|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
OP
|
$365.26
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$34.25 |
| Max. Negotiated Rate |
$365.26 |
| Rate for Payer: Aetna Commercial |
$328.73
|
| Rate for Payer: Aetna Medicare |
$62.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.28
|
| Rate for Payer: ASR ASR |
$354.30
|
| Rate for Payer: BCBS Complete |
$35.97
|
| Rate for Payer: BCBS MAPPO |
$62.62
|
| Rate for Payer: BCBS Trust/PPO |
$283.19
|
| Rate for Payer: BCN Commercial |
$283.19
|
| Rate for Payer: BCN Medicare Advantage |
$62.62
|
| Rate for Payer: Cash Price |
$292.21
|
| Rate for Payer: Cash Price |
$292.21
|
| Rate for Payer: Cofinity Commercial |
$343.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.62
|
| Rate for Payer: Healthscope Commercial |
$365.26
|
| Rate for Payer: Healthscope Whirlpool |
$354.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.62
|
| Rate for Payer: Mclaren Commercial |
$328.73
|
| Rate for Payer: Mclaren Medicaid |
$34.25
|
| Rate for Payer: Mclaren Medicare |
$62.62
|
| Rate for Payer: Meridian Medicaid |
$35.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$310.47
|
| Rate for Payer: PACE Medicare |
$59.49
|
| Rate for Payer: PACE SWMI |
$62.62
|
| Rate for Payer: PHP Commercial |
$68.88
|
| Rate for Payer: PHP Medicaid |
$34.25
|
| Rate for Payer: PHP Medicare Advantage |
$62.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.96
|
| Rate for Payer: Priority Health Medicare |
$62.62
|
| Rate for Payer: Priority Health Narrow Network |
$123.97
|
| Rate for Payer: Railroad Medicare Medicare |
$62.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.43
|
| Rate for Payer: UHC Medicare Advantage |
$64.50
|
| Rate for Payer: VA VA |
$62.62
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
IP
|
$669.39
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$468.57 |
| Max. Negotiated Rate |
$669.39 |
| Rate for Payer: Aetna Commercial |
$602.45
|
| Rate for Payer: ASR ASR |
$649.31
|
| Rate for Payer: BCBS Trust/PPO |
$518.98
|
| Rate for Payer: BCN Commercial |
$518.98
|
| Rate for Payer: Cash Price |
$535.51
|
| Rate for Payer: Cofinity Commercial |
$629.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.51
|
| Rate for Payer: Healthscope Commercial |
$669.39
|
| Rate for Payer: Healthscope Whirlpool |
$649.31
|
| Rate for Payer: Mclaren Commercial |
$602.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$568.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$589.06
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
OP
|
$669.39
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$164.66 |
| Max. Negotiated Rate |
$669.39 |
| Rate for Payer: Aetna Commercial |
$602.45
|
| Rate for Payer: Aetna Medicare |
$301.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$376.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$376.29
|
| Rate for Payer: ASR ASR |
$649.31
|
| Rate for Payer: BCBS Complete |
$172.91
|
| Rate for Payer: BCBS MAPPO |
$301.03
|
| Rate for Payer: BCBS Trust/PPO |
$518.98
|
| Rate for Payer: BCN Commercial |
$518.98
|
| Rate for Payer: BCN Medicare Advantage |
$301.03
|
| Rate for Payer: Cash Price |
$535.51
|
| Rate for Payer: Cash Price |
$535.51
|
| Rate for Payer: Cofinity Commercial |
$629.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.03
|
| Rate for Payer: Healthscope Commercial |
$669.39
|
| Rate for Payer: Healthscope Whirlpool |
$649.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$301.03
|
| Rate for Payer: Mclaren Commercial |
$602.45
|
| Rate for Payer: Mclaren Medicaid |
$164.66
|
| Rate for Payer: Mclaren Medicare |
$301.03
|
| Rate for Payer: Meridian Medicaid |
$172.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$316.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$568.98
|
| Rate for Payer: PACE Medicare |
$285.98
|
| Rate for Payer: PACE SWMI |
$301.03
|
| Rate for Payer: PHP Commercial |
$331.13
|
| Rate for Payer: PHP Medicaid |
$164.66
|
| Rate for Payer: PHP Medicare Advantage |
$301.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.72
|
| Rate for Payer: Priority Health Medicare |
$301.03
|
| Rate for Payer: Priority Health Narrow Network |
$210.98
|
| Rate for Payer: Railroad Medicare Medicare |
$301.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$589.06
|
| Rate for Payer: UHC Medicare Advantage |
$310.06
|
| Rate for Payer: VA VA |
$301.03
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
OP
|
$277.09
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.22 |
| Max. Negotiated Rate |
$277.09 |
| Rate for Payer: Aetna Commercial |
$249.38
|
| Rate for Payer: Aetna Medicare |
$190.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.15
|
| Rate for Payer: ASR ASR |
$268.78
|
| Rate for Payer: BCBS Complete |
$109.43
|
| Rate for Payer: BCBS MAPPO |
$190.52
|
| Rate for Payer: BCBS Trust/PPO |
$214.83
|
| Rate for Payer: BCN Commercial |
$214.83
|
| Rate for Payer: BCN Medicare Advantage |
$190.52
|
| Rate for Payer: Cash Price |
$221.67
|
| Rate for Payer: Cash Price |
$221.67
|
| Rate for Payer: Cofinity Commercial |
$260.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.52
|
| Rate for Payer: Healthscope Commercial |
$277.09
|
| Rate for Payer: Healthscope Whirlpool |
$268.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$190.52
|
| Rate for Payer: Mclaren Commercial |
$249.38
|
| Rate for Payer: Mclaren Medicaid |
$104.21
|
| Rate for Payer: Mclaren Medicare |
$190.52
|
| Rate for Payer: Meridian Medicaid |
$109.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.53
|
| Rate for Payer: PACE Medicare |
$180.99
|
| Rate for Payer: PACE SWMI |
$190.52
|
| Rate for Payer: PHP Commercial |
$209.57
|
| Rate for Payer: PHP Medicaid |
$104.21
|
| Rate for Payer: PHP Medicare Advantage |
$190.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.03
|
| Rate for Payer: Priority Health Medicare |
$190.52
|
| Rate for Payer: Priority Health Narrow Network |
$79.22
|
| Rate for Payer: Railroad Medicare Medicare |
$190.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.84
|
| Rate for Payer: UHC Medicare Advantage |
$196.24
|
| Rate for Payer: VA VA |
$190.52
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
IP
|
$277.09
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.96 |
| Max. Negotiated Rate |
$277.09 |
| Rate for Payer: Aetna Commercial |
$249.38
|
| Rate for Payer: ASR ASR |
$268.78
|
| Rate for Payer: BCBS Trust/PPO |
$214.83
|
| Rate for Payer: BCN Commercial |
$214.83
|
| Rate for Payer: Cash Price |
$221.67
|
| Rate for Payer: Cofinity Commercial |
$260.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.67
|
| Rate for Payer: Healthscope Commercial |
$277.09
|
| Rate for Payer: Healthscope Whirlpool |
$268.78
|
| Rate for Payer: Mclaren Commercial |
$249.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.84
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
OP
|
$217.88
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$34.25 |
| Max. Negotiated Rate |
$217.88 |
| Rate for Payer: Aetna Commercial |
$196.09
|
| Rate for Payer: Aetna Medicare |
$62.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.28
|
| Rate for Payer: ASR ASR |
$211.34
|
| Rate for Payer: BCBS Complete |
$35.97
|
| Rate for Payer: BCBS MAPPO |
$62.62
|
| Rate for Payer: BCBS Trust/PPO |
$168.92
|
| Rate for Payer: BCN Commercial |
$168.92
|
| Rate for Payer: BCN Medicare Advantage |
$62.62
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cofinity Commercial |
$204.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.62
|
| Rate for Payer: Healthscope Commercial |
$217.88
|
| Rate for Payer: Healthscope Whirlpool |
$211.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$62.62
|
| Rate for Payer: Mclaren Commercial |
$196.09
|
| Rate for Payer: Mclaren Medicaid |
$34.25
|
| Rate for Payer: Mclaren Medicare |
$62.62
|
| Rate for Payer: Meridian Medicaid |
$35.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.20
|
| Rate for Payer: PACE Medicare |
$59.49
|
| Rate for Payer: PACE SWMI |
$62.62
|
| Rate for Payer: PHP Commercial |
$68.88
|
| Rate for Payer: PHP Medicaid |
$34.25
|
| Rate for Payer: PHP Medicare Advantage |
$62.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.23
|
| Rate for Payer: Priority Health Medicare |
$62.62
|
| Rate for Payer: Priority Health Narrow Network |
$69.78
|
| Rate for Payer: Railroad Medicare Medicare |
$62.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.73
|
| Rate for Payer: UHC Medicare Advantage |
$64.50
|
| Rate for Payer: VA VA |
$62.62
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
IP
|
$217.88
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$152.52 |
| Max. Negotiated Rate |
$217.88 |
| Rate for Payer: Aetna Commercial |
$196.09
|
| Rate for Payer: ASR ASR |
$211.34
|
| Rate for Payer: BCBS Trust/PPO |
$168.92
|
| Rate for Payer: BCN Commercial |
$168.92
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cofinity Commercial |
$204.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.30
|
| Rate for Payer: Healthscope Commercial |
$217.88
|
| Rate for Payer: Healthscope Whirlpool |
$211.34
|
| Rate for Payer: Mclaren Commercial |
$196.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.73
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
OP
|
$524.28
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$229.89 |
| Max. Negotiated Rate |
$525.35 |
| Rate for Payer: Aetna Commercial |
$471.85
|
| Rate for Payer: Aetna Medicare |
$420.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$525.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$525.35
|
| Rate for Payer: ASR ASR |
$508.55
|
| Rate for Payer: BCBS Complete |
$241.41
|
| Rate for Payer: BCBS MAPPO |
$420.28
|
| Rate for Payer: BCBS Trust/PPO |
$406.47
|
| Rate for Payer: BCN Commercial |
$406.47
|
| Rate for Payer: BCN Medicare Advantage |
$420.28
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$492.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.28
|
| Rate for Payer: Healthscope Commercial |
$524.28
|
| Rate for Payer: Healthscope Whirlpool |
$508.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$420.28
|
| Rate for Payer: Mclaren Commercial |
$471.85
|
| Rate for Payer: Mclaren Medicaid |
$229.89
|
| Rate for Payer: Mclaren Medicare |
$420.28
|
| Rate for Payer: Meridian Medicaid |
$241.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$441.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$483.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PACE Medicare |
$399.27
|
| Rate for Payer: PACE SWMI |
$420.28
|
| Rate for Payer: PHP Commercial |
$462.31
|
| Rate for Payer: PHP Medicaid |
$229.89
|
| Rate for Payer: PHP Medicare Advantage |
$420.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.09
|
| Rate for Payer: Priority Health Medicare |
$420.28
|
| Rate for Payer: Priority Health Narrow Network |
$372.24
|
| Rate for Payer: Railroad Medicare Medicare |
$420.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.37
|
| Rate for Payer: UHC Medicare Advantage |
$432.89
|
| Rate for Payer: VA VA |
$420.28
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
IP
|
$524.28
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$367.00 |
| Max. Negotiated Rate |
$524.28 |
| Rate for Payer: Aetna Commercial |
$471.85
|
| Rate for Payer: ASR ASR |
$508.55
|
| Rate for Payer: BCBS Trust/PPO |
$406.47
|
| Rate for Payer: BCN Commercial |
$406.47
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$492.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Healthscope Commercial |
$524.28
|
| Rate for Payer: Healthscope Whirlpool |
$508.55
|
| Rate for Payer: Mclaren Commercial |
$471.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.37
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
OP
|
$524.28
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$229.89 |
| Max. Negotiated Rate |
$525.35 |
| Rate for Payer: Aetna Commercial |
$471.85
|
| Rate for Payer: Aetna Medicare |
$420.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$525.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$525.35
|
| Rate for Payer: ASR ASR |
$508.55
|
| Rate for Payer: BCBS Complete |
$241.41
|
| Rate for Payer: BCBS MAPPO |
$420.28
|
| Rate for Payer: BCBS Trust/PPO |
$406.47
|
| Rate for Payer: BCN Commercial |
$406.47
|
| Rate for Payer: BCN Medicare Advantage |
$420.28
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$492.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.28
|
| Rate for Payer: Healthscope Commercial |
$524.28
|
| Rate for Payer: Healthscope Whirlpool |
$508.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$420.28
|
| Rate for Payer: Mclaren Commercial |
$471.85
|
| Rate for Payer: Mclaren Medicaid |
$229.89
|
| Rate for Payer: Mclaren Medicare |
$420.28
|
| Rate for Payer: Meridian Medicaid |
$241.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$441.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$483.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PACE Medicare |
$399.27
|
| Rate for Payer: PACE SWMI |
$420.28
|
| Rate for Payer: PHP Commercial |
$462.31
|
| Rate for Payer: PHP Medicaid |
$229.89
|
| Rate for Payer: PHP Medicare Advantage |
$420.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.09
|
| Rate for Payer: Priority Health Medicare |
$420.28
|
| Rate for Payer: Priority Health Narrow Network |
$372.24
|
| Rate for Payer: Railroad Medicare Medicare |
$420.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.37
|
| Rate for Payer: UHC Medicare Advantage |
$432.89
|
| Rate for Payer: VA VA |
$420.28
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
IP
|
$524.28
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$367.00 |
| Max. Negotiated Rate |
$524.28 |
| Rate for Payer: Aetna Commercial |
$471.85
|
| Rate for Payer: ASR ASR |
$508.55
|
| Rate for Payer: BCBS Trust/PPO |
$406.47
|
| Rate for Payer: BCN Commercial |
$406.47
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$492.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Healthscope Commercial |
$524.28
|
| Rate for Payer: Healthscope Whirlpool |
$508.55
|
| Rate for Payer: Mclaren Commercial |
$471.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$461.37
|
|
|
HC IVUS CATHETER
|
Facility
|
IP
|
$2,685.65
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,879.96 |
| Max. Negotiated Rate |
$2,685.65 |
| Rate for Payer: Aetna Commercial |
$2,417.08
|
| Rate for Payer: ASR ASR |
$2,605.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,082.18
|
| Rate for Payer: BCN Commercial |
$2,082.18
|
| Rate for Payer: Cash Price |
$2,148.52
|
| Rate for Payer: Cofinity Commercial |
$2,524.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,148.52
|
| Rate for Payer: Healthscope Commercial |
$2,685.65
|
| Rate for Payer: Healthscope Whirlpool |
$2,605.08
|
| Rate for Payer: Mclaren Commercial |
$2,417.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,282.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,879.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,363.37
|
|
|
HC IVUS CATHETER
|
Facility
|
OP
|
$2,685.65
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,074.26 |
| Max. Negotiated Rate |
$2,685.65 |
| Rate for Payer: Aetna Commercial |
$2,417.08
|
| Rate for Payer: ASR ASR |
$2,605.08
|
| Rate for Payer: BCBS Complete |
$1,074.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,082.18
|
| Rate for Payer: BCN Commercial |
$2,082.18
|
| Rate for Payer: Cash Price |
$2,148.52
|
| Rate for Payer: Cofinity Commercial |
$2,524.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,148.52
|
| Rate for Payer: Healthscope Commercial |
$2,685.65
|
| Rate for Payer: Healthscope Whirlpool |
$2,605.08
|
| Rate for Payer: Mclaren Commercial |
$2,417.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,282.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,879.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,443.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,906.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,363.37
|
|
|
HC IVUS EA ADDL NON CORONARY VESSEL
|
Facility
|
OP
|
$1,298.86
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
36100484
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$519.54 |
| Max. Negotiated Rate |
$1,298.86 |
| Rate for Payer: Aetna Commercial |
$1,168.97
|
| Rate for Payer: ASR ASR |
$1,259.89
|
| Rate for Payer: BCBS Complete |
$519.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,007.01
|
| Rate for Payer: BCN Commercial |
$1,007.01
|
| Rate for Payer: Cash Price |
$1,039.09
|
| Rate for Payer: Cofinity Commercial |
$1,220.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,039.09
|
| Rate for Payer: Healthscope Commercial |
$1,298.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,259.89
|
| Rate for Payer: Mclaren Commercial |
$1,168.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,104.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,181.96
|
| Rate for Payer: Priority Health Narrow Network |
$922.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,143.00
|
|
|
HC IVUS EA ADDL NON CORONARY VESSEL
|
Facility
|
IP
|
$1,298.86
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
36100484
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$909.20 |
| Max. Negotiated Rate |
$1,298.86 |
| Rate for Payer: Aetna Commercial |
$1,168.97
|
| Rate for Payer: ASR ASR |
$1,259.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,007.01
|
| Rate for Payer: BCN Commercial |
$1,007.01
|
| Rate for Payer: Cash Price |
$1,039.09
|
| Rate for Payer: Cofinity Commercial |
$1,220.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,039.09
|
| Rate for Payer: Healthscope Commercial |
$1,298.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,259.89
|
| Rate for Payer: Mclaren Commercial |
$1,168.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,104.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,143.00
|
|
|
HC IVUS NON CORONARY INITIAL
|
Facility
|
IP
|
$7,678.97
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
36100483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,375.28 |
| Max. Negotiated Rate |
$7,678.97 |
| Rate for Payer: Aetna Commercial |
$6,911.07
|
| Rate for Payer: ASR ASR |
$7,448.60
|
| Rate for Payer: BCBS Trust/PPO |
$5,953.51
|
| Rate for Payer: BCN Commercial |
$5,953.51
|
| Rate for Payer: Cash Price |
$6,143.18
|
| Rate for Payer: Cofinity Commercial |
$7,218.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,143.18
|
| Rate for Payer: Healthscope Commercial |
$7,678.97
|
| Rate for Payer: Healthscope Whirlpool |
$7,448.60
|
| Rate for Payer: Mclaren Commercial |
$6,911.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,527.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,375.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,757.49
|
|
|
HC IVUS NON CORONARY INITIAL
|
Facility
|
OP
|
$7,678.97
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
36100483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,071.59 |
| Max. Negotiated Rate |
$7,678.97 |
| Rate for Payer: Aetna Commercial |
$6,911.07
|
| Rate for Payer: ASR ASR |
$7,448.60
|
| Rate for Payer: BCBS Complete |
$3,071.59
|
| Rate for Payer: BCBS Trust/PPO |
$5,953.51
|
| Rate for Payer: BCN Commercial |
$5,953.51
|
| Rate for Payer: Cash Price |
$6,143.18
|
| Rate for Payer: Cofinity Commercial |
$7,218.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,143.18
|
| Rate for Payer: Healthscope Commercial |
$7,678.97
|
| Rate for Payer: Healthscope Whirlpool |
$7,448.60
|
| Rate for Payer: Mclaren Commercial |
$6,911.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,527.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,375.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,987.86
|
| Rate for Payer: Priority Health Narrow Network |
$5,452.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,757.49
|
|
|
HC IVUS OR OCT EACH ADDL VESSEL
|
Facility
|
IP
|
$1,502.16
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
48100107
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,051.51 |
| Max. Negotiated Rate |
$1,502.16 |
| Rate for Payer: Aetna Commercial |
$1,351.94
|
| Rate for Payer: ASR ASR |
$1,457.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,164.62
|
| Rate for Payer: BCN Commercial |
$1,164.62
|
| Rate for Payer: Cash Price |
$1,201.73
|
| Rate for Payer: Cofinity Commercial |
$1,412.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,201.73
|
| Rate for Payer: Healthscope Commercial |
$1,502.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,457.10
|
| Rate for Payer: Mclaren Commercial |
$1,351.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,276.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,321.90
|
|
|
HC IVUS OR OCT EACH ADDL VESSEL
|
Facility
|
OP
|
$1,502.16
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
48100107
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$600.86 |
| Max. Negotiated Rate |
$1,502.16 |
| Rate for Payer: Aetna Commercial |
$1,351.94
|
| Rate for Payer: ASR ASR |
$1,457.10
|
| Rate for Payer: BCBS Complete |
$600.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,164.62
|
| Rate for Payer: BCN Commercial |
$1,164.62
|
| Rate for Payer: Cash Price |
$1,201.73
|
| Rate for Payer: Cofinity Commercial |
$1,412.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,201.73
|
| Rate for Payer: Healthscope Commercial |
$1,502.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,457.10
|
| Rate for Payer: Mclaren Commercial |
$1,351.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,276.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,366.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,066.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,321.90
|
|
|
HC IVUS OR OCT INITIAL VESSEL
|
Facility
|
OP
|
$3,621.45
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
48100106
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,448.58 |
| Max. Negotiated Rate |
$3,621.45 |
| Rate for Payer: Aetna Commercial |
$3,259.30
|
| Rate for Payer: ASR ASR |
$3,512.81
|
| Rate for Payer: BCBS Complete |
$1,448.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,807.71
|
| Rate for Payer: BCN Commercial |
$2,807.71
|
| Rate for Payer: Cash Price |
$2,897.16
|
| Rate for Payer: Cofinity Commercial |
$3,404.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,897.16
|
| Rate for Payer: Healthscope Commercial |
$3,621.45
|
| Rate for Payer: Healthscope Whirlpool |
$3,512.81
|
| Rate for Payer: Mclaren Commercial |
$3,259.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,078.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,535.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,295.52
|
| Rate for Payer: Priority Health Narrow Network |
$2,571.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,186.88
|
|
|
HC IVUS OR OCT INITIAL VESSEL
|
Facility
|
IP
|
$3,621.45
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
48100106
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,535.02 |
| Max. Negotiated Rate |
$3,621.45 |
| Rate for Payer: Aetna Commercial |
$3,259.30
|
| Rate for Payer: ASR ASR |
$3,512.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,807.71
|
| Rate for Payer: BCN Commercial |
$2,807.71
|
| Rate for Payer: Cash Price |
$2,897.16
|
| Rate for Payer: Cofinity Commercial |
$3,404.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,897.16
|
| Rate for Payer: Healthscope Commercial |
$3,621.45
|
| Rate for Payer: Healthscope Whirlpool |
$3,512.81
|
| Rate for Payer: Mclaren Commercial |
$3,259.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,078.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,535.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,186.88
|
|
|
HC JAK2 EXON 12 MUTATION DETECTION
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
CPT 0027U
|
| Hospital Charge Code |
31000148
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.68 |
| Max. Negotiated Rate |
$366.00 |
| Rate for Payer: Aetna Commercial |
$329.40
|
| Rate for Payer: Aetna Medicare |
$121.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.39
|
| Rate for Payer: ASR ASR |
$355.02
|
| Rate for Payer: BCBS Complete |
$70.03
|
| Rate for Payer: BCBS MAPPO |
$121.91
|
| Rate for Payer: BCBS Trust/PPO |
$283.76
|
| Rate for Payer: BCN Commercial |
$283.76
|
| Rate for Payer: BCN Medicare Advantage |
$121.91
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$344.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.91
|
| Rate for Payer: Healthscope Commercial |
$366.00
|
| Rate for Payer: Healthscope Whirlpool |
$355.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$121.91
|
| Rate for Payer: Mclaren Commercial |
$329.40
|
| Rate for Payer: Mclaren Medicaid |
$66.68
|
| Rate for Payer: Mclaren Medicare |
$121.91
|
| Rate for Payer: Meridian Medicaid |
$70.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.10
|
| Rate for Payer: PACE Medicare |
$115.81
|
| Rate for Payer: PACE SWMI |
$121.91
|
| Rate for Payer: PHP Commercial |
$134.10
|
| Rate for Payer: PHP Medicaid |
$66.68
|
| Rate for Payer: PHP Medicare Advantage |
$121.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.06
|
| Rate for Payer: Priority Health Medicare |
$121.91
|
| Rate for Payer: Priority Health Narrow Network |
$128.85
|
| Rate for Payer: Railroad Medicare Medicare |
$121.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.08
|
| Rate for Payer: UHC Medicare Advantage |
$125.57
|
| Rate for Payer: VA VA |
$121.91
|
|
|
HC JAK2 EXON 12 MUTATION DETECTION
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
CPT 0027U
|
| Hospital Charge Code |
31000148
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$256.20 |
| Max. Negotiated Rate |
$366.00 |
| Rate for Payer: Aetna Commercial |
$329.40
|
| Rate for Payer: ASR ASR |
$355.02
|
| Rate for Payer: BCBS Trust/PPO |
$283.76
|
| Rate for Payer: BCN Commercial |
$283.76
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$344.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.80
|
| Rate for Payer: Healthscope Commercial |
$366.00
|
| Rate for Payer: Healthscope Whirlpool |
$355.02
|
| Rate for Payer: Mclaren Commercial |
$329.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.08
|
|
|
HC JAK2 V617F MUTATION
|
Facility
|
OP
|
$380.46
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$380.46 |
| Rate for Payer: Aetna Commercial |
$342.41
|
| Rate for Payer: Aetna Medicare |
$91.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.58
|
| Rate for Payer: ASR ASR |
$369.05
|
| Rate for Payer: BCBS Complete |
$52.65
|
| Rate for Payer: BCBS MAPPO |
$91.66
|
| Rate for Payer: BCBS Trust/PPO |
$294.97
|
| Rate for Payer: BCN Commercial |
$294.97
|
| Rate for Payer: BCN Medicare Advantage |
$91.66
|
| Rate for Payer: Cash Price |
$304.37
|
| Rate for Payer: Cash Price |
$304.37
|
| Rate for Payer: Cofinity Commercial |
$357.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.66
|
| Rate for Payer: Healthscope Commercial |
$380.46
|
| Rate for Payer: Healthscope Whirlpool |
$369.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$91.66
|
| Rate for Payer: Mclaren Commercial |
$342.41
|
| Rate for Payer: Mclaren Medicaid |
$50.14
|
| Rate for Payer: Mclaren Medicare |
$91.66
|
| Rate for Payer: Meridian Medicaid |
$52.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$96.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.39
|
| Rate for Payer: PACE Medicare |
$87.08
|
| Rate for Payer: PACE SWMI |
$91.66
|
| Rate for Payer: PHP Commercial |
$100.83
|
| Rate for Payer: PHP Medicaid |
$50.14
|
| Rate for Payer: PHP Medicare Advantage |
$91.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.88
|
| Rate for Payer: Priority Health Medicare |
$91.66
|
| Rate for Payer: Priority Health Narrow Network |
$44.70
|
| Rate for Payer: Railroad Medicare Medicare |
$91.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$334.80
|
| Rate for Payer: UHC Medicare Advantage |
$94.41
|
| Rate for Payer: VA VA |
$91.66
|
|
|
HC JAK2 V617F MUTATION
|
Facility
|
IP
|
$380.46
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$266.32 |
| Max. Negotiated Rate |
$380.46 |
| Rate for Payer: Aetna Commercial |
$342.41
|
| Rate for Payer: ASR ASR |
$369.05
|
| Rate for Payer: BCBS Trust/PPO |
$294.97
|
| Rate for Payer: BCN Commercial |
$294.97
|
| Rate for Payer: Cash Price |
$304.37
|
| Rate for Payer: Cofinity Commercial |
$357.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.37
|
| Rate for Payer: Healthscope Commercial |
$380.46
|
| Rate for Payer: Healthscope Whirlpool |
$369.05
|
| Rate for Payer: Mclaren Commercial |
$342.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$334.80
|
|
