|
HC TANGENTIAL BIOPSY SKIN ADDL LESION
|
Facility
|
IP
|
$81.91
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
76100149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.34 |
| Max. Negotiated Rate |
$81.91 |
| Rate for Payer: Aetna Commercial |
$73.72
|
| Rate for Payer: ASR ASR |
$79.45
|
| Rate for Payer: BCBS Trust/PPO |
$63.50
|
| Rate for Payer: BCN Commercial |
$63.50
|
| Rate for Payer: Cash Price |
$65.53
|
| Rate for Payer: Cofinity Commercial |
$77.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.53
|
| Rate for Payer: Healthscope Commercial |
$81.91
|
| Rate for Payer: Healthscope Whirlpool |
$79.45
|
| Rate for Payer: Mclaren Commercial |
$73.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.08
|
|
|
HC TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$270.30
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
76100148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.21 |
| Max. Negotiated Rate |
$270.30 |
| Rate for Payer: Aetna Commercial |
$243.27
|
| Rate for Payer: ASR ASR |
$262.19
|
| Rate for Payer: BCBS Trust/PPO |
$209.56
|
| Rate for Payer: BCN Commercial |
$209.56
|
| Rate for Payer: Cash Price |
$216.24
|
| Rate for Payer: Cofinity Commercial |
$254.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.24
|
| Rate for Payer: Healthscope Commercial |
$270.30
|
| Rate for Payer: Healthscope Whirlpool |
$262.19
|
| Rate for Payer: Mclaren Commercial |
$243.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.86
|
|
|
HC TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$270.30
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
76100148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$270.30 |
| Rate for Payer: Aetna Commercial |
$243.27
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$262.19
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$209.56
|
| Rate for Payer: BCN Commercial |
$209.56
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$216.24
|
| Rate for Payer: Cash Price |
$216.24
|
| Rate for Payer: Cofinity Commercial |
$254.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$270.30
|
| Rate for Payer: Healthscope Whirlpool |
$262.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$243.27
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.76
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.80
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$151.04
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.86
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC TAVR VALVE LVL 37
|
Facility
|
IP
|
$37,500.00
|
|
| Hospital Charge Code |
27800353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26,250.00 |
| Max. Negotiated Rate |
$37,500.00 |
| Rate for Payer: Aetna Commercial |
$33,750.00
|
| Rate for Payer: ASR ASR |
$36,375.00
|
| Rate for Payer: BCBS Trust/PPO |
$29,073.75
|
| Rate for Payer: BCN Commercial |
$29,073.75
|
| Rate for Payer: Cash Price |
$30,000.00
|
| Rate for Payer: Cofinity Commercial |
$35,250.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30,000.00
|
| Rate for Payer: Healthscope Commercial |
$37,500.00
|
| Rate for Payer: Healthscope Whirlpool |
$36,375.00
|
| Rate for Payer: Mclaren Commercial |
$33,750.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31,875.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26,250.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33,000.00
|
|
|
HC TAVR VALVE LVL 37
|
Facility
|
OP
|
$37,500.00
|
|
| Hospital Charge Code |
27800353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,000.00 |
| Max. Negotiated Rate |
$37,500.00 |
| Rate for Payer: Aetna Commercial |
$33,750.00
|
| Rate for Payer: ASR ASR |
$36,375.00
|
| Rate for Payer: BCBS Complete |
$15,000.00
|
| Rate for Payer: BCBS Trust/PPO |
$29,073.75
|
| Rate for Payer: BCN Commercial |
$29,073.75
|
| Rate for Payer: Cash Price |
$30,000.00
|
| Rate for Payer: Cofinity Commercial |
$35,250.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30,000.00
|
| Rate for Payer: Healthscope Commercial |
$37,500.00
|
| Rate for Payer: Healthscope Whirlpool |
$36,375.00
|
| Rate for Payer: Mclaren Commercial |
$33,750.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31,875.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26,250.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,125.00
|
| Rate for Payer: Priority Health Narrow Network |
$26,625.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33,000.00
|
|
|
HC TAVR VALVE LVL 40
|
Facility
|
OP
|
$40,625.00
|
|
| Hospital Charge Code |
27800354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16,250.00 |
| Max. Negotiated Rate |
$40,625.00 |
| Rate for Payer: Aetna Commercial |
$36,562.50
|
| Rate for Payer: ASR ASR |
$39,406.25
|
| Rate for Payer: BCBS Complete |
$16,250.00
|
| Rate for Payer: BCBS Trust/PPO |
$31,496.56
|
| Rate for Payer: BCN Commercial |
$31,496.56
|
| Rate for Payer: Cash Price |
$32,500.00
|
| Rate for Payer: Cofinity Commercial |
$38,187.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32,500.00
|
| Rate for Payer: Healthscope Commercial |
$40,625.00
|
| Rate for Payer: Healthscope Whirlpool |
$39,406.25
|
| Rate for Payer: Mclaren Commercial |
$36,562.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34,531.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28,437.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,968.75
|
| Rate for Payer: Priority Health Narrow Network |
$28,843.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35,750.00
|
|
|
HC TAVR VALVE LVL 40
|
Facility
|
IP
|
$40,625.00
|
|
| Hospital Charge Code |
27800354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28,437.50 |
| Max. Negotiated Rate |
$40,625.00 |
| Rate for Payer: Aetna Commercial |
$36,562.50
|
| Rate for Payer: ASR ASR |
$39,406.25
|
| Rate for Payer: BCBS Trust/PPO |
$31,496.56
|
| Rate for Payer: BCN Commercial |
$31,496.56
|
| Rate for Payer: Cash Price |
$32,500.00
|
| Rate for Payer: Cofinity Commercial |
$38,187.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32,500.00
|
| Rate for Payer: Healthscope Commercial |
$40,625.00
|
| Rate for Payer: Healthscope Whirlpool |
$39,406.25
|
| Rate for Payer: Mclaren Commercial |
$36,562.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34,531.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28,437.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35,750.00
|
|
|
HC TBS TECHNICAL CALCULATION ONLY
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
32000335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: ASR ASR |
$237.65
|
| Rate for Payer: BCBS Trust/PPO |
$189.95
|
| Rate for Payer: BCN Commercial |
$189.95
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$230.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Healthscope Commercial |
$245.00
|
| Rate for Payer: Healthscope Whirlpool |
$237.65
|
| Rate for Payer: Mclaren Commercial |
$220.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.60
|
|
|
HC TBS TECHNICAL CALCULATION ONLY
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
32000335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: ASR ASR |
$237.65
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$189.95
|
| Rate for Payer: BCN Commercial |
$189.95
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$230.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Healthscope Commercial |
$245.00
|
| Rate for Payer: Healthscope Whirlpool |
$237.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$80.77
|
| Rate for Payer: Mclaren Commercial |
$220.50
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Commercial |
$88.85
|
| Rate for Payer: PHP Medicaid |
$44.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.95
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$173.95
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.60
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
HC TB TEST
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: ASR ASR |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$18.61
|
| Rate for Payer: BCN Commercial |
$18.61
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$22.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$24.00
|
| Rate for Payer: Healthscope Whirlpool |
$23.28
|
| Rate for Payer: Mclaren Commercial |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.12
|
|
|
HC TB TEST
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$33.09 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.09
|
| Rate for Payer: ASR ASR |
$23.28
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$26.47
|
| Rate for Payer: BCBS Trust/PPO |
$18.61
|
| Rate for Payer: BCN Commercial |
$18.61
|
| Rate for Payer: BCN Medicare Advantage |
$26.47
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$22.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.47
|
| Rate for Payer: Healthscope Commercial |
$24.00
|
| Rate for Payer: Healthscope Whirlpool |
$23.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$26.47
|
| Rate for Payer: Mclaren Commercial |
$21.60
|
| Rate for Payer: Mclaren Medicaid |
$14.48
|
| Rate for Payer: Mclaren Medicare |
$26.47
|
| Rate for Payer: Meridian Medicaid |
$15.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.40
|
| Rate for Payer: PACE Medicare |
$25.15
|
| Rate for Payer: PACE SWMI |
$26.47
|
| Rate for Payer: PHP Commercial |
$29.12
|
| Rate for Payer: PHP Medicaid |
$14.48
|
| Rate for Payer: PHP Medicare Advantage |
$26.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.32
|
| Rate for Payer: Priority Health Medicare |
$26.47
|
| Rate for Payer: Priority Health Narrow Network |
$9.86
|
| Rate for Payer: Railroad Medicare Medicare |
$26.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.12
|
| Rate for Payer: UHC Medicare Advantage |
$27.26
|
| Rate for Payer: VA VA |
$26.47
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
OP
|
$154.43
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$61.77 |
| Max. Negotiated Rate |
$258.08 |
| Rate for Payer: Aetna Commercial |
$138.99
|
| Rate for Payer: ASR ASR |
$149.80
|
| Rate for Payer: BCBS Complete |
$61.77
|
| Rate for Payer: BCBS Trust/PPO |
$119.73
|
| Rate for Payer: BCN Commercial |
$119.73
|
| Rate for Payer: Cash Price |
$123.54
|
| Rate for Payer: Cash Price |
$123.54
|
| Rate for Payer: Cofinity Commercial |
$145.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.54
|
| Rate for Payer: Healthscope Commercial |
$154.43
|
| Rate for Payer: Healthscope Whirlpool |
$149.80
|
| Rate for Payer: Mclaren Commercial |
$138.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$258.08
|
| Rate for Payer: Priority Health Narrow Network |
$206.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.90
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
IP
|
$154.43
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$108.10 |
| Max. Negotiated Rate |
$154.43 |
| Rate for Payer: Aetna Commercial |
$138.99
|
| Rate for Payer: ASR ASR |
$149.80
|
| Rate for Payer: BCBS Trust/PPO |
$119.73
|
| Rate for Payer: BCN Commercial |
$119.73
|
| Rate for Payer: Cash Price |
$123.54
|
| Rate for Payer: Cofinity Commercial |
$145.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.54
|
| Rate for Payer: Healthscope Commercial |
$154.43
|
| Rate for Payer: Healthscope Whirlpool |
$149.80
|
| Rate for Payer: Mclaren Commercial |
$138.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.90
|
|
|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
IP
|
$1,745.01
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,221.51 |
| Max. Negotiated Rate |
$1,745.01 |
| Rate for Payer: Aetna Commercial |
$1,570.51
|
| Rate for Payer: ASR ASR |
$1,692.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,352.91
|
| Rate for Payer: BCN Commercial |
$1,352.91
|
| Rate for Payer: Cash Price |
$1,396.01
|
| Rate for Payer: Cofinity Commercial |
$1,640.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.01
|
| Rate for Payer: Healthscope Commercial |
$1,745.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,692.66
|
| Rate for Payer: Mclaren Commercial |
$1,570.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,483.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,221.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,535.61
|
|
|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
OP
|
$1,745.01
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$698.00 |
| Max. Negotiated Rate |
$1,745.01 |
| Rate for Payer: Aetna Commercial |
$1,570.51
|
| Rate for Payer: ASR ASR |
$1,692.66
|
| Rate for Payer: BCBS Complete |
$698.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,352.91
|
| Rate for Payer: BCN Commercial |
$1,352.91
|
| Rate for Payer: Cash Price |
$1,396.01
|
| Rate for Payer: Cofinity Commercial |
$1,640.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.01
|
| Rate for Payer: Healthscope Commercial |
$1,745.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,692.66
|
| Rate for Payer: Mclaren Commercial |
$1,570.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,483.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,221.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,587.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,238.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,535.61
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
OP
|
$131.39
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$52.56 |
| Max. Negotiated Rate |
$131.39 |
| Rate for Payer: Aetna Commercial |
$118.25
|
| Rate for Payer: ASR ASR |
$127.45
|
| Rate for Payer: BCBS Complete |
$52.56
|
| Rate for Payer: BCBS Trust/PPO |
$101.87
|
| Rate for Payer: BCN Commercial |
$101.87
|
| Rate for Payer: Cash Price |
$105.11
|
| Rate for Payer: Cofinity Commercial |
$123.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.11
|
| Rate for Payer: Healthscope Commercial |
$131.39
|
| Rate for Payer: Healthscope Whirlpool |
$127.45
|
| Rate for Payer: Mclaren Commercial |
$118.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.56
|
| Rate for Payer: Priority Health Narrow Network |
$93.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.62
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
IP
|
$131.39
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$91.97 |
| Max. Negotiated Rate |
$131.39 |
| Rate for Payer: Aetna Commercial |
$118.25
|
| Rate for Payer: ASR ASR |
$127.45
|
| Rate for Payer: BCBS Trust/PPO |
$101.87
|
| Rate for Payer: BCN Commercial |
$101.87
|
| Rate for Payer: Cash Price |
$105.11
|
| Rate for Payer: Cofinity Commercial |
$123.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.11
|
| Rate for Payer: Healthscope Commercial |
$131.39
|
| Rate for Payer: Healthscope Whirlpool |
$127.45
|
| Rate for Payer: Mclaren Commercial |
$118.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.62
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
IP
|
$124.80
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: ASR ASR |
$121.06
|
| Rate for Payer: BCBS Trust/PPO |
$96.76
|
| Rate for Payer: BCN Commercial |
$96.76
|
| Rate for Payer: Cash Price |
$99.84
|
| Rate for Payer: Cofinity Commercial |
$117.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.84
|
| Rate for Payer: Healthscope Commercial |
$124.80
|
| Rate for Payer: Healthscope Whirlpool |
$121.06
|
| Rate for Payer: Mclaren Commercial |
$112.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.82
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
OP
|
$124.80
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$49.92 |
| Max. Negotiated Rate |
$140.59 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: ASR ASR |
$121.06
|
| Rate for Payer: BCBS Complete |
$49.92
|
| Rate for Payer: BCBS Trust/PPO |
$96.76
|
| Rate for Payer: BCN Commercial |
$96.76
|
| Rate for Payer: Cash Price |
$99.84
|
| Rate for Payer: Cash Price |
$99.84
|
| Rate for Payer: Cofinity Commercial |
$117.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.84
|
| Rate for Payer: Healthscope Commercial |
$124.80
|
| Rate for Payer: Healthscope Whirlpool |
$121.06
|
| Rate for Payer: Mclaren Commercial |
$112.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.59
|
| Rate for Payer: Priority Health Narrow Network |
$112.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.82
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
IP
|
$140.03
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$98.02 |
| Max. Negotiated Rate |
$140.03 |
| Rate for Payer: Aetna Commercial |
$126.03
|
| Rate for Payer: ASR ASR |
$135.83
|
| Rate for Payer: BCBS Trust/PPO |
$108.57
|
| Rate for Payer: BCN Commercial |
$108.57
|
| Rate for Payer: Cash Price |
$112.02
|
| Rate for Payer: Cofinity Commercial |
$131.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.02
|
| Rate for Payer: Healthscope Commercial |
$140.03
|
| Rate for Payer: Healthscope Whirlpool |
$135.83
|
| Rate for Payer: Mclaren Commercial |
$126.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.23
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
OP
|
$140.03
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$56.01 |
| Max. Negotiated Rate |
$140.59 |
| Rate for Payer: Aetna Commercial |
$126.03
|
| Rate for Payer: ASR ASR |
$135.83
|
| Rate for Payer: BCBS Complete |
$56.01
|
| Rate for Payer: BCBS Trust/PPO |
$108.57
|
| Rate for Payer: BCN Commercial |
$108.57
|
| Rate for Payer: Cash Price |
$112.02
|
| Rate for Payer: Cash Price |
$112.02
|
| Rate for Payer: Cofinity Commercial |
$131.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.02
|
| Rate for Payer: Healthscope Commercial |
$140.03
|
| Rate for Payer: Healthscope Whirlpool |
$135.83
|
| Rate for Payer: Mclaren Commercial |
$126.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.59
|
| Rate for Payer: Priority Health Narrow Network |
$112.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.23
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
IP
|
$46.68
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$32.68 |
| Max. Negotiated Rate |
$46.68 |
| Rate for Payer: Aetna Commercial |
$42.01
|
| Rate for Payer: ASR ASR |
$45.28
|
| Rate for Payer: BCBS Trust/PPO |
$36.19
|
| Rate for Payer: BCN Commercial |
$36.19
|
| Rate for Payer: Cash Price |
$37.34
|
| Rate for Payer: Cofinity Commercial |
$43.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.34
|
| Rate for Payer: Healthscope Commercial |
$46.68
|
| Rate for Payer: Healthscope Whirlpool |
$45.28
|
| Rate for Payer: Mclaren Commercial |
$42.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.08
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
OP
|
$46.68
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$18.67 |
| Max. Negotiated Rate |
$140.59 |
| Rate for Payer: Aetna Commercial |
$42.01
|
| Rate for Payer: ASR ASR |
$45.28
|
| Rate for Payer: BCBS Complete |
$18.67
|
| Rate for Payer: BCBS Trust/PPO |
$36.19
|
| Rate for Payer: BCN Commercial |
$36.19
|
| Rate for Payer: Cash Price |
$37.34
|
| Rate for Payer: Cash Price |
$37.34
|
| Rate for Payer: Cofinity Commercial |
$43.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.34
|
| Rate for Payer: Healthscope Commercial |
$46.68
|
| Rate for Payer: Healthscope Whirlpool |
$45.28
|
| Rate for Payer: Mclaren Commercial |
$42.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.59
|
| Rate for Payer: Priority Health Narrow Network |
$112.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.08
|
|
|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
OP
|
$231.54
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$92.62 |
| Max. Negotiated Rate |
$231.54 |
| Rate for Payer: Aetna Commercial |
$208.39
|
| Rate for Payer: ASR ASR |
$224.59
|
| Rate for Payer: BCBS Complete |
$92.62
|
| Rate for Payer: BCBS Trust/PPO |
$179.51
|
| Rate for Payer: BCN Commercial |
$179.51
|
| Rate for Payer: Cash Price |
$185.23
|
| Rate for Payer: Cofinity Commercial |
$217.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.23
|
| Rate for Payer: Healthscope Commercial |
$231.54
|
| Rate for Payer: Healthscope Whirlpool |
$224.59
|
| Rate for Payer: Mclaren Commercial |
$208.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$196.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.70
|
| Rate for Payer: Priority Health Narrow Network |
$164.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.76
|
|
|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
IP
|
$231.54
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$162.08 |
| Max. Negotiated Rate |
$231.54 |
| Rate for Payer: Aetna Commercial |
$208.39
|
| Rate for Payer: ASR ASR |
$224.59
|
| Rate for Payer: BCBS Trust/PPO |
$179.51
|
| Rate for Payer: BCN Commercial |
$179.51
|
| Rate for Payer: Cash Price |
$185.23
|
| Rate for Payer: Cofinity Commercial |
$217.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.23
|
| Rate for Payer: Healthscope Commercial |
$231.54
|
| Rate for Payer: Healthscope Whirlpool |
$224.59
|
| Rate for Payer: Mclaren Commercial |
$208.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$196.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.76
|
|
