|
HC TISSUE MARKER PROSTATE
|
Facility
|
OP
|
$1,357.72
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.58 |
| Max. Negotiated Rate |
$1,221.95 |
| Rate for Payer: Aetna Commercial |
$1,154.06
|
| Rate for Payer: Aetna Medicare |
$678.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$882.52
|
| Rate for Payer: BCBS Complete |
$543.09
|
| Rate for Payer: Cash Price |
$1,086.18
|
| Rate for Payer: Cofinity Advantage |
$950.40
|
| Rate for Payer: Cofinity Commercial |
$1,167.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,086.18
|
| Rate for Payer: Healthscope Commercial |
$1,221.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,086.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,154.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,018.29
|
| Rate for Payer: PHP Commercial |
$1,154.06
|
| Rate for Payer: Priority Health SBD |
$855.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$882.52
|
| Rate for Payer: UHC Core |
$707.37
|
| Rate for Payer: UHC Exchange |
$533.58
|
|
|
HC TISSUE PROCESSING
|
Facility
|
IP
|
$52.34
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.97 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.02
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Advantage |
$36.64
|
| Rate for Payer: Cofinity Commercial |
$45.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Healthscope Commercial |
$47.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: PHP Commercial |
$44.49
|
| Rate for Payer: Priority Health SBD |
$32.97
|
|
|
HC TISSUE PROCESSING
|
Facility
|
OP
|
$52.34
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: Aetna Medicare |
$6.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.35
|
| Rate for Payer: BCBS Complete |
$3.23
|
| Rate for Payer: BCBS MAPPO |
$5.88
|
| Rate for Payer: BCBS Trust/PPO |
$6.27
|
| Rate for Payer: BCN Commercial |
$6.27
|
| Rate for Payer: BCN Medicare Advantage |
$5.88
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Advantage |
$36.64
|
| Rate for Payer: Cofinity Commercial |
$45.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.88
|
| Rate for Payer: Healthscope Commercial |
$47.11
|
| Rate for Payer: Mclaren Medicaid |
$3.08
|
| Rate for Payer: Mclaren Medicare |
$5.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.17
|
| Rate for Payer: Meridian Medicaid |
$6.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Nomi Health Commercial |
$8.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: PACE Medicare |
$5.59
|
| Rate for Payer: PACE SWMI |
$5.88
|
| Rate for Payer: PHP Commercial |
$44.49
|
| Rate for Payer: PHP Medicare Advantage |
$5.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.88
|
| Rate for Payer: Priority Health Medicare |
$5.88
|
| Rate for Payer: Priority Health SBD |
$32.97
|
| Rate for Payer: Priority Health Tiered Network |
$4.70
|
| Rate for Payer: Railroad Medicare Medicare |
$5.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.82
|
| Rate for Payer: UHC Core |
$8.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.88
|
| Rate for Payer: UHC Exchange |
$8.82
|
| Rate for Payer: UHC Medicaid |
$3.08
|
| Rate for Payer: UHCCP Medicaid |
$3.08
|
| Rate for Payer: VA VA |
$5.88
|
|
|
HC TISSUE TRANSFER ANY AREA 30.1-60 SQ CM
|
Facility
|
IP
|
$10,750.80
|
|
|
Service Code
|
CPT 14301
|
| Hospital Charge Code |
76100537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,773.00 |
| Max. Negotiated Rate |
$9,675.72 |
| Rate for Payer: Aetna Commercial |
$9,138.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,988.02
|
| Rate for Payer: Cash Price |
$8,600.64
|
| Rate for Payer: Cofinity Advantage |
$7,525.56
|
| Rate for Payer: Cofinity Commercial |
$9,245.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,600.64
|
| Rate for Payer: Healthscope Commercial |
$9,675.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,138.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,063.10
|
| Rate for Payer: PHP Commercial |
$9,138.18
|
| Rate for Payer: Priority Health SBD |
$6,773.00
|
|
|
HC TISSUE TRANSFER ANY AREA 30.1-60 SQ CM
|
Facility
|
OP
|
$10,750.80
|
|
|
Service Code
|
CPT 14301
|
| Hospital Charge Code |
76100537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,549.68 |
| Max. Negotiated Rate |
$11,418.88 |
| Rate for Payer: Aetna Commercial |
$9,138.18
|
| Rate for Payer: Aetna Medicare |
$3,672.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,988.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,413.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,413.73
|
| Rate for Payer: BCBS Complete |
$1,939.21
|
| Rate for Payer: BCBS MAPPO |
$3,530.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,549.68
|
| Rate for Payer: BCN Commercial |
$1,549.68
|
| Rate for Payer: BCN Medicare Advantage |
$3,530.98
|
| Rate for Payer: Cash Price |
$8,600.64
|
| Rate for Payer: Cash Price |
$8,600.64
|
| Rate for Payer: Cash Price |
$8,600.64
|
| Rate for Payer: Cofinity Advantage |
$7,525.56
|
| Rate for Payer: Cofinity Commercial |
$9,245.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,600.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,530.98
|
| Rate for Payer: Healthscope Commercial |
$9,675.72
|
| Rate for Payer: Mclaren Medicaid |
$1,846.70
|
| Rate for Payer: Mclaren Medicare |
$3,530.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,707.53
|
| Rate for Payer: Meridian Medicaid |
$3,707.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,060.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,884.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,138.18
|
| Rate for Payer: Nomi Health Commercial |
$10,592.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,063.10
|
| Rate for Payer: PACE Medicare |
$3,354.43
|
| Rate for Payer: PACE SWMI |
$3,530.98
|
| Rate for Payer: PHP Commercial |
$9,138.18
|
| Rate for Payer: PHP Medicare Advantage |
$3,530.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,846.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,418.88
|
| Rate for Payer: Priority Health Medicare |
$3,530.98
|
| Rate for Payer: Priority Health SBD |
$6,773.00
|
| Rate for Payer: Priority Health Tiered Network |
$9,135.10
|
| Rate for Payer: Railroad Medicare Medicare |
$3,530.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,988.02
|
| Rate for Payer: UHC Core |
$5,601.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,530.98
|
| Rate for Payer: UHC Exchange |
$4,225.06
|
| Rate for Payer: UHC Medicaid |
$1,846.70
|
| Rate for Payer: UHCCP Medicaid |
$1,846.70
|
| Rate for Payer: VA VA |
$3,530.98
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
OP
|
$58.26
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna Commercial |
$49.52
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$12.30
|
| Rate for Payer: BCN Commercial |
$12.30
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Advantage |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$50.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$52.43
|
| Rate for Payer: Mclaren Medicaid |
$6.03
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.52
|
| Rate for Payer: Nomi Health Commercial |
$17.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.70
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$49.52
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.53
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$36.70
|
| Rate for Payer: Priority Health Tiered Network |
$9.22
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.30
|
| Rate for Payer: UHC Core |
$17.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.30
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
IP
|
$58.26
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.70 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna Commercial |
$49.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.87
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Advantage |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$50.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Healthscope Commercial |
$52.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.70
|
| Rate for Payer: PHP Commercial |
$49.52
|
| Rate for Payer: Priority Health SBD |
$36.70
|
|
|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
IP
|
$37.14
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.14
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Advantage |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: Priority Health SBD |
$23.40
|
|
|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
OP
|
$37.14
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$12.30
|
| Rate for Payer: BCN Commercial |
$12.30
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Advantage |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Mclaren Medicaid |
$6.03
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$17.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.53
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$23.40
|
| Rate for Payer: Priority Health Tiered Network |
$9.22
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.30
|
| Rate for Payer: UHC Core |
$17.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.30
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
IP
|
$37.14
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.14
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Advantage |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: Priority Health SBD |
$23.40
|
|
|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
OP
|
$37.14
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$12.30
|
| Rate for Payer: BCN Commercial |
$12.30
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Advantage |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Mclaren Medicaid |
$6.03
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$17.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.53
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$23.40
|
| Rate for Payer: Priority Health Tiered Network |
$9.22
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.30
|
| Rate for Payer: UHC Core |
$17.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.30
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC TIXAGEVIMAB/CILGAVIMAB 150 MG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0220
|
| Hospital Charge Code |
63600197
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.01
|
|
|
HC TIXAGEVIMAB/CILGAVIMAB 150 MG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0220
|
| Hospital Charge Code |
63600197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
|
HC TIXAGEVIMAB/CILGAVIMAB 300 MG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0221
|
| Hospital Charge Code |
63600203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
|
HC TIXAGEVIMAB/CILGAVIMAB 300 MG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0221
|
| Hospital Charge Code |
63600203
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.01
|
|
|
HC TL 201 PER MCI
|
Facility
|
IP
|
$197.13
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
34300022
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$124.19 |
| Max. Negotiated Rate |
$177.42 |
| Rate for Payer: Aetna Commercial |
$167.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.13
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cofinity Advantage |
$137.99
|
| Rate for Payer: Cofinity Commercial |
$169.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.70
|
| Rate for Payer: Healthscope Commercial |
$177.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.85
|
| Rate for Payer: PHP Commercial |
$167.56
|
| Rate for Payer: Priority Health SBD |
$124.19
|
|
|
HC TL 201 PER MCI
|
Facility
|
OP
|
$197.13
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
34300022
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$177.42 |
| Rate for Payer: Aetna Commercial |
$167.56
|
| Rate for Payer: Aetna Medicare |
$98.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.13
|
| Rate for Payer: BCBS Complete |
$78.85
|
| Rate for Payer: BCBS Trust/PPO |
$49.73
|
| Rate for Payer: BCN Commercial |
$49.73
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cofinity Advantage |
$137.99
|
| Rate for Payer: Cofinity Commercial |
$169.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.70
|
| Rate for Payer: Healthscope Commercial |
$177.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.85
|
| Rate for Payer: PHP Commercial |
$167.56
|
| Rate for Payer: Priority Health SBD |
$124.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.80
|
| Rate for Payer: UHC Core |
$78.80
|
| Rate for Payer: UHC Exchange |
$78.80
|
|
|
HC TOBRAMYCIN LEVEL
|
Facility
|
IP
|
$109.66
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
30100049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Aetna Commercial |
$93.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.28
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Advantage |
$76.76
|
| Rate for Payer: Cofinity Commercial |
$94.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Healthscope Commercial |
$98.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: PHP Commercial |
$93.21
|
| Rate for Payer: Priority Health SBD |
$69.09
|
|
|
HC TOBRAMYCIN LEVEL
|
Facility
|
OP
|
$109.66
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
30100049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Aetna Commercial |
$93.21
|
| Rate for Payer: Aetna Medicare |
$16.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.16
|
| Rate for Payer: BCBS Complete |
$8.86
|
| Rate for Payer: BCBS MAPPO |
$16.13
|
| Rate for Payer: BCBS Trust/PPO |
$17.20
|
| Rate for Payer: BCN Commercial |
$17.20
|
| Rate for Payer: BCN Medicare Advantage |
$16.13
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Advantage |
$76.76
|
| Rate for Payer: Cofinity Commercial |
$94.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.13
|
| Rate for Payer: Healthscope Commercial |
$98.69
|
| Rate for Payer: Mclaren Medicaid |
$8.44
|
| Rate for Payer: Mclaren Medicare |
$16.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.94
|
| Rate for Payer: Meridian Medicaid |
$16.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Nomi Health Commercial |
$24.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: PACE Medicare |
$15.32
|
| Rate for Payer: PACE SWMI |
$16.13
|
| Rate for Payer: PHP Commercial |
$93.21
|
| Rate for Payer: PHP Medicare Advantage |
$16.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.13
|
| Rate for Payer: Priority Health Medicare |
$16.13
|
| Rate for Payer: Priority Health SBD |
$69.09
|
| Rate for Payer: Priority Health Tiered Network |
$12.90
|
| Rate for Payer: Railroad Medicare Medicare |
$16.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.20
|
| Rate for Payer: UHC Core |
$24.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.13
|
| Rate for Payer: UHC Exchange |
$24.20
|
| Rate for Payer: UHC Medicaid |
$8.44
|
| Rate for Payer: UHCCP Medicaid |
$8.44
|
| Rate for Payer: VA VA |
$16.13
|
|
|
HC TOMATO IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| 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 Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| 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 |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| 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 |
$5.48
|
| 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 |
$7.83
|
| 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 |
$22.02
|
| 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/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC TOMATO IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC TOMO GUIDED BREAST BIOPSY
|
Facility
|
IP
|
$4,826.42
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100566
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,040.64 |
| Max. Negotiated Rate |
$4,343.78 |
| Rate for Payer: Aetna Commercial |
$4,102.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,137.17
|
| Rate for Payer: Cash Price |
$3,861.14
|
| Rate for Payer: Cofinity Advantage |
$3,378.49
|
| Rate for Payer: Cofinity Commercial |
$4,150.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,861.14
|
| Rate for Payer: Healthscope Commercial |
$4,343.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,102.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,619.82
|
| Rate for Payer: PHP Commercial |
$4,102.46
|
| Rate for Payer: Priority Health SBD |
$3,040.64
|
|
|
HC TOMO GUIDED BREAST BIOPSY
|
Facility
|
OP
|
$4,826.42
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100566
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,716.11 |
| Max. Negotiated Rate |
$12,616.62 |
| Rate for Payer: Aetna Commercial |
$4,102.46
|
| Rate for Payer: Aetna Medicare |
$4,057.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,137.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,876.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,876.69
|
| Rate for Payer: BCBS Complete |
$2,142.62
|
| Rate for Payer: BCBS MAPPO |
$3,901.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,716.11
|
| Rate for Payer: BCN Commercial |
$1,716.11
|
| Rate for Payer: BCN Medicare Advantage |
$3,901.35
|
| Rate for Payer: Cash Price |
$3,861.14
|
| Rate for Payer: Cash Price |
$3,861.14
|
| Rate for Payer: Cash Price |
$3,861.14
|
| Rate for Payer: Cofinity Advantage |
$3,378.49
|
| Rate for Payer: Cofinity Commercial |
$4,150.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,861.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,901.35
|
| Rate for Payer: Healthscope Commercial |
$4,343.78
|
| Rate for Payer: Mclaren Medicaid |
$2,040.41
|
| Rate for Payer: Mclaren Medicare |
$3,901.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,096.42
|
| Rate for Payer: Meridian Medicaid |
$4,096.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,486.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,291.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,102.46
|
| Rate for Payer: Nomi Health Commercial |
$11,704.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,619.82
|
| Rate for Payer: PACE Medicare |
$3,706.28
|
| Rate for Payer: PACE SWMI |
$3,901.35
|
| Rate for Payer: PHP Commercial |
$4,102.46
|
| Rate for Payer: PHP Medicare Advantage |
$3,901.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,040.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,616.62
|
| Rate for Payer: Priority Health Medicare |
$3,901.35
|
| Rate for Payer: Priority Health SBD |
$3,040.64
|
| Rate for Payer: Priority Health Tiered Network |
$10,093.30
|
| Rate for Payer: Railroad Medicare Medicare |
$3,901.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,901.35
|
| Rate for Payer: UHC Medicaid |
$2,040.41
|
| Rate for Payer: UHCCP Medicaid |
$2,040.41
|
| Rate for Payer: VA VA |
$3,901.35
|
|
|
HC TOMO GUIDED BREAST LOCALIZATION
|
Facility
|
OP
|
$3,312.83
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,716.11 |
| Max. Negotiated Rate |
$12,616.62 |
| Rate for Payer: Aetna Commercial |
$2,815.91
|
| Rate for Payer: Aetna Medicare |
$4,057.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,153.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,876.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,876.69
|
| Rate for Payer: BCBS Complete |
$2,142.62
|
| Rate for Payer: BCBS MAPPO |
$3,901.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,716.11
|
| Rate for Payer: BCN Commercial |
$1,716.11
|
| Rate for Payer: BCN Medicare Advantage |
$3,901.35
|
| Rate for Payer: Cash Price |
$2,650.26
|
| Rate for Payer: Cash Price |
$2,650.26
|
| Rate for Payer: Cash Price |
$2,650.26
|
| Rate for Payer: Cofinity Advantage |
$2,318.98
|
| Rate for Payer: Cofinity Commercial |
$2,849.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,650.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,901.35
|
| Rate for Payer: Healthscope Commercial |
$2,981.55
|
| Rate for Payer: Mclaren Medicaid |
$2,040.41
|
| Rate for Payer: Mclaren Medicare |
$3,901.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,096.42
|
| Rate for Payer: Meridian Medicaid |
$4,096.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,486.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,291.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,815.91
|
| Rate for Payer: Nomi Health Commercial |
$11,704.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,484.62
|
| Rate for Payer: PACE Medicare |
$3,706.28
|
| Rate for Payer: PACE SWMI |
$3,901.35
|
| Rate for Payer: PHP Commercial |
$2,815.91
|
| Rate for Payer: PHP Medicare Advantage |
$3,901.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,040.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,616.62
|
| Rate for Payer: Priority Health Medicare |
$3,901.35
|
| Rate for Payer: Priority Health SBD |
$2,087.08
|
| Rate for Payer: Priority Health Tiered Network |
$10,093.30
|
| Rate for Payer: Railroad Medicare Medicare |
$3,901.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,901.35
|
| Rate for Payer: UHC Medicaid |
$2,040.41
|
| Rate for Payer: UHCCP Medicaid |
$2,040.41
|
| Rate for Payer: VA VA |
$3,901.35
|
|
|
HC TOMO GUIDED BREAST LOCALIZATION
|
Facility
|
IP
|
$3,312.83
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,087.08 |
| Max. Negotiated Rate |
$2,981.55 |
| Rate for Payer: Aetna Commercial |
$2,815.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,153.34
|
| Rate for Payer: Cash Price |
$2,650.26
|
| Rate for Payer: Cofinity Advantage |
$2,318.98
|
| Rate for Payer: Cofinity Commercial |
$2,849.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,650.26
|
| Rate for Payer: Healthscope Commercial |
$2,981.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,815.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,484.62
|
| Rate for Payer: PHP Commercial |
$2,815.91
|
| Rate for Payer: Priority Health SBD |
$2,087.08
|
|
