|
HC TC 99M ABD PER STUDY
|
Facility
|
IP
|
$160.67
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$101.22 |
| Max. Negotiated Rate |
$144.60 |
| Rate for Payer: Aetna Commercial |
$136.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.44
|
| Rate for Payer: Cash Price |
$128.54
|
| Rate for Payer: Cofinity Advantage |
$112.47
|
| Rate for Payer: Cofinity Commercial |
$138.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.54
|
| Rate for Payer: Healthscope Commercial |
$144.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.50
|
| Rate for Payer: PHP Commercial |
$136.57
|
| Rate for Payer: Priority Health SBD |
$101.22
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
OP
|
$160.67
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$64.27 |
| Max. Negotiated Rate |
$743.46 |
| Rate for Payer: Aetna Commercial |
$136.57
|
| Rate for Payer: Aetna Medicare |
$80.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.44
|
| Rate for Payer: BCBS Complete |
$64.27
|
| Rate for Payer: BCBS Trust/PPO |
$182.11
|
| Rate for Payer: BCN Commercial |
$182.11
|
| Rate for Payer: Cash Price |
$128.54
|
| Rate for Payer: Cash Price |
$128.54
|
| Rate for Payer: Cofinity Advantage |
$112.47
|
| Rate for Payer: Cofinity Commercial |
$138.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.54
|
| Rate for Payer: Healthscope Commercial |
$144.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.50
|
| Rate for Payer: PHP Commercial |
$136.57
|
| Rate for Payer: Priority Health SBD |
$101.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$743.46
|
| Rate for Payer: UHC Core |
$743.46
|
| Rate for Payer: UHC Exchange |
$743.46
|
|
|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
OP
|
$2,706.00
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$488.55 |
| Max. Negotiated Rate |
$2,946.23 |
| Rate for Payer: Aetna Commercial |
$2,300.10
|
| Rate for Payer: Aetna Medicare |
$971.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,758.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,167.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,167.66
|
| Rate for Payer: BCBS Complete |
$513.02
|
| Rate for Payer: BCBS MAPPO |
$934.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,478.92
|
| Rate for Payer: BCN Commercial |
$1,478.92
|
| Rate for Payer: BCN Medicare Advantage |
$934.13
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cofinity Advantage |
$1,894.20
|
| Rate for Payer: Cofinity Commercial |
$2,327.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,164.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$934.13
|
| Rate for Payer: Healthscope Commercial |
$2,435.40
|
| Rate for Payer: Mclaren Medicaid |
$488.55
|
| Rate for Payer: Mclaren Medicare |
$934.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$980.84
|
| Rate for Payer: Meridian Medicaid |
$980.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,074.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,027.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,300.10
|
| Rate for Payer: Nomi Health Commercial |
$2,802.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,029.50
|
| Rate for Payer: PACE Medicare |
$887.42
|
| Rate for Payer: PACE SWMI |
$934.13
|
| Rate for Payer: PHP Commercial |
$2,300.10
|
| Rate for Payer: PHP Medicare Advantage |
$934.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$488.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,946.23
|
| Rate for Payer: Priority Health Medicare |
$934.13
|
| Rate for Payer: Priority Health SBD |
$1,704.78
|
| Rate for Payer: Priority Health Tiered Network |
$2,356.98
|
| Rate for Payer: Railroad Medicare Medicare |
$934.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,541.31
|
| Rate for Payer: UHC Core |
$1,541.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$934.13
|
| Rate for Payer: UHC Exchange |
$1,541.31
|
| Rate for Payer: UHC Medicaid |
$488.55
|
| Rate for Payer: UHCCP Medicaid |
$488.55
|
| Rate for Payer: VA VA |
$934.13
|
|
|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
IP
|
$2,706.00
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,704.78 |
| Max. Negotiated Rate |
$2,435.40 |
| Rate for Payer: Aetna Commercial |
$2,300.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,758.90
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cofinity Advantage |
$1,894.20
|
| Rate for Payer: Cofinity Commercial |
$2,327.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,164.80
|
| Rate for Payer: Healthscope Commercial |
$2,435.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,300.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,029.50
|
| Rate for Payer: PHP Commercial |
$2,300.10
|
| Rate for Payer: Priority Health SBD |
$1,704.78
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
IP
|
$136.70
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$86.12 |
| Max. Negotiated Rate |
$123.03 |
| Rate for Payer: Aetna Commercial |
$116.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.86
|
| Rate for Payer: Cash Price |
$109.36
|
| Rate for Payer: Cofinity Advantage |
$95.69
|
| Rate for Payer: Cofinity Commercial |
$117.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.36
|
| Rate for Payer: Healthscope Commercial |
$123.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.53
|
| Rate for Payer: PHP Commercial |
$116.19
|
| Rate for Payer: Priority Health SBD |
$86.12
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
OP
|
$136.70
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$123.03 |
| Rate for Payer: Aetna Commercial |
$116.19
|
| Rate for Payer: Aetna Medicare |
$68.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.86
|
| Rate for Payer: BCBS Complete |
$54.68
|
| Rate for Payer: BCBS Trust/PPO |
$91.37
|
| Rate for Payer: BCN Commercial |
$91.37
|
| Rate for Payer: Cash Price |
$109.36
|
| Rate for Payer: Cash Price |
$109.36
|
| Rate for Payer: Cofinity Advantage |
$95.69
|
| Rate for Payer: Cofinity Commercial |
$117.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.36
|
| Rate for Payer: Healthscope Commercial |
$123.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.53
|
| Rate for Payer: PHP Commercial |
$116.19
|
| Rate for Payer: Priority Health SBD |
$86.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.72
|
| Rate for Payer: UHC Core |
$34.72
|
| Rate for Payer: UHC Exchange |
$34.72
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
OP
|
$140.39
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$126.35 |
| Rate for Payer: Aetna Commercial |
$119.33
|
| Rate for Payer: Aetna Medicare |
$70.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.25
|
| Rate for Payer: BCBS Complete |
$56.16
|
| Rate for Payer: BCBS Trust/PPO |
$89.72
|
| Rate for Payer: BCN Commercial |
$89.72
|
| Rate for Payer: Cash Price |
$112.31
|
| Rate for Payer: Cash Price |
$112.31
|
| Rate for Payer: Cofinity Advantage |
$98.27
|
| Rate for Payer: Cofinity Commercial |
$120.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.31
|
| Rate for Payer: Healthscope Commercial |
$126.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.29
|
| Rate for Payer: PHP Commercial |
$119.33
|
| Rate for Payer: Priority Health SBD |
$88.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.14
|
| Rate for Payer: UHC Core |
$50.14
|
| Rate for Payer: UHC Exchange |
$50.14
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
IP
|
$140.39
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$88.45 |
| Max. Negotiated Rate |
$126.35 |
| Rate for Payer: Aetna Commercial |
$119.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.25
|
| Rate for Payer: Cash Price |
$112.31
|
| Rate for Payer: Cofinity Advantage |
$98.27
|
| Rate for Payer: Cofinity Commercial |
$120.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.31
|
| Rate for Payer: Healthscope Commercial |
$126.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.29
|
| Rate for Payer: PHP Commercial |
$119.33
|
| Rate for Payer: Priority Health SBD |
$88.45
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
OP
|
$145.69
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$49.76 |
| Max. Negotiated Rate |
$131.12 |
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: Aetna Medicare |
$72.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.70
|
| Rate for Payer: BCBS Complete |
$58.28
|
| Rate for Payer: BCBS Trust/PPO |
$49.76
|
| Rate for Payer: BCN Commercial |
$49.76
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cofinity Advantage |
$101.98
|
| Rate for Payer: Cofinity Commercial |
$125.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.55
|
| Rate for Payer: Healthscope Commercial |
$131.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.27
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: Priority Health SBD |
$91.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.36
|
| Rate for Payer: UHC Core |
$106.36
|
| Rate for Payer: UHC Exchange |
$106.36
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
IP
|
$145.69
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$91.78 |
| Max. Negotiated Rate |
$131.12 |
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.70
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cofinity Advantage |
$101.98
|
| Rate for Payer: Cofinity Commercial |
$125.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.55
|
| Rate for Payer: Healthscope Commercial |
$131.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.27
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: Priority Health SBD |
$91.78
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
OP
|
$48.56
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna Commercial |
$41.28
|
| Rate for Payer: Aetna Medicare |
$24.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.56
|
| Rate for Payer: BCBS Complete |
$19.42
|
| Rate for Payer: BCBS Trust/PPO |
$4.26
|
| Rate for Payer: BCN Commercial |
$4.26
|
| Rate for Payer: Cash Price |
$38.85
|
| Rate for Payer: Cash Price |
$38.85
|
| Rate for Payer: Cofinity Advantage |
$33.99
|
| Rate for Payer: Cofinity Commercial |
$41.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.85
|
| Rate for Payer: Healthscope Commercial |
$43.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.42
|
| Rate for Payer: PHP Commercial |
$41.28
|
| Rate for Payer: Priority Health SBD |
$30.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.83
|
| Rate for Payer: UHC Core |
$19.83
|
| Rate for Payer: UHC Exchange |
$19.83
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
IP
|
$48.56
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna Commercial |
$41.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.56
|
| Rate for Payer: Cash Price |
$38.85
|
| Rate for Payer: Cofinity Advantage |
$33.99
|
| Rate for Payer: Cofinity Commercial |
$41.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.85
|
| Rate for Payer: Healthscope Commercial |
$43.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.42
|
| Rate for Payer: PHP Commercial |
$41.28
|
| Rate for Payer: Priority Health SBD |
$30.59
|
|
|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
IP
|
$240.89
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$151.76 |
| Max. Negotiated Rate |
$216.80 |
| Rate for Payer: Aetna Commercial |
$204.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.58
|
| Rate for Payer: Cash Price |
$192.71
|
| Rate for Payer: Cofinity Advantage |
$168.62
|
| Rate for Payer: Cofinity Commercial |
$207.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.71
|
| Rate for Payer: Healthscope Commercial |
$216.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.67
|
| Rate for Payer: PHP Commercial |
$204.76
|
| Rate for Payer: Priority Health SBD |
$151.76
|
|
|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
OP
|
$240.89
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$49.09 |
| Max. Negotiated Rate |
$216.80 |
| Rate for Payer: Aetna Commercial |
$204.76
|
| Rate for Payer: Aetna Medicare |
$120.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.58
|
| Rate for Payer: BCBS Complete |
$96.36
|
| Rate for Payer: BCBS Trust/PPO |
$49.09
|
| Rate for Payer: BCN Commercial |
$49.09
|
| Rate for Payer: Cash Price |
$192.71
|
| Rate for Payer: Cash Price |
$192.71
|
| Rate for Payer: Cofinity Advantage |
$168.62
|
| Rate for Payer: Cofinity Commercial |
$207.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.71
|
| Rate for Payer: Healthscope Commercial |
$216.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.67
|
| Rate for Payer: PHP Commercial |
$204.76
|
| Rate for Payer: Priority Health SBD |
$151.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.59
|
| Rate for Payer: UHC Core |
$65.59
|
| Rate for Payer: UHC Exchange |
$65.59
|
|
|
HC TC 99M SULFUR COLLOID PER STUDY
|
Facility
|
IP
|
$255.30
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
34300020
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$160.84 |
| Max. Negotiated Rate |
$229.77 |
| Rate for Payer: Aetna Commercial |
$217.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.94
|
| Rate for Payer: Cash Price |
$204.24
|
| Rate for Payer: Cofinity Advantage |
$178.71
|
| Rate for Payer: Cofinity Commercial |
$219.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.24
|
| Rate for Payer: Healthscope Commercial |
$229.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.47
|
| Rate for Payer: PHP Commercial |
$217.00
|
| Rate for Payer: Priority Health SBD |
$160.84
|
|
|
HC TC 99M SULFUR COLLOID PER STUDY
|
Facility
|
OP
|
$255.30
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
34300020
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$102.12 |
| Max. Negotiated Rate |
$1,239.81 |
| Rate for Payer: Aetna Commercial |
$217.00
|
| Rate for Payer: Aetna Medicare |
$127.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.94
|
| Rate for Payer: BCBS Complete |
$102.12
|
| Rate for Payer: BCBS Trust/PPO |
$116.24
|
| Rate for Payer: BCN Commercial |
$116.24
|
| Rate for Payer: Cash Price |
$204.24
|
| Rate for Payer: Cash Price |
$204.24
|
| Rate for Payer: Cofinity Advantage |
$178.71
|
| Rate for Payer: Cofinity Commercial |
$219.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.24
|
| Rate for Payer: Healthscope Commercial |
$229.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.47
|
| Rate for Payer: PHP Commercial |
$217.00
|
| Rate for Payer: Priority Health SBD |
$160.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,239.81
|
| Rate for Payer: UHC Core |
$1,239.81
|
| Rate for Payer: UHC Exchange |
$1,239.81
|
|
|
HC T CELL ACUTE LYMPH LEUK
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000133
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Advantage |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.31
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health SBD |
$22.94
|
|
|
HC T CELL ACUTE LYMPH LEUK
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000133
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna Medicare |
$22.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.77
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$22.85
|
| Rate for Payer: BCN Commercial |
$22.85
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Advantage |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Mclaren Medicaid |
$11.20
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Meridian Medicaid |
$22.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$32.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.31
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.42
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: Priority Health Tiered Network |
$17.14
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.13
|
| Rate for Payer: UHC Core |
$32.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.42
|
| Rate for Payer: UHC Exchange |
$32.13
|
| Rate for Payer: UHC Medicaid |
$11.20
|
| Rate for Payer: UHCCP Medicaid |
$11.20
|
| Rate for Payer: VA VA |
$21.42
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT1
|
Facility
|
OP
|
$120.98
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.77 |
| Max. Negotiated Rate |
$108.88 |
| Rate for Payer: Aetna Commercial |
$102.83
|
| Rate for Payer: Aetna Medicare |
$53.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: BCBS Complete |
$28.11
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$54.58
|
| Rate for Payer: BCN Commercial |
$54.58
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$96.78
|
| Rate for Payer: Cash Price |
$96.78
|
| Rate for Payer: Cofinity Advantage |
$84.69
|
| Rate for Payer: Cofinity Commercial |
$104.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$108.88
|
| Rate for Payer: Mclaren Medicaid |
$26.77
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: Meridian Medicaid |
$53.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.83
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.73
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$102.83
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$51.19
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health SBD |
$76.22
|
| Rate for Payer: Priority Health Tiered Network |
$40.95
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.79
|
| Rate for Payer: UHC Core |
$76.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.19
|
| Rate for Payer: UHC Exchange |
$76.79
|
| Rate for Payer: UHC Medicaid |
$26.77
|
| Rate for Payer: UHCCP Medicaid |
$26.77
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT1
|
Facility
|
IP
|
$120.98
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$76.22 |
| Max. Negotiated Rate |
$108.88 |
| Rate for Payer: Aetna Commercial |
$102.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.64
|
| Rate for Payer: Cash Price |
$96.78
|
| Rate for Payer: Cofinity Advantage |
$84.69
|
| Rate for Payer: Cofinity Commercial |
$104.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.78
|
| Rate for Payer: Healthscope Commercial |
$108.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.73
|
| Rate for Payer: PHP Commercial |
$102.83
|
| Rate for Payer: Priority Health SBD |
$76.22
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT2
|
Facility
|
OP
|
$107.18
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$96.46 |
| Rate for Payer: Aetna Commercial |
$91.10
|
| Rate for Payer: Aetna Medicare |
$22.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.77
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$22.85
|
| Rate for Payer: BCN Commercial |
$22.85
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$85.74
|
| Rate for Payer: Cash Price |
$85.74
|
| Rate for Payer: Cofinity Advantage |
$75.03
|
| Rate for Payer: Cofinity Commercial |
$92.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$96.46
|
| Rate for Payer: Mclaren Medicaid |
$11.20
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Meridian Medicaid |
$22.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.10
|
| Rate for Payer: Nomi Health Commercial |
$32.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.39
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$91.10
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.42
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health SBD |
$67.52
|
| Rate for Payer: Priority Health Tiered Network |
$17.14
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.13
|
| Rate for Payer: UHC Core |
$32.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.42
|
| Rate for Payer: UHC Exchange |
$32.13
|
| Rate for Payer: UHC Medicaid |
$11.20
|
| Rate for Payer: UHCCP Medicaid |
$11.20
|
| Rate for Payer: VA VA |
$21.42
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT2
|
Facility
|
IP
|
$107.18
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$96.46 |
| Rate for Payer: Aetna Commercial |
$91.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.67
|
| Rate for Payer: Cash Price |
$85.74
|
| Rate for Payer: Cofinity Advantage |
$75.03
|
| Rate for Payer: Cofinity Commercial |
$92.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.74
|
| Rate for Payer: Healthscope Commercial |
$96.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.39
|
| Rate for Payer: PHP Commercial |
$91.10
|
| Rate for Payer: Priority Health SBD |
$67.52
|
|
|
HC T CELL ACUTE LYMPH LEUK FISH
|
Facility
|
OP
|
$86.35
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.77 |
| Max. Negotiated Rate |
$77.72 |
| Rate for Payer: Aetna Commercial |
$73.40
|
| Rate for Payer: Aetna Medicare |
$53.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: BCBS Complete |
$28.11
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$54.58
|
| Rate for Payer: BCN Commercial |
$54.58
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cofinity Advantage |
$60.45
|
| Rate for Payer: Cofinity Commercial |
$74.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$77.72
|
| Rate for Payer: Mclaren Medicaid |
$26.77
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: Meridian Medicaid |
$53.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.40
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.76
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$73.40
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$51.19
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health SBD |
$54.40
|
| Rate for Payer: Priority Health Tiered Network |
$40.95
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.79
|
| Rate for Payer: UHC Core |
$76.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.19
|
| Rate for Payer: UHC Exchange |
$76.79
|
| Rate for Payer: UHC Medicaid |
$26.77
|
| Rate for Payer: UHCCP Medicaid |
$26.77
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC T CELL ACUTE LYMPH LEUK FISH
|
Facility
|
IP
|
$86.35
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$77.72 |
| Rate for Payer: Aetna Commercial |
$73.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.13
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cofinity Advantage |
$60.45
|
| Rate for Payer: Cofinity Commercial |
$74.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.08
|
| Rate for Payer: Healthscope Commercial |
$77.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.76
|
| Rate for Payer: PHP Commercial |
$73.40
|
| Rate for Payer: Priority Health SBD |
$54.40
|
|
|
HC T CELLS CD4 CD8 COUNT
|
Facility
|
OP
|
$84.11
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
30200207
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$75.70 |
| Rate for Payer: Aetna Commercial |
$71.49
|
| Rate for Payer: Aetna Medicare |
$48.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.73
|
| Rate for Payer: BCBS Complete |
$25.80
|
| Rate for Payer: BCBS MAPPO |
$46.98
|
| Rate for Payer: BCBS Trust/PPO |
$50.10
|
| Rate for Payer: BCN Commercial |
$50.10
|
| Rate for Payer: BCN Medicare Advantage |
$46.98
|
| Rate for Payer: Cash Price |
$67.29
|
| Rate for Payer: Cash Price |
$67.29
|
| Rate for Payer: Cofinity Advantage |
$58.88
|
| Rate for Payer: Cofinity Commercial |
$72.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.98
|
| Rate for Payer: Healthscope Commercial |
$75.70
|
| Rate for Payer: Mclaren Medicaid |
$24.57
|
| Rate for Payer: Mclaren Medicare |
$46.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.33
|
| Rate for Payer: Meridian Medicaid |
$49.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.49
|
| Rate for Payer: Nomi Health Commercial |
$70.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.08
|
| Rate for Payer: PACE Medicare |
$44.63
|
| Rate for Payer: PACE SWMI |
$46.98
|
| Rate for Payer: PHP Commercial |
$71.49
|
| Rate for Payer: PHP Medicare Advantage |
$46.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$46.98
|
| Rate for Payer: Priority Health Medicare |
$46.98
|
| Rate for Payer: Priority Health SBD |
$52.99
|
| Rate for Payer: Priority Health Tiered Network |
$37.58
|
| Rate for Payer: Railroad Medicare Medicare |
$46.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.47
|
| Rate for Payer: UHC Core |
$70.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.98
|
| Rate for Payer: UHC Exchange |
$70.47
|
| Rate for Payer: UHC Medicaid |
$24.57
|
| Rate for Payer: UHCCP Medicaid |
$24.57
|
| Rate for Payer: VA VA |
$46.98
|
|
