|
HC TIER 4 TRAUMA CONSULT
|
Facility
|
IP
|
$2,620.38
|
|
| Hospital Charge Code |
68100003
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,834.27 |
| Max. Negotiated Rate |
$2,620.38 |
| Rate for Payer: Aetna Commercial |
$2,358.34
|
| Rate for Payer: ASR ASR |
$2,541.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,031.58
|
| Rate for Payer: BCN Commercial |
$2,031.58
|
| Rate for Payer: Cash Price |
$2,096.30
|
| Rate for Payer: Cofinity Commercial |
$2,463.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,096.30
|
| Rate for Payer: Healthscope Commercial |
$2,620.38
|
| Rate for Payer: Healthscope Whirlpool |
$2,541.77
|
| Rate for Payer: Mclaren Commercial |
$2,358.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,227.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,834.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,305.93
|
|
|
HC TILT TABLE STRESS
|
Facility
|
IP
|
$1,100.84
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$770.59 |
| Max. Negotiated Rate |
$1,100.84 |
| Rate for Payer: Aetna Commercial |
$990.76
|
| Rate for Payer: ASR ASR |
$1,067.81
|
| Rate for Payer: BCBS Trust/PPO |
$853.48
|
| Rate for Payer: BCN Commercial |
$853.48
|
| Rate for Payer: Cash Price |
$880.67
|
| Rate for Payer: Cofinity Commercial |
$1,034.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$880.67
|
| Rate for Payer: Healthscope Commercial |
$1,100.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,067.81
|
| Rate for Payer: Mclaren Commercial |
$990.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$968.74
|
|
|
HC TILT TABLE STRESS
|
Facility
|
OP
|
$1,100.84
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$260.60 |
| Max. Negotiated Rate |
$1,100.84 |
| Rate for Payer: Aetna Commercial |
$990.76
|
| Rate for Payer: Aetna Medicare |
$476.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: ASR ASR |
$1,067.81
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$853.48
|
| Rate for Payer: BCN Commercial |
$853.48
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Cash Price |
$880.67
|
| Rate for Payer: Cash Price |
$880.67
|
| Rate for Payer: Cofinity Commercial |
$1,034.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$880.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Healthscope Commercial |
$1,100.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,067.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$476.42
|
| Rate for Payer: Mclaren Commercial |
$990.76
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.71
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Commercial |
$524.06
|
| Rate for Payer: PHP Medicaid |
$260.60
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,001.76
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$781.60
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$968.74
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: VA VA |
$476.42
|
|
|
HC TIMOTHY GRASS IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC TIMOTHY GRASS IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC TIP PUMP SUCTION
|
Facility
|
IP
|
$42.00
|
|
| Hospital Charge Code |
27000111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: ASR ASR |
$40.74
|
| Rate for Payer: BCBS Trust/PPO |
$32.56
|
| Rate for Payer: BCN Commercial |
$32.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$39.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$42.00
|
| Rate for Payer: Healthscope Whirlpool |
$40.74
|
| Rate for Payer: Mclaren Commercial |
$37.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.96
|
|
|
HC TIP PUMP SUCTION
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
27000111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: ASR ASR |
$40.74
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$32.56
|
| Rate for Payer: BCN Commercial |
$32.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$39.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$42.00
|
| Rate for Payer: Healthscope Whirlpool |
$40.74
|
| Rate for Payer: Mclaren Commercial |
$37.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.22
|
| Rate for Payer: Priority Health Narrow Network |
$29.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.96
|
|
|
HC TISSUE IN SITU HYB QUANT EA ADD
|
Facility
|
IP
|
$264.18
|
|
|
Service Code
|
CPT 88369
|
| Hospital Charge Code |
31000123
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$184.93 |
| Max. Negotiated Rate |
$264.18 |
| Rate for Payer: Aetna Commercial |
$237.76
|
| Rate for Payer: ASR ASR |
$256.25
|
| Rate for Payer: BCBS Trust/PPO |
$204.82
|
| Rate for Payer: BCN Commercial |
$204.82
|
| Rate for Payer: Cash Price |
$211.34
|
| Rate for Payer: Cofinity Commercial |
$248.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.34
|
| Rate for Payer: Healthscope Commercial |
$264.18
|
| Rate for Payer: Healthscope Whirlpool |
$256.25
|
| Rate for Payer: Mclaren Commercial |
$237.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.48
|
|
|
HC TISSUE IN SITU HYB QUANT EA ADD
|
Facility
|
OP
|
$264.18
|
|
|
Service Code
|
CPT 88369
|
| Hospital Charge Code |
31000123
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$105.67 |
| Max. Negotiated Rate |
$264.18 |
| Rate for Payer: Aetna Commercial |
$237.76
|
| Rate for Payer: ASR ASR |
$256.25
|
| Rate for Payer: BCBS Complete |
$105.67
|
| Rate for Payer: BCBS Trust/PPO |
$204.82
|
| Rate for Payer: BCCCP Commercial |
$123.01
|
| Rate for Payer: BCN Commercial |
$204.82
|
| Rate for Payer: Cash Price |
$211.34
|
| Rate for Payer: Cash Price |
$211.34
|
| Rate for Payer: Cofinity Commercial |
$248.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.34
|
| Rate for Payer: Healthscope Commercial |
$264.18
|
| Rate for Payer: Healthscope Whirlpool |
$256.25
|
| Rate for Payer: Mclaren Commercial |
$237.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.40
|
| Rate for Payer: Priority Health Narrow Network |
$187.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.48
|
|
|
HC TISSUE IN SITU HYBRIDIZATION
|
Facility
|
OP
|
$330.21
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
31000060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$83.05 |
| Max. Negotiated Rate |
$330.21 |
| Rate for Payer: Aetna Commercial |
$297.19
|
| Rate for Payer: Aetna Medicare |
$151.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.78
|
| Rate for Payer: ASR ASR |
$320.30
|
| Rate for Payer: BCBS Complete |
$87.21
|
| Rate for Payer: BCBS MAPPO |
$151.82
|
| Rate for Payer: BCBS Trust/PPO |
$256.01
|
| Rate for Payer: BCCCP Commercial |
$181.78
|
| Rate for Payer: BCN Commercial |
$256.01
|
| Rate for Payer: BCN Medicare Advantage |
$151.82
|
| Rate for Payer: Cash Price |
$264.17
|
| Rate for Payer: Cash Price |
$264.17
|
| Rate for Payer: Cofinity Commercial |
$310.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$330.21
|
| Rate for Payer: Healthscope Whirlpool |
$320.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$151.82
|
| Rate for Payer: Mclaren Commercial |
$297.19
|
| Rate for Payer: Mclaren Medicaid |
$83.05
|
| Rate for Payer: Mclaren Medicare |
$151.82
|
| Rate for Payer: Meridian Medicaid |
$87.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.68
|
| Rate for Payer: PACE Medicare |
$144.23
|
| Rate for Payer: PACE SWMI |
$151.82
|
| Rate for Payer: PHP Commercial |
$167.00
|
| Rate for Payer: PHP Medicaid |
$83.05
|
| Rate for Payer: PHP Medicare Advantage |
$151.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.35
|
| Rate for Payer: Priority Health Medicare |
$151.82
|
| Rate for Payer: Priority Health Narrow Network |
$214.68
|
| Rate for Payer: Railroad Medicare Medicare |
$151.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$290.58
|
| Rate for Payer: UHC Medicare Advantage |
$156.37
|
| Rate for Payer: VA VA |
$151.82
|
|
|
HC TISSUE IN SITU HYBRIDIZATION
|
Facility
|
IP
|
$330.21
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
31000060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$231.15 |
| Max. Negotiated Rate |
$330.21 |
| Rate for Payer: Aetna Commercial |
$297.19
|
| Rate for Payer: ASR ASR |
$320.30
|
| Rate for Payer: BCBS Trust/PPO |
$256.01
|
| Rate for Payer: BCN Commercial |
$256.01
|
| Rate for Payer: Cash Price |
$264.17
|
| Rate for Payer: Cofinity Commercial |
$310.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.17
|
| Rate for Payer: Healthscope Commercial |
$330.21
|
| Rate for Payer: Healthscope Whirlpool |
$320.30
|
| Rate for Payer: Mclaren Commercial |
$297.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$290.58
|
|
|
HC TISSUE IN SITU HYBRID QUANT
|
Facility
|
OP
|
$264.18
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$143.46 |
| Max. Negotiated Rate |
$399.39 |
| Rate for Payer: Aetna Commercial |
$237.76
|
| Rate for Payer: Aetna Medicare |
$319.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.39
|
| Rate for Payer: ASR ASR |
$256.25
|
| Rate for Payer: BCBS Complete |
$183.53
|
| Rate for Payer: BCBS MAPPO |
$319.51
|
| Rate for Payer: BCBS Trust/PPO |
$204.82
|
| Rate for Payer: BCCCP Commercial |
$143.46
|
| Rate for Payer: BCN Commercial |
$204.82
|
| Rate for Payer: BCN Medicare Advantage |
$319.51
|
| Rate for Payer: Cash Price |
$211.34
|
| Rate for Payer: Cash Price |
$211.34
|
| Rate for Payer: Cofinity Commercial |
$248.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.51
|
| Rate for Payer: Healthscope Commercial |
$264.18
|
| Rate for Payer: Healthscope Whirlpool |
$256.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$319.51
|
| Rate for Payer: Mclaren Commercial |
$237.76
|
| Rate for Payer: Mclaren Medicaid |
$174.77
|
| Rate for Payer: Mclaren Medicare |
$319.51
|
| Rate for Payer: Meridian Medicaid |
$183.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.55
|
| Rate for Payer: PACE Medicare |
$303.53
|
| Rate for Payer: PACE SWMI |
$319.51
|
| Rate for Payer: PHP Commercial |
$351.46
|
| Rate for Payer: PHP Medicaid |
$174.77
|
| Rate for Payer: PHP Medicare Advantage |
$319.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.40
|
| Rate for Payer: Priority Health Medicare |
$319.51
|
| Rate for Payer: Priority Health Narrow Network |
$187.57
|
| Rate for Payer: Railroad Medicare Medicare |
$319.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.48
|
| Rate for Payer: UHC Medicare Advantage |
$329.10
|
| Rate for Payer: VA VA |
$319.51
|
|
|
HC TISSUE IN SITU HYBRID QUANT
|
Facility
|
IP
|
$264.18
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$184.93 |
| Max. Negotiated Rate |
$264.18 |
| Rate for Payer: Aetna Commercial |
$237.76
|
| Rate for Payer: ASR ASR |
$256.25
|
| Rate for Payer: BCBS Trust/PPO |
$204.82
|
| Rate for Payer: BCN Commercial |
$204.82
|
| Rate for Payer: Cash Price |
$211.34
|
| Rate for Payer: Cofinity Commercial |
$248.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.34
|
| Rate for Payer: Healthscope Commercial |
$264.18
|
| Rate for Payer: Healthscope Whirlpool |
$256.25
|
| Rate for Payer: Mclaren Commercial |
$237.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.48
|
|
|
HC TISSUE MARKER IMPLANTABLE
|
Facility
|
OP
|
$1,441.26
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.50 |
| Max. Negotiated Rate |
$1,441.26 |
| Rate for Payer: Aetna Commercial |
$1,297.13
|
| Rate for Payer: ASR ASR |
$1,398.02
|
| Rate for Payer: BCBS Complete |
$576.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.41
|
| Rate for Payer: BCN Commercial |
$1,117.41
|
| Rate for Payer: Cash Price |
$1,153.01
|
| Rate for Payer: Cofinity Commercial |
$1,354.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,153.01
|
| Rate for Payer: Healthscope Commercial |
$1,441.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,398.02
|
| Rate for Payer: Mclaren Commercial |
$1,297.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,225.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,311.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,023.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,268.31
|
|
|
HC TISSUE MARKER IMPLANTABLE
|
Facility
|
IP
|
$1,441.26
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.88 |
| Max. Negotiated Rate |
$1,441.26 |
| Rate for Payer: Aetna Commercial |
$1,297.13
|
| Rate for Payer: ASR ASR |
$1,398.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.41
|
| Rate for Payer: BCN Commercial |
$1,117.41
|
| Rate for Payer: Cash Price |
$1,153.01
|
| Rate for Payer: Cofinity Commercial |
$1,354.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,153.01
|
| Rate for Payer: Healthscope Commercial |
$1,441.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,398.02
|
| Rate for Payer: Mclaren Commercial |
$1,297.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,225.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,268.31
|
|
|
HC TISSUE MARKER PROSTATE
|
Facility
|
IP
|
$1,305.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.50 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Aetna Commercial |
$1,174.50
|
| Rate for Payer: ASR ASR |
$1,265.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,011.77
|
| Rate for Payer: BCN Commercial |
$1,011.77
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cofinity Commercial |
$1,226.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,044.00
|
| Rate for Payer: Healthscope Commercial |
$1,305.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,265.85
|
| Rate for Payer: Mclaren Commercial |
$1,174.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,109.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,148.40
|
|
|
HC TISSUE MARKER PROSTATE
|
Facility
|
OP
|
$1,305.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.00 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Aetna Commercial |
$1,174.50
|
| Rate for Payer: ASR ASR |
$1,265.85
|
| Rate for Payer: BCBS Complete |
$522.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,011.77
|
| Rate for Payer: BCN Commercial |
$1,011.77
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cofinity Commercial |
$1,226.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,044.00
|
| Rate for Payer: Healthscope Commercial |
$1,305.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,265.85
|
| Rate for Payer: Mclaren Commercial |
$1,174.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,109.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,187.55
|
| Rate for Payer: Priority Health Narrow Network |
$926.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,148.40
|
|
|
HC TISSUE PROCESSING
|
Facility
|
OP
|
$50.30
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$50.30 |
| Rate for Payer: Aetna Commercial |
$45.27
|
| Rate for Payer: Aetna Medicare |
$5.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.35
|
| Rate for Payer: ASR ASR |
$48.79
|
| Rate for Payer: BCBS Complete |
$3.38
|
| Rate for Payer: BCBS MAPPO |
$5.88
|
| Rate for Payer: BCBS Trust/PPO |
$39.00
|
| Rate for Payer: BCN Commercial |
$39.00
|
| Rate for Payer: BCN Medicare Advantage |
$5.88
|
| Rate for Payer: Cash Price |
$40.24
|
| Rate for Payer: Cash Price |
$40.24
|
| Rate for Payer: Cofinity Commercial |
$47.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.88
|
| Rate for Payer: Healthscope Commercial |
$50.30
|
| Rate for Payer: Healthscope Whirlpool |
$48.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.88
|
| Rate for Payer: Mclaren Commercial |
$45.27
|
| Rate for Payer: Mclaren Medicaid |
$3.22
|
| Rate for Payer: Mclaren Medicare |
$5.88
|
| Rate for Payer: Meridian Medicaid |
$3.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.76
|
| Rate for Payer: PACE Medicare |
$5.59
|
| Rate for Payer: PACE SWMI |
$5.88
|
| Rate for Payer: PHP Commercial |
$6.47
|
| Rate for Payer: PHP Medicaid |
$3.22
|
| Rate for Payer: PHP Medicare Advantage |
$5.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.77
|
| Rate for Payer: Priority Health Medicare |
$5.88
|
| Rate for Payer: Priority Health Narrow Network |
$35.71
|
| Rate for Payer: Railroad Medicare Medicare |
$5.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.26
|
| Rate for Payer: UHC Medicare Advantage |
$6.06
|
| Rate for Payer: VA VA |
$5.88
|
|
|
HC TISSUE PROCESSING
|
Facility
|
IP
|
$50.30
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.21 |
| Max. Negotiated Rate |
$50.30 |
| Rate for Payer: Aetna Commercial |
$45.27
|
| Rate for Payer: ASR ASR |
$48.79
|
| Rate for Payer: BCBS Trust/PPO |
$39.00
|
| Rate for Payer: BCN Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$40.24
|
| Rate for Payer: Cofinity Commercial |
$47.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.24
|
| Rate for Payer: Healthscope Commercial |
$50.30
|
| Rate for Payer: Healthscope Whirlpool |
$48.79
|
| Rate for Payer: Mclaren Commercial |
$45.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.26
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: ASR ASR |
$54.32
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$43.42
|
| Rate for Payer: BCN Commercial |
$43.42
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Healthscope Whirlpool |
$54.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$50.40
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.31
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.96
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$39.76
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.28
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: ASR ASR |
$54.32
|
| Rate for Payer: BCBS Trust/PPO |
$43.42
|
| Rate for Payer: BCN Commercial |
$43.42
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$52.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Healthscope Whirlpool |
$54.32
|
| Rate for Payer: Mclaren Commercial |
$50.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.28
|
|
|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$27.68
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$35.70
|
| Rate for Payer: Healthscope Whirlpool |
$34.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.31
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.03
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$157.62
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.99 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: BCBS Trust/PPO |
$27.68
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$35.70
|
| Rate for Payer: Healthscope Whirlpool |
$34.63
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
|
|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$27.68
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$35.70
|
| Rate for Payer: Healthscope Whirlpool |
$34.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.31
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.03
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$157.62
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.99 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: BCBS Trust/PPO |
$27.68
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$35.70
|
| Rate for Payer: Healthscope Whirlpool |
$34.63
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
|
