|
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 |
$41.95 |
| Max. Negotiated Rate |
$55.93 |
| Rate for Payer: Aetna Commercial |
$50.34
|
| Rate for Payer: ASR ASR |
$54.25
|
| Rate for Payer: BCBS Trust/PPO |
$45.93
|
| Rate for Payer: BCN Commercial |
$45.93
|
| Rate for Payer: Cash Price |
$44.74
|
| Rate for Payer: Cofinity Commercial |
$52.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.74
|
| Rate for Payer: Healthscope Commercial |
$54.25
|
| Rate for Payer: Healthscope Whirlpool |
$55.93
|
| Rate for Payer: Mclaren Commercial |
$50.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.54
|
| Rate for Payer: Nomi Health Commercial |
$45.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.22
|
|
|
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 |
$20.69 |
| Max. Negotiated Rate |
$65.38 |
| Rate for Payer: Aetna Commercial |
$50.34
|
| Rate for Payer: Aetna Medicare |
$20.69
|
| Rate for Payer: ASR ASR |
$54.25
|
| Rate for Payer: BCBS Complete |
$22.37
|
| Rate for Payer: BCBS Trust/PPO |
$46.11
|
| Rate for Payer: BCN Commercial |
$46.11
|
| Rate for Payer: Cash Price |
$44.74
|
| Rate for Payer: Cash Price |
$44.74
|
| Rate for Payer: Cofinity Commercial |
$52.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.74
|
| Rate for Payer: Healthscope Commercial |
$54.25
|
| Rate for Payer: Healthscope Whirlpool |
$55.93
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$45.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.38
|
| Rate for Payer: Priority Health Narrow Network |
$52.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.22
|
|
|
HC LEUK LYMPHOMA IMMUNOPHEN TISSUE
|
Facility
|
OP
|
$53.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100015
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.71 |
| Max. Negotiated Rate |
$65.38 |
| Rate for Payer: Aetna Commercial |
$47.95
|
| Rate for Payer: Aetna Medicare |
$19.71
|
| Rate for Payer: ASR ASR |
$51.68
|
| Rate for Payer: BCBS Complete |
$21.31
|
| Rate for Payer: BCBS Trust/PPO |
$43.93
|
| Rate for Payer: BCN Commercial |
$43.93
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.62
|
| Rate for Payer: Healthscope Commercial |
$51.68
|
| Rate for Payer: Healthscope Whirlpool |
$53.28
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$43.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$65.38
|
| Rate for Payer: Priority Health Narrow Network |
$52.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.89
|
|
|
HC LEUK LYMPHOMA IMMUNOPHEN TISSUE
|
Facility
|
IP
|
$53.28
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100015
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$53.28 |
| Rate for Payer: Aetna Commercial |
$47.95
|
| Rate for Payer: ASR ASR |
$51.68
|
| Rate for Payer: BCBS Trust/PPO |
$43.75
|
| Rate for Payer: BCN Commercial |
$43.75
|
| Rate for Payer: Cash Price |
$42.62
|
| Rate for Payer: Cofinity Commercial |
$50.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.62
|
| Rate for Payer: Healthscope Commercial |
$51.68
|
| Rate for Payer: Healthscope Whirlpool |
$53.28
|
| Rate for Payer: Mclaren Commercial |
$47.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.29
|
| Rate for Payer: Nomi Health Commercial |
$43.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.89
|
|
|
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 |
$265.30 |
| Rate for Payer: Aetna Commercial |
$238.77
|
| Rate for Payer: Aetna Medicare |
$24.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: ASR ASR |
$257.34
|
| Rate for Payer: BCBS Complete |
$13.23
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$218.74
|
| Rate for Payer: BCN Commercial |
$218.74
|
| 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 Commercial |
$249.38
|
| 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 |
$257.34
|
| Rate for Payer: Healthscope Whirlpool |
$265.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$238.77
|
| Rate for Payer: Mclaren Medicaid |
$24.09
|
| 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 |
$13.23
|
| 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 |
$217.55
|
| 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 |
$26.50
|
| Rate for Payer: PHP Medicaid |
$12.91
|
| 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/Tiered Network |
$232.46
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$185.98
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.09
|
| Rate for Payer: UHC Exchange |
$37.34
|
| Rate for Payer: UHC Medicaid |
$12.60
|
| Rate for Payer: UHCCP DNSP |
$24.09
|
| Rate for Payer: UHCCP Medicaid |
$12.60
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC LEUKOTRIENE E4, U
|
Facility
|
IP
|
$265.30
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$198.97 |
| Max. Negotiated Rate |
$265.30 |
| Rate for Payer: Aetna Commercial |
$238.77
|
| Rate for Payer: ASR ASR |
$257.34
|
| Rate for Payer: BCBS Trust/PPO |
$217.86
|
| Rate for Payer: BCN Commercial |
$217.86
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cofinity Commercial |
$249.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.24
|
| Rate for Payer: Healthscope Commercial |
$257.34
|
| Rate for Payer: Healthscope Whirlpool |
$265.30
|
| Rate for Payer: Mclaren Commercial |
$238.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.50
|
| Rate for Payer: Nomi Health Commercial |
$217.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.46
|
|
|
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 |
$788.82 |
| Max. Negotiated Rate |
$1,051.76 |
| Rate for Payer: Aetna Commercial |
$946.58
|
| Rate for Payer: ASR ASR |
$1,020.21
|
| Rate for Payer: BCBS Trust/PPO |
$863.71
|
| Rate for Payer: BCN Commercial |
$863.71
|
| Rate for Payer: Cash Price |
$841.41
|
| Rate for Payer: Cofinity Commercial |
$988.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.41
|
| Rate for Payer: Healthscope Commercial |
$1,020.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,051.76
|
| Rate for Payer: Mclaren Commercial |
$946.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$894.00
|
| Rate for Payer: Nomi Health Commercial |
$862.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$788.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$925.55
|
|
|
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 |
$788.82 |
| Max. Negotiated Rate |
$2,736.63 |
| Rate for Payer: Aetna Commercial |
$946.58
|
| Rate for Payer: Aetna Medicare |
$1,765.57
|
| 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: ASR ASR |
$1,020.21
|
| Rate for Payer: BCBS Complete |
$969.65
|
| Rate for Payer: BCBS MAPPO |
$1,765.57
|
| Rate for Payer: BCBS Trust/PPO |
$867.18
|
| Rate for Payer: BCN Commercial |
$867.18
|
| 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 Commercial |
$988.65
|
| 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 |
$1,020.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,051.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,765.57
|
| Rate for Payer: Mclaren Commercial |
$946.58
|
| Rate for Payer: Mclaren Medicaid |
$1,765.57
|
| 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 |
$969.65
|
| 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 |
$862.44
|
| 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 |
$1,942.13
|
| Rate for Payer: PHP Medicaid |
$946.35
|
| 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/Tiered Network |
$1,830.43
|
| Rate for Payer: Priority Health Medicare |
$1,765.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,464.34
|
| Rate for Payer: Railroad Medicare Medicare |
$1,765.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$925.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,765.57
|
| Rate for Payer: UHC Exchange |
$2,736.63
|
| Rate for Payer: UHC Medicaid |
$923.39
|
| Rate for Payer: UHCCP DNSP |
$1,765.57
|
| 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 |
$470.26 |
| Rate for Payer: Aetna Commercial |
$423.23
|
| Rate for Payer: Aetna Medicare |
$176.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.25
|
| Rate for Payer: ASR ASR |
$456.15
|
| Rate for Payer: BCBS Complete |
$96.77
|
| Rate for Payer: BCBS MAPPO |
$176.20
|
| Rate for Payer: BCBS Trust/PPO |
$387.73
|
| Rate for Payer: BCN Commercial |
$387.73
|
| 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 Commercial |
$442.04
|
| 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 |
$456.15
|
| Rate for Payer: Healthscope Whirlpool |
$470.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$176.20
|
| Rate for Payer: Mclaren Commercial |
$423.23
|
| Rate for Payer: Mclaren Medicaid |
$176.20
|
| 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 |
$96.77
|
| 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 |
$385.61
|
| 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 |
$193.82
|
| Rate for Payer: PHP Medicaid |
$94.44
|
| 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/Tiered Network |
$177.22
|
| Rate for Payer: Priority Health Medicare |
$176.20
|
| Rate for Payer: Priority Health Narrow Network |
$141.78
|
| Rate for Payer: Railroad Medicare Medicare |
$176.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$413.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$176.20
|
| Rate for Payer: UHC Exchange |
$273.11
|
| Rate for Payer: UHC Medicaid |
$92.15
|
| Rate for Payer: UHCCP DNSP |
$176.20
|
| 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 |
$352.69 |
| Max. Negotiated Rate |
$470.26 |
| Rate for Payer: Aetna Commercial |
$423.23
|
| Rate for Payer: ASR ASR |
$456.15
|
| Rate for Payer: BCBS Trust/PPO |
$386.18
|
| Rate for Payer: BCN Commercial |
$386.18
|
| Rate for Payer: Cash Price |
$376.21
|
| Rate for Payer: Cofinity Commercial |
$442.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.21
|
| Rate for Payer: Healthscope Commercial |
$456.15
|
| Rate for Payer: Healthscope Whirlpool |
$470.26
|
| Rate for Payer: Mclaren Commercial |
$423.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.72
|
| Rate for Payer: Nomi Health Commercial |
$385.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$413.83
|
|
|
HC LEVEL 0.5 INIT 30 MIN
|
Facility
|
IP
|
$939.78
|
|
| Hospital Charge Code |
36000060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$704.84 |
| Max. Negotiated Rate |
$939.78 |
| Rate for Payer: Aetna Commercial |
$845.80
|
| Rate for Payer: ASR ASR |
$911.59
|
| Rate for Payer: BCBS Trust/PPO |
$771.75
|
| Rate for Payer: BCN Commercial |
$771.75
|
| Rate for Payer: Cash Price |
$751.82
|
| Rate for Payer: Cofinity Commercial |
$883.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$751.82
|
| Rate for Payer: Healthscope Commercial |
$911.59
|
| Rate for Payer: Healthscope Whirlpool |
$939.78
|
| Rate for Payer: Mclaren Commercial |
$845.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$798.81
|
| Rate for Payer: Nomi Health Commercial |
$770.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$704.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$827.01
|
|
|
HC LEVEL 0.5 INIT 30 MIN
|
Facility
|
OP
|
$939.78
|
|
| Hospital Charge Code |
36000060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$347.72 |
| Max. Negotiated Rate |
$939.78 |
| Rate for Payer: Aetna Commercial |
$845.80
|
| Rate for Payer: Aetna Medicare |
$347.72
|
| Rate for Payer: ASR ASR |
$911.59
|
| Rate for Payer: BCBS Complete |
$375.91
|
| Rate for Payer: BCBS Trust/PPO |
$774.85
|
| Rate for Payer: BCN Commercial |
$774.85
|
| Rate for Payer: Cash Price |
$751.82
|
| Rate for Payer: Cofinity Commercial |
$883.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$751.82
|
| Rate for Payer: Healthscope Commercial |
$911.59
|
| Rate for Payer: Healthscope Whirlpool |
$939.78
|
| Rate for Payer: Mclaren Commercial |
$845.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$751.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$798.81
|
| Rate for Payer: Nomi Health Commercial |
$770.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$704.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$823.44
|
| Rate for Payer: Priority Health Narrow Network |
$658.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$827.01
|
|
|
HC LEVEL 0.5 SUBSQ 15 MIN
|
Facility
|
IP
|
$270.72
|
|
| Hospital Charge Code |
36000061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$203.04 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna Commercial |
$243.65
|
| Rate for Payer: ASR ASR |
$262.60
|
| Rate for Payer: BCBS Trust/PPO |
$222.32
|
| Rate for Payer: BCN Commercial |
$222.32
|
| Rate for Payer: Cash Price |
$216.58
|
| Rate for Payer: Cofinity Commercial |
$254.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.58
|
| Rate for Payer: Healthscope Commercial |
$262.60
|
| Rate for Payer: Healthscope Whirlpool |
$270.72
|
| Rate for Payer: Mclaren Commercial |
$243.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.11
|
| Rate for Payer: Nomi Health Commercial |
$221.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.23
|
|
|
HC LEVEL 0.5 SUBSQ 15 MIN
|
Facility
|
OP
|
$270.72
|
|
| Hospital Charge Code |
36000061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$100.17 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna Commercial |
$243.65
|
| Rate for Payer: Aetna Medicare |
$100.17
|
| Rate for Payer: ASR ASR |
$262.60
|
| Rate for Payer: BCBS Complete |
$108.29
|
| Rate for Payer: BCBS Trust/PPO |
$223.21
|
| Rate for Payer: BCN Commercial |
$223.21
|
| Rate for Payer: Cash Price |
$216.58
|
| Rate for Payer: Cofinity Commercial |
$254.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.58
|
| Rate for Payer: Healthscope Commercial |
$262.60
|
| Rate for Payer: Healthscope Whirlpool |
$270.72
|
| Rate for Payer: Mclaren Commercial |
$243.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.11
|
| Rate for Payer: Nomi Health Commercial |
$221.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$237.20
|
| Rate for Payer: Priority Health Narrow Network |
$189.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.23
|
|
|
HC LEVEL 1 INIT 30 MIN
|
Facility
|
IP
|
$2,074.72
|
|
| Hospital Charge Code |
36000062
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,556.04 |
| Max. Negotiated Rate |
$2,074.72 |
| Rate for Payer: Aetna Commercial |
$1,867.25
|
| Rate for Payer: ASR ASR |
$2,012.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,703.76
|
| Rate for Payer: BCN Commercial |
$1,703.76
|
| Rate for Payer: Cash Price |
$1,659.78
|
| Rate for Payer: Cofinity Commercial |
$1,950.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,659.78
|
| Rate for Payer: Healthscope Commercial |
$2,012.48
|
| Rate for Payer: Healthscope Whirlpool |
$2,074.72
|
| Rate for Payer: Mclaren Commercial |
$1,867.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,763.51
|
| Rate for Payer: Nomi Health Commercial |
$1,701.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,556.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,825.75
|
|
|
HC LEVEL 1 INIT 30 MIN
|
Facility
|
OP
|
$2,074.72
|
|
| Hospital Charge Code |
36000062
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$767.65 |
| Max. Negotiated Rate |
$2,074.72 |
| Rate for Payer: Aetna Commercial |
$1,867.25
|
| Rate for Payer: Aetna Medicare |
$767.65
|
| Rate for Payer: ASR ASR |
$2,012.48
|
| Rate for Payer: BCBS Complete |
$829.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,710.61
|
| Rate for Payer: BCN Commercial |
$1,710.61
|
| Rate for Payer: Cash Price |
$1,659.78
|
| Rate for Payer: Cofinity Commercial |
$1,950.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,659.78
|
| Rate for Payer: Healthscope Commercial |
$2,012.48
|
| Rate for Payer: Healthscope Whirlpool |
$2,074.72
|
| Rate for Payer: Mclaren Commercial |
$1,867.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,659.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,763.51
|
| Rate for Payer: Nomi Health Commercial |
$1,701.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,556.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,817.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,454.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,825.75
|
|
|
HC LEVEL 1 SUBSQ 15 MIN
|
Facility
|
IP
|
$412.97
|
|
| Hospital Charge Code |
36000063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$309.73 |
| Max. Negotiated Rate |
$412.97 |
| Rate for Payer: Aetna Commercial |
$371.67
|
| Rate for Payer: ASR ASR |
$400.58
|
| Rate for Payer: BCBS Trust/PPO |
$339.13
|
| Rate for Payer: BCN Commercial |
$339.13
|
| Rate for Payer: Cash Price |
$330.38
|
| Rate for Payer: Cofinity Commercial |
$388.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.38
|
| Rate for Payer: Healthscope Commercial |
$400.58
|
| Rate for Payer: Healthscope Whirlpool |
$412.97
|
| Rate for Payer: Mclaren Commercial |
$371.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.02
|
| Rate for Payer: Nomi Health Commercial |
$338.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.41
|
|
|
HC LEVEL 1 SUBSQ 15 MIN
|
Facility
|
OP
|
$412.97
|
|
| Hospital Charge Code |
36000063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$412.97 |
| Rate for Payer: Aetna Commercial |
$371.67
|
| Rate for Payer: Aetna Medicare |
$152.80
|
| Rate for Payer: ASR ASR |
$400.58
|
| Rate for Payer: BCBS Complete |
$165.19
|
| Rate for Payer: BCBS Trust/PPO |
$340.49
|
| Rate for Payer: BCN Commercial |
$340.49
|
| Rate for Payer: Cash Price |
$330.38
|
| Rate for Payer: Cofinity Commercial |
$388.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.38
|
| Rate for Payer: Healthscope Commercial |
$400.58
|
| Rate for Payer: Healthscope Whirlpool |
$412.97
|
| Rate for Payer: Mclaren Commercial |
$371.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$330.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.02
|
| Rate for Payer: Nomi Health Commercial |
$338.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$361.84
|
| Rate for Payer: Priority Health Narrow Network |
$289.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.41
|
|
|
HC LEVEL 2 INIT 30 MIN
|
Facility
|
IP
|
$3,226.85
|
|
| Hospital Charge Code |
36000064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,420.14 |
| Max. Negotiated Rate |
$3,226.85 |
| Rate for Payer: Aetna Commercial |
$2,904.16
|
| Rate for Payer: ASR ASR |
$3,130.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,649.89
|
| Rate for Payer: BCN Commercial |
$2,649.89
|
| Rate for Payer: Cash Price |
$2,581.48
|
| Rate for Payer: Cofinity Commercial |
$3,033.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,581.48
|
| Rate for Payer: Healthscope Commercial |
$3,130.04
|
| Rate for Payer: Healthscope Whirlpool |
$3,226.85
|
| Rate for Payer: Mclaren Commercial |
$2,904.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,742.82
|
| Rate for Payer: Nomi Health Commercial |
$2,646.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,420.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,839.63
|
|
|
HC LEVEL 2 INIT 30 MIN
|
Facility
|
OP
|
$3,226.85
|
|
| Hospital Charge Code |
36000064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,193.93 |
| Max. Negotiated Rate |
$3,226.85 |
| Rate for Payer: Aetna Commercial |
$2,904.16
|
| Rate for Payer: Aetna Medicare |
$1,193.93
|
| Rate for Payer: ASR ASR |
$3,130.04
|
| Rate for Payer: BCBS Complete |
$1,290.74
|
| Rate for Payer: BCBS Trust/PPO |
$2,660.54
|
| Rate for Payer: BCN Commercial |
$2,660.54
|
| Rate for Payer: Cash Price |
$2,581.48
|
| Rate for Payer: Cofinity Commercial |
$3,033.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,581.48
|
| Rate for Payer: Healthscope Commercial |
$3,130.04
|
| Rate for Payer: Healthscope Whirlpool |
$3,226.85
|
| Rate for Payer: Mclaren Commercial |
$2,904.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,581.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,742.82
|
| Rate for Payer: Nomi Health Commercial |
$2,646.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,420.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,827.37
|
| Rate for Payer: Priority Health Narrow Network |
$2,262.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,839.63
|
|
|
HC LEVEL 2 SUBSQ 15 MIN
|
Facility
|
IP
|
$1,237.94
|
|
| Hospital Charge Code |
36000065
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$928.46 |
| Max. Negotiated Rate |
$1,237.94 |
| Rate for Payer: Aetna Commercial |
$1,114.15
|
| Rate for Payer: ASR ASR |
$1,200.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,016.60
|
| Rate for Payer: BCN Commercial |
$1,016.60
|
| Rate for Payer: Cash Price |
$990.35
|
| Rate for Payer: Cofinity Commercial |
$1,163.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.35
|
| Rate for Payer: Healthscope Commercial |
$1,200.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,237.94
|
| Rate for Payer: Mclaren Commercial |
$1,114.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.25
|
| Rate for Payer: Nomi Health Commercial |
$1,015.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$928.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,089.39
|
|
|
HC LEVEL 2 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,237.94
|
|
| Hospital Charge Code |
36000065
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$458.04 |
| Max. Negotiated Rate |
$1,237.94 |
| Rate for Payer: Aetna Commercial |
$1,114.15
|
| Rate for Payer: Aetna Medicare |
$458.04
|
| Rate for Payer: ASR ASR |
$1,200.80
|
| Rate for Payer: BCBS Complete |
$495.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,020.68
|
| Rate for Payer: BCN Commercial |
$1,020.68
|
| Rate for Payer: Cash Price |
$990.35
|
| Rate for Payer: Cofinity Commercial |
$1,163.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.35
|
| Rate for Payer: Healthscope Commercial |
$1,200.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,237.94
|
| Rate for Payer: Mclaren Commercial |
$1,114.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$990.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.25
|
| Rate for Payer: Nomi Health Commercial |
$1,015.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$928.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,084.68
|
| Rate for Payer: Priority Health Narrow Network |
$867.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,089.39
|
|
|
HC LEVEL 3 INIT 30 MIN
|
Facility
|
IP
|
$3,827.33
|
|
| Hospital Charge Code |
36000066
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,870.50 |
| Max. Negotiated Rate |
$3,827.33 |
| Rate for Payer: Aetna Commercial |
$3,444.60
|
| Rate for Payer: ASR ASR |
$3,712.51
|
| Rate for Payer: BCBS Trust/PPO |
$3,143.00
|
| Rate for Payer: BCN Commercial |
$3,143.00
|
| Rate for Payer: Cash Price |
$3,061.86
|
| Rate for Payer: Cofinity Commercial |
$3,597.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,061.86
|
| Rate for Payer: Healthscope Commercial |
$3,712.51
|
| Rate for Payer: Healthscope Whirlpool |
$3,827.33
|
| Rate for Payer: Mclaren Commercial |
$3,444.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,253.23
|
| Rate for Payer: Nomi Health Commercial |
$3,138.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,870.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,368.05
|
|
|
HC LEVEL 3 INIT 30 MIN
|
Facility
|
OP
|
$3,827.33
|
|
| Hospital Charge Code |
36000066
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,416.11 |
| Max. Negotiated Rate |
$3,827.33 |
| Rate for Payer: Aetna Commercial |
$3,444.60
|
| Rate for Payer: Aetna Medicare |
$1,416.11
|
| Rate for Payer: ASR ASR |
$3,712.51
|
| Rate for Payer: BCBS Complete |
$1,530.93
|
| Rate for Payer: BCBS Trust/PPO |
$3,155.63
|
| Rate for Payer: BCN Commercial |
$3,155.63
|
| Rate for Payer: Cash Price |
$3,061.86
|
| Rate for Payer: Cofinity Commercial |
$3,597.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,061.86
|
| Rate for Payer: Healthscope Commercial |
$3,712.51
|
| Rate for Payer: Healthscope Whirlpool |
$3,827.33
|
| Rate for Payer: Mclaren Commercial |
$3,444.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,061.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,253.23
|
| Rate for Payer: Nomi Health Commercial |
$3,138.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,870.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,353.51
|
| Rate for Payer: Priority Health Narrow Network |
$2,682.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,368.05
|
|
|
HC LEVEL 3 SUBSQ 15 MIN
|
Facility
|
OP
|
$1,487.89
|
|
| Hospital Charge Code |
36000067
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$550.52 |
| Max. Negotiated Rate |
$1,487.89 |
| Rate for Payer: Aetna Commercial |
$1,339.10
|
| Rate for Payer: Aetna Medicare |
$550.52
|
| Rate for Payer: ASR ASR |
$1,443.25
|
| Rate for Payer: BCBS Complete |
$595.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,226.77
|
| Rate for Payer: BCN Commercial |
$1,226.77
|
| Rate for Payer: Cash Price |
$1,190.31
|
| Rate for Payer: Cofinity Commercial |
$1,398.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,190.31
|
| Rate for Payer: Healthscope Commercial |
$1,443.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,487.89
|
| Rate for Payer: Mclaren Commercial |
$1,339.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,190.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.71
|
| Rate for Payer: Nomi Health Commercial |
$1,220.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,115.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,303.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,043.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,309.34
|
|
