|
HC LEUKEMIA LYMPHOMA PLASMA CELL
|
Facility
|
IP
|
$52.24
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100013
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$52.24 |
| Rate for Payer: Aetna Commercial |
$47.02
|
| Rate for Payer: ASR ASR |
$50.67
|
| Rate for Payer: ASR Commercial |
$50.67
|
| Rate for Payer: BCBS Trust/PPO |
$42.57
|
| Rate for Payer: BCN Commercial |
$40.50
|
| Rate for Payer: Cash Price |
$41.79
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.79
|
| Rate for Payer: Healthscope Commercial |
$52.24
|
| Rate for Payer: Healthscope Whirlpool |
$50.67
|
| Rate for Payer: Mclaren Commercial |
$47.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.40
|
| Rate for Payer: Nomi Health Commercial |
$42.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.97
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT B
|
Facility
|
IP
|
$52.24
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$52.24 |
| Rate for Payer: Aetna Commercial |
$47.02
|
| Rate for Payer: ASR ASR |
$50.67
|
| Rate for Payer: ASR Commercial |
$50.67
|
| Rate for Payer: BCBS Trust/PPO |
$42.57
|
| Rate for Payer: BCN Commercial |
$40.50
|
| Rate for Payer: Cash Price |
$41.79
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.79
|
| Rate for Payer: Healthscope Commercial |
$52.24
|
| Rate for Payer: Healthscope Whirlpool |
$50.67
|
| Rate for Payer: Mclaren Commercial |
$47.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.40
|
| Rate for Payer: Nomi Health Commercial |
$42.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.97
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT B
|
Facility
|
OP
|
$52.24
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$52.24 |
| Rate for Payer: Aetna Commercial |
$47.02
|
| Rate for Payer: Aetna Medicare |
$26.12
|
| Rate for Payer: ASR ASR |
$50.67
|
| Rate for Payer: ASR Commercial |
$50.67
|
| Rate for Payer: BCBS Complete |
$20.90
|
| Rate for Payer: BCBS Trust/PPO |
$42.78
|
| Rate for Payer: BCN Commercial |
$40.50
|
| Rate for Payer: Cash Price |
$41.79
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.79
|
| Rate for Payer: Healthscope Commercial |
$52.24
|
| Rate for Payer: Healthscope Whirlpool |
$50.67
|
| Rate for Payer: Mclaren Commercial |
$47.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.40
|
| Rate for Payer: Nomi Health Commercial |
$42.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.77
|
| Rate for Payer: Priority Health Narrow Network |
$36.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.97
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT C
|
Facility
|
IP
|
$52.24
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000009
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$52.24 |
| Rate for Payer: Aetna Commercial |
$47.02
|
| Rate for Payer: ASR ASR |
$50.67
|
| Rate for Payer: ASR Commercial |
$50.67
|
| Rate for Payer: BCBS Trust/PPO |
$42.57
|
| Rate for Payer: BCN Commercial |
$40.50
|
| Rate for Payer: Cash Price |
$41.79
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.79
|
| Rate for Payer: Healthscope Commercial |
$52.24
|
| Rate for Payer: Healthscope Whirlpool |
$50.67
|
| Rate for Payer: Mclaren Commercial |
$47.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.40
|
| Rate for Payer: Nomi Health Commercial |
$42.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.97
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT C
|
Facility
|
OP
|
$52.24
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000009
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$52.24 |
| Rate for Payer: Aetna Commercial |
$47.02
|
| Rate for Payer: Aetna Medicare |
$26.12
|
| Rate for Payer: ASR ASR |
$50.67
|
| Rate for Payer: ASR Commercial |
$50.67
|
| Rate for Payer: BCBS Complete |
$20.90
|
| Rate for Payer: BCBS Trust/PPO |
$42.78
|
| Rate for Payer: BCN Commercial |
$40.50
|
| Rate for Payer: Cash Price |
$41.79
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.79
|
| Rate for Payer: Healthscope Commercial |
$52.24
|
| Rate for Payer: Healthscope Whirlpool |
$50.67
|
| Rate for Payer: Mclaren Commercial |
$47.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.40
|
| Rate for Payer: Nomi Health Commercial |
$42.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.77
|
| Rate for Payer: Priority Health Narrow Network |
$36.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.97
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT D
|
Facility
|
OP
|
$54.83
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000010
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$54.83 |
| Rate for Payer: Aetna Commercial |
$49.35
|
| Rate for Payer: Aetna Medicare |
$27.41
|
| Rate for Payer: ASR ASR |
$53.19
|
| Rate for Payer: ASR Commercial |
$53.19
|
| Rate for Payer: BCBS Complete |
$21.93
|
| Rate for Payer: BCBS Trust/PPO |
$44.90
|
| Rate for Payer: BCN Commercial |
$42.51
|
| Rate for Payer: Cash Price |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$51.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$54.83
|
| Rate for Payer: Healthscope Whirlpool |
$53.19
|
| Rate for Payer: Mclaren Commercial |
$49.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.61
|
| Rate for Payer: Nomi Health Commercial |
$44.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.04
|
| Rate for Payer: Priority Health Narrow Network |
$38.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.25
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT D
|
Facility
|
IP
|
$54.83
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000010
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.64 |
| Max. Negotiated Rate |
$54.83 |
| Rate for Payer: Aetna Commercial |
$49.35
|
| Rate for Payer: ASR ASR |
$53.19
|
| Rate for Payer: ASR Commercial |
$53.19
|
| Rate for Payer: BCBS Trust/PPO |
$44.68
|
| Rate for Payer: BCN Commercial |
$42.51
|
| Rate for Payer: Cash Price |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$51.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$54.83
|
| Rate for Payer: Healthscope Whirlpool |
$53.19
|
| Rate for Payer: Mclaren Commercial |
$49.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.61
|
| Rate for Payer: Nomi Health Commercial |
$44.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.25
|
|
|
HC LEUK LYMPHOMA IMMUNOPHEN TISSUE
|
Facility
|
IP
|
$52.24
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100015
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$52.24 |
| Rate for Payer: Aetna Commercial |
$47.02
|
| Rate for Payer: ASR ASR |
$50.67
|
| Rate for Payer: ASR Commercial |
$50.67
|
| Rate for Payer: BCBS Trust/PPO |
$42.57
|
| Rate for Payer: BCN Commercial |
$40.50
|
| Rate for Payer: Cash Price |
$41.79
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.79
|
| Rate for Payer: Healthscope Commercial |
$52.24
|
| Rate for Payer: Healthscope Whirlpool |
$50.67
|
| Rate for Payer: Mclaren Commercial |
$47.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.40
|
| Rate for Payer: Nomi Health Commercial |
$42.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.97
|
|
|
HC LEUK LYMPHOMA IMMUNOPHEN TISSUE
|
Facility
|
OP
|
$52.24
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100015
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$52.24 |
| Rate for Payer: Aetna Commercial |
$47.02
|
| Rate for Payer: Aetna Medicare |
$26.12
|
| Rate for Payer: ASR ASR |
$50.67
|
| Rate for Payer: ASR Commercial |
$50.67
|
| Rate for Payer: BCBS Complete |
$20.90
|
| Rate for Payer: BCBS Trust/PPO |
$42.78
|
| Rate for Payer: BCN Commercial |
$40.50
|
| Rate for Payer: Cash Price |
$41.79
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.79
|
| Rate for Payer: Healthscope Commercial |
$52.24
|
| Rate for Payer: Healthscope Whirlpool |
$50.67
|
| Rate for Payer: Mclaren Commercial |
$47.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.40
|
| Rate for Payer: Nomi Health Commercial |
$42.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.77
|
| Rate for Payer: Priority Health Narrow Network |
$36.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.97
|
|
|
HC LEUKOTRIENE E4, U
|
Facility
|
IP
|
$260.10
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$169.06 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Aetna Commercial |
$234.09
|
| Rate for Payer: ASR ASR |
$252.30
|
| Rate for Payer: ASR Commercial |
$252.30
|
| Rate for Payer: BCBS Trust/PPO |
$211.96
|
| Rate for Payer: BCN Commercial |
$201.66
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$244.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Healthscope Commercial |
$260.10
|
| Rate for Payer: Healthscope Whirlpool |
$252.30
|
| Rate for Payer: Mclaren Commercial |
$234.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Nomi Health Commercial |
$213.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.89
|
|
|
HC LEUKOTRIENE E4, U
|
Facility
|
OP
|
$260.10
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Aetna Commercial |
$234.09
|
| 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 |
$252.30
|
| Rate for Payer: ASR Commercial |
$252.30
|
| Rate for Payer: BCBS Complete |
$13.56
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$213.00
|
| Rate for Payer: BCN Commercial |
$201.66
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$244.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$260.10
|
| Rate for Payer: Healthscope Whirlpool |
$252.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$234.09
|
| Rate for Payer: Mclaren Medicaid |
$12.91
|
| 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 |
$13.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Nomi Health Commercial |
$213.28
|
| 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 |
$12.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.90
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$182.33
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$228.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.09
|
| Rate for Payer: UHC Exchange |
$37.34
|
| Rate for Payer: UHC Medicare Advantage |
$24.09
|
| Rate for Payer: UHCCP DNSP |
$24.09
|
| Rate for Payer: UHCCP Medicaid |
$12.91
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC LEUPROLIDE ACETATE 3.75MG
|
Facility
|
IP
|
$1,031.14
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
63600142
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$670.24 |
| Max. Negotiated Rate |
$1,031.14 |
| Rate for Payer: Aetna Commercial |
$928.03
|
| Rate for Payer: ASR ASR |
$1,000.21
|
| Rate for Payer: ASR Commercial |
$1,000.21
|
| Rate for Payer: BCBS Trust/PPO |
$840.28
|
| Rate for Payer: BCN Commercial |
$799.44
|
| Rate for Payer: Cash Price |
$824.91
|
| Rate for Payer: Cofinity Commercial |
$969.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$824.91
|
| Rate for Payer: Healthscope Commercial |
$1,031.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,000.21
|
| Rate for Payer: Mclaren Commercial |
$928.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.47
|
| Rate for Payer: Nomi Health Commercial |
$845.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$907.40
|
|
|
HC LEUPROLIDE ACETATE 3.75MG
|
Facility
|
OP
|
$1,031.14
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
63600142
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$670.24 |
| Max. Negotiated Rate |
$2,682.00 |
| Rate for Payer: Aetna Commercial |
$928.03
|
| Rate for Payer: Aetna Medicare |
$1,730.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,162.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,162.90
|
| Rate for Payer: ASR ASR |
$1,000.21
|
| Rate for Payer: ASR Commercial |
$1,000.21
|
| Rate for Payer: BCBS Complete |
$973.82
|
| Rate for Payer: BCBS MAPPO |
$1,730.32
|
| Rate for Payer: BCBS Trust/PPO |
$844.40
|
| Rate for Payer: BCN Commercial |
$799.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,730.32
|
| Rate for Payer: Cash Price |
$824.91
|
| Rate for Payer: Cash Price |
$824.91
|
| Rate for Payer: Cofinity Commercial |
$969.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$824.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,730.32
|
| Rate for Payer: Healthscope Commercial |
$1,031.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,000.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,730.32
|
| Rate for Payer: Mclaren Commercial |
$928.03
|
| Rate for Payer: Mclaren Medicaid |
$927.45
|
| Rate for Payer: Mclaren Medicare |
$1,730.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,816.84
|
| Rate for Payer: Meridian Medicaid |
$973.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,989.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.47
|
| Rate for Payer: Nomi Health Commercial |
$845.53
|
| Rate for Payer: PACE Medicare |
$1,643.80
|
| Rate for Payer: PACE SWMI |
$1,730.32
|
| Rate for Payer: PHP Commercial |
$1,903.35
|
| Rate for Payer: PHP Medicaid |
$927.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,730.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$903.48
|
| Rate for Payer: Priority Health Medicare |
$1,730.32
|
| Rate for Payer: Priority Health Narrow Network |
$722.83
|
| Rate for Payer: Railroad Medicare Medicare |
$1,730.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$907.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,730.32
|
| Rate for Payer: UHC Exchange |
$2,682.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,730.32
|
| Rate for Payer: UHCCP DNSP |
$1,730.32
|
| Rate for Payer: UHCCP Medicaid |
$927.45
|
| Rate for Payer: VA VA |
$1,730.32
|
|
|
HC LEUPROLIDE ACETATE SUSPNSION/ 7.5MG
|
Facility
|
OP
|
$461.04
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
63600147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.58 |
| Max. Negotiated Rate |
$461.04 |
| Rate for Payer: Aetna Commercial |
$414.94
|
| Rate for Payer: Aetna Medicare |
$176.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.56
|
| Rate for Payer: ASR ASR |
$447.21
|
| Rate for Payer: ASR Commercial |
$447.21
|
| Rate for Payer: BCBS Complete |
$99.31
|
| Rate for Payer: BCBS MAPPO |
$176.45
|
| Rate for Payer: BCBS Trust/PPO |
$377.55
|
| Rate for Payer: BCN Commercial |
$357.44
|
| Rate for Payer: BCN Medicare Advantage |
$176.45
|
| Rate for Payer: Cash Price |
$368.83
|
| Rate for Payer: Cash Price |
$368.83
|
| Rate for Payer: Cofinity Commercial |
$433.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.45
|
| Rate for Payer: Healthscope Commercial |
$461.04
|
| Rate for Payer: Healthscope Whirlpool |
$447.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$176.45
|
| Rate for Payer: Mclaren Commercial |
$414.94
|
| Rate for Payer: Mclaren Medicaid |
$94.58
|
| Rate for Payer: Mclaren Medicare |
$176.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.27
|
| Rate for Payer: Meridian Medicaid |
$99.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.88
|
| Rate for Payer: Nomi Health Commercial |
$378.05
|
| Rate for Payer: PACE Medicare |
$167.63
|
| Rate for Payer: PACE SWMI |
$176.45
|
| Rate for Payer: PHP Commercial |
$194.09
|
| Rate for Payer: PHP Medicaid |
$94.58
|
| Rate for Payer: PHP Medicare Advantage |
$176.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$403.96
|
| Rate for Payer: Priority Health Medicare |
$176.45
|
| Rate for Payer: Priority Health Narrow Network |
$323.19
|
| Rate for Payer: Railroad Medicare Medicare |
$176.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$405.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.45
|
| Rate for Payer: UHC Exchange |
$273.50
|
| Rate for Payer: UHC Medicare Advantage |
$176.45
|
| Rate for Payer: UHCCP DNSP |
$176.45
|
| Rate for Payer: UHCCP Medicaid |
$94.58
|
| Rate for Payer: VA VA |
$176.45
|
|
|
HC LEUPROLIDE ACETATE SUSPNSION/ 7.5MG
|
Facility
|
IP
|
$461.04
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
63600147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$299.68 |
| Max. Negotiated Rate |
$461.04 |
| Rate for Payer: Aetna Commercial |
$414.94
|
| Rate for Payer: ASR ASR |
$447.21
|
| Rate for Payer: ASR Commercial |
$447.21
|
| Rate for Payer: BCBS Trust/PPO |
$375.70
|
| Rate for Payer: BCN Commercial |
$357.44
|
| Rate for Payer: Cash Price |
$368.83
|
| Rate for Payer: Cofinity Commercial |
$433.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.83
|
| Rate for Payer: Healthscope Commercial |
$461.04
|
| Rate for Payer: Healthscope Whirlpool |
$447.21
|
| Rate for Payer: Mclaren Commercial |
$414.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.88
|
| Rate for Payer: Nomi Health Commercial |
$378.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$405.72
|
|
|
HC LEVEL 0.5 INIT 30 MIN
|
Facility
|
OP
|
$939.78
|
|
| Hospital Charge Code |
36000060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$375.91 |
| Max. Negotiated Rate |
$939.78 |
| Rate for Payer: Aetna Commercial |
$845.80
|
| Rate for Payer: Aetna Medicare |
$469.89
|
| Rate for Payer: ASR ASR |
$911.59
|
| Rate for Payer: ASR Commercial |
$911.59
|
| Rate for Payer: BCBS Complete |
$375.91
|
| Rate for Payer: BCBS Trust/PPO |
$769.59
|
| Rate for Payer: BCN Commercial |
$728.61
|
| 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 |
$939.78
|
| Rate for Payer: Healthscope Whirlpool |
$911.59
|
| 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: Priority Health Cigna Priority Health |
$610.86
|
| Rate for Payer: 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 INIT 30 MIN
|
Facility
|
IP
|
$939.78
|
|
| Hospital Charge Code |
36000060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$610.86 |
| Max. Negotiated Rate |
$939.78 |
| Rate for Payer: Aetna Commercial |
$845.80
|
| Rate for Payer: ASR ASR |
$911.59
|
| Rate for Payer: ASR Commercial |
$911.59
|
| Rate for Payer: BCBS Trust/PPO |
$765.83
|
| Rate for Payer: BCN Commercial |
$728.61
|
| 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 |
$939.78
|
| Rate for Payer: Healthscope Whirlpool |
$911.59
|
| 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: Priority Health Cigna Priority Health |
$610.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$827.01
|
|
|
HC LEVEL 0.5 SUBSQ 15 MIN
|
Facility
|
OP
|
$270.72
|
|
| Hospital Charge Code |
36000061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$108.29 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna Commercial |
$243.65
|
| Rate for Payer: Aetna Medicare |
$135.36
|
| Rate for Payer: ASR ASR |
$262.60
|
| Rate for Payer: ASR Commercial |
$262.60
|
| Rate for Payer: BCBS Complete |
$108.29
|
| Rate for Payer: BCBS Trust/PPO |
$221.69
|
| Rate for Payer: BCN Commercial |
$209.89
|
| 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 |
$270.72
|
| Rate for Payer: Healthscope Whirlpool |
$262.60
|
| 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: Priority Health Cigna Priority Health |
$175.97
|
| Rate for Payer: 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 0.5 SUBSQ 15 MIN
|
Facility
|
IP
|
$270.72
|
|
| Hospital Charge Code |
36000061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$175.97 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna Commercial |
$243.65
|
| Rate for Payer: ASR ASR |
$262.60
|
| Rate for Payer: ASR Commercial |
$262.60
|
| Rate for Payer: BCBS Trust/PPO |
$220.61
|
| Rate for Payer: BCN Commercial |
$209.89
|
| 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 |
$270.72
|
| Rate for Payer: Healthscope Whirlpool |
$262.60
|
| 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: Priority Health Cigna Priority Health |
$175.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.23
|
|
|
HC LEVEL 1 INIT 30 MIN
|
Facility
|
OP
|
$2,074.72
|
|
| Hospital Charge Code |
36000062
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$829.89 |
| Max. Negotiated Rate |
$2,074.72 |
| Rate for Payer: Aetna Commercial |
$1,867.25
|
| Rate for Payer: Aetna Medicare |
$1,037.36
|
| Rate for Payer: ASR ASR |
$2,012.48
|
| Rate for Payer: ASR Commercial |
$2,012.48
|
| Rate for Payer: BCBS Complete |
$829.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,698.99
|
| Rate for Payer: BCN Commercial |
$1,608.53
|
| 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 |
$2,074.72
|
| Rate for Payer: Healthscope Whirlpool |
$2,012.48
|
| 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: Priority Health Cigna Priority Health |
$1,348.57
|
| Rate for Payer: 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 INIT 30 MIN
|
Facility
|
IP
|
$2,074.72
|
|
| Hospital Charge Code |
36000062
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,348.57 |
| 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: ASR Commercial |
$2,012.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,690.69
|
| Rate for Payer: BCN Commercial |
$1,608.53
|
| 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 |
$2,074.72
|
| Rate for Payer: Healthscope Whirlpool |
$2,012.48
|
| 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: Priority Health Cigna Priority Health |
$1,348.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,825.75
|
|
|
HC LEVEL 1 SUBSQ 15 MIN
|
Facility
|
OP
|
$412.97
|
|
| Hospital Charge Code |
36000063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$165.19 |
| Max. Negotiated Rate |
$412.97 |
| Rate for Payer: Aetna Commercial |
$371.67
|
| Rate for Payer: Aetna Medicare |
$206.49
|
| Rate for Payer: ASR ASR |
$400.58
|
| Rate for Payer: ASR Commercial |
$400.58
|
| Rate for Payer: BCBS Complete |
$165.19
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: BCN Commercial |
$320.18
|
| 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 |
$412.97
|
| Rate for Payer: Healthscope Whirlpool |
$400.58
|
| 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: Priority Health Cigna Priority Health |
$268.43
|
| Rate for Payer: 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 1 SUBSQ 15 MIN
|
Facility
|
IP
|
$412.97
|
|
| Hospital Charge Code |
36000063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$268.43 |
| Max. Negotiated Rate |
$412.97 |
| Rate for Payer: Aetna Commercial |
$371.67
|
| Rate for Payer: ASR ASR |
$400.58
|
| Rate for Payer: ASR Commercial |
$400.58
|
| Rate for Payer: BCBS Trust/PPO |
$336.53
|
| Rate for Payer: BCN Commercial |
$320.18
|
| 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 |
$412.97
|
| Rate for Payer: Healthscope Whirlpool |
$400.58
|
| 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: Priority Health Cigna Priority Health |
$268.43
|
| 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 |
$2,097.45 |
| 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: ASR Commercial |
$3,130.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,629.56
|
| Rate for Payer: BCN Commercial |
$2,501.78
|
| 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 |
$3,226.85
|
| Rate for Payer: Healthscope Whirlpool |
$3,130.04
|
| 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: Priority Health Cigna Priority Health |
$2,097.45
|
| 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 |
$1,290.74 |
| Max. Negotiated Rate |
$3,226.85 |
| Rate for Payer: Aetna Commercial |
$2,904.16
|
| Rate for Payer: Aetna Medicare |
$1,613.42
|
| Rate for Payer: ASR ASR |
$3,130.04
|
| Rate for Payer: ASR Commercial |
$3,130.04
|
| Rate for Payer: BCBS Complete |
$1,290.74
|
| Rate for Payer: BCBS Trust/PPO |
$2,642.47
|
| Rate for Payer: BCN Commercial |
$2,501.78
|
| 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 |
$3,226.85
|
| Rate for Payer: Healthscope Whirlpool |
$3,130.04
|
| 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: Priority Health Cigna Priority Health |
$2,097.45
|
| Rate for Payer: 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
|
|
