|
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 |
$104.44 |
| Max. Negotiated Rate |
$1,056.63 |
| Rate for Payer: Aetna Commercial |
$950.97
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$1,024.93
|
| Rate for Payer: ASR Commercial |
$1,024.93
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$865.27
|
| Rate for Payer: BCN Commercial |
$819.21
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| 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 |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,056.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,024.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$950.97
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$898.14
|
| Rate for Payer: Nomi Health Commercial |
$866.44
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.55
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$104.44
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$929.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
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 |
$52.15
|
| Rate for Payer: Priority Health Medicare |
$9.02
|
| Rate for Payer: Priority Health Narrow Network |
$41.72
|
| 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 |
$18.19
|
| Rate for Payer: Priority Health Medicare |
$27.11
|
| Rate for Payer: Priority Health Narrow Network |
$14.55
|
| 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
|
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 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 |
$3,011.00
|
| 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 2 TRAUMA RESUSCITATION
|
Facility
|
IP
|
$4,592.66
|
|
| Hospital Charge Code |
68200001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,985.23 |
| Max. Negotiated Rate |
$4,592.66 |
| Rate for Payer: Aetna Commercial |
$4,133.39
|
| Rate for Payer: ASR ASR |
$4,454.88
|
| Rate for Payer: ASR Commercial |
$4,454.88
|
| Rate for Payer: BCBS Trust/PPO |
$3,742.56
|
| 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: UHC All Payor (Choice/PPO) + Core |
$4,041.54
|
|
|
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
|
|
|
HC TIER 3 TRAUMA CONSULT
|
Facility
|
OP
|
$3,503.03
|
|
| Hospital Charge Code |
68100002
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,401.21 |
| Max. Negotiated Rate |
$3,503.03 |
| Rate for Payer: Aetna Commercial |
$3,152.73
|
| Rate for Payer: Aetna Medicare |
$1,751.52
|
| Rate for Payer: ASR ASR |
$3,397.94
|
| Rate for Payer: ASR Commercial |
$3,397.94
|
| Rate for Payer: BCBS Complete |
$1,401.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,868.63
|
| Rate for Payer: BCN Commercial |
$2,715.90
|
| Rate for Payer: Cash Price |
$2,802.42
|
| Rate for Payer: Cofinity Commercial |
$3,292.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,802.42
|
| Rate for Payer: Healthscope Commercial |
$3,503.03
|
| Rate for Payer: Healthscope Whirlpool |
$3,397.94
|
| Rate for Payer: Mclaren Commercial |
$3,152.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,977.58
|
| Rate for Payer: Nomi Health Commercial |
$2,872.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,276.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,069.35
|
| Rate for Payer: Priority Health Narrow Network |
$2,455.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,082.67
|
|
|
HC TIER 3 TRAUMA CONSULT
|
Facility
|
IP
|
$3,503.03
|
|
| Hospital Charge Code |
68100002
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,276.97 |
| Max. Negotiated Rate |
$3,503.03 |
| Rate for Payer: Aetna Commercial |
$3,152.73
|
| Rate for Payer: ASR ASR |
$3,397.94
|
| Rate for Payer: ASR Commercial |
$3,397.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,854.62
|
| Rate for Payer: BCN Commercial |
$2,715.90
|
| Rate for Payer: Cash Price |
$2,802.42
|
| Rate for Payer: Cofinity Commercial |
$3,292.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,802.42
|
| Rate for Payer: Healthscope Commercial |
$3,503.03
|
| Rate for Payer: Healthscope Whirlpool |
$3,397.94
|
| Rate for Payer: Mclaren Commercial |
$3,152.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,977.58
|
| Rate for Payer: Nomi Health Commercial |
$2,872.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,276.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,082.67
|
|
|
HC TIER 4 TRAUMA CONSULT
|
Facility
|
IP
|
$2,672.79
|
|
| Hospital Charge Code |
68100003
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,737.31 |
| Max. Negotiated Rate |
$2,672.79 |
| Rate for Payer: Aetna Commercial |
$2,405.51
|
| Rate for Payer: ASR ASR |
$2,592.61
|
| Rate for Payer: ASR Commercial |
$2,592.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,178.06
|
| Rate for Payer: BCN Commercial |
$2,072.21
|
| Rate for Payer: Cash Price |
$2,138.23
|
| Rate for Payer: Cofinity Commercial |
$2,512.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,138.23
|
| Rate for Payer: Healthscope Commercial |
$2,672.79
|
| Rate for Payer: Healthscope Whirlpool |
$2,592.61
|
| Rate for Payer: Mclaren Commercial |
$2,405.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,271.87
|
| Rate for Payer: Nomi Health Commercial |
$2,191.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,737.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,352.06
|
|
|
HC TIER 4 TRAUMA CONSULT
|
Facility
|
OP
|
$2,672.79
|
|
| Hospital Charge Code |
68100003
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,069.12 |
| Max. Negotiated Rate |
$2,672.79 |
| Rate for Payer: Aetna Commercial |
$2,405.51
|
| Rate for Payer: Aetna Medicare |
$1,336.40
|
| Rate for Payer: ASR ASR |
$2,592.61
|
| Rate for Payer: ASR Commercial |
$2,592.61
|
| Rate for Payer: BCBS Complete |
$1,069.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,188.75
|
| Rate for Payer: BCN Commercial |
$2,072.21
|
| Rate for Payer: Cash Price |
$2,138.23
|
| Rate for Payer: Cofinity Commercial |
$2,512.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,138.23
|
| Rate for Payer: Healthscope Commercial |
$2,672.79
|
| Rate for Payer: Healthscope Whirlpool |
$2,592.61
|
| Rate for Payer: Mclaren Commercial |
$2,405.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,271.87
|
| Rate for Payer: Nomi Health Commercial |
$2,191.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,737.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,341.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,873.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,352.06
|
|
|
HC TILT TABLE STRESS
|
Facility
|
OP
|
$1,122.86
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$278.65 |
| Max. Negotiated Rate |
$1,122.86 |
| Rate for Payer: Aetna Commercial |
$1,010.57
|
| Rate for Payer: Aetna Medicare |
$519.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: ASR ASR |
$1,089.17
|
| Rate for Payer: ASR Commercial |
$1,089.17
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$919.51
|
| Rate for Payer: BCN Commercial |
$870.55
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Cash Price |
$898.29
|
| Rate for Payer: Cash Price |
$898.29
|
| Rate for Payer: Cofinity Commercial |
$1,055.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Healthscope Commercial |
$1,122.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,089.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$519.87
|
| Rate for Payer: Mclaren Commercial |
$1,010.57
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.43
|
| Rate for Payer: Nomi Health Commercial |
$920.75
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Commercial |
$571.86
|
| Rate for Payer: PHP Medicaid |
$278.65
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$983.85
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$787.12
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$988.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$805.80
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP DNSP |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: VA VA |
$519.87
|
|
|
HC TILT TABLE STRESS
|
Facility
|
IP
|
$1,122.86
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$729.86 |
| Max. Negotiated Rate |
$1,122.86 |
| Rate for Payer: Aetna Commercial |
$1,010.57
|
| Rate for Payer: ASR ASR |
$1,089.17
|
| Rate for Payer: ASR Commercial |
$1,089.17
|
| Rate for Payer: BCBS Trust/PPO |
$915.02
|
| Rate for Payer: BCN Commercial |
$870.55
|
| Rate for Payer: Cash Price |
$898.29
|
| Rate for Payer: Cofinity Commercial |
$1,055.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.29
|
| Rate for Payer: Healthscope Commercial |
$1,122.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,089.17
|
| Rate for Payer: Mclaren Commercial |
$1,010.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.43
|
| Rate for Payer: Nomi Health Commercial |
$920.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$988.12
|
|
|
HC TIMOTHY GRASS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| 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 |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC TIMOTHY GRASS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC TIP PUMP SUCTION
|
Facility
|
IP
|
$42.84
|
|
| Hospital Charge Code |
27000111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: ASR Commercial |
$41.55
|
| Rate for Payer: BCBS Trust/PPO |
$34.91
|
| Rate for Payer: BCN Commercial |
$33.21
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$42.84
|
| Rate for Payer: Healthscope Whirlpool |
$41.55
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
HC TIP PUMP SUCTION
|
Facility
|
OP
|
$42.84
|
|
| Hospital Charge Code |
27000111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: ASR ASR |
$41.55
|
| Rate for Payer: ASR Commercial |
$41.55
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$35.08
|
| Rate for Payer: BCN Commercial |
$33.21
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$42.84
|
| Rate for Payer: Healthscope Whirlpool |
$41.55
|
| Rate for Payer: Mclaren Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.54
|
| Rate for Payer: Priority Health Narrow Network |
$30.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.70
|
|
|
HC TISSUE IN SITU HYB QUANT EA ADD
|
Facility
|
OP
|
$269.46
|
|
|
Service Code
|
CPT 88369
|
| Hospital Charge Code |
31000123
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$107.78 |
| Max. Negotiated Rate |
$269.46 |
| Rate for Payer: Aetna Commercial |
$242.51
|
| Rate for Payer: Aetna Medicare |
$134.73
|
| Rate for Payer: ASR ASR |
$261.38
|
| Rate for Payer: ASR Commercial |
$261.38
|
| Rate for Payer: BCBS Complete |
$107.78
|
| Rate for Payer: BCBS Trust/PPO |
$220.66
|
| Rate for Payer: BCCCP Commercial |
$121.51
|
| Rate for Payer: BCN Commercial |
$208.91
|
| Rate for Payer: Cash Price |
$215.57
|
| Rate for Payer: Cash Price |
$215.57
|
| Rate for Payer: Cofinity Commercial |
$253.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.57
|
| Rate for Payer: Healthscope Commercial |
$269.46
|
| Rate for Payer: Healthscope Whirlpool |
$261.38
|
| Rate for Payer: Mclaren Commercial |
$242.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.04
|
| Rate for Payer: Nomi Health Commercial |
$220.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$236.10
|
| Rate for Payer: Priority Health Narrow Network |
$188.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.12
|
|
|
HC TISSUE IN SITU HYB QUANT EA ADD
|
Facility
|
IP
|
$269.46
|
|
|
Service Code
|
CPT 88369
|
| Hospital Charge Code |
31000123
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$175.15 |
| Max. Negotiated Rate |
$269.46 |
| Rate for Payer: Aetna Commercial |
$242.51
|
| Rate for Payer: ASR ASR |
$261.38
|
| Rate for Payer: ASR Commercial |
$261.38
|
| Rate for Payer: BCBS Trust/PPO |
$219.58
|
| Rate for Payer: BCN Commercial |
$208.91
|
| Rate for Payer: Cash Price |
$215.57
|
| Rate for Payer: Cofinity Commercial |
$253.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.57
|
| Rate for Payer: Healthscope Commercial |
$269.46
|
| Rate for Payer: Healthscope Whirlpool |
$261.38
|
| Rate for Payer: Mclaren Commercial |
$242.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.04
|
| Rate for Payer: Nomi Health Commercial |
$220.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.12
|
|
|
HC TISSUE IN SITU HYBRIDIZATION
|
Facility
|
OP
|
$355.46
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
31000060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$89.99 |
| Max. Negotiated Rate |
$355.46 |
| Rate for Payer: Aetna Commercial |
$319.91
|
| Rate for Payer: Aetna Medicare |
$167.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$209.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$209.88
|
| Rate for Payer: ASR ASR |
$344.80
|
| Rate for Payer: ASR Commercial |
$344.80
|
| Rate for Payer: BCBS Complete |
$94.49
|
| Rate for Payer: BCBS MAPPO |
$167.90
|
| Rate for Payer: BCBS Trust/PPO |
$291.09
|
| Rate for Payer: BCCCP Commercial |
$161.79
|
| Rate for Payer: BCN Commercial |
$275.59
|
| Rate for Payer: BCN Medicare Advantage |
$167.90
|
| Rate for Payer: Cash Price |
$284.37
|
| Rate for Payer: Cash Price |
$284.37
|
| Rate for Payer: Cofinity Commercial |
$334.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.90
|
| Rate for Payer: Healthscope Commercial |
$355.46
|
| Rate for Payer: Healthscope Whirlpool |
$344.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$167.90
|
| Rate for Payer: Mclaren Commercial |
$319.91
|
| Rate for Payer: Mclaren Medicaid |
$89.99
|
| Rate for Payer: Mclaren Medicare |
$167.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.30
|
| Rate for Payer: Meridian Medicaid |
$94.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.14
|
| Rate for Payer: Nomi Health Commercial |
$291.48
|
| Rate for Payer: PACE Medicare |
$159.50
|
| Rate for Payer: PACE SWMI |
$167.90
|
| Rate for Payer: PHP Commercial |
$184.69
|
| Rate for Payer: PHP Medicaid |
$89.99
|
| Rate for Payer: PHP Medicare Advantage |
$167.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$287.13
|
| Rate for Payer: Priority Health Medicare |
$167.90
|
| Rate for Payer: Priority Health Narrow Network |
$229.70
|
| Rate for Payer: Railroad Medicare Medicare |
$167.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.90
|
| Rate for Payer: UHC Exchange |
$260.24
|
| Rate for Payer: UHC Medicare Advantage |
$167.90
|
| Rate for Payer: UHCCP DNSP |
$167.90
|
| Rate for Payer: UHCCP Medicaid |
$89.99
|
| Rate for Payer: VA VA |
$167.90
|
|
|
HC TISSUE IN SITU HYBRIDIZATION
|
Facility
|
IP
|
$355.46
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
31000060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$231.05 |
| Max. Negotiated Rate |
$355.46 |
| Rate for Payer: Aetna Commercial |
$319.91
|
| Rate for Payer: ASR ASR |
$344.80
|
| Rate for Payer: ASR Commercial |
$344.80
|
| Rate for Payer: BCBS Trust/PPO |
$289.66
|
| Rate for Payer: BCN Commercial |
$275.59
|
| Rate for Payer: Cash Price |
$284.37
|
| Rate for Payer: Cofinity Commercial |
$334.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.37
|
| Rate for Payer: Healthscope Commercial |
$355.46
|
| Rate for Payer: Healthscope Whirlpool |
$344.80
|
| Rate for Payer: Mclaren Commercial |
$319.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.14
|
| Rate for Payer: Nomi Health Commercial |
$291.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.80
|
|
