|
HC LEGIONELLA PNEUMOPHILA AB
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
30200301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: ASR ASR |
$46.56
|
| Rate for Payer: BCBS Trust/PPO |
$37.21
|
| Rate for Payer: BCN Commercial |
$37.21
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$45.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.40
|
| Rate for Payer: Healthscope Commercial |
$48.00
|
| Rate for Payer: Healthscope Whirlpool |
$46.56
|
| Rate for Payer: Mclaren Commercial |
$43.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.24
|
|
|
HC LEPTOSPIRA ANTIBODY
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
30200303
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.90 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: ASR ASR |
$64.99
|
| Rate for Payer: BCBS Trust/PPO |
$51.95
|
| Rate for Payer: BCN Commercial |
$51.95
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$62.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.60
|
| Rate for Payer: Healthscope Commercial |
$67.00
|
| Rate for Payer: Healthscope Whirlpool |
$64.99
|
| Rate for Payer: Mclaren Commercial |
$60.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.96
|
|
|
HC LEPTOSPIRA ANTIBODY
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
30200303
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Medicare |
$16.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.25
|
| Rate for Payer: ASR ASR |
$64.99
|
| Rate for Payer: BCBS Complete |
$9.31
|
| Rate for Payer: BCBS MAPPO |
$16.20
|
| Rate for Payer: BCBS Trust/PPO |
$51.95
|
| Rate for Payer: BCN Commercial |
$51.95
|
| Rate for Payer: BCN Medicare Advantage |
$16.20
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$62.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.20
|
| Rate for Payer: Healthscope Commercial |
$67.00
|
| Rate for Payer: Healthscope Whirlpool |
$64.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.20
|
| Rate for Payer: Mclaren Commercial |
$60.30
|
| Rate for Payer: Mclaren Medicaid |
$8.86
|
| Rate for Payer: Mclaren Medicare |
$16.20
|
| Rate for Payer: Meridian Medicaid |
$9.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.95
|
| Rate for Payer: PACE Medicare |
$15.39
|
| Rate for Payer: PACE SWMI |
$16.20
|
| Rate for Payer: PHP Commercial |
$17.82
|
| Rate for Payer: PHP Medicaid |
$8.86
|
| Rate for Payer: PHP Medicare Advantage |
$16.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.97
|
| Rate for Payer: Priority Health Medicare |
$16.20
|
| Rate for Payer: Priority Health Narrow Network |
$47.57
|
| Rate for Payer: Railroad Medicare Medicare |
$16.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.96
|
| Rate for Payer: UHC Medicare Advantage |
$16.69
|
| Rate for Payer: VA VA |
$16.20
|
|
|
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 |
$35.85 |
| Max. Negotiated Rate |
$51.22 |
| Rate for Payer: Aetna Commercial |
$46.10
|
| Rate for Payer: ASR ASR |
$49.68
|
| Rate for Payer: BCBS Trust/PPO |
$39.71
|
| Rate for Payer: BCN Commercial |
$39.71
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$51.22
|
| Rate for Payer: Healthscope Whirlpool |
$49.68
|
| Rate for Payer: Mclaren Commercial |
$46.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.07
|
|
|
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 |
$20.49 |
| Max. Negotiated Rate |
$55.42 |
| Rate for Payer: Aetna Commercial |
$46.10
|
| Rate for Payer: ASR ASR |
$49.68
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS Trust/PPO |
$39.71
|
| Rate for Payer: BCN Commercial |
$39.71
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$51.22
|
| Rate for Payer: Healthscope Whirlpool |
$49.68
|
| Rate for Payer: Mclaren Commercial |
$46.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.42
|
| Rate for Payer: Priority Health Narrow Network |
$44.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.07
|
|
|
HC LEUKEMIA LYMPHOMA IMMUNOPH GLL
|
Facility
|
IP
|
$53.75
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100010
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$37.62 |
| Max. Negotiated Rate |
$53.75 |
| Rate for Payer: Aetna Commercial |
$48.38
|
| Rate for Payer: ASR ASR |
$52.14
|
| Rate for Payer: BCBS Trust/PPO |
$41.67
|
| Rate for Payer: BCN Commercial |
$41.67
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$53.75
|
| Rate for Payer: Healthscope Whirlpool |
$52.14
|
| Rate for Payer: Mclaren Commercial |
$48.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.30
|
|
|
HC LEUKEMIA LYMPHOMA IMMUNOPH GLL
|
Facility
|
OP
|
$53.75
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100010
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$55.42 |
| Rate for Payer: Aetna Commercial |
$48.38
|
| Rate for Payer: ASR ASR |
$52.14
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Trust/PPO |
$41.67
|
| Rate for Payer: BCN Commercial |
$41.67
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$53.75
|
| Rate for Payer: Healthscope Whirlpool |
$52.14
|
| Rate for Payer: Mclaren Commercial |
$48.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.42
|
| Rate for Payer: Priority Health Narrow Network |
$44.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.30
|
|
|
HC LEUKEMIA LYMPHOMA IMMUNOPH TCR
|
Facility
|
IP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100009
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$35.85 |
| Max. Negotiated Rate |
$51.22 |
| Rate for Payer: Aetna Commercial |
$46.10
|
| Rate for Payer: ASR ASR |
$49.68
|
| Rate for Payer: BCBS Trust/PPO |
$39.71
|
| Rate for Payer: BCN Commercial |
$39.71
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$51.22
|
| Rate for Payer: Healthscope Whirlpool |
$49.68
|
| Rate for Payer: Mclaren Commercial |
$46.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.07
|
|
|
HC LEUKEMIA LYMPHOMA IMMUNOPH TCR
|
Facility
|
OP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100009
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.49 |
| Max. Negotiated Rate |
$55.42 |
| Rate for Payer: Aetna Commercial |
$46.10
|
| Rate for Payer: ASR ASR |
$49.68
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS Trust/PPO |
$39.71
|
| Rate for Payer: BCN Commercial |
$39.71
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$51.22
|
| Rate for Payer: Healthscope Whirlpool |
$49.68
|
| Rate for Payer: Mclaren Commercial |
$46.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.42
|
| Rate for Payer: Priority Health Narrow Network |
$44.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.07
|
|
|
HC LEUKEMIA LYMPHOMA PLASMA CELL
|
Facility
|
OP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100013
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.49 |
| Max. Negotiated Rate |
$55.42 |
| Rate for Payer: Aetna Commercial |
$46.10
|
| Rate for Payer: ASR ASR |
$49.68
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS Trust/PPO |
$39.71
|
| Rate for Payer: BCN Commercial |
$39.71
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$51.22
|
| Rate for Payer: Healthscope Whirlpool |
$49.68
|
| Rate for Payer: Mclaren Commercial |
$46.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.42
|
| Rate for Payer: Priority Health Narrow Network |
$44.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.07
|
|
|
HC LEUKEMIA LYMPHOMA PLASMA CELL
|
Facility
|
IP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100013
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$35.85 |
| Max. Negotiated Rate |
$51.22 |
| Rate for Payer: Aetna Commercial |
$46.10
|
| Rate for Payer: ASR ASR |
$49.68
|
| Rate for Payer: BCBS Trust/PPO |
$39.71
|
| Rate for Payer: BCN Commercial |
$39.71
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$51.22
|
| Rate for Payer: Healthscope Whirlpool |
$49.68
|
| Rate for Payer: Mclaren Commercial |
$46.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.07
|
|
|
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 |
$35.85 |
| Max. Negotiated Rate |
$51.22 |
| Rate for Payer: Aetna Commercial |
$46.10
|
| Rate for Payer: ASR ASR |
$49.68
|
| Rate for Payer: BCBS Trust/PPO |
$39.71
|
| Rate for Payer: BCN Commercial |
$39.71
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$51.22
|
| Rate for Payer: Healthscope Whirlpool |
$49.68
|
| Rate for Payer: Mclaren Commercial |
$46.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.07
|
|
|
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 |
$20.49 |
| Max. Negotiated Rate |
$55.42 |
| Rate for Payer: Aetna Commercial |
$46.10
|
| Rate for Payer: ASR ASR |
$49.68
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS Trust/PPO |
$39.71
|
| Rate for Payer: BCN Commercial |
$39.71
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$51.22
|
| Rate for Payer: Healthscope Whirlpool |
$49.68
|
| Rate for Payer: Mclaren Commercial |
$46.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.42
|
| Rate for Payer: Priority Health Narrow Network |
$44.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.07
|
|
|
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 |
$35.85 |
| Max. Negotiated Rate |
$51.22 |
| Rate for Payer: Aetna Commercial |
$46.10
|
| Rate for Payer: ASR ASR |
$49.68
|
| Rate for Payer: BCBS Trust/PPO |
$39.71
|
| Rate for Payer: BCN Commercial |
$39.71
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$51.22
|
| Rate for Payer: Healthscope Whirlpool |
$49.68
|
| Rate for Payer: Mclaren Commercial |
$46.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.07
|
|
|
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 |
$20.49 |
| Max. Negotiated Rate |
$55.42 |
| Rate for Payer: Aetna Commercial |
$46.10
|
| Rate for Payer: ASR ASR |
$49.68
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS Trust/PPO |
$39.71
|
| Rate for Payer: BCN Commercial |
$39.71
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$51.22
|
| Rate for Payer: Healthscope Whirlpool |
$49.68
|
| Rate for Payer: Mclaren Commercial |
$46.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.42
|
| Rate for Payer: Priority Health Narrow Network |
$44.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.07
|
|
|
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 |
$37.62 |
| Max. Negotiated Rate |
$53.75 |
| Rate for Payer: Aetna Commercial |
$48.38
|
| Rate for Payer: ASR ASR |
$52.14
|
| Rate for Payer: BCBS Trust/PPO |
$41.67
|
| Rate for Payer: BCN Commercial |
$41.67
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$53.75
|
| Rate for Payer: Healthscope Whirlpool |
$52.14
|
| Rate for Payer: Mclaren Commercial |
$48.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.30
|
|
|
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 |
$21.50 |
| Max. Negotiated Rate |
$55.42 |
| Rate for Payer: Aetna Commercial |
$48.38
|
| Rate for Payer: ASR ASR |
$52.14
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Trust/PPO |
$41.67
|
| Rate for Payer: BCN Commercial |
$41.67
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$53.75
|
| Rate for Payer: Healthscope Whirlpool |
$52.14
|
| Rate for Payer: Mclaren Commercial |
$48.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.42
|
| Rate for Payer: Priority Health Narrow Network |
$44.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.30
|
|
|
HC LEUK LYMPHOMA IMMUNOPHEN TISSUE
|
Facility
|
OP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100015
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.49 |
| Max. Negotiated Rate |
$55.42 |
| Rate for Payer: Aetna Commercial |
$46.10
|
| Rate for Payer: ASR ASR |
$49.68
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS Trust/PPO |
$39.71
|
| Rate for Payer: BCN Commercial |
$39.71
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$51.22
|
| Rate for Payer: Healthscope Whirlpool |
$49.68
|
| Rate for Payer: Mclaren Commercial |
$46.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.42
|
| Rate for Payer: Priority Health Narrow Network |
$44.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.07
|
|
|
HC LEUK LYMPHOMA IMMUNOPHEN TISSUE
|
Facility
|
IP
|
$51.22
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100015
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$35.85 |
| Max. Negotiated Rate |
$51.22 |
| Rate for Payer: Aetna Commercial |
$46.10
|
| Rate for Payer: ASR ASR |
$49.68
|
| Rate for Payer: BCBS Trust/PPO |
$39.71
|
| Rate for Payer: BCN Commercial |
$39.71
|
| Rate for Payer: Cash Price |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$48.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$51.22
|
| Rate for Payer: Healthscope Whirlpool |
$49.68
|
| Rate for Payer: Mclaren Commercial |
$46.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.07
|
|
|
HC LEUKOTRIENE E4, U
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.18 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| 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 |
$247.35
|
| Rate for Payer: BCBS Complete |
$13.84
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$197.70
|
| Rate for Payer: BCN Commercial |
$197.70
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$239.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$255.00
|
| Rate for Payer: Healthscope Whirlpool |
$247.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$229.50
|
| Rate for Payer: Mclaren Medicaid |
$13.18
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$13.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.75
|
| 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 |
$13.18
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.05
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$181.05
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.40
|
| Rate for Payer: UHC Medicare Advantage |
$24.81
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC LEUKOTRIENE E4, U
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$178.50 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: ASR ASR |
$247.35
|
| Rate for Payer: BCBS Trust/PPO |
$197.70
|
| Rate for Payer: BCN Commercial |
$197.70
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$239.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Healthscope Commercial |
$255.00
|
| Rate for Payer: Healthscope Whirlpool |
$247.35
|
| Rate for Payer: Mclaren Commercial |
$229.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.40
|
|
|
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 |
$707.64 |
| Max. Negotiated Rate |
$1,955.76 |
| Rate for Payer: Aetna Commercial |
$909.83
|
| Rate for Payer: Aetna Medicare |
$1,564.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,955.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,955.76
|
| Rate for Payer: ASR ASR |
$980.59
|
| Rate for Payer: BCBS Complete |
$898.71
|
| Rate for Payer: BCBS MAPPO |
$1,564.60
|
| Rate for Payer: BCBS Trust/PPO |
$783.77
|
| Rate for Payer: BCN Commercial |
$783.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,564.60
|
| Rate for Payer: Cash Price |
$808.74
|
| Rate for Payer: Cash Price |
$808.74
|
| Rate for Payer: Cofinity Commercial |
$950.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,564.60
|
| Rate for Payer: Healthscope Commercial |
$1,010.92
|
| Rate for Payer: Healthscope Whirlpool |
$980.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,564.60
|
| Rate for Payer: Mclaren Commercial |
$909.83
|
| Rate for Payer: Mclaren Medicaid |
$855.84
|
| Rate for Payer: Mclaren Medicare |
$1,564.60
|
| Rate for Payer: Meridian Medicaid |
$898.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,642.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,799.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$859.28
|
| Rate for Payer: PACE Medicare |
$1,486.37
|
| Rate for Payer: PACE SWMI |
$1,564.60
|
| Rate for Payer: PHP Commercial |
$1,721.06
|
| Rate for Payer: PHP Medicaid |
$855.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,564.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$855.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$919.94
|
| Rate for Payer: Priority Health Medicare |
$1,564.60
|
| Rate for Payer: Priority Health Narrow Network |
$717.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,564.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$889.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,611.54
|
| Rate for Payer: VA VA |
$1,564.60
|
|
|
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 |
$707.64 |
| Max. Negotiated Rate |
$1,010.92 |
| Rate for Payer: Aetna Commercial |
$909.83
|
| Rate for Payer: ASR ASR |
$980.59
|
| Rate for Payer: BCBS Trust/PPO |
$783.77
|
| Rate for Payer: BCN Commercial |
$783.77
|
| Rate for Payer: Cash Price |
$808.74
|
| Rate for Payer: Cofinity Commercial |
$950.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.74
|
| Rate for Payer: Healthscope Commercial |
$1,010.92
|
| Rate for Payer: Healthscope Whirlpool |
$980.59
|
| Rate for Payer: Mclaren Commercial |
$909.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$859.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$889.61
|
|
|
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 |
$99.17 |
| Max. Negotiated Rate |
$452.00 |
| Rate for Payer: Aetna Commercial |
$406.80
|
| Rate for Payer: Aetna Medicare |
$181.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$226.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$226.63
|
| Rate for Payer: ASR ASR |
$438.44
|
| Rate for Payer: BCBS Complete |
$104.14
|
| Rate for Payer: BCBS MAPPO |
$181.30
|
| Rate for Payer: BCBS Trust/PPO |
$350.44
|
| Rate for Payer: BCN Commercial |
$350.44
|
| Rate for Payer: BCN Medicare Advantage |
$181.30
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$424.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$181.30
|
| Rate for Payer: Healthscope Commercial |
$452.00
|
| Rate for Payer: Healthscope Whirlpool |
$438.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$181.30
|
| Rate for Payer: Mclaren Commercial |
$406.80
|
| Rate for Payer: Mclaren Medicaid |
$99.17
|
| Rate for Payer: Mclaren Medicare |
$181.30
|
| Rate for Payer: Meridian Medicaid |
$104.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$190.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$384.20
|
| Rate for Payer: PACE Medicare |
$172.24
|
| Rate for Payer: PACE SWMI |
$181.30
|
| Rate for Payer: PHP Commercial |
$199.43
|
| Rate for Payer: PHP Medicaid |
$99.17
|
| Rate for Payer: PHP Medicare Advantage |
$181.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$411.32
|
| Rate for Payer: Priority Health Medicare |
$181.30
|
| Rate for Payer: Priority Health Narrow Network |
$320.92
|
| Rate for Payer: Railroad Medicare Medicare |
$181.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.76
|
| Rate for Payer: UHC Medicare Advantage |
$186.74
|
| Rate for Payer: VA VA |
$181.30
|
|
|
HC LEUPROLIDE ACETATE SUSPNSION/ 7.5MG
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
63600147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$316.40 |
| Max. Negotiated Rate |
$452.00 |
| Rate for Payer: Aetna Commercial |
$406.80
|
| Rate for Payer: ASR ASR |
$438.44
|
| Rate for Payer: BCBS Trust/PPO |
$350.44
|
| Rate for Payer: BCN Commercial |
$350.44
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$424.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.60
|
| Rate for Payer: Healthscope Commercial |
$452.00
|
| Rate for Payer: Healthscope Whirlpool |
$438.44
|
| Rate for Payer: Mclaren Commercial |
$406.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$384.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.76
|
|
