|
HC TISSUE IN SITU HYBRID QUANT
|
Facility
|
IP
|
$269.46
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$175.15 |
| Max. Negotiated Rate |
$269.46 |
| Rate for Payer: Aetna Commercial |
$242.51
|
| Rate for Payer: ASR ASR |
$261.38
|
| Rate for Payer: ASR Commercial |
$261.38
|
| Rate for Payer: BCBS Trust/PPO |
$219.58
|
| Rate for Payer: BCN Commercial |
$208.91
|
| Rate for Payer: Cash Price |
$215.57
|
| Rate for Payer: Cofinity Commercial |
$253.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.57
|
| Rate for Payer: Healthscope Commercial |
$269.46
|
| Rate for Payer: Healthscope Whirlpool |
$261.38
|
| Rate for Payer: Mclaren Commercial |
$242.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.04
|
| Rate for Payer: Nomi Health Commercial |
$220.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.12
|
|
|
HC TISSUE IN SITU HYBRID QUANT
|
Facility
|
OP
|
$269.46
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$138.78 |
| Max. Negotiated Rate |
$546.30 |
| Rate for Payer: Aetna Commercial |
$242.51
|
| Rate for Payer: Aetna Medicare |
$352.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$440.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$440.56
|
| Rate for Payer: ASR ASR |
$261.38
|
| Rate for Payer: ASR Commercial |
$261.38
|
| Rate for Payer: BCBS Complete |
$198.36
|
| Rate for Payer: BCBS MAPPO |
$352.45
|
| Rate for Payer: BCBS Trust/PPO |
$220.66
|
| Rate for Payer: BCCCP Commercial |
$138.78
|
| Rate for Payer: BCN Commercial |
$208.91
|
| Rate for Payer: BCN Medicare Advantage |
$352.45
|
| Rate for Payer: Cash Price |
$215.57
|
| Rate for Payer: Cash Price |
$215.57
|
| Rate for Payer: Cofinity Commercial |
$253.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.45
|
| Rate for Payer: Healthscope Commercial |
$269.46
|
| Rate for Payer: Healthscope Whirlpool |
$261.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$352.45
|
| Rate for Payer: Mclaren Commercial |
$242.51
|
| Rate for Payer: Mclaren Medicaid |
$188.91
|
| Rate for Payer: Mclaren Medicare |
$352.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$370.07
|
| Rate for Payer: Meridian Medicaid |
$198.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$405.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.04
|
| Rate for Payer: Nomi Health Commercial |
$220.96
|
| Rate for Payer: PACE Medicare |
$334.83
|
| Rate for Payer: PACE SWMI |
$352.45
|
| Rate for Payer: PHP Commercial |
$387.70
|
| Rate for Payer: PHP Medicaid |
$188.91
|
| Rate for Payer: PHP Medicare Advantage |
$352.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$236.10
|
| Rate for Payer: Priority Health Medicare |
$352.45
|
| Rate for Payer: Priority Health Narrow Network |
$188.89
|
| Rate for Payer: Railroad Medicare Medicare |
$352.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.45
|
| Rate for Payer: UHC Exchange |
$546.30
|
| Rate for Payer: UHC Medicare Advantage |
$352.45
|
| Rate for Payer: UHCCP DNSP |
$352.45
|
| Rate for Payer: UHCCP Medicaid |
$188.91
|
| Rate for Payer: VA VA |
$352.45
|
|
|
HC TISSUE MARKER IMPLANTABLE
|
Facility
|
IP
|
$1,470.09
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.56 |
| Max. Negotiated Rate |
$1,470.09 |
| Rate for Payer: Aetna Commercial |
$1,323.08
|
| Rate for Payer: ASR ASR |
$1,425.99
|
| Rate for Payer: ASR Commercial |
$1,425.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,197.98
|
| Rate for Payer: BCN Commercial |
$1,139.76
|
| Rate for Payer: Cash Price |
$1,176.07
|
| Rate for Payer: Cofinity Commercial |
$1,381.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,176.07
|
| Rate for Payer: Healthscope Commercial |
$1,470.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,425.99
|
| Rate for Payer: Mclaren Commercial |
$1,323.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,249.58
|
| Rate for Payer: Nomi Health Commercial |
$1,205.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$955.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,293.68
|
|
|
HC TISSUE MARKER IMPLANTABLE
|
Facility
|
OP
|
$1,470.09
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.04 |
| Max. Negotiated Rate |
$1,470.09 |
| Rate for Payer: Aetna Commercial |
$1,323.08
|
| Rate for Payer: Aetna Medicare |
$735.04
|
| Rate for Payer: ASR ASR |
$1,425.99
|
| Rate for Payer: ASR Commercial |
$1,425.99
|
| Rate for Payer: BCBS Complete |
$588.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,203.86
|
| Rate for Payer: BCN Commercial |
$1,139.76
|
| Rate for Payer: Cash Price |
$1,176.07
|
| Rate for Payer: Cofinity Commercial |
$1,381.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,176.07
|
| Rate for Payer: Healthscope Commercial |
$1,470.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,425.99
|
| Rate for Payer: Mclaren Commercial |
$1,323.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,249.58
|
| Rate for Payer: Nomi Health Commercial |
$1,205.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$955.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,288.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,030.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,293.68
|
|
|
HC TISSUE MARKER PROSTATE
|
Facility
|
IP
|
$1,331.10
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.22 |
| Max. Negotiated Rate |
$1,331.10 |
| Rate for Payer: Aetna Commercial |
$1,197.99
|
| Rate for Payer: ASR ASR |
$1,291.17
|
| Rate for Payer: ASR Commercial |
$1,291.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,084.71
|
| Rate for Payer: BCN Commercial |
$1,032.00
|
| Rate for Payer: Cash Price |
$1,064.88
|
| Rate for Payer: Cofinity Commercial |
$1,251.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,064.88
|
| Rate for Payer: Healthscope Commercial |
$1,331.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,291.17
|
| Rate for Payer: Mclaren Commercial |
$1,197.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,131.44
|
| Rate for Payer: Nomi Health Commercial |
$1,091.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$865.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,171.37
|
|
|
HC TISSUE MARKER PROSTATE
|
Facility
|
OP
|
$1,331.10
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.44 |
| Max. Negotiated Rate |
$1,331.10 |
| Rate for Payer: Aetna Commercial |
$1,197.99
|
| Rate for Payer: Aetna Medicare |
$665.55
|
| Rate for Payer: ASR ASR |
$1,291.17
|
| Rate for Payer: ASR Commercial |
$1,291.17
|
| Rate for Payer: BCBS Complete |
$532.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,090.04
|
| Rate for Payer: BCN Commercial |
$1,032.00
|
| Rate for Payer: Cash Price |
$1,064.88
|
| Rate for Payer: Cofinity Commercial |
$1,251.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,064.88
|
| Rate for Payer: Healthscope Commercial |
$1,331.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,291.17
|
| Rate for Payer: Mclaren Commercial |
$1,197.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,131.44
|
| Rate for Payer: Nomi Health Commercial |
$1,091.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$865.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,166.31
|
| Rate for Payer: Priority Health Narrow Network |
$933.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,171.37
|
|
|
HC TISSUE PROCESSING
|
Facility
|
OP
|
$51.31
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$51.31 |
| Rate for Payer: Aetna Commercial |
$46.18
|
| 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 |
$49.77
|
| Rate for Payer: ASR Commercial |
$49.77
|
| Rate for Payer: BCBS Complete |
$3.31
|
| Rate for Payer: BCBS MAPPO |
$5.88
|
| Rate for Payer: BCBS Trust/PPO |
$42.02
|
| Rate for Payer: BCN Commercial |
$39.78
|
| Rate for Payer: BCN Medicare Advantage |
$5.88
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$48.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.88
|
| Rate for Payer: Healthscope Commercial |
$51.31
|
| Rate for Payer: Healthscope Whirlpool |
$49.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.88
|
| Rate for Payer: Mclaren Commercial |
$46.18
|
| Rate for Payer: Mclaren Medicaid |
$3.15
|
| 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 |
$3.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: Nomi Health Commercial |
$42.07
|
| 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 |
$3.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.96
|
| Rate for Payer: Priority Health Medicare |
$5.88
|
| Rate for Payer: Priority Health Narrow Network |
$35.97
|
| Rate for Payer: Railroad Medicare Medicare |
$5.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.88
|
| Rate for Payer: UHC Exchange |
$9.11
|
| Rate for Payer: UHC Medicare Advantage |
$5.88
|
| Rate for Payer: UHCCP DNSP |
$5.88
|
| Rate for Payer: UHCCP Medicaid |
$3.15
|
| Rate for Payer: VA VA |
$5.88
|
|
|
HC TISSUE PROCESSING
|
Facility
|
IP
|
$51.31
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$51.31 |
| Rate for Payer: Aetna Commercial |
$46.18
|
| Rate for Payer: ASR ASR |
$49.77
|
| Rate for Payer: ASR Commercial |
$49.77
|
| Rate for Payer: BCBS Trust/PPO |
$41.81
|
| Rate for Payer: BCN Commercial |
$39.78
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$48.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Healthscope Commercial |
$51.31
|
| Rate for Payer: Healthscope Whirlpool |
$49.77
|
| Rate for Payer: Mclaren Commercial |
$46.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: Nomi Health Commercial |
$42.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.15
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
IP
|
$57.12
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$57.12 |
| Rate for Payer: Aetna Commercial |
$51.41
|
| Rate for Payer: ASR ASR |
$55.41
|
| Rate for Payer: ASR Commercial |
$55.41
|
| Rate for Payer: BCBS Trust/PPO |
$46.55
|
| Rate for Payer: BCN Commercial |
$44.29
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$53.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Healthscope Commercial |
$57.12
|
| Rate for Payer: Healthscope Whirlpool |
$55.41
|
| Rate for Payer: Mclaren Commercial |
$51.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: Nomi Health Commercial |
$46.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.27
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
OP
|
$57.12
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$57.12 |
| Rate for Payer: Aetna Commercial |
$51.41
|
| 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 |
$55.41
|
| Rate for Payer: ASR Commercial |
$55.41
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$46.78
|
| Rate for Payer: BCN Commercial |
$44.29
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$53.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$57.12
|
| Rate for Payer: Healthscope Whirlpool |
$55.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$51.41
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| 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 |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: Nomi Health Commercial |
$46.84
|
| 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 |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.05
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$40.04
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP DNSP |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$36.41 |
| Rate for Payer: Aetna Commercial |
$32.77
|
| Rate for Payer: ASR ASR |
$35.32
|
| Rate for Payer: ASR Commercial |
$35.32
|
| Rate for Payer: BCBS Trust/PPO |
$29.67
|
| Rate for Payer: BCN Commercial |
$28.23
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$36.41
|
| Rate for Payer: Healthscope Whirlpool |
$35.32
|
| Rate for Payer: Mclaren Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.04
|
|
|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$210.82 |
| Rate for Payer: Aetna Commercial |
$32.77
|
| 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 |
$35.32
|
| Rate for Payer: ASR Commercial |
$35.32
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$29.82
|
| Rate for Payer: BCN Commercial |
$28.23
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$36.41
|
| Rate for Payer: Healthscope Whirlpool |
$35.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$32.77
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| 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 |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| 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 |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.82
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$168.66
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP DNSP |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$36.41 |
| Rate for Payer: Aetna Commercial |
$32.77
|
| Rate for Payer: ASR ASR |
$35.32
|
| Rate for Payer: ASR Commercial |
$35.32
|
| Rate for Payer: BCBS Trust/PPO |
$29.67
|
| Rate for Payer: BCN Commercial |
$28.23
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$36.41
|
| Rate for Payer: Healthscope Whirlpool |
$35.32
|
| Rate for Payer: Mclaren Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.04
|
|
|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$210.82 |
| Rate for Payer: Aetna Commercial |
$32.77
|
| 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 |
$35.32
|
| Rate for Payer: ASR Commercial |
$35.32
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$29.82
|
| Rate for Payer: BCN Commercial |
$28.23
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$36.41
|
| Rate for Payer: Healthscope Whirlpool |
$35.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.53
|
| Rate for Payer: Mclaren Commercial |
$32.77
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| 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 |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| 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 |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.82
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$168.66
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.87
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP DNSP |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
| Rate for Payer: VA VA |
$11.53
|
|
|
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: ASR Commercial |
$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: Priority Health Cigna Priority Health |
$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 |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: ASR Commercial |
$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: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$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 |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: ASR Commercial |
$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: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC TIXAGEVIMAB/CILGAVIMAB 300 MG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0221
|
| Hospital Charge Code |
63600203
|
|
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: ASR Commercial |
$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: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC TL 201 PER MCI
|
Facility
|
OP
|
$193.26
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
34300022
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$193.26 |
| Rate for Payer: Aetna Commercial |
$173.93
|
| Rate for Payer: Aetna Medicare |
$96.63
|
| Rate for Payer: ASR ASR |
$187.46
|
| Rate for Payer: ASR Commercial |
$187.46
|
| Rate for Payer: BCBS Complete |
$77.30
|
| Rate for Payer: BCBS Trust/PPO |
$158.26
|
| Rate for Payer: BCN Commercial |
$149.83
|
| Rate for Payer: Cash Price |
$154.61
|
| Rate for Payer: Cash Price |
$154.61
|
| Rate for Payer: Cofinity Commercial |
$181.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.61
|
| Rate for Payer: Healthscope Commercial |
$193.26
|
| Rate for Payer: Healthscope Whirlpool |
$187.46
|
| Rate for Payer: Mclaren Commercial |
$173.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.27
|
| Rate for Payer: Nomi Health Commercial |
$158.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.31
|
| Rate for Payer: Priority Health Narrow Network |
$26.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.07
|
|
|
HC TL 201 PER MCI
|
Facility
|
IP
|
$193.26
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
34300022
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$125.62 |
| Max. Negotiated Rate |
$193.26 |
| Rate for Payer: Aetna Commercial |
$173.93
|
| Rate for Payer: ASR ASR |
$187.46
|
| Rate for Payer: ASR Commercial |
$187.46
|
| Rate for Payer: BCBS Trust/PPO |
$157.49
|
| Rate for Payer: BCN Commercial |
$149.83
|
| Rate for Payer: Cash Price |
$154.61
|
| Rate for Payer: Cofinity Commercial |
$181.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.61
|
| Rate for Payer: Healthscope Commercial |
$193.26
|
| Rate for Payer: Healthscope Whirlpool |
$187.46
|
| Rate for Payer: Mclaren Commercial |
$173.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.27
|
| Rate for Payer: Nomi Health Commercial |
$158.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.07
|
|
|
HC TOBRAMYCIN LEVEL
|
Facility
|
IP
|
$107.51
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
30100049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.88 |
| Max. Negotiated Rate |
$107.51 |
| Rate for Payer: Aetna Commercial |
$96.76
|
| Rate for Payer: ASR ASR |
$104.28
|
| Rate for Payer: ASR Commercial |
$104.28
|
| Rate for Payer: BCBS Trust/PPO |
$87.61
|
| Rate for Payer: BCN Commercial |
$83.35
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$101.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Healthscope Commercial |
$107.51
|
| Rate for Payer: Healthscope Whirlpool |
$104.28
|
| Rate for Payer: Mclaren Commercial |
$96.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: Nomi Health Commercial |
$88.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.61
|
|
|
HC TOBRAMYCIN LEVEL
|
Facility
|
OP
|
$107.51
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
30100049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$107.51 |
| Rate for Payer: Aetna Commercial |
$96.76
|
| Rate for Payer: Aetna Medicare |
$16.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.16
|
| Rate for Payer: ASR ASR |
$104.28
|
| Rate for Payer: ASR Commercial |
$104.28
|
| Rate for Payer: BCBS Complete |
$9.08
|
| Rate for Payer: BCBS MAPPO |
$16.13
|
| Rate for Payer: BCBS Trust/PPO |
$88.04
|
| Rate for Payer: BCN Commercial |
$83.35
|
| Rate for Payer: BCN Medicare Advantage |
$16.13
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$101.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.13
|
| Rate for Payer: Healthscope Commercial |
$107.51
|
| Rate for Payer: Healthscope Whirlpool |
$104.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.13
|
| Rate for Payer: Mclaren Commercial |
$96.76
|
| Rate for Payer: Mclaren Medicaid |
$8.65
|
| Rate for Payer: Mclaren Medicare |
$16.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.94
|
| Rate for Payer: Meridian Medicaid |
$9.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: Nomi Health Commercial |
$88.16
|
| Rate for Payer: PACE Medicare |
$15.32
|
| Rate for Payer: PACE SWMI |
$16.13
|
| Rate for Payer: PHP Commercial |
$17.74
|
| Rate for Payer: PHP Medicaid |
$8.65
|
| Rate for Payer: PHP Medicare Advantage |
$16.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.94
|
| Rate for Payer: Priority Health Medicare |
$16.13
|
| Rate for Payer: Priority Health Narrow Network |
$71.15
|
| Rate for Payer: Railroad Medicare Medicare |
$16.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.13
|
| Rate for Payer: UHC Exchange |
$25.00
|
| Rate for Payer: UHC Medicare Advantage |
$16.13
|
| Rate for Payer: UHCCP DNSP |
$16.13
|
| Rate for Payer: UHCCP Medicaid |
$8.65
|
| Rate for Payer: VA VA |
$16.13
|
|
|
HC TOMATO IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC TOMATO IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| 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 |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| 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 |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC TOMO GUIDED BREAST BIOPSY
|
Facility
|
IP
|
$4,731.78
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100566
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,075.66 |
| Max. Negotiated Rate |
$4,731.78 |
| Rate for Payer: Aetna Commercial |
$4,258.60
|
| Rate for Payer: ASR ASR |
$4,589.83
|
| Rate for Payer: ASR Commercial |
$4,589.83
|
| Rate for Payer: BCBS Trust/PPO |
$3,855.93
|
| Rate for Payer: BCN Commercial |
$3,668.55
|
| Rate for Payer: Cash Price |
$3,785.42
|
| Rate for Payer: Cofinity Commercial |
$4,447.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,785.42
|
| Rate for Payer: Healthscope Commercial |
$4,731.78
|
| Rate for Payer: Healthscope Whirlpool |
$4,589.83
|
| Rate for Payer: Mclaren Commercial |
$4,258.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,022.01
|
| Rate for Payer: Nomi Health Commercial |
$3,880.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,163.97
|
|
