|
HC IMMUNOGLOBULIN SUBCLASSES
|
Facility
|
OP
|
$22.89
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$52.70 |
| Rate for Payer: Aetna Commercial |
$20.60
|
| Rate for Payer: Aetna Medicare |
$9.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.62
|
| Rate for Payer: ASR ASR |
$22.20
|
| Rate for Payer: ASR Commercial |
$22.20
|
| Rate for Payer: BCBS Complete |
$5.23
|
| Rate for Payer: BCBS MAPPO |
$9.30
|
| Rate for Payer: BCBS Trust/PPO |
$18.74
|
| Rate for Payer: BCN Commercial |
$17.75
|
| Rate for Payer: BCN Medicare Advantage |
$9.30
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$21.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$22.89
|
| Rate for Payer: Healthscope Whirlpool |
$22.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.30
|
| Rate for Payer: Mclaren Commercial |
$20.60
|
| Rate for Payer: Mclaren Medicaid |
$4.98
|
| Rate for Payer: Mclaren Medicare |
$9.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.76
|
| Rate for Payer: Meridian Medicaid |
$5.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Nomi Health Commercial |
$18.77
|
| Rate for Payer: PACE Medicare |
$8.84
|
| Rate for Payer: PACE SWMI |
$9.30
|
| Rate for Payer: PHP Commercial |
$10.23
|
| Rate for Payer: PHP Medicaid |
$4.98
|
| Rate for Payer: PHP Medicare Advantage |
$9.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.70
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health Narrow Network |
$42.16
|
| Rate for Payer: Railroad Medicare Medicare |
$9.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.30
|
| Rate for Payer: UHC Exchange |
$14.42
|
| Rate for Payer: UHC Medicare Advantage |
$9.30
|
| Rate for Payer: UHCCP DNSP |
$9.30
|
| Rate for Payer: UHCCP Medicaid |
$4.98
|
| Rate for Payer: VA VA |
$9.30
|
|
|
HC IMMUNOGLOBULIN SUBCLASSES
|
Facility
|
IP
|
$22.89
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100211
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$22.89 |
| Rate for Payer: Aetna Commercial |
$20.60
|
| Rate for Payer: ASR ASR |
$22.20
|
| Rate for Payer: ASR Commercial |
$22.20
|
| Rate for Payer: BCBS Trust/PPO |
$18.65
|
| Rate for Payer: BCN Commercial |
$17.75
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$21.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$22.89
|
| Rate for Payer: Healthscope Whirlpool |
$22.20
|
| Rate for Payer: Mclaren Commercial |
$20.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Nomi Health Commercial |
$18.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.14
|
|
|
HC IMMUNOHISTOCHEMISTRY EA ADDL STAIN PER SPECIMEN
|
Facility
|
OP
|
$168.30
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
31000118
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.32 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Aetna Commercial |
$151.47
|
| Rate for Payer: Aetna Medicare |
$84.15
|
| Rate for Payer: ASR ASR |
$163.25
|
| Rate for Payer: ASR Commercial |
$163.25
|
| Rate for Payer: BCBS Complete |
$67.32
|
| Rate for Payer: BCBS Trust/PPO |
$137.82
|
| Rate for Payer: BCCCP Commercial |
$89.57
|
| Rate for Payer: BCN Commercial |
$130.48
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cofinity Commercial |
$158.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.64
|
| Rate for Payer: Healthscope Commercial |
$168.30
|
| Rate for Payer: Healthscope Whirlpool |
$163.25
|
| Rate for Payer: Mclaren Commercial |
$151.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.06
|
| Rate for Payer: Nomi Health Commercial |
$138.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.46
|
| Rate for Payer: Priority Health Narrow Network |
$117.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.10
|
|
|
HC IMMUNOHISTOCHEMISTRY EA ADDL STAIN PER SPECIMEN
|
Facility
|
IP
|
$168.30
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
31000118
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$109.40 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Aetna Commercial |
$151.47
|
| Rate for Payer: ASR ASR |
$163.25
|
| Rate for Payer: ASR Commercial |
$163.25
|
| Rate for Payer: BCBS Trust/PPO |
$137.15
|
| Rate for Payer: BCN Commercial |
$130.48
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cofinity Commercial |
$158.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.64
|
| Rate for Payer: Healthscope Commercial |
$168.30
|
| Rate for Payer: Healthscope Whirlpool |
$163.25
|
| Rate for Payer: Mclaren Commercial |
$151.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.06
|
| Rate for Payer: Nomi Health Commercial |
$138.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.10
|
|
|
HC IMMUNOHISTOCHEMISTRY STAIN
|
Facility
|
IP
|
$190.42
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
31000058
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$123.77 |
| Max. Negotiated Rate |
$190.42 |
| Rate for Payer: Aetna Commercial |
$171.38
|
| Rate for Payer: ASR ASR |
$184.71
|
| Rate for Payer: ASR Commercial |
$184.71
|
| Rate for Payer: BCBS Trust/PPO |
$155.17
|
| Rate for Payer: BCN Commercial |
$147.63
|
| Rate for Payer: Cash Price |
$152.34
|
| Rate for Payer: Cofinity Commercial |
$178.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.34
|
| Rate for Payer: Healthscope Commercial |
$190.42
|
| Rate for Payer: Healthscope Whirlpool |
$184.71
|
| Rate for Payer: Mclaren Commercial |
$171.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.86
|
| Rate for Payer: Nomi Health Commercial |
$156.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.57
|
|
|
HC IMMUNOHISTOCHEMISTRY STAIN
|
Facility
|
OP
|
$190.42
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
31000058
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$89.99 |
| Max. Negotiated Rate |
$260.24 |
| Rate for Payer: Aetna Commercial |
$171.38
|
| 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 |
$184.71
|
| Rate for Payer: ASR Commercial |
$184.71
|
| Rate for Payer: BCBS Complete |
$94.49
|
| Rate for Payer: BCBS MAPPO |
$167.90
|
| Rate for Payer: BCBS Trust/PPO |
$155.93
|
| Rate for Payer: BCCCP Commercial |
$104.63
|
| Rate for Payer: BCN Commercial |
$147.63
|
| Rate for Payer: BCN Medicare Advantage |
$167.90
|
| Rate for Payer: Cash Price |
$152.34
|
| Rate for Payer: Cash Price |
$152.34
|
| Rate for Payer: Cofinity Commercial |
$178.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.90
|
| Rate for Payer: Healthscope Commercial |
$190.42
|
| Rate for Payer: Healthscope Whirlpool |
$184.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$167.90
|
| Rate for Payer: Mclaren Commercial |
$171.38
|
| 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 |
$161.86
|
| Rate for Payer: Nomi Health Commercial |
$156.14
|
| 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 |
$123.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.37
|
| Rate for Payer: Priority Health Medicare |
$167.90
|
| Rate for Payer: Priority Health Narrow Network |
$146.70
|
| Rate for Payer: Railroad Medicare Medicare |
$167.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.57
|
| 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 IMMUNOHISTOCHEMISTY MULTIPLEX STAINS
|
Facility
|
IP
|
$355.46
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
31000117
|
|
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
|
|
|
HC IMMUNOHISTOCHEMISTY MULTIPLEX STAINS
|
Facility
|
OP
|
$355.46
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
31000117
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$188.91 |
| Max. Negotiated Rate |
$546.30 |
| Rate for Payer: Aetna Commercial |
$319.91
|
| Rate for Payer: Aetna Medicare |
$352.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$440.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$440.56
|
| Rate for Payer: ASR ASR |
$344.80
|
| Rate for Payer: ASR Commercial |
$344.80
|
| Rate for Payer: BCBS Complete |
$198.36
|
| Rate for Payer: BCBS MAPPO |
$352.45
|
| Rate for Payer: BCBS Trust/PPO |
$291.09
|
| Rate for Payer: BCN Commercial |
$275.59
|
| Rate for Payer: BCN Medicare Advantage |
$352.45
|
| 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 |
$352.45
|
| Rate for Payer: Healthscope Commercial |
$355.46
|
| Rate for Payer: Healthscope Whirlpool |
$344.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$352.45
|
| Rate for Payer: Mclaren Commercial |
$319.91
|
| Rate for Payer: Mclaren Medicaid |
$188.91
|
| Rate for Payer: Mclaren Medicare |
$352.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$370.07
|
| Rate for Payer: Meridian Medicaid |
$198.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$405.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.14
|
| Rate for Payer: Nomi Health Commercial |
$291.48
|
| Rate for Payer: PACE Medicare |
$334.83
|
| Rate for Payer: PACE SWMI |
$352.45
|
| Rate for Payer: PHP Commercial |
$387.70
|
| Rate for Payer: PHP Medicaid |
$188.91
|
| Rate for Payer: PHP Medicare Advantage |
$352.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.45
|
| Rate for Payer: Priority Health Medicare |
$352.45
|
| Rate for Payer: Priority Health Narrow Network |
$249.18
|
| Rate for Payer: Railroad Medicare Medicare |
$352.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.45
|
| Rate for Payer: UHC Exchange |
$546.30
|
| Rate for Payer: UHC Medicare Advantage |
$352.45
|
| Rate for Payer: UHCCP DNSP |
$352.45
|
| Rate for Payer: UHCCP Medicaid |
$188.91
|
| Rate for Payer: VA VA |
$352.45
|
|
|
HC IMPELLA LVAD
|
Facility
|
IP
|
$46,227.59
|
|
| Hospital Charge Code |
27200132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30,047.93 |
| Max. Negotiated Rate |
$46,227.59 |
| Rate for Payer: Aetna Commercial |
$41,604.83
|
| Rate for Payer: ASR ASR |
$44,840.76
|
| Rate for Payer: ASR Commercial |
$44,840.76
|
| Rate for Payer: BCBS Trust/PPO |
$37,670.86
|
| Rate for Payer: BCN Commercial |
$35,840.25
|
| Rate for Payer: Cash Price |
$36,982.07
|
| Rate for Payer: Cofinity Commercial |
$43,453.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36,982.07
|
| Rate for Payer: Healthscope Commercial |
$46,227.59
|
| Rate for Payer: Healthscope Whirlpool |
$44,840.76
|
| Rate for Payer: Mclaren Commercial |
$41,604.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39,293.45
|
| Rate for Payer: Nomi Health Commercial |
$37,906.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30,047.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40,680.28
|
|
|
HC IMPELLA LVAD
|
Facility
|
OP
|
$46,227.59
|
|
| Hospital Charge Code |
27200132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18,491.04 |
| Max. Negotiated Rate |
$46,227.59 |
| Rate for Payer: Aetna Commercial |
$41,604.83
|
| Rate for Payer: Aetna Medicare |
$23,113.80
|
| Rate for Payer: ASR ASR |
$44,840.76
|
| Rate for Payer: ASR Commercial |
$44,840.76
|
| Rate for Payer: BCBS Complete |
$18,491.04
|
| Rate for Payer: BCBS Trust/PPO |
$37,855.77
|
| Rate for Payer: BCN Commercial |
$35,840.25
|
| Rate for Payer: Cash Price |
$36,982.07
|
| Rate for Payer: Cofinity Commercial |
$43,453.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36,982.07
|
| Rate for Payer: Healthscope Commercial |
$46,227.59
|
| Rate for Payer: Healthscope Whirlpool |
$44,840.76
|
| Rate for Payer: Mclaren Commercial |
$41,604.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39,293.45
|
| Rate for Payer: Nomi Health Commercial |
$37,906.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30,047.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40,504.61
|
| Rate for Payer: Priority Health Narrow Network |
$32,405.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40,680.28
|
|
|
HC IMPELLA MONITORING KIT
|
Facility
|
OP
|
$339.45
|
|
| Hospital Charge Code |
27200133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.78 |
| Max. Negotiated Rate |
$339.45 |
| Rate for Payer: Aetna Commercial |
$305.50
|
| Rate for Payer: Aetna Medicare |
$169.72
|
| Rate for Payer: ASR ASR |
$329.27
|
| Rate for Payer: ASR Commercial |
$329.27
|
| Rate for Payer: BCBS Complete |
$135.78
|
| Rate for Payer: BCBS Trust/PPO |
$277.98
|
| Rate for Payer: BCN Commercial |
$263.18
|
| Rate for Payer: Cash Price |
$271.56
|
| Rate for Payer: Cofinity Commercial |
$319.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.56
|
| Rate for Payer: Healthscope Commercial |
$339.45
|
| Rate for Payer: Healthscope Whirlpool |
$329.27
|
| Rate for Payer: Mclaren Commercial |
$305.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.53
|
| Rate for Payer: Nomi Health Commercial |
$278.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$297.43
|
| Rate for Payer: Priority Health Narrow Network |
$237.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.72
|
|
|
HC IMPELLA MONITORING KIT
|
Facility
|
IP
|
$339.45
|
|
| Hospital Charge Code |
27200133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$220.64 |
| Max. Negotiated Rate |
$339.45 |
| Rate for Payer: Aetna Commercial |
$305.50
|
| Rate for Payer: ASR ASR |
$329.27
|
| Rate for Payer: ASR Commercial |
$329.27
|
| Rate for Payer: BCBS Trust/PPO |
$276.62
|
| Rate for Payer: BCN Commercial |
$263.18
|
| Rate for Payer: Cash Price |
$271.56
|
| Rate for Payer: Cofinity Commercial |
$319.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.56
|
| Rate for Payer: Healthscope Commercial |
$339.45
|
| Rate for Payer: Healthscope Whirlpool |
$329.27
|
| Rate for Payer: Mclaren Commercial |
$305.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.53
|
| Rate for Payer: Nomi Health Commercial |
$278.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.72
|
|
|
HC IMPELLA REMOVAL
|
Facility
|
OP
|
$2,930.58
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
48100114
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$2,930.58 |
| Rate for Payer: Aetna Commercial |
$2,637.52
|
| Rate for Payer: Aetna Medicare |
$1,465.29
|
| Rate for Payer: ASR ASR |
$2,842.66
|
| Rate for Payer: ASR Commercial |
$2,842.66
|
| Rate for Payer: BCBS Complete |
$1,172.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,399.85
|
| Rate for Payer: BCN Commercial |
$2,272.08
|
| Rate for Payer: Cash Price |
$2,344.46
|
| Rate for Payer: Cash Price |
$2,344.46
|
| Rate for Payer: Cofinity Commercial |
$2,754.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,344.46
|
| Rate for Payer: Healthscope Commercial |
$2,930.58
|
| Rate for Payer: Healthscope Whirlpool |
$2,842.66
|
| Rate for Payer: Mclaren Commercial |
$2,637.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,490.99
|
| Rate for Payer: Nomi Health Commercial |
$2,403.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,904.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,578.91
|
|
|
HC IMPELLA REMOVAL
|
Facility
|
IP
|
$2,930.58
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
48100114
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,904.88 |
| Max. Negotiated Rate |
$2,930.58 |
| Rate for Payer: Aetna Commercial |
$2,637.52
|
| Rate for Payer: ASR ASR |
$2,842.66
|
| Rate for Payer: ASR Commercial |
$2,842.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,388.13
|
| Rate for Payer: BCN Commercial |
$2,272.08
|
| Rate for Payer: Cash Price |
$2,344.46
|
| Rate for Payer: Cofinity Commercial |
$2,754.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,344.46
|
| Rate for Payer: Healthscope Commercial |
$2,930.58
|
| Rate for Payer: Healthscope Whirlpool |
$2,842.66
|
| Rate for Payer: Mclaren Commercial |
$2,637.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,490.99
|
| Rate for Payer: Nomi Health Commercial |
$2,403.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,904.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,578.91
|
|
|
HC IMPLANTABLE PRESSURE SENSOR W ANGIO
|
Facility
|
IP
|
$6,202.63
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
48100105
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,031.71 |
| Max. Negotiated Rate |
$6,202.63 |
| Rate for Payer: Aetna Commercial |
$5,582.37
|
| Rate for Payer: ASR ASR |
$6,016.55
|
| Rate for Payer: ASR Commercial |
$6,016.55
|
| Rate for Payer: BCBS Trust/PPO |
$5,054.52
|
| Rate for Payer: BCN Commercial |
$4,808.90
|
| Rate for Payer: Cash Price |
$4,962.10
|
| Rate for Payer: Cofinity Commercial |
$5,830.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,962.10
|
| Rate for Payer: Healthscope Commercial |
$6,202.63
|
| Rate for Payer: Healthscope Whirlpool |
$6,016.55
|
| Rate for Payer: Mclaren Commercial |
$5,582.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,272.24
|
| Rate for Payer: Nomi Health Commercial |
$5,086.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,031.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,458.31
|
|
|
HC IMPLANTABLE PRESSURE SENSOR W ANGIO
|
Facility
|
OP
|
$6,202.63
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
48100105
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,031.71 |
| Max. Negotiated Rate |
$43,172.94 |
| Rate for Payer: Aetna Commercial |
$5,582.37
|
| Rate for Payer: Aetna Medicare |
$27,853.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,816.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,816.89
|
| Rate for Payer: ASR ASR |
$6,016.55
|
| Rate for Payer: ASR Commercial |
$6,016.55
|
| Rate for Payer: BCBS Complete |
$15,675.96
|
| Rate for Payer: BCBS MAPPO |
$27,853.51
|
| Rate for Payer: BCBS Trust/PPO |
$5,079.33
|
| Rate for Payer: BCN Commercial |
$4,808.90
|
| Rate for Payer: BCN Medicare Advantage |
$27,853.51
|
| Rate for Payer: Cash Price |
$4,962.10
|
| Rate for Payer: Cash Price |
$4,962.10
|
| Rate for Payer: Cofinity Commercial |
$5,830.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,962.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,853.51
|
| Rate for Payer: Healthscope Commercial |
$6,202.63
|
| Rate for Payer: Healthscope Whirlpool |
$6,016.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$27,853.51
|
| Rate for Payer: Mclaren Commercial |
$5,582.37
|
| Rate for Payer: Mclaren Medicaid |
$14,929.48
|
| Rate for Payer: Mclaren Medicare |
$27,853.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,246.19
|
| Rate for Payer: Meridian Medicaid |
$15,675.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,031.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,272.24
|
| Rate for Payer: Nomi Health Commercial |
$5,086.16
|
| Rate for Payer: PACE Medicare |
$26,460.83
|
| Rate for Payer: PACE SWMI |
$27,853.51
|
| Rate for Payer: PHP Commercial |
$30,638.86
|
| Rate for Payer: PHP Medicaid |
$14,929.48
|
| Rate for Payer: PHP Medicare Advantage |
$27,853.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,929.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,031.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33,592.20
|
| Rate for Payer: Priority Health Medicare |
$27,853.51
|
| Rate for Payer: Priority Health Narrow Network |
$26,873.76
|
| Rate for Payer: Railroad Medicare Medicare |
$27,853.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,458.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$27,853.51
|
| Rate for Payer: UHC Exchange |
$43,172.94
|
| Rate for Payer: UHC Medicare Advantage |
$27,853.51
|
| Rate for Payer: UHCCP DNSP |
$27,853.51
|
| Rate for Payer: UHCCP Medicaid |
$14,929.48
|
| Rate for Payer: VA VA |
$27,853.51
|
|
|
HC IMPLANTABLE PRESSURE SENSOR WO LEAD
|
Facility
|
OP
|
$72,139.89
|
|
|
Service Code
|
HCPCS C2624
|
| Hospital Charge Code |
27800103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28,855.96 |
| Max. Negotiated Rate |
$72,139.89 |
| Rate for Payer: Aetna Commercial |
$64,925.90
|
| Rate for Payer: Aetna Medicare |
$36,069.94
|
| Rate for Payer: ASR ASR |
$69,975.69
|
| Rate for Payer: ASR Commercial |
$69,975.69
|
| Rate for Payer: BCBS Complete |
$28,855.96
|
| Rate for Payer: BCBS Trust/PPO |
$59,075.36
|
| Rate for Payer: BCN Commercial |
$55,930.06
|
| Rate for Payer: Cash Price |
$57,711.91
|
| Rate for Payer: Cofinity Commercial |
$67,811.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57,711.91
|
| Rate for Payer: Healthscope Commercial |
$72,139.89
|
| Rate for Payer: Healthscope Whirlpool |
$69,975.69
|
| Rate for Payer: Mclaren Commercial |
$64,925.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61,318.91
|
| Rate for Payer: Nomi Health Commercial |
$59,154.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46,890.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63,208.97
|
| Rate for Payer: Priority Health Narrow Network |
$50,570.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63,483.10
|
|
|
HC IMPLANTABLE PRESSURE SENSOR WO LEAD
|
Facility
|
IP
|
$72,139.89
|
|
|
Service Code
|
HCPCS C2624
|
| Hospital Charge Code |
27800103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46,890.93 |
| Max. Negotiated Rate |
$72,139.89 |
| Rate for Payer: Aetna Commercial |
$64,925.90
|
| Rate for Payer: ASR ASR |
$69,975.69
|
| Rate for Payer: ASR Commercial |
$69,975.69
|
| Rate for Payer: BCBS Trust/PPO |
$58,786.80
|
| Rate for Payer: BCN Commercial |
$55,930.06
|
| Rate for Payer: Cash Price |
$57,711.91
|
| Rate for Payer: Cofinity Commercial |
$67,811.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57,711.91
|
| Rate for Payer: Healthscope Commercial |
$72,139.89
|
| Rate for Payer: Healthscope Whirlpool |
$69,975.69
|
| Rate for Payer: Mclaren Commercial |
$64,925.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61,318.91
|
| Rate for Payer: Nomi Health Commercial |
$59,154.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46,890.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63,483.10
|
|
|
HC IMPLANT HORMONE SUBCUTANEOUS
|
Facility
|
IP
|
$543.33
|
|
|
Service Code
|
CPT 11980
|
| Hospital Charge Code |
76100178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$353.16 |
| Max. Negotiated Rate |
$543.33 |
| Rate for Payer: Aetna Commercial |
$489.00
|
| Rate for Payer: ASR ASR |
$527.03
|
| Rate for Payer: ASR Commercial |
$527.03
|
| Rate for Payer: BCBS Trust/PPO |
$442.76
|
| Rate for Payer: BCN Commercial |
$421.24
|
| Rate for Payer: Cash Price |
$434.66
|
| Rate for Payer: Cofinity Commercial |
$510.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.66
|
| Rate for Payer: Healthscope Commercial |
$543.33
|
| Rate for Payer: Healthscope Whirlpool |
$527.03
|
| Rate for Payer: Mclaren Commercial |
$489.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.83
|
| Rate for Payer: Nomi Health Commercial |
$445.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$478.13
|
|
|
HC IMPLANT HORMONE SUBCUTANEOUS
|
Facility
|
OP
|
$543.33
|
|
|
Service Code
|
CPT 11980
|
| Hospital Charge Code |
76100178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.56 |
| Max. Negotiated Rate |
$606.00 |
| Rate for Payer: Aetna Commercial |
$489.00
|
| Rate for Payer: Aetna Medicare |
$390.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$488.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$488.71
|
| Rate for Payer: ASR ASR |
$527.03
|
| Rate for Payer: ASR Commercial |
$527.03
|
| Rate for Payer: BCBS Complete |
$220.04
|
| Rate for Payer: BCBS MAPPO |
$390.97
|
| Rate for Payer: BCBS Trust/PPO |
$444.93
|
| Rate for Payer: BCN Commercial |
$421.24
|
| Rate for Payer: BCN Medicare Advantage |
$390.97
|
| Rate for Payer: Cash Price |
$434.66
|
| Rate for Payer: Cash Price |
$434.66
|
| Rate for Payer: Cofinity Commercial |
$510.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.97
|
| Rate for Payer: Healthscope Commercial |
$543.33
|
| Rate for Payer: Healthscope Whirlpool |
$527.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$390.97
|
| Rate for Payer: Mclaren Commercial |
$489.00
|
| Rate for Payer: Mclaren Medicaid |
$209.56
|
| Rate for Payer: Mclaren Medicare |
$390.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.52
|
| Rate for Payer: Meridian Medicaid |
$220.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.83
|
| Rate for Payer: Nomi Health Commercial |
$445.53
|
| Rate for Payer: PACE Medicare |
$371.42
|
| Rate for Payer: PACE SWMI |
$390.97
|
| Rate for Payer: PHP Commercial |
$430.07
|
| Rate for Payer: PHP Medicaid |
$209.56
|
| Rate for Payer: PHP Medicare Advantage |
$390.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$476.07
|
| Rate for Payer: Priority Health Medicare |
$390.97
|
| Rate for Payer: Priority Health Narrow Network |
$380.87
|
| Rate for Payer: Railroad Medicare Medicare |
$390.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$478.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.97
|
| Rate for Payer: UHC Exchange |
$606.00
|
| Rate for Payer: UHC Medicare Advantage |
$390.97
|
| Rate for Payer: UHCCP DNSP |
$390.97
|
| Rate for Payer: UHCCP Medicaid |
$209.56
|
| Rate for Payer: VA VA |
$390.97
|
|
|
HC IMRT PLAN
|
Facility
|
OP
|
$7,125.70
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
33300006
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$718.56 |
| Max. Negotiated Rate |
$7,125.70 |
| Rate for Payer: Aetna Commercial |
$6,413.13
|
| Rate for Payer: Aetna Medicare |
$1,340.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,675.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,675.74
|
| Rate for Payer: ASR ASR |
$6,911.93
|
| Rate for Payer: ASR Commercial |
$6,911.93
|
| Rate for Payer: BCBS Complete |
$754.48
|
| Rate for Payer: BCBS MAPPO |
$1,340.59
|
| Rate for Payer: BCBS Trust/PPO |
$5,835.24
|
| Rate for Payer: BCN Commercial |
$5,524.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,340.59
|
| Rate for Payer: Cash Price |
$5,700.56
|
| Rate for Payer: Cash Price |
$5,700.56
|
| Rate for Payer: Cofinity Commercial |
$6,698.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,700.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,340.59
|
| Rate for Payer: Healthscope Commercial |
$7,125.70
|
| Rate for Payer: Healthscope Whirlpool |
$6,911.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,340.59
|
| Rate for Payer: Mclaren Commercial |
$6,413.13
|
| Rate for Payer: Mclaren Medicaid |
$718.56
|
| Rate for Payer: Mclaren Medicare |
$1,340.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,407.62
|
| Rate for Payer: Meridian Medicaid |
$754.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,541.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,056.84
|
| Rate for Payer: Nomi Health Commercial |
$5,843.07
|
| Rate for Payer: PACE Medicare |
$1,273.56
|
| Rate for Payer: PACE SWMI |
$1,340.59
|
| Rate for Payer: PHP Commercial |
$1,474.65
|
| Rate for Payer: PHP Medicaid |
$718.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,340.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$718.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,631.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,243.54
|
| Rate for Payer: Priority Health Medicare |
$1,340.59
|
| Rate for Payer: Priority Health Narrow Network |
$4,995.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,340.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,270.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,340.59
|
| Rate for Payer: UHC Exchange |
$2,077.91
|
| Rate for Payer: UHC Medicare Advantage |
$1,340.59
|
| Rate for Payer: UHCCP DNSP |
$1,340.59
|
| Rate for Payer: UHCCP Medicaid |
$718.56
|
| Rate for Payer: VA VA |
$1,340.59
|
|
|
HC IMRT PLAN
|
Facility
|
IP
|
$7,125.70
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
33300006
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$4,631.70 |
| Max. Negotiated Rate |
$7,125.70 |
| Rate for Payer: Aetna Commercial |
$6,413.13
|
| Rate for Payer: ASR ASR |
$6,911.93
|
| Rate for Payer: ASR Commercial |
$6,911.93
|
| Rate for Payer: BCBS Trust/PPO |
$5,806.73
|
| Rate for Payer: BCN Commercial |
$5,524.56
|
| Rate for Payer: Cash Price |
$5,700.56
|
| Rate for Payer: Cofinity Commercial |
$6,698.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,700.56
|
| Rate for Payer: Healthscope Commercial |
$7,125.70
|
| Rate for Payer: Healthscope Whirlpool |
$6,911.93
|
| Rate for Payer: Mclaren Commercial |
$6,413.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,056.84
|
| Rate for Payer: Nomi Health Commercial |
$5,843.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,631.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,270.62
|
|
|
HC IN 111 AUTOLOG WBC PER STUDY
|
Facility
|
OP
|
$784.03
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
34300013
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$509.62 |
| Max. Negotiated Rate |
$4,294.16 |
| Rate for Payer: Aetna Commercial |
$705.63
|
| Rate for Payer: Aetna Medicare |
$1,031.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,289.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,289.24
|
| Rate for Payer: ASR ASR |
$760.51
|
| Rate for Payer: ASR Commercial |
$760.51
|
| Rate for Payer: BCBS Complete |
$580.47
|
| Rate for Payer: BCBS MAPPO |
$1,031.39
|
| Rate for Payer: BCBS Trust/PPO |
$642.04
|
| Rate for Payer: BCN Commercial |
$607.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,031.39
|
| Rate for Payer: Cash Price |
$627.22
|
| Rate for Payer: Cash Price |
$627.22
|
| Rate for Payer: Cofinity Commercial |
$736.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$627.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,031.39
|
| Rate for Payer: Healthscope Commercial |
$784.03
|
| Rate for Payer: Healthscope Whirlpool |
$760.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,031.39
|
| Rate for Payer: Mclaren Commercial |
$705.63
|
| Rate for Payer: Mclaren Medicaid |
$552.83
|
| Rate for Payer: Mclaren Medicare |
$1,031.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,082.96
|
| Rate for Payer: Meridian Medicaid |
$580.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,186.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$666.43
|
| Rate for Payer: Nomi Health Commercial |
$642.90
|
| Rate for Payer: PACE Medicare |
$979.82
|
| Rate for Payer: PACE SWMI |
$1,031.39
|
| Rate for Payer: PHP Commercial |
$1,134.53
|
| Rate for Payer: PHP Medicaid |
$552.83
|
| Rate for Payer: PHP Medicare Advantage |
$1,031.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$552.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$509.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,294.16
|
| Rate for Payer: Priority Health Medicare |
$1,031.39
|
| Rate for Payer: Priority Health Narrow Network |
$3,435.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,031.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$689.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,031.39
|
| Rate for Payer: UHC Exchange |
$1,598.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,031.39
|
| Rate for Payer: UHCCP DNSP |
$1,031.39
|
| Rate for Payer: UHCCP Medicaid |
$552.83
|
| Rate for Payer: VA VA |
$1,031.39
|
|
|
HC IN 111 AUTOLOG WBC PER STUDY
|
Facility
|
IP
|
$784.03
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
34300013
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$509.62 |
| Max. Negotiated Rate |
$784.03 |
| Rate for Payer: Aetna Commercial |
$705.63
|
| Rate for Payer: ASR ASR |
$760.51
|
| Rate for Payer: ASR Commercial |
$760.51
|
| Rate for Payer: BCBS Trust/PPO |
$638.91
|
| Rate for Payer: BCN Commercial |
$607.86
|
| Rate for Payer: Cash Price |
$627.22
|
| Rate for Payer: Cofinity Commercial |
$736.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$627.22
|
| Rate for Payer: Healthscope Commercial |
$784.03
|
| Rate for Payer: Healthscope Whirlpool |
$760.51
|
| Rate for Payer: Mclaren Commercial |
$705.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$666.43
|
| Rate for Payer: Nomi Health Commercial |
$642.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$509.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$689.95
|
|
|
HC IN 111 OCTEO PER STUDY UP TO 6 MCI
|
Facility
|
IP
|
$5,411.53
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
34300014
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3,517.49 |
| Max. Negotiated Rate |
$5,411.53 |
| Rate for Payer: Aetna Commercial |
$4,870.38
|
| Rate for Payer: ASR ASR |
$5,249.18
|
| Rate for Payer: ASR Commercial |
$5,249.18
|
| Rate for Payer: BCBS Trust/PPO |
$4,409.86
|
| Rate for Payer: BCN Commercial |
$4,195.56
|
| Rate for Payer: Cash Price |
$4,329.22
|
| Rate for Payer: Cofinity Commercial |
$5,086.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,329.22
|
| Rate for Payer: Healthscope Commercial |
$5,411.53
|
| Rate for Payer: Healthscope Whirlpool |
$5,249.18
|
| Rate for Payer: Mclaren Commercial |
$4,870.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,599.80
|
| Rate for Payer: Nomi Health Commercial |
$4,437.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,517.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,762.15
|
|
