|
HC LEPTOSPIRA ANTIBODY
|
Facility
|
IP
|
$69.71
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
30200303
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$62.74 |
| Rate for Payer: Aetna Commercial |
$59.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.31
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cofinity Advantage |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$59.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.77
|
| Rate for Payer: Healthscope Commercial |
$62.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.28
|
| Rate for Payer: PHP Commercial |
$59.25
|
| Rate for Payer: Priority Health SBD |
$43.92
|
|
|
HC LEPTOSPIRA ANTIBODY
|
Facility
|
OP
|
$69.71
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
30200303
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$62.74 |
| Rate for Payer: Aetna Commercial |
$59.25
|
| Rate for Payer: Aetna Medicare |
$16.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.25
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS MAPPO |
$16.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.27
|
| Rate for Payer: BCN Commercial |
$17.27
|
| Rate for Payer: BCN Medicare Advantage |
$16.20
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cofinity Advantage |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$59.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.20
|
| Rate for Payer: Healthscope Commercial |
$62.74
|
| Rate for Payer: Mclaren Medicaid |
$8.47
|
| Rate for Payer: Mclaren Medicare |
$16.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.01
|
| Rate for Payer: Meridian Medicaid |
$17.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.25
|
| Rate for Payer: Nomi Health Commercial |
$24.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.28
|
| Rate for Payer: PACE Medicare |
$15.39
|
| Rate for Payer: PACE SWMI |
$16.20
|
| Rate for Payer: PHP Commercial |
$59.25
|
| Rate for Payer: PHP Medicare Advantage |
$16.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.20
|
| Rate for Payer: Priority Health Medicare |
$16.20
|
| Rate for Payer: Priority Health SBD |
$43.92
|
| Rate for Payer: Priority Health Tiered Network |
$12.96
|
| Rate for Payer: Railroad Medicare Medicare |
$16.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.30
|
| Rate for Payer: UHC Core |
$24.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.20
|
| Rate for Payer: UHC Exchange |
$24.30
|
| Rate for Payer: UHC Medicaid |
$8.47
|
| Rate for Payer: UHCCP Medicaid |
$8.47
|
| Rate for Payer: VA VA |
$16.20
|
|
|
HC LEUKEMIA LYMPHOMA IMM T PANEL
|
Facility
|
OP
|
$53.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100014
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$47.95 |
| Rate for Payer: Aetna Commercial |
$45.29
|
| Rate for Payer: Aetna Medicare |
$26.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.63
|
| Rate for Payer: BCBS Complete |
$21.31
|
| Rate for Payer: BCBS Trust/PPO |
$38.62
|
| Rate for Payer: BCN Commercial |
$38.62
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cofinity Advantage |
$37.30
|
| Rate for Payer: Cofinity Commercial |
$45.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.62
|
| Rate for Payer: Healthscope Commercial |
$47.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.96
|
| Rate for Payer: PHP Commercial |
$45.29
|
| Rate for Payer: Priority Health SBD |
$33.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.00
|
| Rate for Payer: UHC Core |
$33.00
|
| Rate for Payer: UHC Exchange |
$33.00
|
|
|
HC LEUKEMIA LYMPHOMA IMM T PANEL
|
Facility
|
IP
|
$53.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100014
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$47.95 |
| Rate for Payer: Aetna Commercial |
$45.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.63
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cofinity Advantage |
$37.30
|
| Rate for Payer: Cofinity Commercial |
$45.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.62
|
| Rate for Payer: Healthscope Commercial |
$47.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.96
|
| Rate for Payer: PHP Commercial |
$45.29
|
| Rate for Payer: Priority Health SBD |
$33.57
|
|
|
HC LEUKEMIA LYMPHOMA IMMUNOPH GLL
|
Facility
|
OP
|
$55.93
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100010
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$22.37 |
| Max. Negotiated Rate |
$50.34 |
| Rate for Payer: Aetna Commercial |
$47.54
|
| Rate for Payer: Aetna Medicare |
$27.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.35
|
| Rate for Payer: BCBS Complete |
$22.37
|
| Rate for Payer: BCBS Trust/PPO |
$38.62
|
| Rate for Payer: BCN Commercial |
$38.62
|
| Rate for Payer: Cash Price |
$44.74
|
| Rate for Payer: Cash Price |
$44.74
|
| Rate for Payer: Cofinity Advantage |
$39.15
|
| Rate for Payer: Cofinity Commercial |
$48.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.74
|
| Rate for Payer: Healthscope Commercial |
$50.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.95
|
| Rate for Payer: PHP Commercial |
$47.54
|
| Rate for Payer: Priority Health SBD |
$35.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.00
|
| Rate for Payer: UHC Core |
$33.00
|
| Rate for Payer: UHC Exchange |
$33.00
|
|
|
HC LEUKEMIA LYMPHOMA IMMUNOPH GLL
|
Facility
|
IP
|
$55.93
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100010
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$50.34 |
| Rate for Payer: Aetna Commercial |
$47.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.35
|
| Rate for Payer: Cash Price |
$44.74
|
| Rate for Payer: Cofinity Advantage |
$39.15
|
| Rate for Payer: Cofinity Commercial |
$48.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.74
|
| Rate for Payer: Healthscope Commercial |
$50.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.95
|
| Rate for Payer: PHP Commercial |
$47.54
|
| Rate for Payer: Priority Health SBD |
$35.24
|
|
|
HC LEUKEMIA LYMPHOMA IMMUNOPH TCR
|
Facility
|
IP
|
$53.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100009
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$47.95 |
| Rate for Payer: Aetna Commercial |
$45.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.63
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cofinity Advantage |
$37.30
|
| Rate for Payer: Cofinity Commercial |
$45.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.62
|
| Rate for Payer: Healthscope Commercial |
$47.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.96
|
| Rate for Payer: PHP Commercial |
$45.29
|
| Rate for Payer: Priority Health SBD |
$33.57
|
|
|
HC LEUKEMIA LYMPHOMA IMMUNOPH TCR
|
Facility
|
OP
|
$53.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100009
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$47.95 |
| Rate for Payer: Aetna Commercial |
$45.29
|
| Rate for Payer: Aetna Medicare |
$26.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.63
|
| Rate for Payer: BCBS Complete |
$21.31
|
| Rate for Payer: BCBS Trust/PPO |
$38.62
|
| Rate for Payer: BCN Commercial |
$38.62
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cofinity Advantage |
$37.30
|
| Rate for Payer: Cofinity Commercial |
$45.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.62
|
| Rate for Payer: Healthscope Commercial |
$47.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.96
|
| Rate for Payer: PHP Commercial |
$45.29
|
| Rate for Payer: Priority Health SBD |
$33.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.00
|
| Rate for Payer: UHC Core |
$33.00
|
| Rate for Payer: UHC Exchange |
$33.00
|
|
|
HC LEUKEMIA LYMPHOMA PLASMA CELL
|
Facility
|
IP
|
$53.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100013
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$47.95 |
| Rate for Payer: Aetna Commercial |
$45.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.63
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cofinity Advantage |
$37.30
|
| Rate for Payer: Cofinity Commercial |
$45.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.62
|
| Rate for Payer: Healthscope Commercial |
$47.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.96
|
| Rate for Payer: PHP Commercial |
$45.29
|
| Rate for Payer: Priority Health SBD |
$33.57
|
|
|
HC LEUKEMIA LYMPHOMA PLASMA CELL
|
Facility
|
OP
|
$53.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100013
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$47.95 |
| Rate for Payer: Aetna Commercial |
$45.29
|
| Rate for Payer: Aetna Medicare |
$26.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.63
|
| Rate for Payer: BCBS Complete |
$21.31
|
| Rate for Payer: BCBS Trust/PPO |
$38.62
|
| Rate for Payer: BCN Commercial |
$38.62
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cofinity Advantage |
$37.30
|
| Rate for Payer: Cofinity Commercial |
$45.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.62
|
| Rate for Payer: Healthscope Commercial |
$47.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.96
|
| Rate for Payer: PHP Commercial |
$45.29
|
| Rate for Payer: Priority Health SBD |
$33.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.00
|
| Rate for Payer: UHC Core |
$33.00
|
| Rate for Payer: UHC Exchange |
$33.00
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT B
|
Facility
|
IP
|
$53.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$47.95 |
| Rate for Payer: Aetna Commercial |
$45.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.63
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cofinity Advantage |
$37.30
|
| Rate for Payer: Cofinity Commercial |
$45.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.62
|
| Rate for Payer: Healthscope Commercial |
$47.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.96
|
| Rate for Payer: PHP Commercial |
$45.29
|
| Rate for Payer: Priority Health SBD |
$33.57
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT B
|
Facility
|
OP
|
$53.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$47.95 |
| Rate for Payer: Aetna Commercial |
$45.29
|
| Rate for Payer: Aetna Medicare |
$26.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.63
|
| Rate for Payer: BCBS Complete |
$21.31
|
| Rate for Payer: BCBS Trust/PPO |
$38.62
|
| Rate for Payer: BCN Commercial |
$38.62
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cofinity Advantage |
$37.30
|
| Rate for Payer: Cofinity Commercial |
$45.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.62
|
| Rate for Payer: Healthscope Commercial |
$47.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.96
|
| Rate for Payer: PHP Commercial |
$45.29
|
| Rate for Payer: Priority Health SBD |
$33.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.00
|
| Rate for Payer: UHC Core |
$33.00
|
| Rate for Payer: UHC Exchange |
$33.00
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT C
|
Facility
|
IP
|
$53.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000009
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$47.95 |
| Rate for Payer: Aetna Commercial |
$45.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.63
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cofinity Advantage |
$37.30
|
| Rate for Payer: Cofinity Commercial |
$45.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.62
|
| Rate for Payer: Healthscope Commercial |
$47.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.96
|
| Rate for Payer: PHP Commercial |
$45.29
|
| Rate for Payer: Priority Health SBD |
$33.57
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT C
|
Facility
|
OP
|
$53.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000009
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$47.95 |
| Rate for Payer: Aetna Commercial |
$45.29
|
| Rate for Payer: Aetna Medicare |
$26.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.63
|
| Rate for Payer: BCBS Complete |
$21.31
|
| Rate for Payer: BCBS Trust/PPO |
$38.62
|
| Rate for Payer: BCN Commercial |
$38.62
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cofinity Advantage |
$37.30
|
| Rate for Payer: Cofinity Commercial |
$45.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.62
|
| Rate for Payer: Healthscope Commercial |
$47.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.96
|
| Rate for Payer: PHP Commercial |
$45.29
|
| Rate for Payer: Priority Health SBD |
$33.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.00
|
| Rate for Payer: UHC Core |
$33.00
|
| Rate for Payer: UHC Exchange |
$33.00
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT D
|
Facility
|
IP
|
$55.93
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000010
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$50.34 |
| Rate for Payer: Aetna Commercial |
$47.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.35
|
| Rate for Payer: Cash Price |
$44.74
|
| Rate for Payer: Cofinity Advantage |
$39.15
|
| Rate for Payer: Cofinity Commercial |
$48.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.74
|
| Rate for Payer: Healthscope Commercial |
$50.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.95
|
| Rate for Payer: PHP Commercial |
$47.54
|
| Rate for Payer: Priority Health SBD |
$35.24
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT D
|
Facility
|
OP
|
$55.93
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000010
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.37 |
| Max. Negotiated Rate |
$50.34 |
| Rate for Payer: Aetna Commercial |
$47.54
|
| Rate for Payer: Aetna Medicare |
$27.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.35
|
| Rate for Payer: BCBS Complete |
$22.37
|
| Rate for Payer: BCBS Trust/PPO |
$38.62
|
| Rate for Payer: BCN Commercial |
$38.62
|
| Rate for Payer: Cash Price |
$44.74
|
| Rate for Payer: Cash Price |
$44.74
|
| Rate for Payer: Cofinity Advantage |
$39.15
|
| Rate for Payer: Cofinity Commercial |
$48.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.74
|
| Rate for Payer: Healthscope Commercial |
$50.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.95
|
| Rate for Payer: PHP Commercial |
$47.54
|
| Rate for Payer: Priority Health SBD |
$35.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.00
|
| Rate for Payer: UHC Core |
$33.00
|
| Rate for Payer: UHC Exchange |
$33.00
|
|
|
HC LEUK LYMPHOMA IMMUNOPHEN TISSUE
|
Facility
|
OP
|
$53.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100015
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$47.95 |
| Rate for Payer: Aetna Commercial |
$45.29
|
| Rate for Payer: Aetna Medicare |
$26.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.63
|
| Rate for Payer: BCBS Complete |
$21.31
|
| Rate for Payer: BCBS Trust/PPO |
$38.62
|
| Rate for Payer: BCN Commercial |
$38.62
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cofinity Advantage |
$37.30
|
| Rate for Payer: Cofinity Commercial |
$45.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.62
|
| Rate for Payer: Healthscope Commercial |
$47.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.96
|
| Rate for Payer: PHP Commercial |
$45.29
|
| Rate for Payer: Priority Health SBD |
$33.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.00
|
| Rate for Payer: UHC Core |
$33.00
|
| Rate for Payer: UHC Exchange |
$33.00
|
|
|
HC LEUK LYMPHOMA IMMUNOPHEN TISSUE
|
Facility
|
IP
|
$53.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100015
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$47.95 |
| Rate for Payer: Aetna Commercial |
$45.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.63
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cofinity Advantage |
$37.30
|
| Rate for Payer: Cofinity Commercial |
$45.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.62
|
| Rate for Payer: Healthscope Commercial |
$47.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.96
|
| Rate for Payer: PHP Commercial |
$45.29
|
| Rate for Payer: Priority Health SBD |
$33.57
|
|
|
HC LEUKOTRIENE E4, U
|
Facility
|
IP
|
$265.30
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$167.14 |
| Max. Negotiated Rate |
$238.77 |
| Rate for Payer: Aetna Commercial |
$225.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.44
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cofinity Advantage |
$185.71
|
| Rate for Payer: Cofinity Commercial |
$228.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.24
|
| Rate for Payer: Healthscope Commercial |
$238.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.97
|
| Rate for Payer: PHP Commercial |
$225.50
|
| Rate for Payer: Priority Health SBD |
$167.14
|
|
|
HC LEUKOTRIENE E4, U
|
Facility
|
OP
|
$265.30
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$238.77 |
| Rate for Payer: Aetna Commercial |
$225.50
|
| Rate for Payer: Aetna Medicare |
$25.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: BCBS Complete |
$13.23
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$25.69
|
| Rate for Payer: BCN Commercial |
$25.69
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cofinity Advantage |
$185.71
|
| Rate for Payer: Cofinity Commercial |
$228.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$238.77
|
| Rate for Payer: Mclaren Medicaid |
$12.60
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: Meridian Medicaid |
$25.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.50
|
| Rate for Payer: Nomi Health Commercial |
$36.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.97
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$225.50
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.09
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health SBD |
$167.14
|
| Rate for Payer: Priority Health Tiered Network |
$19.27
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.14
|
| Rate for Payer: UHC Core |
$36.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.09
|
| Rate for Payer: UHC Exchange |
$36.14
|
| Rate for Payer: UHC Medicaid |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$12.60
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC LEUPROLIDE ACETATE 3.75MG
|
Facility
|
IP
|
$1,051.76
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
63600142
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$662.61 |
| Max. Negotiated Rate |
$946.58 |
| Rate for Payer: Aetna Commercial |
$894.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.64
|
| Rate for Payer: Cash Price |
$841.41
|
| Rate for Payer: Cofinity Advantage |
$736.23
|
| Rate for Payer: Cofinity Commercial |
$904.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.41
|
| Rate for Payer: Healthscope Commercial |
$946.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$894.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$788.82
|
| Rate for Payer: PHP Commercial |
$894.00
|
| Rate for Payer: Priority Health SBD |
$662.61
|
|
|
HC LEUPROLIDE ACETATE 3.75MG
|
Facility
|
OP
|
$1,051.76
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
63600142
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$662.61 |
| Max. Negotiated Rate |
$5,457.38 |
| Rate for Payer: Aetna Commercial |
$894.00
|
| Rate for Payer: Aetna Medicare |
$1,836.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,206.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,206.96
|
| Rate for Payer: BCBS Complete |
$969.65
|
| Rate for Payer: BCBS MAPPO |
$1,765.57
|
| Rate for Payer: BCBS Trust/PPO |
$4,425.28
|
| Rate for Payer: BCN Commercial |
$4,425.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,765.57
|
| Rate for Payer: Cash Price |
$841.41
|
| Rate for Payer: Cash Price |
$841.41
|
| Rate for Payer: Cofinity Advantage |
$736.23
|
| Rate for Payer: Cofinity Commercial |
$904.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,765.57
|
| Rate for Payer: Healthscope Commercial |
$946.58
|
| Rate for Payer: Mclaren Medicaid |
$923.39
|
| Rate for Payer: Mclaren Medicare |
$1,765.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,853.85
|
| Rate for Payer: Meridian Medicaid |
$1,853.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,030.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,942.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$894.00
|
| Rate for Payer: Nomi Health Commercial |
$5,296.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$788.82
|
| Rate for Payer: PACE Medicare |
$1,677.29
|
| Rate for Payer: PACE SWMI |
$1,765.57
|
| Rate for Payer: PHP Commercial |
$894.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,765.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$923.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,457.38
|
| Rate for Payer: Priority Health Medicare |
$1,765.57
|
| Rate for Payer: Priority Health SBD |
$662.61
|
| Rate for Payer: Priority Health Tiered Network |
$4,365.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,765.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,910.39
|
| Rate for Payer: UHC Core |
$2,910.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,765.57
|
| Rate for Payer: UHC Exchange |
$2,910.39
|
| Rate for Payer: UHC Medicaid |
$923.39
|
| Rate for Payer: UHCCP Medicaid |
$923.39
|
| Rate for Payer: VA VA |
$1,765.57
|
|
|
HC LEUPROLIDE ACETATE SUSPNSION/ 7.5MG
|
Facility
|
OP
|
$470.26
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
63600147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.15 |
| Max. Negotiated Rate |
$556.52 |
| Rate for Payer: Aetna Commercial |
$399.72
|
| Rate for Payer: Aetna Medicare |
$183.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.25
|
| Rate for Payer: BCBS Complete |
$96.77
|
| Rate for Payer: BCBS MAPPO |
$176.20
|
| Rate for Payer: BCBS Trust/PPO |
$444.32
|
| Rate for Payer: BCN Commercial |
$444.32
|
| Rate for Payer: BCN Medicare Advantage |
$176.20
|
| Rate for Payer: Cash Price |
$376.21
|
| Rate for Payer: Cash Price |
$376.21
|
| Rate for Payer: Cofinity Advantage |
$329.18
|
| Rate for Payer: Cofinity Commercial |
$404.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.20
|
| Rate for Payer: Healthscope Commercial |
$423.23
|
| Rate for Payer: Mclaren Medicaid |
$92.15
|
| Rate for Payer: Mclaren Medicare |
$176.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.01
|
| Rate for Payer: Meridian Medicaid |
$185.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$193.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.72
|
| Rate for Payer: Nomi Health Commercial |
$528.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.69
|
| Rate for Payer: PACE Medicare |
$167.39
|
| Rate for Payer: PACE SWMI |
$176.20
|
| Rate for Payer: PHP Commercial |
$399.72
|
| Rate for Payer: PHP Medicare Advantage |
$176.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$556.52
|
| Rate for Payer: Priority Health Medicare |
$176.20
|
| Rate for Payer: Priority Health SBD |
$296.26
|
| Rate for Payer: Priority Health Tiered Network |
$445.22
|
| Rate for Payer: Railroad Medicare Medicare |
$176.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.79
|
| Rate for Payer: UHC Core |
$281.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$176.20
|
| Rate for Payer: UHC Exchange |
$281.79
|
| Rate for Payer: UHC Medicaid |
$92.15
|
| Rate for Payer: UHCCP Medicaid |
$92.15
|
| Rate for Payer: VA VA |
$176.20
|
|
|
HC LEUPROLIDE ACETATE SUSPNSION/ 7.5MG
|
Facility
|
IP
|
$470.26
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
63600147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$296.26 |
| Max. Negotiated Rate |
$423.23 |
| Rate for Payer: Aetna Commercial |
$399.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.67
|
| Rate for Payer: Cash Price |
$376.21
|
| Rate for Payer: Cofinity Advantage |
$329.18
|
| Rate for Payer: Cofinity Commercial |
$404.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.21
|
| Rate for Payer: Healthscope Commercial |
$423.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.69
|
| Rate for Payer: PHP Commercial |
$399.72
|
| Rate for Payer: Priority Health SBD |
$296.26
|
|
|
HC LEVEL 0.5 INIT 30 MIN
|
Facility
|
IP
|
$939.78
|
|
| Hospital Charge Code |
36000060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$592.06 |
| Max. Negotiated Rate |
$845.80 |
| Rate for Payer: Aetna Commercial |
$798.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$610.86
|
| Rate for Payer: Cash Price |
$751.82
|
| Rate for Payer: Cofinity Advantage |
$657.85
|
| Rate for Payer: Cofinity Commercial |
$808.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$751.82
|
| Rate for Payer: Healthscope Commercial |
$845.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$798.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$704.84
|
| Rate for Payer: PHP Commercial |
$798.81
|
| Rate for Payer: Priority Health SBD |
$592.06
|
|
