$55.84
|
| Rate for Payer: BCN Medicare Advantage |
$14.78
|
| Rate for Payer: Cash Price |
$54.18
|
| Rate for Payer: Cash Price |
$54.18
|
| Rate for Payer: Cofinity Commercial |
$63.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.78
|
| Rate for Payer: Healthscope Commercial |
$65.70
|
| Rate for Payer: Healthscope Whirlpool |
$67.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.78
|
| Rate for Payer: Mclaren Commercial |
$60.96
|
| Rate for Payer: Mclaren Medicaid |
$14.78
|
| 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 |
$8.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.57
|
| Rate for Payer: Nomi Health Commercial |
$55.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.80
|
| Rate for Payer: PACE Medicare |
$14.04
|
| Rate for Payer: PACE SWMI |
$14.78
|
| Rate for Payer: PHP Commercial |
$16.26
|
| Rate for Payer: PHP Medicaid |
$7.92
|
| Rate for Payer: PHP Medicare Advantage |
$14.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$59.35
|
| Rate for Payer: Priority Health Medicare |
$14.78
|
| Rate for Payer: Priority Health Narrow Network |
$47.48
|
| Rate for Payer: Railroad Medicare Medicare |
$14.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.78
|
| Rate for Payer: UHC Exchange |
$22.91
|
| Rate for Payer: UHC Medicaid |
$7.73
|
| Rate for Payer: UHCCP DNSP |
$14.78
|
| Rate for Payer: UHCCP Medicaid |
$7.73
|
| Rate for Payer: VA VA |
$14.78
|
|
|
HC THYROXINE BINDING GLOBULIN
|
Facility
|
IP
|
$67.73
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
30100437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$67.73 |
| Rate for Payer: Aetna Commercial |
$60.96
|
| Rate for Payer: ASR ASR |
$65.70
|
| Rate for Payer: BCBS Trust/PPO |
$55.62
|
| Rate for Payer: BCN Commercial |
$55.62
|
| Rate for Payer: Cash Price |
$54.18
|
| Rate for Payer: Cofinity Commercial |
$63.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.18
|
| Rate for Payer: Healthscope Commercial |
$65.70
|
| Rate for Payer: Healthscope Whirlpool |
$67.73
|
| Rate for Payer: Mclaren Commercial |
$60.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.57
|
| Rate for Payer: Nomi Health Commercial |
$55.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.60
|
|
|
HC THYROXINE FREE T4
|
Facility
|
IP
|
$117.57
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
30100436
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.18 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$105.81
|
| Rate for Payer: ASR ASR |
$114.04
|
| Rate for Payer: BCBS Trust/PPO |
$96.55
|
| Rate for Payer: BCN Commercial |
$96.55
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Commercial |
$110.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Healthscope Commercial |
$114.04
|
| Rate for Payer: Healthscope Whirlpool |
$117.57
|
| Rate for Payer: Mclaren Commercial |
$105.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$96.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.46
|
|
|
HC THYROXINE FREE T4
|
Facility
|
OP
|
$117.57
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
30100436
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$105.81
|
| 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 |
$114.04
|
| Rate for Payer: BCBS Complete |
$4.95
|
| Rate for Payer: BCBS MAPPO |
$9.02
|
| Rate for Payer: BCBS Trust/PPO |
$96.94
|
| Rate for Payer: BCN Commercial |
$96.94
|
| Rate for Payer: BCN Medicare Advantage |
$9.02
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Commercial |
$110.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.02
|
| Rate for Payer: Healthscope Commercial |
$114.04
|
| Rate for Payer: Healthscope Whirlpool |
$117.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.02
|
| Rate for Payer: Mclaren Commercial |
$105.81
|
| Rate for Payer: Mclaren Medicaid |
$9.02
|
| 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 |
$4.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$96.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PACE Medicare |
$8.57
|
| Rate for Payer: PACE SWMI |
$9.02
|
| Rate for Payer: PHP Commercial |
$9.92
|
| Rate for Payer: PHP Medicaid |
$4.83
|
| Rate for Payer: PHP Medicare Advantage |
$9.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$57.50
|
| Rate for Payer: Priority Health Medicare |
$9.02
|
| Rate for Payer: Priority Health Narrow Network |
$46.00
|
| Rate for Payer: Railroad Medicare Medicare |
$9.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.02
|
| Rate for Payer: UHC Exchange |
$13.98
|
| Rate for Payer: UHC Medicaid |
$4.72
|
| Rate for Payer: UHCCP DNSP |
$9.02
|
| Rate for Payer: UHCCP Medicaid |
$4.72
|
| Rate for Payer: VA VA |
$9.02
|
|
|
HC TIAGABINE LEVEL
|
Facility
|
OP
|
$118.25
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
30100058
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$118.25 |
| Rate for Payer: Aetna Commercial |
$106.42
|
| 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 |
$114.70
|
| Rate for Payer: BCBS Complete |
$14.89
|
| Rate for Payer: BCBS MAPPO |
$27.11
|
| Rate for Payer: BCBS Trust/PPO |
$97.50
|
| Rate for Payer: BCN Commercial |
$97.50
|
| Rate for Payer: BCN Medicare Advantage |
$27.11
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cofinity Commercial |
$111.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.11
|
| Rate for Payer: Healthscope Commercial |
$114.70
|
| Rate for Payer: Healthscope Whirlpool |
$118.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.11
|
| Rate for Payer: Mclaren Commercial |
$106.42
|
| Rate for Payer: Mclaren Medicaid |
$27.11
|
| 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 |
$14.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.51
|
| Rate for Payer: Nomi Health Commercial |
$96.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.69
|
| Rate for Payer: PACE Medicare |
$25.75
|
| Rate for Payer: PACE SWMI |
$27.11
|
| Rate for Payer: PHP Commercial |
$29.82
|
| Rate for Payer: PHP Medicaid |
$14.53
|
| Rate for Payer: PHP Medicare Advantage |
$27.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.05
|
| Rate for Payer: Priority Health Medicare |
$27.11
|
| Rate for Payer: Priority Health Narrow Network |
$16.04
|
| Rate for Payer: Railroad Medicare Medicare |
$27.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.11
|
| Rate for Payer: UHC Exchange |
$42.02
|
| Rate for Payer: UHC Medicaid |
$14.18
|
| Rate for Payer: UHCCP DNSP |
$27.11
|
| Rate for Payer: UHCCP Medicaid |
$14.18
|
| Rate for Payer: VA VA |
$27.11
|
|
|
HC TIAGABINE LEVEL
|
Facility
|
IP
|
$118.25
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
30100058
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.69 |
| Max. Negotiated Rate |
$118.25 |
| Rate for Payer: Aetna Commercial |
$106.42
|
| Rate for Payer: ASR ASR |
$114.70
|
| Rate for Payer: BCBS Trust/PPO |
$97.11
|
| Rate for Payer: BCN Commercial |
$97.11
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Cofinity Commercial |
$111.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.60
|
| Rate for Payer: Healthscope Commercial |
$114.70
|
| Rate for Payer: Healthscope Whirlpool |
$118.25
|
| Rate for Payer: Mclaren Commercial |
$106.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.51
|
| Rate for Payer: Nomi Health Commercial |
$96.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.06
|
|
|
HC TICK-BORNE AB CMPT 2
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
30200521
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: Aetna Medicare |
$12.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.49
|
| Rate for Payer: ASR ASR |
$32.98
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$12.39
|
| Rate for Payer: BCBS Trust/PPO |
$28.03
|
| Rate for Payer: BCN Commercial |
$28.03
|
| Rate for Payer: BCN Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$31.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.39
|
| Rate for Payer: Healthscope Commercial |
$32.98
|
| Rate for Payer: Healthscope Whirlpool |
$34.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.39
|
| Rate for Payer: Mclaren Commercial |
$30.60
|
| Rate for Payer: Mclaren Medicaid |
$12.39
|
| Rate for Payer: Mclaren Medicare |
$12.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.01
|
| Rate for Payer: Meridian Medicaid |
$6.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.90
|
| Rate for Payer: Nomi Health Commercial |
$27.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: PACE Medicare |
$11.77
|
| Rate for Payer: PACE SWMI |
$12.39
|
| Rate for Payer: PHP Commercial |
$13.63
|
| Rate for Payer: PHP Medicaid |
$6.64
|
| Rate for Payer: PHP Medicare Advantage |
$12.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29.79
|
| Rate for Payer: Priority Health Medicare |
$12.39
|
| Rate for Payer: Priority Health Narrow Network |
$23.83
|
| Rate for Payer: Railroad Medicare Medicare |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.39
|
| Rate for Payer: UHC Exchange |
$19.20
|
| Rate for Payer: UHC Medicaid |
$6.48
|
| Rate for Payer: UHCCP DNSP |
$12.39
|
| Rate for Payer: UHCCP Medicaid |
$6.48
|
| Rate for Payer: VA VA |
$12.39
|
|
|
HC TICK-BORNE AB CMPT 2
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
30200521
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: ASR ASR |
$32.98
|
| Rate for Payer: BCBS Trust/PPO |
$27.92
|
| Rate for Payer: BCN Commercial |
$27.92
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$31.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.20
|
| Rate for Payer: Healthscope Commercial |
$32.98
|
| Rate for Payer: Healthscope Whirlpool |
$34.00
|
| Rate for Payer: Mclaren Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.90
|
| Rate for Payer: Nomi Health Commercial |
$27.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.92
|
|
|
HC TICK-BORNE AB CMPT 3
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
30200520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Aetna Medicare |
$10.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.72
|
| Rate for Payer: ASR ASR |
$27.16
|
| Rate for Payer: BCBS Complete |
$5.59
|
| Rate for Payer: BCBS MAPPO |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$23.09
|
| Rate for Payer: BCN Commercial |
$23.09
|
| Rate for Payer: BCN Medicare Advantage |
$10.18
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$27.16
|
| Rate for Payer: Healthscope Whirlpool |
$28.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$25.20
|
| Rate for Payer: Mclaren Medicaid |
$10.18
|
| Rate for Payer: Mclaren Medicare |
$10.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.69
|
| Rate for Payer: Meridian Medicaid |
$5.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.80
|
| Rate for Payer: Nomi Health Commercial |
$22.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.00
|
| Rate for Payer: PACE Medicare |
$9.67
|
| Rate for Payer: PACE SWMI |
$10.18
|
| Rate for Payer: PHP Commercial |
$11.20
|
| Rate for Payer: PHP Medicaid |
$5.46
|
| Rate for Payer: PHP Medicare Advantage |
$10.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$24.53
|
| Rate for Payer: Priority Health Medicare |
$10.18
|
| Rate for Payer: Priority Health Narrow Network |
$19.63
|
| Rate for Payer: Railroad Medicare Medicare |
$10.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.18
|
| Rate for Payer: UHC Exchange |
$15.78
|
| Rate for Payer: UHC Medicaid |
$5.32
|
| Rate for Payer: UHCCP DNSP |
$10.18
|
| Rate for Payer: UHCCP Medicaid |
$5.32
|
| Rate for Payer: VA VA |
$10.18
|
|
|
HC TICK-BORNE AB CMPT 3
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
30200520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: ASR ASR |
$27.16
|
| Rate for Payer: BCBS Trust/PPO |
$22.99
|
| Rate for Payer: BCN Commercial |
$22.99
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.40
|
| Rate for Payer: Healthscope Commercial |
$27.16
|
| Rate for Payer: Healthscope Whirlpool |
$28.00
|
| Rate for Payer: Mclaren Commercial |
$25.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.80
|
| Rate for Payer: Nomi Health Commercial |
$22.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.64
|
|
|
HC TIER 1 MAJOR TRAUMA RESUSCITATION
|
Facility
|
IP
|
$6,142.45
|
|
| Hospital Charge Code |
68100001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$4,606.84 |
| Max. Negotiated Rate |
$6,142.45 |
| Rate for Payer: Aetna Commercial |
$5,528.20
|
| Rate for Payer: ASR ASR |
$5,958.18
|
| Rate for Payer: BCBS Trust/PPO |
$5,044.18
|
| Rate for Payer: BCN Commercial |
$5,044.18
|
| Rate for Payer: Cash Price |
$4,913.96
|
| Rate for Payer: Cofinity Commercial |
$5,773.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,913.96
|
| Rate for Payer: Healthscope Commercial |
$5,958.18
|
| Rate for Payer: Healthscope Whirlpool |
$6,142.45
|
| Rate for Payer: Mclaren Commercial |
$5,528.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,221.08
|
| Rate for Payer: Nomi Health Commercial |
$5,036.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,606.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,405.36
|
|
|
HC TIER 1 MAJOR TRAUMA RESUSCITATION
|
Facility
|
OP
|
$6,142.45
|
|
| Hospital Charge Code |
68100001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,272.71 |
| Max. Negotiated Rate |
$6,142.45 |
| Rate for Payer: Aetna Commercial |
$5,528.20
|
| Rate for Payer: Aetna Medicare |
$2,272.71
|
| Rate for Payer: ASR ASR |
$5,958.18
|
| Rate for Payer: BCBS Complete |
$2,456.98
|
| Rate for Payer: BCBS Trust/PPO |
$5,064.45
|
| Rate for Payer: BCN Commercial |
$5,064.45
|
| Rate for Payer: Cash Price |
$4,913.96
|
| Rate for Payer: Cofinity Commercial |
$5,773.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,913.96
|
| Rate for Payer: Healthscope Commercial |
$5,958.18
|
| Rate for Payer: Healthscope Whirlpool |
$6,142.45
|
| Rate for Payer: Mclaren Commercial |
$5,528.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,913.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,221.08
|
| Rate for Payer: Nomi Health Commercial |
$5,036.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,606.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,382.01
|
| Rate for Payer: Priority Health Narrow Network |
$4,305.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,405.36
|
|
|
HC TIER 2 TRAUMA RESUSCITATION
|
Facility
|
IP
|
$4,684.51
|
|
| Hospital Charge Code |
68200001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$3,513.38 |
| Max. Negotiated Rate |
$4,684.51 |
| Rate for Payer: Aetna Commercial |
$4,216.06
|
| Rate for Payer: ASR ASR |
$4,543.97
|
| Rate for Payer: BCBS Trust/PPO |
$3,846.92
|
| Rate for Payer: BCN Commercial |
$3,846.92
|
| Rate for Payer: Cash Price |
$3,747.61
|
| Rate for Payer: Cofinity Commercial |
$4,403.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,747.61
|
| Rate for Payer: Healthscope Commercial |
$4,543.97
|
| Rate for Payer: Healthscope Whirlpool |
$4,684.51
|
| Rate for Payer: Mclaren Commercial |
$4,216.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,981.83
|
| Rate for Payer: Nomi Health Commercial |
$3,841.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,513.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,122.37
|
|
|
HC TIER 2 TRAUMA RESUSCITATION
|
Facility
|
OP
|
$4,684.51
|
|
| Hospital Charge Code |
68200001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,733.27 |
| Max. Negotiated Rate |
$4,684.51 |
| Rate for Payer: Aetna Commercial |
$4,216.06
|
| Rate for Payer: Aetna Medicare |
$1,733.27
|
| Rate for Payer: ASR ASR |
$4,543.97
|
| Rate for Payer: BCBS Complete |
$1,873.80
|
| Rate for Payer: BCBS Trust/PPO |
$3,862.38
|
| Rate for Payer: BCN Commercial |
$3,862.38
|
| Rate for Payer: Cash Price |
$3,747.61
|
| Rate for Payer: Cofinity Commercial |
$4,403.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,747.61
|
| Rate for Payer: Healthscope Commercial |
$4,543.97
|
| Rate for Payer: Healthscope Whirlpool |
$4,684.51
|
| Rate for Payer: Mclaren Commercial |
$4,216.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,747.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,981.83
|
| Rate for Payer: Nomi Health Commercial |
$3,841.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,513.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,104.57
|
| Rate for Payer: Priority Health Narrow Network |
$3,283.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,122.37
|
|
|
HC TIER 3 TRAUMA CONSULT
|
Facility
|
OP
|
$3,573.09
|
|
| Hospital Charge Code |
68100002
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,322.04 |
| Max. Negotiated Rate |
$3,573.09 |
| Rate for Payer: Aetna Commercial |
$3,215.78
|
| Rate for Payer: Aetna Medicare |
$1,322.04
|
| Rate for Payer: ASR ASR |
$3,465.90
|
| Rate for Payer: BCBS Complete |
$1,429.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,946.01
|
| Rate for Payer: BCN Commercial |
$2,946.01
|
| Rate for Payer: Cash Price |
$2,858.47
|
| Rate for Payer: Cofinity Commercial |
$3,358.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,858.47
|
| Rate for Payer: Healthscope Commercial |
$3,465.90
|
| Rate for Payer: Healthscope Whirlpool |
$3,573.09
|
| Rate for Payer: Mclaren Commercial |
$3,215.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,858.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,037.13
|
| Rate for Payer: Nomi Health Commercial |
$2,929.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,679.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,130.74
|
| Rate for Payer: Priority Health Narrow Network |
$2,504.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,144.32
|
|
|
HC TIER 3 TRAUMA CONSULT
|
Facility
|
IP
|
$3,573.09
|
|
| Hospital Charge Code |
68100002
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,679.82 |
| Max. Negotiated Rate |
$3,573.09 |
| Rate for Payer: Aetna Commercial |
$3,215.78
|
| Rate for Payer: ASR ASR |
$3,465.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,934.22
|
| Rate for Payer: BCN Commercial |
$2,934.22
|
| Rate for Payer: Cash Price |
$2,858.47
|
| Rate for Payer: Cofinity Commercial |
$3,358.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,858.47
|
| Rate for Payer: Healthscope Commercial |
$3,465.90
|
| Rate for Payer: Healthscope Whirlpool |
$3,573.09
|
| Rate for Payer: Mclaren Commercial |
$3,215.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,037.13
|
| Rate for Payer: Nomi Health Commercial |
$2,929.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,679.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,144.32
|
|
|
HC TIER 4 TRAUMA CONSULT
|
Facility
|
OP
|
$2,726.25
|
|
| Hospital Charge Code |
68100003
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,008.71 |
| Max. Negotiated Rate |
$2,726.25 |
| Rate for Payer: Aetna Commercial |
$2,453.62
|
| Rate for Payer: Aetna Medicare |
$1,008.71
|
| Rate for Payer: ASR ASR |
$2,644.46
|
| Rate for Payer: BCBS Complete |
$1,090.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,247.79
|
| Rate for Payer: BCN Commercial |
$2,247.79
|
| Rate for Payer: Cash Price |
$2,181.00
|
| Rate for Payer: Cofinity Commercial |
$2,562.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,181.00
|
| Rate for Payer: Healthscope Commercial |
$2,644.46
|
| Rate for Payer: Healthscope Whirlpool |
$2,726.25
|
| Rate for Payer: Mclaren Commercial |
$2,453.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,181.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,317.31
|
| Rate for Payer: Nomi Health Commercial |
$2,235.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,044.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,388.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,911.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,399.10
|
|
|
HC TIER 4 TRAUMA CONSULT
|
Facility
|
IP
|
$2,726.25
|
|
| Hospital Charge Code |
68100003
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,044.69 |
| Max. Negotiated Rate |
$2,726.25 |
| Rate for Payer: Aetna Commercial |
$2,453.62
|
| Rate for Payer: ASR ASR |
$2,644.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,238.80
|
| Rate for Payer: BCN Commercial |
$2,238.80
|
| Rate for Payer: Cash Price |
$2,181.00
|
| Rate for Payer: Cofinity Commercial |
$2,562.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,181.00
|
| Rate for Payer: Healthscope Commercial |
$2,644.46
|
| Rate for Payer: Healthscope Whirlpool |
$2,726.25
|
| Rate for Payer: Mclaren Commercial |
$2,453.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,317.31
|
| Rate for Payer: Nomi Health Commercial |
$2,235.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,044.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,399.10
|
|
|
HC TILT TABLE STRESS
|
Facility
|
OP
|
$1,145.32
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$1,145.32 |
| Rate for Payer: Aetna Commercial |
$1,030.79
|
| Rate for Payer: Aetna Medicare |
$371.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: ASR ASR |
$1,110.96
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$944.32
|
| Rate for Payer: BCN Commercial |
$944.32
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$916.26
|
| Rate for Payer: Cash Price |
$916.26
|
| Rate for Payer: Cofinity Commercial |
$1,076.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$1,110.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,145.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$371.82
|
| Rate for Payer: Mclaren Commercial |
$1,030.79
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$204.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$973.52
|
| Rate for Payer: Nomi Health Commercial |
$939.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$858.99
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$409.00
|
| Rate for Payer: PHP Medicaid |
$199.30
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,003.53
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health Narrow Network |
$802.87
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,007.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$576.32
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP DNSP |
$371.82
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC TILT TABLE STRESS
|
Facility
|
IP
|
$1,145.32
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$858.99 |
| Max. Negotiated Rate |
$1,145.32 |
| Rate for Payer: Aetna Commercial |
$1,030.79
|
| Rate for Payer: ASR ASR |
$1,110.96
|
| Rate for Payer: BCBS Trust/PPO |
$940.54
|
| Rate for Payer: BCN Commercial |
$940.54
|
| Rate for Payer: Cash Price |
$916.26
|
| Rate for Payer: Cofinity Commercial |
$1,076.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.26
|
| Rate for Payer: Healthscope Commercial |
$1,110.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,145.32
|
| Rate for Payer: Mclaren Commercial |
$1,030.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$973.52
|
| Rate for Payer: Nomi Health Commercial |
$939.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$858.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,007.88
|
|
|
HC TIMOTHY GRASS IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| 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 |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC TIMOTHY GRASS IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
