|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
OP
|
$1,779.91
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$557.61 |
| Max. Negotiated Rate |
$2,928.40 |
| Rate for Payer: Aetna Commercial |
$1,512.92
|
| Rate for Payer: Aetna Medicare |
$1,081.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,156.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,300.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,300.40
|
| Rate for Payer: BCBS Complete |
$585.49
|
| Rate for Payer: BCBS MAPPO |
$1,040.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,040.32
|
| Rate for Payer: Cash Price |
$1,423.93
|
| Rate for Payer: Cash Price |
$1,423.93
|
| Rate for Payer: Cofinity Commercial |
$1,245.94
|
| Rate for Payer: Cofinity Commercial |
$1,530.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,245.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,423.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,040.32
|
| Rate for Payer: Healthscope Commercial |
$1,601.92
|
| Rate for Payer: Mclaren Medicaid |
$557.61
|
| Rate for Payer: Mclaren Medicare |
$1,040.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,092.34
|
| Rate for Payer: Meridian Medicaid |
$585.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,196.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,512.92
|
| Rate for Payer: PACE Medicare |
$988.30
|
| Rate for Payer: PACE SWMI |
$1,040.32
|
| Rate for Payer: PHP Commercial |
$1,512.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,040.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$557.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,156.94
|
| Rate for Payer: Priority Health Medicare |
$1,040.32
|
| Rate for Payer: Priority Health SBD |
$1,121.34
|
| Rate for Payer: Railroad Medicare Medicare |
$1,040.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,928.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,040.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,040.32
|
| Rate for Payer: UHCCP Medicaid |
$585.70
|
| Rate for Payer: VA VA |
$1,040.32
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
OP
|
$134.02
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$53.61 |
| Max. Negotiated Rate |
$120.62 |
| Rate for Payer: Aetna Commercial |
$113.92
|
| Rate for Payer: Aetna Medicare |
$67.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.11
|
| Rate for Payer: BCBS Complete |
$53.61
|
| Rate for Payer: Cash Price |
$107.22
|
| Rate for Payer: Cofinity Commercial |
$115.26
|
| Rate for Payer: Cofinity Commercial |
$93.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.22
|
| Rate for Payer: Healthscope Commercial |
$120.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.92
|
| Rate for Payer: PHP Commercial |
$113.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.11
|
| Rate for Payer: Priority Health SBD |
$84.43
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
IP
|
$134.02
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$84.43 |
| Max. Negotiated Rate |
$120.62 |
| Rate for Payer: Aetna Commercial |
$113.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.11
|
| Rate for Payer: Cash Price |
$107.22
|
| Rate for Payer: Cofinity Commercial |
$115.26
|
| Rate for Payer: Cofinity Commercial |
$93.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.22
|
| Rate for Payer: Healthscope Commercial |
$120.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.92
|
| Rate for Payer: PHP Commercial |
$113.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.11
|
| Rate for Payer: Priority Health SBD |
$84.43
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
IP
|
$137.64
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$86.71 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.47
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Commercial |
$118.37
|
| Rate for Payer: Cofinity Commercial |
$96.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.11
|
| Rate for Payer: Healthscope Commercial |
$123.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: PHP Commercial |
$116.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.47
|
| Rate for Payer: Priority Health SBD |
$86.71
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
OP
|
$137.64
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$55.06 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: Aetna Medicare |
$68.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.47
|
| Rate for Payer: BCBS Complete |
$55.06
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Commercial |
$118.37
|
| Rate for Payer: Cofinity Commercial |
$96.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.11
|
| Rate for Payer: Healthscope Commercial |
$123.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: PHP Commercial |
$116.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.47
|
| Rate for Payer: Priority Health SBD |
$86.71
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
IP
|
$142.83
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$89.98 |
| Max. Negotiated Rate |
$128.55 |
| Rate for Payer: Aetna Commercial |
$121.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.84
|
| Rate for Payer: Cash Price |
$114.26
|
| Rate for Payer: Cofinity Commercial |
$122.83
|
| Rate for Payer: Cofinity Commercial |
$99.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.26
|
| Rate for Payer: Healthscope Commercial |
$128.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.41
|
| Rate for Payer: PHP Commercial |
$121.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.84
|
| Rate for Payer: Priority Health SBD |
$89.98
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
OP
|
$142.83
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$57.13 |
| Max. Negotiated Rate |
$128.55 |
| Rate for Payer: Aetna Commercial |
$121.41
|
| Rate for Payer: Aetna Medicare |
$71.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.84
|
| Rate for Payer: BCBS Complete |
$57.13
|
| Rate for Payer: Cash Price |
$114.26
|
| Rate for Payer: Cofinity Commercial |
$122.83
|
| Rate for Payer: Cofinity Commercial |
$99.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.26
|
| Rate for Payer: Healthscope Commercial |
$128.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.41
|
| Rate for Payer: PHP Commercial |
$121.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.84
|
| Rate for Payer: Priority Health SBD |
$89.98
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
IP
|
$47.61
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$42.85 |
| Rate for Payer: Aetna Commercial |
$40.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.95
|
| Rate for Payer: Cash Price |
$38.09
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Cofinity Commercial |
$40.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.09
|
| Rate for Payer: Healthscope Commercial |
$42.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.47
|
| Rate for Payer: PHP Commercial |
$40.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.95
|
| Rate for Payer: Priority Health SBD |
$29.99
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
OP
|
$47.61
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$42.85 |
| Rate for Payer: Aetna Commercial |
$40.47
|
| Rate for Payer: Aetna Medicare |
$23.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.95
|
| Rate for Payer: BCBS Complete |
$19.04
|
| Rate for Payer: Cash Price |
$38.09
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Cofinity Commercial |
$40.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.09
|
| Rate for Payer: Healthscope Commercial |
$42.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.47
|
| Rate for Payer: PHP Commercial |
$40.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.95
|
| Rate for Payer: Priority Health SBD |
$29.99
|
|
|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
IP
|
$236.17
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$148.79 |
| Max. Negotiated Rate |
$212.55 |
| Rate for Payer: Aetna Commercial |
$200.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.51
|
| Rate for Payer: Cash Price |
$188.94
|
| Rate for Payer: Cofinity Commercial |
$165.32
|
| Rate for Payer: Cofinity Commercial |
$203.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.94
|
| Rate for Payer: Healthscope Commercial |
$212.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.74
|
| Rate for Payer: PHP Commercial |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.51
|
| Rate for Payer: Priority Health SBD |
$148.79
|
|
|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
OP
|
$236.17
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$94.47 |
| Max. Negotiated Rate |
$212.55 |
| Rate for Payer: Aetna Commercial |
$200.74
|
| Rate for Payer: Aetna Medicare |
$118.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.51
|
| Rate for Payer: BCBS Complete |
$94.47
|
| Rate for Payer: Cash Price |
$188.94
|
| Rate for Payer: Cofinity Commercial |
$165.32
|
| Rate for Payer: Cofinity Commercial |
$203.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.94
|
| Rate for Payer: Healthscope Commercial |
$212.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.74
|
| Rate for Payer: PHP Commercial |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.51
|
| Rate for Payer: Priority Health SBD |
$148.79
|
|
|
HC TC 99M SULFUR COLLOID PER STUDY
|
Facility
|
IP
|
$250.29
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
34300020
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$157.68 |
| Max. Negotiated Rate |
$225.26 |
| Rate for Payer: Aetna Commercial |
$212.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.69
|
| Rate for Payer: Cash Price |
$200.23
|
| Rate for Payer: Cofinity Commercial |
$175.20
|
| Rate for Payer: Cofinity Commercial |
$215.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.23
|
| Rate for Payer: Healthscope Commercial |
$225.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.75
|
| Rate for Payer: PHP Commercial |
$212.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.69
|
| Rate for Payer: Priority Health SBD |
$157.68
|
|
|
HC TC 99M SULFUR COLLOID PER STUDY
|
Facility
|
OP
|
$250.29
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
34300020
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$100.12 |
| Max. Negotiated Rate |
$225.26 |
| Rate for Payer: Aetna Commercial |
$212.75
|
| Rate for Payer: Aetna Medicare |
$125.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.69
|
| Rate for Payer: BCBS Complete |
$100.12
|
| Rate for Payer: Cash Price |
$200.23
|
| Rate for Payer: Cofinity Commercial |
$175.20
|
| Rate for Payer: Cofinity Commercial |
$215.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.23
|
| Rate for Payer: Healthscope Commercial |
$225.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.75
|
| Rate for Payer: PHP Commercial |
$212.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.69
|
| Rate for Payer: Priority Health SBD |
$157.68
|
|
|
HC T CELL ACUTE LYMPH LEUK
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000133
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.49 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.20
|
| Rate for Payer: Priority Health SBD |
$22.49
|
|
|
HC T CELL ACUTE LYMPH LEUK
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000133
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$22.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| 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 |
$12.06
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$11.48
|
| 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 |
$12.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.20
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health SBD |
$22.49
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.42
|
| Rate for Payer: UHC Medicare Advantage |
$21.42
|
| Rate for Payer: UHCCP Medicaid |
$12.06
|
| Rate for Payer: VA VA |
$21.42
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT1
|
Facility
|
OP
|
$118.61
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$144.09 |
| Rate for Payer: Aetna Commercial |
$100.82
|
| Rate for Payer: Aetna Medicare |
$53.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.10
|
| 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 |
$28.81
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$94.89
|
| Rate for Payer: Cash Price |
$94.89
|
| Rate for Payer: Cofinity Commercial |
$83.03
|
| Rate for Payer: Cofinity Commercial |
$102.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$106.75
|
| Rate for Payer: Mclaren Medicaid |
$27.44
|
| 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 |
$28.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.82
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$100.82
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.10
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health SBD |
$74.72
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.19
|
| Rate for Payer: UHC Medicare Advantage |
$51.19
|
| Rate for Payer: UHCCP Medicaid |
$28.82
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT1
|
Facility
|
IP
|
$118.61
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.72 |
| Max. Negotiated Rate |
$106.75 |
| Rate for Payer: Aetna Commercial |
$100.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.10
|
| Rate for Payer: Cash Price |
$94.89
|
| Rate for Payer: Cofinity Commercial |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$83.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.89
|
| Rate for Payer: Healthscope Commercial |
$106.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.82
|
| Rate for Payer: PHP Commercial |
$100.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.10
|
| Rate for Payer: Priority Health SBD |
$74.72
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT2
|
Facility
|
IP
|
$105.08
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$94.57 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.30
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cofinity Commercial |
$73.56
|
| Rate for Payer: Cofinity Commercial |
$90.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.06
|
| Rate for Payer: Healthscope Commercial |
$94.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.32
|
| Rate for Payer: PHP Commercial |
$89.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.30
|
| Rate for Payer: Priority Health SBD |
$66.20
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT2
|
Facility
|
OP
|
$105.08
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$94.57 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Aetna Medicare |
$22.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.30
|
| 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 |
$12.06
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cofinity Commercial |
$90.37
|
| Rate for Payer: Cofinity Commercial |
$73.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$94.57
|
| Rate for Payer: Mclaren Medicaid |
$11.48
|
| 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 |
$12.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.32
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$89.32
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.30
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health SBD |
$66.20
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.42
|
| Rate for Payer: UHC Medicare Advantage |
$21.42
|
| Rate for Payer: UHCCP Medicaid |
$12.06
|
| Rate for Payer: VA VA |
$21.42
|
|
|
HC T CELL ACUTE LYMPH LEUK FISH
|
Facility
|
OP
|
$84.66
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$144.09 |
| Rate for Payer: Aetna Commercial |
$71.96
|
| Rate for Payer: Aetna Medicare |
$53.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.03
|
| 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 |
$28.81
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$72.81
|
| Rate for Payer: Cofinity Commercial |
$59.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$76.19
|
| Rate for Payer: Mclaren Medicaid |
$27.44
|
| 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 |
$28.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$71.96
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health SBD |
$53.34
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.19
|
| Rate for Payer: UHC Medicare Advantage |
$51.19
|
| Rate for Payer: UHCCP Medicaid |
$28.82
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC T CELL ACUTE LYMPH LEUK FISH
|
Facility
|
IP
|
$84.66
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.34 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Aetna Commercial |
$71.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.03
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$59.26
|
| Rate for Payer: Cofinity Commercial |
$72.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Healthscope Commercial |
$76.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: PHP Commercial |
$71.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: Priority Health SBD |
$53.34
|
|
|
HC T CELLS CD4 CD8 COUNT
|
Facility
|
OP
|
$76.86
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
30200207
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.18 |
| Max. Negotiated Rate |
$132.24 |
| Rate for Payer: Aetna Commercial |
$65.33
|
| Rate for Payer: Aetna Medicare |
$48.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.96
|
| 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 |
$26.44
|
| Rate for Payer: BCBS MAPPO |
$46.98
|
| Rate for Payer: BCN Medicare Advantage |
$46.98
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Cofinity Commercial |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$53.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.98
|
| Rate for Payer: Healthscope Commercial |
$69.17
|
| Rate for Payer: Mclaren Medicaid |
$25.18
|
| 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 |
$26.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.33
|
| Rate for Payer: PACE Medicare |
$44.63
|
| Rate for Payer: PACE SWMI |
$46.98
|
| Rate for Payer: PHP Commercial |
$65.33
|
| Rate for Payer: PHP Medicare Advantage |
$46.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.96
|
| Rate for Payer: Priority Health Medicare |
$46.98
|
| Rate for Payer: Priority Health SBD |
$48.42
|
| Rate for Payer: Railroad Medicare Medicare |
$46.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.98
|
| Rate for Payer: UHC Medicare Advantage |
$46.98
|
| Rate for Payer: UHCCP Medicaid |
$26.45
|
| Rate for Payer: VA VA |
$46.98
|
|
|
HC T CELLS CD4 CD8 COUNT
|
Facility
|
IP
|
$76.86
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
30200207
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$48.42 |
| Max. Negotiated Rate |
$69.17 |
| Rate for Payer: Aetna Commercial |
$65.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.96
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Cofinity Commercial |
$53.80
|
| Rate for Payer: Cofinity Commercial |
$66.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.49
|
| Rate for Payer: Healthscope Commercial |
$69.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.33
|
| Rate for Payer: PHP Commercial |
$65.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.96
|
| Rate for Payer: Priority Health SBD |
$48.42
|
|
|
HC T CELL TOTAL
|
Facility
|
IP
|
$61.72
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
30200205
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$55.55 |
| Rate for Payer: Aetna Commercial |
$52.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.12
|
| Rate for Payer: Cash Price |
$49.38
|
| Rate for Payer: Cofinity Commercial |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$53.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.38
|
| Rate for Payer: Healthscope Commercial |
$55.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.46
|
| Rate for Payer: PHP Commercial |
$52.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.12
|
| Rate for Payer: Priority Health SBD |
$38.88
|
|
|
HC T CELL TOTAL
|
Facility
|
OP
|
$61.72
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
30200205
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$106.21 |
| Rate for Payer: Aetna Commercial |
$52.46
|
| Rate for Payer: Aetna Medicare |
$39.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.16
|
| Rate for Payer: BCBS Complete |
$21.23
|
| Rate for Payer: BCBS MAPPO |
$37.73
|
| Rate for Payer: BCN Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$49.38
|
| Rate for Payer: Cash Price |
$49.38
|
| Rate for Payer: Cofinity Commercial |
$53.08
|
| Rate for Payer: Cofinity Commercial |
$43.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.73
|
| Rate for Payer: Healthscope Commercial |
$55.55
|
| Rate for Payer: Mclaren Medicaid |
$20.22
|
| Rate for Payer: Mclaren Medicare |
$37.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.62
|
| Rate for Payer: Meridian Medicaid |
$21.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.46
|
| Rate for Payer: PACE Medicare |
$35.84
|
| Rate for Payer: PACE SWMI |
$37.73
|
| Rate for Payer: PHP Commercial |
$52.46
|
| Rate for Payer: PHP Medicare Advantage |
$37.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.12
|
| Rate for Payer: Priority Health Medicare |
$37.73
|
| Rate for Payer: Priority Health SBD |
$38.88
|
| Rate for Payer: Railroad Medicare Medicare |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.73
|
| Rate for Payer: UHC Medicare Advantage |
$37.73
|
| Rate for Payer: UHCCP Medicaid |
$21.24
|
| Rate for Payer: VA VA |
$37.73
|
|
