|
HC THYROGLOBULIN
|
Facility
|
IP
|
$57.89
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
30100434
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$57.89 |
| Rate for Payer: Aetna Commercial |
$52.10
|
| Rate for Payer: ASR ASR |
$56.15
|
| Rate for Payer: ASR Commercial |
$56.15
|
| Rate for Payer: BCBS Trust/PPO |
$47.17
|
| Rate for Payer: BCN Commercial |
$44.88
|
| Rate for Payer: Cash Price |
$46.31
|
| Rate for Payer: Cofinity Commercial |
$54.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.31
|
| Rate for Payer: Healthscope Commercial |
$57.89
|
| Rate for Payer: Healthscope Whirlpool |
$56.15
|
| Rate for Payer: Mclaren Commercial |
$52.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.21
|
| Rate for Payer: Nomi Health Commercial |
$47.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.94
|
|
|
HC THYROGLOBULIN
|
Facility
|
OP
|
$57.89
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
30100434
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$57.89 |
| Rate for Payer: Aetna Commercial |
$52.10
|
| 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 |
$56.15
|
| Rate for Payer: ASR Commercial |
$56.15
|
| Rate for Payer: BCBS Complete |
$9.04
|
| Rate for Payer: BCBS MAPPO |
$16.06
|
| Rate for Payer: BCBS Trust/PPO |
$47.41
|
| Rate for Payer: BCN Commercial |
$44.88
|
| Rate for Payer: BCN Medicare Advantage |
$16.06
|
| Rate for Payer: Cash Price |
$46.31
|
| Rate for Payer: Cash Price |
$46.31
|
| Rate for Payer: Cofinity Commercial |
$54.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$57.89
|
| Rate for Payer: Healthscope Whirlpool |
$56.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.06
|
| Rate for Payer: Mclaren Commercial |
$52.10
|
| Rate for Payer: Mclaren Medicaid |
$8.61
|
| Rate for Payer: Mclaren Medicare |
$16.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.86
|
| Rate for Payer: Meridian Medicaid |
$9.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.21
|
| Rate for Payer: Nomi Health Commercial |
$47.47
|
| 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 |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.72
|
| Rate for Payer: Priority Health Medicare |
$16.06
|
| Rate for Payer: Priority Health Narrow Network |
$40.58
|
| Rate for Payer: Railroad Medicare Medicare |
$16.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.06
|
| Rate for Payer: UHC Exchange |
$24.89
|
| Rate for Payer: UHC Medicare Advantage |
$16.06
|
| Rate for Payer: UHCCP DNSP |
$16.06
|
| Rate for Payer: UHCCP Medicaid |
$8.61
|
| Rate for Payer: VA VA |
$16.06
|
|
|
HC THYROGLOBULIN CMPT
|
Facility
|
OP
|
$60.24
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
30200335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$60.24 |
| Rate for Payer: Aetna Commercial |
$54.22
|
| 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 |
$58.43
|
| Rate for Payer: ASR Commercial |
$58.43
|
| Rate for Payer: BCBS Complete |
$8.95
|
| Rate for Payer: BCBS MAPPO |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$49.33
|
| Rate for Payer: BCN Commercial |
$46.70
|
| Rate for Payer: BCN Medicare Advantage |
$15.91
|
| Rate for Payer: Cash Price |
$48.19
|
| Rate for Payer: Cash Price |
$48.19
|
| Rate for Payer: Cofinity Commercial |
$56.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.91
|
| Rate for Payer: Healthscope Commercial |
$60.24
|
| Rate for Payer: Healthscope Whirlpool |
$58.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.91
|
| Rate for Payer: Mclaren Commercial |
$54.22
|
| Rate for Payer: Mclaren Medicaid |
$8.53
|
| Rate for Payer: Mclaren Medicare |
$15.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.71
|
| Rate for Payer: Meridian Medicaid |
$8.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.20
|
| Rate for Payer: Nomi Health Commercial |
$49.40
|
| 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 |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.78
|
| Rate for Payer: Priority Health Medicare |
$15.91
|
| Rate for Payer: Priority Health Narrow Network |
$42.23
|
| Rate for Payer: Railroad Medicare Medicare |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.91
|
| Rate for Payer: UHC Exchange |
$24.66
|
| Rate for Payer: UHC Medicare Advantage |
$15.91
|
| Rate for Payer: UHCCP DNSP |
$15.91
|
| Rate for Payer: UHCCP Medicaid |
$8.53
|
| Rate for Payer: VA VA |
$15.91
|
|
|
HC THYROGLOBULIN CMPT
|
Facility
|
IP
|
$60.24
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
30200335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.16 |
| Max. Negotiated Rate |
$60.24 |
| Rate for Payer: Aetna Commercial |
$54.22
|
| Rate for Payer: ASR ASR |
$58.43
|
| Rate for Payer: ASR Commercial |
$58.43
|
| Rate for Payer: BCBS Trust/PPO |
$49.09
|
| Rate for Payer: BCN Commercial |
$46.70
|
| Rate for Payer: Cash Price |
$48.19
|
| Rate for Payer: Cofinity Commercial |
$56.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.19
|
| Rate for Payer: Healthscope Commercial |
$60.24
|
| Rate for Payer: Healthscope Whirlpool |
$58.43
|
| Rate for Payer: Mclaren Commercial |
$54.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.20
|
| Rate for Payer: Nomi Health Commercial |
$49.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.01
|
|
|
HC THYROID IMAGING W VASC FLOW
|
Facility
|
OP
|
$583.41
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
34100075
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$607.45 |
| Rate for Payer: Aetna Commercial |
$525.07
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$565.91
|
| Rate for Payer: ASR Commercial |
$565.91
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$477.75
|
| Rate for Payer: BCN Commercial |
$452.32
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$466.73
|
| Rate for Payer: Cash Price |
$466.73
|
| Rate for Payer: Cofinity Commercial |
$548.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$583.41
|
| Rate for Payer: Healthscope Whirlpool |
$565.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$525.07
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.90
|
| Rate for Payer: Nomi Health Commercial |
$478.40
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$511.18
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$408.97
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$513.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC THYROID IMAGING W VASC FLOW
|
Facility
|
IP
|
$583.41
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
34100075
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$379.22 |
| Max. Negotiated Rate |
$583.41 |
| Rate for Payer: Aetna Commercial |
$525.07
|
| Rate for Payer: ASR ASR |
$565.91
|
| Rate for Payer: ASR Commercial |
$565.91
|
| Rate for Payer: BCBS Trust/PPO |
$475.42
|
| Rate for Payer: BCN Commercial |
$452.32
|
| Rate for Payer: Cash Price |
$466.73
|
| Rate for Payer: Cofinity Commercial |
$548.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.73
|
| Rate for Payer: Healthscope Commercial |
$583.41
|
| Rate for Payer: Healthscope Whirlpool |
$565.91
|
| Rate for Payer: Mclaren Commercial |
$525.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.90
|
| Rate for Payer: Nomi Health Commercial |
$478.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$513.40
|
|
|
HC THYROID IMAG W VASC FLOW SNGL OR MULTI
|
Facility
|
OP
|
$1,225.64
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
34100076
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,225.64 |
| Rate for Payer: Aetna Commercial |
$1,103.08
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$1,188.87
|
| Rate for Payer: ASR Commercial |
$1,188.87
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,003.68
|
| Rate for Payer: BCN Commercial |
$950.24
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$980.51
|
| Rate for Payer: Cash Price |
$980.51
|
| Rate for Payer: Cofinity Commercial |
$1,152.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$980.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,225.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,188.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$1,103.08
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,041.79
|
| Rate for Payer: Nomi Health Commercial |
$1,005.02
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,073.91
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$859.17
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,078.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC THYROID IMAG W VASC FLOW SNGL OR MULTI
|
Facility
|
IP
|
$1,225.64
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
34100076
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$796.67 |
| Max. Negotiated Rate |
$1,225.64 |
| Rate for Payer: Aetna Commercial |
$1,103.08
|
| Rate for Payer: ASR ASR |
$1,188.87
|
| Rate for Payer: ASR Commercial |
$1,188.87
|
| Rate for Payer: BCBS Trust/PPO |
$998.77
|
| Rate for Payer: BCN Commercial |
$950.24
|
| Rate for Payer: Cash Price |
$980.51
|
| Rate for Payer: Cofinity Commercial |
$1,152.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$980.51
|
| Rate for Payer: Healthscope Commercial |
$1,225.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,188.87
|
| Rate for Payer: Mclaren Commercial |
$1,103.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,041.79
|
| Rate for Payer: Nomi Health Commercial |
$1,005.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,078.56
|
|
|
HC THYROID PEROXIDASE ANTIBODY
|
Facility
|
OP
|
$85.58
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200209
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$85.58 |
| Rate for Payer: Aetna Commercial |
$77.02
|
| 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 |
$83.01
|
| Rate for Payer: ASR Commercial |
$83.01
|
| Rate for Payer: BCBS Complete |
$8.19
|
| Rate for Payer: BCBS MAPPO |
$14.55
|
| Rate for Payer: BCBS Trust/PPO |
$70.08
|
| Rate for Payer: BCN Commercial |
$66.35
|
| Rate for Payer: BCN Medicare Advantage |
$14.55
|
| Rate for Payer: Cash Price |
$68.46
|
| Rate for Payer: Cash Price |
$68.46
|
| Rate for Payer: Cofinity Commercial |
$80.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.55
|
| Rate for Payer: Healthscope Commercial |
$85.58
|
| Rate for Payer: Healthscope Whirlpool |
$83.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.55
|
| Rate for Payer: Mclaren Commercial |
$77.02
|
| Rate for Payer: Mclaren Medicaid |
$7.80
|
| Rate for Payer: Mclaren Medicare |
$14.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.28
|
| Rate for Payer: Meridian Medicaid |
$8.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.74
|
| Rate for Payer: Nomi Health Commercial |
$70.18
|
| 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 |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.99
|
| Rate for Payer: Priority Health Medicare |
$14.55
|
| Rate for Payer: Priority Health Narrow Network |
$59.99
|
| Rate for Payer: Railroad Medicare Medicare |
$14.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.55
|
| Rate for Payer: UHC Exchange |
$22.55
|
| Rate for Payer: UHC Medicare Advantage |
$14.55
|
| Rate for Payer: UHCCP DNSP |
$14.55
|
| Rate for Payer: UHCCP Medicaid |
$7.80
|
| Rate for Payer: VA VA |
$14.55
|
|
|
HC THYROID PEROXIDASE ANTIBODY
|
Facility
|
IP
|
$85.58
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200209
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.63 |
| Max. Negotiated Rate |
$85.58 |
| Rate for Payer: Aetna Commercial |
$77.02
|
| Rate for Payer: ASR ASR |
$83.01
|
| Rate for Payer: ASR Commercial |
$83.01
|
| Rate for Payer: BCBS Trust/PPO |
$69.74
|
| Rate for Payer: BCN Commercial |
$66.35
|
| Rate for Payer: Cash Price |
$68.46
|
| Rate for Payer: Cofinity Commercial |
$80.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.46
|
| Rate for Payer: Healthscope Commercial |
$85.58
|
| Rate for Payer: Healthscope Whirlpool |
$83.01
|
| Rate for Payer: Mclaren Commercial |
$77.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.74
|
| Rate for Payer: Nomi Health Commercial |
$70.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.31
|
|
|
HC THYROID STIMULATING IMMUNOGLOB
|
Facility
|
IP
|
$85.63
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
30100439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.66 |
| Max. Negotiated Rate |
$85.63 |
| Rate for Payer: Aetna Commercial |
$77.07
|
| Rate for Payer: ASR ASR |
$83.06
|
| Rate for Payer: ASR Commercial |
$83.06
|
| Rate for Payer: BCBS Trust/PPO |
$69.78
|
| Rate for Payer: BCN Commercial |
$66.39
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cofinity Commercial |
$80.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.50
|
| Rate for Payer: Healthscope Commercial |
$85.63
|
| Rate for Payer: Healthscope Whirlpool |
$83.06
|
| Rate for Payer: Mclaren Commercial |
$77.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.79
|
| Rate for Payer: Nomi Health Commercial |
$70.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.35
|
|
|
HC THYROID STIMULATING IMMUNOGLOB
|
Facility
|
OP
|
$85.63
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
30100439
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.26 |
| Max. Negotiated Rate |
$85.63 |
| Rate for Payer: Aetna Commercial |
$77.07
|
| 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 |
$83.06
|
| Rate for Payer: ASR Commercial |
$83.06
|
| Rate for Payer: BCBS Complete |
$28.62
|
| Rate for Payer: BCBS MAPPO |
$50.86
|
| Rate for Payer: BCBS Trust/PPO |
$70.12
|
| Rate for Payer: BCN Commercial |
$66.39
|
| Rate for Payer: BCN Medicare Advantage |
$50.86
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cofinity Commercial |
$80.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.86
|
| Rate for Payer: Healthscope Commercial |
$85.63
|
| Rate for Payer: Healthscope Whirlpool |
$83.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$50.86
|
| Rate for Payer: Mclaren Commercial |
$77.07
|
| Rate for Payer: Mclaren Medicaid |
$27.26
|
| Rate for Payer: Mclaren Medicare |
$50.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.40
|
| Rate for Payer: Meridian Medicaid |
$28.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.79
|
| Rate for Payer: Nomi Health Commercial |
$70.22
|
| 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 |
$27.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.03
|
| Rate for Payer: Priority Health Medicare |
$50.86
|
| Rate for Payer: Priority Health Narrow Network |
$60.03
|
| Rate for Payer: Railroad Medicare Medicare |
$50.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.86
|
| Rate for Payer: UHC Exchange |
$78.83
|
| Rate for Payer: UHC Medicare Advantage |
$50.86
|
| Rate for Payer: UHCCP DNSP |
$50.86
|
| Rate for Payer: UHCCP Medicaid |
$27.26
|
| Rate for Payer: VA VA |
$50.86
|
|
|
HC THYROID TC 99M PER STUDY
|
Facility
|
IP
|
$143.20
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300021
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$93.08 |
| Max. Negotiated Rate |
$143.20 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: ASR ASR |
$138.90
|
| Rate for Payer: ASR Commercial |
$138.90
|
| Rate for Payer: BCBS Trust/PPO |
$116.69
|
| Rate for Payer: BCN Commercial |
$111.02
|
| Rate for Payer: Cash Price |
$114.56
|
| Rate for Payer: Cofinity Commercial |
$134.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.56
|
| Rate for Payer: Healthscope Commercial |
$143.20
|
| Rate for Payer: Healthscope Whirlpool |
$138.90
|
| Rate for Payer: Mclaren Commercial |
$128.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.72
|
| Rate for Payer: Nomi Health Commercial |
$117.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.02
|
|
|
HC THYROID TC 99M PER STUDY
|
Facility
|
OP
|
$143.20
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300021
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$57.28 |
| Max. Negotiated Rate |
$143.20 |
| Rate for Payer: Aetna Commercial |
$128.88
|
| Rate for Payer: Aetna Medicare |
$71.60
|
| Rate for Payer: ASR ASR |
$138.90
|
| Rate for Payer: ASR Commercial |
$138.90
|
| Rate for Payer: BCBS Complete |
$57.28
|
| Rate for Payer: BCBS Trust/PPO |
$117.27
|
| Rate for Payer: BCN Commercial |
$111.02
|
| Rate for Payer: Cash Price |
$114.56
|
| Rate for Payer: Cofinity Commercial |
$134.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.56
|
| Rate for Payer: Healthscope Commercial |
$143.20
|
| Rate for Payer: Healthscope Whirlpool |
$138.90
|
| Rate for Payer: Mclaren Commercial |
$128.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.72
|
| Rate for Payer: Nomi Health Commercial |
$117.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.47
|
| Rate for Payer: Priority Health Narrow Network |
$100.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.02
|
|
|
HC THYROID UPTK SNGL OR MULTI DETER
|
Facility
|
IP
|
$1,056.63
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
34100074
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$686.81 |
| Max. Negotiated Rate |
$1,056.63 |
| Rate for Payer: Aetna Commercial |
$950.97
|
| Rate for Payer: ASR ASR |
$1,024.93
|
| Rate for Payer: ASR Commercial |
$1,024.93
|
| Rate for Payer: BCBS Trust/PPO |
$861.05
|
| Rate for Payer: BCN Commercial |
$819.21
|
| Rate for Payer: Cash Price |
$845.30
|
| Rate for Payer: Cofinity Commercial |
$993.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$845.30
|
| Rate for Payer: Healthscope Commercial |
$1,056.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,024.93
|
| Rate for Payer: Mclaren Commercial |
$950.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$898.14
|
| Rate for Payer: Nomi Health Commercial |
$866.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$929.83
|
|
|
HC THYROID UPTK SNGL OR MULTI DETER
|
Facility
|
OP
|
$1,056.63
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
34100074
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,056.63 |
| Rate for Payer: Aetna Commercial |
$950.97
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$1,024.93
|
| Rate for Payer: ASR Commercial |
$1,024.93
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$865.27
|
| Rate for Payer: BCN Commercial |
$819.21
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$845.30
|
| Rate for Payer: Cash Price |
$845.30
|
| Rate for Payer: Cofinity Commercial |
$993.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$845.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,056.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,024.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$950.97
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$898.14
|
| Rate for Payer: Nomi Health Commercial |
$866.44
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$925.82
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$740.70
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$929.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC THYROXINE BINDING GLOBULIN
|
Facility
|
OP
|
$66.40
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
30100437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$66.40 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| 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 |
$64.41
|
| Rate for Payer: ASR Commercial |
$64.41
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS MAPPO |
$14.78
|
| Rate for Payer: BCBS Trust/PPO |
$54.37
|
| Rate for Payer: BCN Commercial |
$51.48
|
| Rate for Payer: BCN Medicare Advantage |
$14.78
|
| Rate for Payer: Cash Price |
$53.12
|
| Rate for Payer: Cash Price |
$53.12
|
| Rate for Payer: Cofinity Commercial |
$62.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.78
|
| Rate for Payer: Healthscope Commercial |
$66.40
|
| Rate for Payer: Healthscope Whirlpool |
$64.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.78
|
| Rate for Payer: Mclaren Commercial |
$59.76
|
| Rate for Payer: Mclaren Medicaid |
$7.92
|
| Rate for Payer: Mclaren Medicare |
$14.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.52
|
| Rate for Payer: Meridian Medicaid |
$8.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.44
|
| Rate for Payer: Nomi Health Commercial |
$54.45
|
| 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 |
$7.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.18
|
| Rate for Payer: Priority Health Medicare |
$14.78
|
| Rate for Payer: Priority Health Narrow Network |
$46.55
|
| Rate for Payer: Railroad Medicare Medicare |
$14.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.78
|
| Rate for Payer: UHC Exchange |
$22.91
|
| Rate for Payer: UHC Medicare Advantage |
$14.78
|
| Rate for Payer: UHCCP DNSP |
$14.78
|
| Rate for Payer: UHCCP Medicaid |
$7.92
|
| Rate for Payer: VA VA |
$14.78
|
|
|
HC THYROXINE BINDING GLOBULIN
|
Facility
|
IP
|
$66.40
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
30100437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$66.40 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: ASR ASR |
$64.41
|
| Rate for Payer: ASR Commercial |
$64.41
|
| Rate for Payer: BCBS Trust/PPO |
$54.11
|
| Rate for Payer: BCN Commercial |
$51.48
|
| Rate for Payer: Cash Price |
$53.12
|
| Rate for Payer: Cofinity Commercial |
$62.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.12
|
| Rate for Payer: Healthscope Commercial |
$66.40
|
| Rate for Payer: Healthscope Whirlpool |
$64.41
|
| Rate for Payer: Mclaren Commercial |
$59.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.44
|
| Rate for Payer: Nomi Health Commercial |
$54.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.43
|
|
|
HC THYROXINE FREE T4
|
Facility
|
OP
|
$115.26
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
30100436
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$115.26 |
| Rate for Payer: Aetna Commercial |
$103.73
|
| 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 |
$111.80
|
| Rate for Payer: ASR Commercial |
$111.80
|
| Rate for Payer: BCBS Complete |
$5.08
|
| Rate for Payer: BCBS MAPPO |
$9.02
|
| Rate for Payer: BCBS Trust/PPO |
$94.39
|
| Rate for Payer: BCN Commercial |
$89.36
|
| Rate for Payer: BCN Medicare Advantage |
$9.02
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cofinity Commercial |
$108.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.02
|
| Rate for Payer: Healthscope Commercial |
$115.26
|
| Rate for Payer: Healthscope Whirlpool |
$111.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.02
|
| Rate for Payer: Mclaren Commercial |
$103.73
|
| Rate for Payer: Mclaren Medicaid |
$4.83
|
| Rate for Payer: Mclaren Medicare |
$9.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.47
|
| Rate for Payer: Meridian Medicaid |
$5.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.97
|
| Rate for Payer: Nomi Health Commercial |
$94.51
|
| 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 |
$4.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.99
|
| Rate for Payer: Priority Health Medicare |
$9.02
|
| Rate for Payer: Priority Health Narrow Network |
$80.80
|
| Rate for Payer: Railroad Medicare Medicare |
$9.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.02
|
| Rate for Payer: UHC Exchange |
$13.98
|
| Rate for Payer: UHC Medicare Advantage |
$9.02
|
| Rate for Payer: UHCCP DNSP |
$9.02
|
| Rate for Payer: UHCCP Medicaid |
$4.83
|
| Rate for Payer: VA VA |
$9.02
|
|
|
HC THYROXINE FREE T4
|
Facility
|
IP
|
$115.26
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
30100436
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.92 |
| Max. Negotiated Rate |
$115.26 |
| Rate for Payer: Aetna Commercial |
$103.73
|
| Rate for Payer: ASR ASR |
$111.80
|
| Rate for Payer: ASR Commercial |
$111.80
|
| Rate for Payer: BCBS Trust/PPO |
$93.93
|
| Rate for Payer: BCN Commercial |
$89.36
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cofinity Commercial |
$108.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.21
|
| Rate for Payer: Healthscope Commercial |
$115.26
|
| Rate for Payer: Healthscope Whirlpool |
$111.80
|
| Rate for Payer: Mclaren Commercial |
$103.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.97
|
| Rate for Payer: Nomi Health Commercial |
$94.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.43
|
|
|
HC TIAGABINE LEVEL
|
Facility
|
IP
|
$115.93
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
30100058
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.35 |
| Max. Negotiated Rate |
$115.93 |
| Rate for Payer: Aetna Commercial |
$104.34
|
| Rate for Payer: ASR ASR |
$112.45
|
| Rate for Payer: ASR Commercial |
$112.45
|
| Rate for Payer: BCBS Trust/PPO |
$94.47
|
| Rate for Payer: BCN Commercial |
$89.88
|
| Rate for Payer: Cash Price |
$92.74
|
| Rate for Payer: Cofinity Commercial |
$108.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.74
|
| Rate for Payer: Healthscope Commercial |
$115.93
|
| Rate for Payer: Healthscope Whirlpool |
$112.45
|
| Rate for Payer: Mclaren Commercial |
$104.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.54
|
| Rate for Payer: Nomi Health Commercial |
$95.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.02
|
|
|
HC TIAGABINE LEVEL
|
Facility
|
OP
|
$115.93
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
30100058
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$115.93 |
| Rate for Payer: Aetna Commercial |
$104.34
|
| 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 |
$112.45
|
| Rate for Payer: ASR Commercial |
$112.45
|
| Rate for Payer: BCBS Complete |
$15.26
|
| Rate for Payer: BCBS MAPPO |
$27.11
|
| Rate for Payer: BCBS Trust/PPO |
$94.94
|
| Rate for Payer: BCN Commercial |
$89.88
|
| Rate for Payer: BCN Medicare Advantage |
$27.11
|
| Rate for Payer: Cash Price |
$92.74
|
| Rate for Payer: Cash Price |
$92.74
|
| Rate for Payer: Cofinity Commercial |
$108.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.11
|
| Rate for Payer: Healthscope Commercial |
$115.93
|
| Rate for Payer: Healthscope Whirlpool |
$112.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$27.11
|
| Rate for Payer: Mclaren Commercial |
$104.34
|
| Rate for Payer: Mclaren Medicaid |
$14.53
|
| Rate for Payer: Mclaren Medicare |
$27.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.47
|
| Rate for Payer: Meridian Medicaid |
$15.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.54
|
| Rate for Payer: Nomi Health Commercial |
$95.06
|
| 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 |
$14.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.58
|
| Rate for Payer: Priority Health Medicare |
$27.11
|
| Rate for Payer: Priority Health Narrow Network |
$81.27
|
| Rate for Payer: Railroad Medicare Medicare |
$27.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.11
|
| Rate for Payer: UHC Exchange |
$42.02
|
| Rate for Payer: UHC Medicare Advantage |
$27.11
|
| Rate for Payer: UHCCP DNSP |
$27.11
|
| Rate for Payer: UHCCP Medicaid |
$14.53
|
| Rate for Payer: VA VA |
$27.11
|
|
|
HC TIER 1 MAJOR TRAUMA RESUSCITATION
|
Facility
|
OP
|
$6,022.01
|
|
| Hospital Charge Code |
68100001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,408.80 |
| Max. Negotiated Rate |
$6,022.01 |
| Rate for Payer: Aetna Commercial |
$5,419.81
|
| Rate for Payer: Aetna Medicare |
$3,011.01
|
| Rate for Payer: ASR ASR |
$5,841.35
|
| Rate for Payer: ASR Commercial |
$5,841.35
|
| Rate for Payer: BCBS Complete |
$2,408.80
|
| Rate for Payer: BCBS Trust/PPO |
$4,931.42
|
| Rate for Payer: BCN Commercial |
$4,668.86
|
| Rate for Payer: Cash Price |
$4,817.61
|
| Rate for Payer: Cofinity Commercial |
$5,660.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,817.61
|
| Rate for Payer: Healthscope Commercial |
$6,022.01
|
| Rate for Payer: Healthscope Whirlpool |
$5,841.35
|
| Rate for Payer: Mclaren Commercial |
$5,419.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,118.71
|
| Rate for Payer: Nomi Health Commercial |
$4,938.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,914.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,276.49
|
| Rate for Payer: Priority Health Narrow Network |
$4,221.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,299.37
|
|
|
HC TIER 1 MAJOR TRAUMA RESUSCITATION
|
Facility
|
IP
|
$6,022.01
|
|
| Hospital Charge Code |
68100001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$3,914.31 |
| Max. Negotiated Rate |
$6,022.01 |
| Rate for Payer: Aetna Commercial |
$5,419.81
|
| Rate for Payer: ASR ASR |
$5,841.35
|
| Rate for Payer: ASR Commercial |
$5,841.35
|
| Rate for Payer: BCBS Trust/PPO |
$4,907.34
|
| Rate for Payer: BCN Commercial |
$4,668.86
|
| Rate for Payer: Cash Price |
$4,817.61
|
| Rate for Payer: Cofinity Commercial |
$5,660.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,817.61
|
| Rate for Payer: Healthscope Commercial |
$6,022.01
|
| Rate for Payer: Healthscope Whirlpool |
$5,841.35
|
| Rate for Payer: Mclaren Commercial |
$5,419.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,118.71
|
| Rate for Payer: Nomi Health Commercial |
$4,938.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,914.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,299.37
|
|
|
HC TIER 2 TRAUMA RESUSCITATION
|
Facility
|
OP
|
$4,592.66
|
|
| Hospital Charge Code |
68200001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,837.06 |
| Max. Negotiated Rate |
$4,592.66 |
| Rate for Payer: Aetna Commercial |
$4,133.39
|
| Rate for Payer: Aetna Medicare |
$2,296.33
|
| Rate for Payer: ASR ASR |
$4,454.88
|
| Rate for Payer: ASR Commercial |
$4,454.88
|
| Rate for Payer: BCBS Complete |
$1,837.06
|
| Rate for Payer: BCBS Trust/PPO |
$3,760.93
|
| Rate for Payer: BCN Commercial |
$3,560.69
|
| Rate for Payer: Cash Price |
$3,674.13
|
| Rate for Payer: Cofinity Commercial |
$4,317.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,674.13
|
| Rate for Payer: Healthscope Commercial |
$4,592.66
|
| Rate for Payer: Healthscope Whirlpool |
$4,454.88
|
| Rate for Payer: Mclaren Commercial |
$4,133.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,903.76
|
| Rate for Payer: Nomi Health Commercial |
$3,765.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,985.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,024.09
|
| Rate for Payer: Priority Health Narrow Network |
$3,219.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,041.54
|
|
