|
HC LEGIONELLA PNEUMOPHILA AB
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
30200301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$40.80
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: BCBS Complete |
$11.86
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$37.32
|
| Rate for Payer: BCN Commercial |
$37.32
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$41.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$43.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.00
|
| Rate for Payer: Mclaren Medicaid |
$11.29
|
| Rate for Payer: Meridian Medicaid |
$11.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.80
|
| Rate for Payer: PACE Senior Care Partners |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$40.80
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.76
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.28
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.24
|
| Rate for Payer: UHC Core |
$40.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.00
|
| Rate for Payer: UHC Medicare Advantage |
$12.36
|
| Rate for Payer: VA VA |
$12.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.00
|
|
|
HC LEGIONELLA PNEUMOPHILA AB
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
30200301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.28 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$40.80
|
| Rate for Payer: BCBS Trust/PPO |
$37.09
|
| Rate for Payer: BCN Commercial |
$37.09
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$41.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.40
|
| Rate for Payer: Healthscope Commercial |
$43.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.80
|
| Rate for Payer: PHP Commercial |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.24
|
| Rate for Payer: UHC Core |
$40.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.00
|
|
|
HC LEPTOSPIRA ANTIBODY
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
30200303
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.86 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Aetna Commercial |
$56.95
|
| Rate for Payer: BCBS Trust/PPO |
$51.78
|
| Rate for Payer: BCN Commercial |
$51.78
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$57.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.60
|
| Rate for Payer: Healthscope Commercial |
$60.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.95
|
| Rate for Payer: PHP Commercial |
$56.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.96
|
| Rate for Payer: UHC Core |
$55.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.25
|
|
|
HC LEPTOSPIRA ANTIBODY
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
30200303
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Aetna Commercial |
$56.95
|
| Rate for Payer: Aetna Medicare |
$17.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.94
|
| Rate for Payer: BCBS Complete |
$12.55
|
| Rate for Payer: BCBS MAPPO |
$16.75
|
| Rate for Payer: BCBS Trust/PPO |
$52.09
|
| Rate for Payer: BCN Commercial |
$52.09
|
| Rate for Payer: BCN Medicare Advantage |
$16.75
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$57.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.75
|
| Rate for Payer: Healthscope Commercial |
$60.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.25
|
| Rate for Payer: Mclaren Medicaid |
$11.96
|
| Rate for Payer: Meridian Medicaid |
$12.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.95
|
| Rate for Payer: PACE Senior Care Partners |
$15.91
|
| Rate for Payer: PACE SWMI |
$16.75
|
| Rate for Payer: PHP Commercial |
$56.95
|
| Rate for Payer: PHP Medicare Advantage |
$16.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.29
|
| Rate for Payer: Priority Health Medicare |
$16.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.86
|
| Rate for Payer: Railroad Medicare Medicare |
$16.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.96
|
| Rate for Payer: UHC Core |
$55.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.75
|
| Rate for Payer: UHC Medicare Advantage |
$17.25
|
| Rate for Payer: VA VA |
$16.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.25
|
|
|
HC LEUKEMIA LYMPHOMA IMM T PANEL
|
Facility
|
OP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100014
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna Commercial |
$43.54
|
| Rate for Payer: Aetna Medicare |
$13.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.01
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS MAPPO |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$39.82
|
| Rate for Payer: BCN Commercial |
$39.82
|
| Rate for Payer: BCN Medicare Advantage |
$12.80
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: PACE Senior Care Partners |
$12.16
|
| Rate for Payer: PACE SWMI |
$12.80
|
| Rate for Payer: PHP Commercial |
$43.54
|
| Rate for Payer: PHP Medicare Advantage |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.56
|
| Rate for Payer: Priority Health Medicare |
$12.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.24
|
| Rate for Payer: Railroad Medicare Medicare |
$12.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.07
|
| Rate for Payer: UHC Core |
$42.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.80
|
| Rate for Payer: UHC Medicare Advantage |
$13.19
|
| Rate for Payer: VA VA |
$12.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.42
|
|
|
HC LEUKEMIA LYMPHOMA IMM T PANEL
|
Facility
|
IP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100014
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna Commercial |
$43.54
|
| Rate for Payer: BCBS Trust/PPO |
$39.58
|
| Rate for Payer: BCN Commercial |
$39.58
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: PHP Commercial |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.07
|
| Rate for Payer: UHC Core |
$42.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.42
|
|
|
HC LEUKEMIA LYMPHOMA IMMUNOPH GLL
|
Facility
|
IP
|
$53.75
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100010
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: BCBS Trust/PPO |
$41.54
|
| Rate for Payer: BCN Commercial |
$41.54
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.30
|
| Rate for Payer: UHC Core |
$44.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
|
|
HC LEUKEMIA LYMPHOMA IMMUNOPH GLL
|
Facility
|
OP
|
$53.75
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100010
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Medicare |
$13.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.80
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS MAPPO |
$13.44
|
| Rate for Payer: BCBS Trust/PPO |
$41.79
|
| Rate for Payer: BCN Commercial |
$41.79
|
| Rate for Payer: BCN Medicare Advantage |
$13.44
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.44
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: PACE Senior Care Partners |
$12.77
|
| Rate for Payer: PACE SWMI |
$13.44
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: PHP Medicare Advantage |
$13.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.76
|
| Rate for Payer: Priority Health Medicare |
$13.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.78
|
| Rate for Payer: Railroad Medicare Medicare |
$13.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.30
|
| Rate for Payer: UHC Core |
$44.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.44
|
| Rate for Payer: UHC Medicare Advantage |
$13.84
|
| Rate for Payer: VA VA |
$13.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
|
|
HC LEUKEMIA LYMPHOMA IMMUNOPH TCR
|
Facility
|
OP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100009
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna Commercial |
$43.54
|
| Rate for Payer: Aetna Medicare |
$13.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.01
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS MAPPO |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$39.82
|
| Rate for Payer: BCN Commercial |
$39.82
|
| Rate for Payer: BCN Medicare Advantage |
$12.80
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: PACE Senior Care Partners |
$12.16
|
| Rate for Payer: PACE SWMI |
$12.80
|
| Rate for Payer: PHP Commercial |
$43.54
|
| Rate for Payer: PHP Medicare Advantage |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.56
|
| Rate for Payer: Priority Health Medicare |
$12.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.24
|
| Rate for Payer: Railroad Medicare Medicare |
$12.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.07
|
| Rate for Payer: UHC Core |
$42.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.80
|
| Rate for Payer: UHC Medicare Advantage |
$13.19
|
| Rate for Payer: VA VA |
$12.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.42
|
|
|
HC LEUKEMIA LYMPHOMA IMMUNOPH TCR
|
Facility
|
IP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100009
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna Commercial |
$43.54
|
| Rate for Payer: BCBS Trust/PPO |
$39.58
|
| Rate for Payer: BCN Commercial |
$39.58
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: PHP Commercial |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.07
|
| Rate for Payer: UHC Core |
$42.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.42
|
|
|
HC LEUKEMIA LYMPHOMA PLASMA CELL
|
Facility
|
IP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100013
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna Commercial |
$43.54
|
| Rate for Payer: BCBS Trust/PPO |
$39.58
|
| Rate for Payer: BCN Commercial |
$39.58
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: PHP Commercial |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.07
|
| Rate for Payer: UHC Core |
$42.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.42
|
|
|
HC LEUKEMIA LYMPHOMA PLASMA CELL
|
Facility
|
OP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100013
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna Commercial |
$43.54
|
| Rate for Payer: Aetna Medicare |
$13.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.01
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS MAPPO |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$39.82
|
| Rate for Payer: BCN Commercial |
$39.82
|
| Rate for Payer: BCN Medicare Advantage |
$12.80
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: PACE Senior Care Partners |
$12.16
|
| Rate for Payer: PACE SWMI |
$12.80
|
| Rate for Payer: PHP Commercial |
$43.54
|
| Rate for Payer: PHP Medicare Advantage |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.56
|
| Rate for Payer: Priority Health Medicare |
$12.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.24
|
| Rate for Payer: Railroad Medicare Medicare |
$12.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.07
|
| Rate for Payer: UHC Core |
$42.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.80
|
| Rate for Payer: UHC Medicare Advantage |
$13.19
|
| Rate for Payer: VA VA |
$12.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.42
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT B
|
Facility
|
IP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna Commercial |
$43.54
|
| Rate for Payer: BCBS Trust/PPO |
$39.58
|
| Rate for Payer: BCN Commercial |
$39.58
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: PHP Commercial |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.07
|
| Rate for Payer: UHC Core |
$42.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.42
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT B
|
Facility
|
OP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna Commercial |
$43.54
|
| Rate for Payer: Aetna Medicare |
$13.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.01
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS MAPPO |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$39.82
|
| Rate for Payer: BCN Commercial |
$39.82
|
| Rate for Payer: BCN Medicare Advantage |
$12.80
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: PACE Senior Care Partners |
$12.16
|
| Rate for Payer: PACE SWMI |
$12.80
|
| Rate for Payer: PHP Commercial |
$43.54
|
| Rate for Payer: PHP Medicare Advantage |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.56
|
| Rate for Payer: Priority Health Medicare |
$12.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.24
|
| Rate for Payer: Railroad Medicare Medicare |
$12.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.07
|
| Rate for Payer: UHC Core |
$42.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.80
|
| Rate for Payer: UHC Medicare Advantage |
$13.19
|
| Rate for Payer: VA VA |
$12.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.42
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT C
|
Facility
|
OP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000009
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna Commercial |
$43.54
|
| Rate for Payer: Aetna Medicare |
$13.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.01
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS MAPPO |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$39.82
|
| Rate for Payer: BCN Commercial |
$39.82
|
| Rate for Payer: BCN Medicare Advantage |
$12.80
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: PACE Senior Care Partners |
$12.16
|
| Rate for Payer: PACE SWMI |
$12.80
|
| Rate for Payer: PHP Commercial |
$43.54
|
| Rate for Payer: PHP Medicare Advantage |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.56
|
| Rate for Payer: Priority Health Medicare |
$12.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.24
|
| Rate for Payer: Railroad Medicare Medicare |
$12.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.07
|
| Rate for Payer: UHC Core |
$42.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.80
|
| Rate for Payer: UHC Medicare Advantage |
$13.19
|
| Rate for Payer: VA VA |
$12.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.42
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT C
|
Facility
|
IP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000009
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna Commercial |
$43.54
|
| Rate for Payer: BCBS Trust/PPO |
$39.58
|
| Rate for Payer: BCN Commercial |
$39.58
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: PHP Commercial |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.07
|
| Rate for Payer: UHC Core |
$42.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.42
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT D
|
Facility
|
OP
|
$53.75
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000010
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Medicare |
$13.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.80
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS MAPPO |
$13.44
|
| Rate for Payer: BCBS Trust/PPO |
$41.79
|
| Rate for Payer: BCN Commercial |
$41.79
|
| Rate for Payer: BCN Medicare Advantage |
$13.44
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.44
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: PACE Senior Care Partners |
$12.77
|
| Rate for Payer: PACE SWMI |
$13.44
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: PHP Medicare Advantage |
$13.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.76
|
| Rate for Payer: Priority Health Medicare |
$13.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.78
|
| Rate for Payer: Railroad Medicare Medicare |
$13.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.30
|
| Rate for Payer: UHC Core |
$44.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.44
|
| Rate for Payer: UHC Medicare Advantage |
$13.84
|
| Rate for Payer: VA VA |
$13.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
|
|
HC LEUK/LYMPH IMMUNOPHENO CMPT D
|
Facility
|
IP
|
$53.75
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000010
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: BCBS Trust/PPO |
$41.54
|
| Rate for Payer: BCN Commercial |
$41.54
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.30
|
| Rate for Payer: UHC Core |
$44.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
|
|
HC LEUK LYMPHOMA IMMUNOPHEN TISSUE
|
Facility
|
OP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100015
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna Commercial |
$43.54
|
| Rate for Payer: Aetna Medicare |
$13.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.01
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS MAPPO |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$39.82
|
| Rate for Payer: BCN Commercial |
$39.82
|
| Rate for Payer: BCN Medicare Advantage |
$12.80
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: PACE Senior Care Partners |
$12.16
|
| Rate for Payer: PACE SWMI |
$12.80
|
| Rate for Payer: PHP Commercial |
$43.54
|
| Rate for Payer: PHP Medicare Advantage |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.56
|
| Rate for Payer: Priority Health Medicare |
$12.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.24
|
| Rate for Payer: Railroad Medicare Medicare |
$12.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.07
|
| Rate for Payer: UHC Core |
$42.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.80
|
| Rate for Payer: UHC Medicare Advantage |
$13.19
|
| Rate for Payer: VA VA |
$12.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.42
|
|
|
HC LEUK LYMPHOMA IMMUNOPHEN TISSUE
|
Facility
|
IP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100015
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$46.10 |
| Rate for Payer: Aetna Commercial |
$43.54
|
| Rate for Payer: BCBS Trust/PPO |
$39.58
|
| Rate for Payer: BCN Commercial |
$39.58
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$44.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$46.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: PHP Commercial |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.07
|
| Rate for Payer: UHC Core |
$42.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.42
|
|
|
HC LEUKOTRIENE E4, U
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.78 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna Commercial |
$216.75
|
| Rate for Payer: Aetna Medicare |
$66.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.69
|
| Rate for Payer: BCBS Complete |
$18.67
|
| Rate for Payer: BCBS MAPPO |
$63.75
|
| Rate for Payer: BCBS Trust/PPO |
$198.26
|
| Rate for Payer: BCN Commercial |
$198.26
|
| Rate for Payer: BCN Medicare Advantage |
$63.75
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$219.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.75
|
| Rate for Payer: Healthscope Commercial |
$229.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.25
|
| Rate for Payer: Mclaren Medicaid |
$17.78
|
| Rate for Payer: Meridian Medicaid |
$18.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.75
|
| Rate for Payer: PACE Senior Care Partners |
$60.56
|
| Rate for Payer: PACE SWMI |
$63.75
|
| Rate for Payer: PHP Commercial |
$216.75
|
| Rate for Payer: PHP Medicare Advantage |
$63.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$221.85
|
| Rate for Payer: Priority Health Medicare |
$63.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.52
|
| Rate for Payer: Railroad Medicare Medicare |
$63.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.40
|
| Rate for Payer: UHC Core |
$212.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.75
|
| Rate for Payer: UHC Medicare Advantage |
$65.66
|
| Rate for Payer: VA VA |
$63.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.25
|
|
|
HC LEUKOTRIENE E4, U
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$155.52 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna Commercial |
$216.75
|
| Rate for Payer: BCBS Trust/PPO |
$197.06
|
| Rate for Payer: BCN Commercial |
$197.06
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$219.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Healthscope Commercial |
$229.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.75
|
| Rate for Payer: PHP Commercial |
$216.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$221.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.40
|
| Rate for Payer: UHC Core |
$212.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.25
|
|
|
HC LEUPROLIDE ACETATE 3.75MG
|
Facility
|
OP
|
$1,010.92
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
63600142
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$240.09 |
| Max. Negotiated Rate |
$1,212.41 |
| Rate for Payer: Aetna Commercial |
$859.28
|
| Rate for Payer: Aetna Medicare |
$262.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$315.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$315.91
|
| Rate for Payer: BCBS Complete |
$1,212.41
|
| Rate for Payer: BCBS MAPPO |
$252.73
|
| Rate for Payer: BCBS Trust/PPO |
$785.99
|
| Rate for Payer: BCN Commercial |
$785.99
|
| Rate for Payer: BCN Medicare Advantage |
$252.73
|
| Rate for Payer: Cash Price |
$808.74
|
| Rate for Payer: Cash Price |
$808.74
|
| Rate for Payer: Cofinity Commercial |
$869.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$252.73
|
| Rate for Payer: Healthscope Commercial |
$909.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$758.19
|
| Rate for Payer: Mclaren Medicaid |
$1,154.68
|
| Rate for Payer: Meridian Medicaid |
$1,212.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$265.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$290.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$859.28
|
| Rate for Payer: PACE Senior Care Partners |
$240.09
|
| Rate for Payer: PACE SWMI |
$252.73
|
| Rate for Payer: PHP Commercial |
$859.28
|
| Rate for Payer: PHP Medicare Advantage |
$252.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,154.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$879.50
|
| Rate for Payer: Priority Health Medicare |
$252.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$616.56
|
| Rate for Payer: Railroad Medicare Medicare |
$252.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$889.61
|
| Rate for Payer: UHC Core |
$844.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$252.73
|
| Rate for Payer: UHC Medicare Advantage |
$260.31
|
| Rate for Payer: VA VA |
$252.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$758.19
|
|
|
HC LEUPROLIDE ACETATE 3.75MG
|
Facility
|
IP
|
$1,010.92
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
63600142
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$616.56 |
| Max. Negotiated Rate |
$909.83 |
| Rate for Payer: Aetna Commercial |
$859.28
|
| Rate for Payer: BCBS Trust/PPO |
$781.24
|
| Rate for Payer: BCN Commercial |
$781.24
|
| Rate for Payer: Cash Price |
$808.74
|
| Rate for Payer: Cofinity Commercial |
$869.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.74
|
| Rate for Payer: Healthscope Commercial |
$909.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$758.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$859.28
|
| Rate for Payer: PHP Commercial |
$859.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$879.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$616.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$889.61
|
| Rate for Payer: UHC Core |
$844.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$758.19
|
|
|
HC LEUPROLIDE ACETATE SUSPNSION/ 7.5MG
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
63600147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.35 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Aetna Commercial |
$384.20
|
| Rate for Payer: Aetna Medicare |
$117.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.25
|
| Rate for Payer: BCBS Complete |
$140.49
|
| Rate for Payer: BCBS MAPPO |
$113.00
|
| Rate for Payer: BCBS Trust/PPO |
$351.43
|
| Rate for Payer: BCN Commercial |
$351.43
|
| Rate for Payer: BCN Medicare Advantage |
$113.00
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$388.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.00
|
| Rate for Payer: Healthscope Commercial |
$406.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.00
|
| Rate for Payer: Mclaren Medicaid |
$133.80
|
| Rate for Payer: Meridian Medicaid |
$140.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$118.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$384.20
|
| Rate for Payer: PACE Senior Care Partners |
$107.35
|
| Rate for Payer: PACE SWMI |
$113.00
|
| Rate for Payer: PHP Commercial |
$384.20
|
| Rate for Payer: PHP Medicare Advantage |
$113.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$393.24
|
| Rate for Payer: Priority Health Medicare |
$113.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.67
|
| Rate for Payer: Railroad Medicare Medicare |
$113.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.76
|
| Rate for Payer: UHC Core |
$377.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.00
|
| Rate for Payer: UHC Medicare Advantage |
$116.39
|
| Rate for Payer: VA VA |
$113.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.00
|
|
