|
HC TIP PUMP SUCTION
|
Facility
|
IP
|
$43.70
|
|
| Hospital Charge Code |
27000111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna Commercial |
$39.33
|
| Rate for Payer: ASR ASR |
$42.39
|
| Rate for Payer: BCBS Trust/PPO |
$35.89
|
| Rate for Payer: BCN Commercial |
$35.89
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$41.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$42.39
|
| Rate for Payer: Healthscope Whirlpool |
$43.70
|
| Rate for Payer: Mclaren Commercial |
$39.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Nomi Health Commercial |
$35.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.46
|
|
|
HC TIP PUMP SUCTION
|
Facility
|
OP
|
$43.70
|
|
| Hospital Charge Code |
27000111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna Commercial |
$39.33
|
| Rate for Payer: Aetna Medicare |
$16.17
|
| Rate for Payer: ASR ASR |
$42.39
|
| Rate for Payer: BCBS Complete |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$36.03
|
| Rate for Payer: BCN Commercial |
$36.03
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$41.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$42.39
|
| Rate for Payer: Healthscope Whirlpool |
$43.70
|
| Rate for Payer: Mclaren Commercial |
$39.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Nomi Health Commercial |
$35.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$38.29
|
| Rate for Payer: Priority Health Narrow Network |
$30.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.46
|
|
|
HC TISSUE IN SITU HYB QUANT EA ADD
|
Facility
|
OP
|
$274.85
|
|
|
Service Code
|
CPT 88369
|
| Hospital Charge Code |
31000123
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$101.69 |
| Max. Negotiated Rate |
$274.85 |
| Rate for Payer: Aetna Commercial |
$247.37
|
| Rate for Payer: Aetna Medicare |
$101.69
|
| Rate for Payer: ASR ASR |
$266.60
|
| Rate for Payer: BCBS Complete |
$109.94
|
| Rate for Payer: BCBS Trust/PPO |
$226.61
|
| Rate for Payer: BCCCP Commercial |
$121.51
|
| Rate for Payer: BCN Commercial |
$226.61
|
| Rate for Payer: Cash Price |
$219.88
|
| Rate for Payer: Cash Price |
$219.88
|
| Rate for Payer: Cofinity Commercial |
$258.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.88
|
| Rate for Payer: Healthscope Commercial |
$266.60
|
| Rate for Payer: Healthscope Whirlpool |
$274.85
|
| Rate for Payer: Mclaren Commercial |
$247.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.62
|
| Rate for Payer: Nomi Health Commercial |
$225.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$240.82
|
| Rate for Payer: Priority Health Narrow Network |
$192.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.87
|
|
|
HC TISSUE IN SITU HYB QUANT EA ADD
|
Facility
|
IP
|
$274.85
|
|
|
Service Code
|
CPT 88369
|
| Hospital Charge Code |
31000123
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$206.14 |
| Max. Negotiated Rate |
$274.85 |
| Rate for Payer: Aetna Commercial |
$247.37
|
| Rate for Payer: ASR ASR |
$266.60
|
| Rate for Payer: BCBS Trust/PPO |
$225.71
|
| Rate for Payer: BCN Commercial |
$225.71
|
| Rate for Payer: Cash Price |
$219.88
|
| Rate for Payer: Cofinity Commercial |
$258.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.88
|
| Rate for Payer: Healthscope Commercial |
$266.60
|
| Rate for Payer: Healthscope Whirlpool |
$274.85
|
| Rate for Payer: Mclaren Commercial |
$247.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.62
|
| Rate for Payer: Nomi Health Commercial |
$225.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.87
|
|
|
HC TISSUE IN SITU HYBRIDIZATION
|
Facility
|
IP
|
$379.45
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
31000060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$284.59 |
| Max. Negotiated Rate |
$379.45 |
| Rate for Payer: Aetna Commercial |
$341.50
|
| Rate for Payer: ASR ASR |
$368.07
|
| Rate for Payer: BCBS Trust/PPO |
$311.60
|
| Rate for Payer: BCN Commercial |
$311.60
|
| Rate for Payer: Cash Price |
$303.56
|
| Rate for Payer: Cofinity Commercial |
$356.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.56
|
| Rate for Payer: Healthscope Commercial |
$368.07
|
| Rate for Payer: Healthscope Whirlpool |
$379.45
|
| Rate for Payer: Mclaren Commercial |
$341.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.53
|
| Rate for Payer: Nomi Health Commercial |
$311.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$333.92
|
|
|
HC TISSUE IN SITU HYBRIDIZATION
|
Facility
|
OP
|
$379.45
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
31000060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.78 |
| Max. Negotiated Rate |
$379.45 |
| Rate for Payer: Aetna Commercial |
$341.50
|
| Rate for Payer: Aetna Medicare |
$169.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: ASR ASR |
$368.07
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$312.86
|
| Rate for Payer: BCCCP Commercial |
$161.79
|
| Rate for Payer: BCN Commercial |
$312.86
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$303.56
|
| Rate for Payer: Cash Price |
$303.56
|
| Rate for Payer: Cofinity Commercial |
$356.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$368.07
|
| Rate for Payer: Healthscope Whirlpool |
$379.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$169.76
|
| Rate for Payer: Mclaren Commercial |
$341.50
|
| Rate for Payer: Mclaren Medicaid |
$169.76
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$93.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.53
|
| Rate for Payer: Nomi Health Commercial |
$311.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.59
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$186.74
|
| Rate for Payer: PHP Medicaid |
$90.99
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$316.56
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health Narrow Network |
$253.25
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$333.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$263.13
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP DNSP |
$169.76
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
|
HC TISSUE IN SITU HYBRID QUANT
|
Facility
|
IP
|
$274.85
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$206.14 |
| Max. Negotiated Rate |
$274.85 |
| Rate for Payer: Aetna Commercial |
$247.37
|
| Rate for Payer: ASR ASR |
$266.60
|
| Rate for Payer: BCBS Trust/PPO |
$225.71
|
| Rate for Payer: BCN Commercial |
$225.71
|
| Rate for Payer: Cash Price |
$219.88
|
| Rate for Payer: Cofinity Commercial |
$258.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.88
|
| Rate for Payer: Healthscope Commercial |
$266.60
|
| Rate for Payer: Healthscope Whirlpool |
$274.85
|
| Rate for Payer: Mclaren Commercial |
$247.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.62
|
| Rate for Payer: Nomi Health Commercial |
$225.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.87
|
|
|
HC TISSUE IN SITU HYBRID QUANT
|
Facility
|
OP
|
$274.85
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$138.78 |
| Max. Negotiated Rate |
$553.60 |
| Rate for Payer: Aetna Commercial |
$247.37
|
| Rate for Payer: Aetna Medicare |
$357.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.45
|
| Rate for Payer: ASR ASR |
$266.60
|
| Rate for Payer: BCBS Complete |
$196.15
|
| Rate for Payer: BCBS MAPPO |
$357.16
|
| Rate for Payer: BCBS Trust/PPO |
$226.61
|
| Rate for Payer: BCCCP Commercial |
$138.78
|
| Rate for Payer: BCN Commercial |
$226.61
|
| Rate for Payer: BCN Medicare Advantage |
$357.16
|
| Rate for Payer: Cash Price |
$219.88
|
| Rate for Payer: Cash Price |
$219.88
|
| Rate for Payer: Cofinity Commercial |
$258.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.16
|
| Rate for Payer: Healthscope Commercial |
$266.60
|
| Rate for Payer: Healthscope Whirlpool |
$274.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$357.16
|
| Rate for Payer: Mclaren Commercial |
$247.37
|
| Rate for Payer: Mclaren Medicaid |
$357.16
|
| Rate for Payer: Mclaren Medicare |
$357.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.02
|
| Rate for Payer: Meridian Medicaid |
$196.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$392.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.62
|
| Rate for Payer: Nomi Health Commercial |
$225.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.14
|
| Rate for Payer: PACE Medicare |
$339.30
|
| Rate for Payer: PACE SWMI |
$357.16
|
| Rate for Payer: PHP Commercial |
$392.88
|
| Rate for Payer: PHP Medicaid |
$191.44
|
| Rate for Payer: PHP Medicare Advantage |
$357.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$240.82
|
| Rate for Payer: Priority Health Medicare |
$357.16
|
| Rate for Payer: Priority Health Narrow Network |
$192.67
|
| Rate for Payer: Railroad Medicare Medicare |
$357.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$357.16
|
| Rate for Payer: UHC Exchange |
$553.60
|
| Rate for Payer: UHC Medicaid |
$186.79
|
| Rate for Payer: UHCCP DNSP |
$357.16
|
| Rate for Payer: UHCCP Medicaid |
$186.79
|
| Rate for Payer: VA VA |
$357.16
|
|
|
HC TISSUE MARKER IMPLANTABLE
|
Facility
|
OP
|
$1,499.49
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.81 |
| Max. Negotiated Rate |
$1,499.49 |
| Rate for Payer: Aetna Commercial |
$1,349.54
|
| Rate for Payer: Aetna Medicare |
$554.81
|
| Rate for Payer: ASR ASR |
$1,454.51
|
| Rate for Payer: BCBS Complete |
$599.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,236.33
|
| Rate for Payer: BCN Commercial |
$1,236.33
|
| Rate for Payer: Cash Price |
$1,199.59
|
| Rate for Payer: Cofinity Commercial |
$1,409.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,199.59
|
| Rate for Payer: Healthscope Commercial |
$1,454.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,499.49
|
| Rate for Payer: Mclaren Commercial |
$1,349.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,199.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,274.57
|
| Rate for Payer: Nomi Health Commercial |
$1,229.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,124.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,313.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,051.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,319.55
|
|
|
HC TISSUE MARKER IMPLANTABLE
|
Facility
|
IP
|
$1,499.49
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,124.62 |
| Max. Negotiated Rate |
$1,499.49 |
| Rate for Payer: Aetna Commercial |
$1,349.54
|
| Rate for Payer: ASR ASR |
$1,454.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,231.38
|
| Rate for Payer: BCN Commercial |
$1,231.38
|
| Rate for Payer: Cash Price |
$1,199.59
|
| Rate for Payer: Cofinity Commercial |
$1,409.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,199.59
|
| Rate for Payer: Healthscope Commercial |
$1,454.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,499.49
|
| Rate for Payer: Mclaren Commercial |
$1,349.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,274.57
|
| Rate for Payer: Nomi Health Commercial |
$1,229.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,124.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,319.55
|
|
|
HC TISSUE MARKER PROSTATE
|
Facility
|
IP
|
$1,357.72
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.29 |
| Max. Negotiated Rate |
$1,357.72 |
| Rate for Payer: Aetna Commercial |
$1,221.95
|
| Rate for Payer: ASR ASR |
$1,316.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,114.96
|
| Rate for Payer: BCN Commercial |
$1,114.96
|
| Rate for Payer: Cash Price |
$1,086.18
|
| Rate for Payer: Cofinity Commercial |
$1,276.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,086.18
|
| Rate for Payer: Healthscope Commercial |
$1,316.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,357.72
|
| Rate for Payer: Mclaren Commercial |
$1,221.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,154.06
|
| Rate for Payer: Nomi Health Commercial |
$1,113.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,018.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,194.79
|
|
|
HC TISSUE MARKER PROSTATE
|
Facility
|
OP
|
$1,357.72
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$502.36 |
| Max. Negotiated Rate |
$1,357.72 |
| Rate for Payer: Aetna Commercial |
$1,221.95
|
| Rate for Payer: Aetna Medicare |
$502.36
|
| Rate for Payer: ASR ASR |
$1,316.99
|
| Rate for Payer: BCBS Complete |
$543.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,119.44
|
| Rate for Payer: BCN Commercial |
$1,119.44
|
| Rate for Payer: Cash Price |
$1,086.18
|
| Rate for Payer: Cofinity Commercial |
$1,276.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,086.18
|
| Rate for Payer: Healthscope Commercial |
$1,316.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,357.72
|
| Rate for Payer: Mclaren Commercial |
$1,221.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,086.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,154.06
|
| Rate for Payer: Nomi Health Commercial |
$1,113.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,018.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,189.63
|
| Rate for Payer: Priority Health Narrow Network |
$951.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,194.79
|
|
|
HC TISSUE PROCESSING
|
Facility
|
IP
|
$52.34
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$52.34 |
| Rate for Payer: Aetna Commercial |
$47.11
|
| Rate for Payer: ASR ASR |
$50.77
|
| Rate for Payer: BCBS Trust/PPO |
$42.98
|
| Rate for Payer: BCN Commercial |
$42.98
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$49.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Healthscope Commercial |
$50.77
|
| Rate for Payer: Healthscope Whirlpool |
$52.34
|
| Rate for Payer: Mclaren Commercial |
$47.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Nomi Health Commercial |
$42.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.06
|
|
|
HC TISSUE PROCESSING
|
Facility
|
OP
|
$52.34
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$52.34 |
| Rate for Payer: Aetna Commercial |
$47.11
|
| 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 |
$50.77
|
| Rate for Payer: BCBS Complete |
$3.23
|
| Rate for Payer: BCBS MAPPO |
$5.88
|
| Rate for Payer: BCBS Trust/PPO |
$43.15
|
| Rate for Payer: BCN Commercial |
$43.15
|
| Rate for Payer: BCN Medicare Advantage |
$5.88
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$49.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.88
|
| Rate for Payer: Healthscope Commercial |
$50.77
|
| Rate for Payer: Healthscope Whirlpool |
$52.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.88
|
| Rate for Payer: Mclaren Commercial |
$47.11
|
| Rate for Payer: Mclaren Medicaid |
$5.88
|
| Rate for Payer: Mclaren Medicare |
$5.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.17
|
| Rate for Payer: Meridian Medicaid |
$3.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Nomi Health Commercial |
$42.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: PACE Medicare |
$5.59
|
| Rate for Payer: PACE SWMI |
$5.88
|
| Rate for Payer: PHP Commercial |
$6.47
|
| Rate for Payer: PHP Medicaid |
$3.15
|
| Rate for Payer: PHP Medicare Advantage |
$5.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$45.86
|
| Rate for Payer: Priority Health Medicare |
$5.88
|
| Rate for Payer: Priority Health Narrow Network |
$36.69
|
| Rate for Payer: Railroad Medicare Medicare |
$5.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.88
|
| Rate for Payer: UHC Exchange |
$9.11
|
| Rate for Payer: UHC Medicaid |
$3.08
|
| Rate for Payer: UHCCP DNSP |
$5.88
|
| Rate for Payer: UHCCP Medicaid |
$3.08
|
| Rate for Payer: VA VA |
$5.88
|
|
|
HC TISSUE TRANSFER ANY AREA 30.1-60 SQ CM
|
Facility
|
OP
|
$10,750.80
|
|
|
Service Code
|
CPT 14301
|
| Hospital Charge Code |
76100537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,846.70 |
| Max. Negotiated Rate |
$10,750.80 |
| Rate for Payer: Aetna Commercial |
$9,675.72
|
| Rate for Payer: Aetna Medicare |
$3,530.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,413.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,413.73
|
| Rate for Payer: ASR ASR |
$10,428.28
|
| Rate for Payer: BCBS Complete |
$1,939.21
|
| Rate for Payer: BCBS MAPPO |
$3,530.98
|
| Rate for Payer: BCBS Trust/PPO |
$8,864.03
|
| Rate for Payer: BCN Commercial |
$8,864.03
|
| Rate for Payer: BCN Medicare Advantage |
$3,530.98
|
| Rate for Payer: Cash Price |
$8,600.64
|
| Rate for Payer: Cash Price |
$8,600.64
|
| Rate for Payer: Cofinity Commercial |
$10,105.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,600.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,530.98
|
| Rate for Payer: Healthscope Commercial |
$10,428.28
|
| Rate for Payer: Healthscope Whirlpool |
$10,750.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,530.98
|
| Rate for Payer: Mclaren Commercial |
$9,675.72
|
| Rate for Payer: Mclaren Medicaid |
$3,530.98
|
| Rate for Payer: Mclaren Medicare |
$3,530.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,707.53
|
| Rate for Payer: Meridian Medicaid |
$1,939.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,060.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,884.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,138.18
|
| Rate for Payer: Nomi Health Commercial |
$8,815.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,063.10
|
| Rate for Payer: PACE Medicare |
$3,354.43
|
| Rate for Payer: PACE SWMI |
$3,530.98
|
| Rate for Payer: PHP Commercial |
$3,884.08
|
| Rate for Payer: PHP Medicaid |
$1,892.61
|
| Rate for Payer: PHP Medicare Advantage |
$3,530.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,846.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9,419.85
|
| Rate for Payer: Priority Health Medicare |
$3,530.98
|
| Rate for Payer: Priority Health Narrow Network |
$7,536.31
|
| Rate for Payer: Railroad Medicare Medicare |
$3,530.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,460.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,530.98
|
| Rate for Payer: UHC Exchange |
$5,473.02
|
| Rate for Payer: UHC Medicaid |
$1,846.70
|
| Rate for Payer: UHCCP DNSP |
$3,530.98
|
| Rate for Payer: UHCCP Medicaid |
$1,846.70
|
| Rate for Payer: VA VA |
$3,530.98
|
|
|
HC TISSUE TRANSFER ANY AREA 30.1-60 SQ CM
|
Facility
|
IP
|
$10,750.80
|
|
|
Service Code
|
CPT 14301
|
| Hospital Charge Code |
76100537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,063.10 |
| Max. Negotiated Rate |
$10,750.80 |
| Rate for Payer: Aetna Commercial |
$9,675.72
|
| Rate for Payer: ASR ASR |
$10,428.28
|
| Rate for Payer: BCBS Trust/PPO |
$8,828.56
|
| Rate for Payer: BCN Commercial |
$8,828.56
|
| Rate for Payer: Cash Price |
$8,600.64
|
| Rate for Payer: Cofinity Commercial |
$10,105.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,600.64
|
| Rate for Payer: Healthscope Commercial |
$10,428.28
|
| Rate for Payer: Healthscope Whirlpool |
$10,750.80
|
| Rate for Payer: Mclaren Commercial |
$9,675.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,138.18
|
| Rate for Payer: Nomi Health Commercial |
$8,815.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,063.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,460.70
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
OP
|
$58.26
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$58.26 |
| Rate for Payer: Aetna Commercial |
$52.43
|
| 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 |
$56.51
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$48.04
|
| Rate for Payer: BCN Commercial |
$48.04
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: Healthscope Whirlpool |
$58.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$52.43
|
| Rate for Payer: Mclaren Medicaid |
$11.53
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.52
|
| Rate for Payer: Nomi Health Commercial |
$47.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.70
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.18
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$51.05
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$40.84
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP DNSP |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
IP
|
$58.26
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.70 |
| Max. Negotiated Rate |
$58.26 |
| Rate for Payer: Aetna Commercial |
$52.43
|
| Rate for Payer: ASR ASR |
$56.51
|
| Rate for Payer: BCBS Trust/PPO |
$47.84
|
| Rate for Payer: BCN Commercial |
$47.84
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: Healthscope Whirlpool |
$58.26
|
| Rate for Payer: Mclaren Commercial |
$52.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.52
|
| Rate for Payer: Nomi Health Commercial |
$47.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.27
|
|
|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
OP
|
$37.14
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$232.43 |
| Rate for Payer: Aetna Commercial |
$33.43
|
| 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 |
$36.03
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$30.62
|
| Rate for Payer: BCN Commercial |
$30.62
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$34.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$36.03
|
| Rate for Payer: Healthscope Whirlpool |
$37.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$33.43
|
| Rate for Payer: Mclaren Medicaid |
$11.53
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.18
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$232.43
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$185.94
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP DNSP |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
IP
|
$37.14
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$37.14 |
| Rate for Payer: Aetna Commercial |
$33.43
|
| Rate for Payer: ASR ASR |
$36.03
|
| Rate for Payer: BCBS Trust/PPO |
$30.50
|
| Rate for Payer: BCN Commercial |
$30.50
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$34.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Healthscope Commercial |
$36.03
|
| Rate for Payer: Healthscope Whirlpool |
$37.14
|
| Rate for Payer: Mclaren Commercial |
$33.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.68
|
|
|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
OP
|
$37.14
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$232.43 |
| Rate for Payer: Aetna Commercial |
$33.43
|
| 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 |
$36.03
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$30.62
|
| Rate for Payer: BCN Commercial |
$30.62
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$34.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$36.03
|
| Rate for Payer: Healthscope Whirlpool |
$37.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$33.43
|
| Rate for Payer: Mclaren Medicaid |
$11.53
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: PHP Medicaid |
$6.18
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$232.43
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$185.94
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP DNSP |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
IP
|
$37.14
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$37.14 |
| Rate for Payer: Aetna Commercial |
$33.43
|
| Rate for Payer: ASR ASR |
$36.03
|
| Rate for Payer: BCBS Trust/PPO |
$30.50
|
| Rate for Payer: BCN Commercial |
$30.50
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$34.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Healthscope Commercial |
$36.03
|
| Rate for Payer: Healthscope Whirlpool |
$37.14
|
| Rate for Payer: Mclaren Commercial |
$33.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.68
|
|
|
HC TIXAGEVIMAB/CILGAVIMAB 150 MG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0220
|
| Hospital Charge Code |
63600197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC TIXAGEVIMAB/CILGAVIMAB 150 MG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0220
|
| Hospital Charge Code |
63600197
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: Priority Health Cigna 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 |
$0.01
|
|
|
HC TIXAGEVIMAB/CILGAVIMAB 300 MG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0221
|
| Hospital Charge Code |
63600203
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: Priority Health Cigna 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 |
$0.01
|
|
