|
HC LEGIONELLA PNEUMOPHILA AB
|
Facility
|
OP
|
$48.96
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
30200301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$83.45 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: Aetna Medicare |
$15.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: ASR ASR |
$47.49
|
| Rate for Payer: ASR Commercial |
$47.49
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$40.09
|
| Rate for Payer: BCN Commercial |
$37.96
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$48.96
|
| Rate for Payer: Healthscope Whirlpool |
$47.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.30
|
| Rate for Payer: Mclaren Commercial |
$44.06
|
| Rate for Payer: Mclaren Medicaid |
$8.20
|
| Rate for Payer: Mclaren Medicare |
$15.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.06
|
| Rate for Payer: Meridian Medicaid |
$8.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.62
|
| Rate for Payer: Nomi Health Commercial |
$40.15
|
| Rate for Payer: PACE Medicare |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$16.83
|
| Rate for Payer: PHP Medicaid |
$8.20
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.45
|
| Rate for Payer: Priority Health Medicare |
$15.30
|
| Rate for Payer: Priority Health Narrow Network |
$66.76
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.30
|
| Rate for Payer: UHC Exchange |
$23.72
|
| Rate for Payer: UHC Medicare Advantage |
$15.30
|
| Rate for Payer: UHCCP DNSP |
$15.30
|
| Rate for Payer: UHCCP Medicaid |
$8.20
|
| Rate for Payer: VA VA |
$15.30
|
|
|
HC LEPTOSPIRA ANTIBODY
|
Facility
|
OP
|
$68.34
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
30200303
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$68.34 |
| Rate for Payer: Aetna Commercial |
$61.51
|
| 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 |
$66.29
|
| Rate for Payer: ASR Commercial |
$66.29
|
| Rate for Payer: BCBS Complete |
$9.12
|
| Rate for Payer: BCBS MAPPO |
$16.20
|
| Rate for Payer: BCBS Trust/PPO |
$55.96
|
| Rate for Payer: BCN Commercial |
$52.98
|
| Rate for Payer: BCN Medicare Advantage |
$16.20
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$64.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.20
|
| Rate for Payer: Healthscope Commercial |
$68.34
|
| Rate for Payer: Healthscope Whirlpool |
$66.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.20
|
| Rate for Payer: Mclaren Commercial |
$61.51
|
| Rate for Payer: Mclaren Medicaid |
$8.68
|
| Rate for Payer: Mclaren Medicare |
$16.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.01
|
| Rate for Payer: Meridian Medicaid |
$9.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.09
|
| Rate for Payer: Nomi Health Commercial |
$56.04
|
| 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 |
$8.68
|
| Rate for Payer: PHP Medicare Advantage |
$16.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.88
|
| Rate for Payer: Priority Health Medicare |
$16.20
|
| Rate for Payer: Priority Health Narrow Network |
$47.91
|
| Rate for Payer: Railroad Medicare Medicare |
$16.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.20
|
| Rate for Payer: UHC Exchange |
$25.11
|
| Rate for Payer: UHC Medicare Advantage |
$16.20
|
| Rate for Payer: UHCCP DNSP |
$16.20
|
| Rate for Payer: UHCCP Medicaid |
$8.68
|
| Rate for Payer: VA VA |
$16.20
|
|
|
HC LEPTOSPIRA ANTIBODY
|
Facility
|
IP
|
$68.34
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
30200303
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.42 |
| Max. Negotiated Rate |
$68.34 |
| Rate for Payer: Aetna Commercial |
$61.51
|
| Rate for Payer: ASR ASR |
$66.29
|
| Rate for Payer: ASR Commercial |
$66.29
|
| Rate for Payer: BCBS Trust/PPO |
$55.69
|
| Rate for Payer: BCN Commercial |
$52.98
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$64.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Healthscope Commercial |
$68.34
|
| Rate for Payer: Healthscope Whirlpool |
$66.29
|
| Rate for Payer: Mclaren Commercial |
$61.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.09
|
| Rate for Payer: Nomi Health Commercial |
$56.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.14
|
|
|
HC LEUKEMIA LYMPHOMA IMM T PANEL
|
Facility
|
IP
|
$52.24
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100014
|
|
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 LEUKEMIA LYMPHOMA IMM T PANEL
|
Facility
|
OP
|
$52.24
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100014
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$59.30 |
| 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: 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 |
$59.30
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.97
|
|
|
HC LEUKEMIA LYMPHOMA IMMUNOPH GLL
|
Facility
|
IP
|
$54.83
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100010
|
|
Hospital Revenue Code
|
311
|
| 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 LEUKEMIA LYMPHOMA IMMUNOPH GLL
|
Facility
|
OP
|
$54.83
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100010
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$59.30 |
| Rate for Payer: Aetna Commercial |
$49.35
|
| Rate for Payer: Aetna Medicare |
$27.42
|
| 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: 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 |
$59.30
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.25
|
|
|
HC LEUKEMIA LYMPHOMA IMMUNOPH TCR
|
Facility
|
IP
|
$52.24
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100009
|
|
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 LEUKEMIA LYMPHOMA IMMUNOPH TCR
|
Facility
|
OP
|
$52.24
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100009
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$59.30 |
| 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: 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 |
$59.30
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.97
|
|
|
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 LEUKEMIA LYMPHOMA PLASMA CELL
|
Facility
|
OP
|
$52.24
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100013
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$59.30 |
| 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: 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 |
$59.30
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| 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 |
$59.30 |
| 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: 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 |
$59.30
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| 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 |
$59.30 |
| 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: 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 |
$59.30
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| 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 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 |
$59.30 |
| Rate for Payer: Aetna Commercial |
$49.35
|
| Rate for Payer: Aetna Medicare |
$27.42
|
| 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: 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 |
$59.30
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| 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
|
OP
|
$52.24
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100015
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$59.30 |
| 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: 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 |
$59.30
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.97
|
|
|
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 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 |
$221.08
|
| 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 |
$221.08
|
| 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
|
OP
|
$1,031.14
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
63600142
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$670.24 |
| Max. Negotiated Rate |
$2,583.51 |
| Rate for Payer: Aetna Commercial |
$928.03
|
| Rate for Payer: Aetna Medicare |
$1,666.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,083.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,083.48
|
| Rate for Payer: ASR ASR |
$1,000.21
|
| Rate for Payer: ASR Commercial |
$1,000.21
|
| Rate for Payer: BCBS Complete |
$938.06
|
| Rate for Payer: BCBS MAPPO |
$1,666.78
|
| Rate for Payer: BCBS Trust/PPO |
$844.40
|
| Rate for Payer: BCN Commercial |
$799.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,666.78
|
| 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 |
$1,666.78
|
| Rate for Payer: Healthscope Commercial |
$1,031.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,000.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,666.78
|
| Rate for Payer: Mclaren Commercial |
$928.03
|
| Rate for Payer: Mclaren Medicaid |
$893.39
|
| Rate for Payer: Mclaren Medicare |
$1,666.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,750.12
|
| Rate for Payer: Meridian Medicaid |
$938.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,916.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.47
|
| Rate for Payer: Nomi Health Commercial |
$845.53
|
| Rate for Payer: PACE Medicare |
$1,583.44
|
| Rate for Payer: PACE SWMI |
$1,666.78
|
| Rate for Payer: PHP Commercial |
$1,833.46
|
| Rate for Payer: PHP Medicaid |
$893.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,666.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$893.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,733.33
|
| Rate for Payer: Priority Health Medicare |
$1,666.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,386.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1,666.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$907.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,666.78
|
| Rate for Payer: UHC Exchange |
$2,583.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,666.78
|
| Rate for Payer: UHCCP DNSP |
$1,666.78
|
| Rate for Payer: UHCCP Medicaid |
$893.39
|
| Rate for Payer: VA VA |
$1,666.78
|
|
|
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 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 LEUPROLIDE ACETATE SUSPNSION/ 7.5MG
|
Facility
|
OP
|
$461.04
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
63600147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$461.04 |
| Rate for Payer: Aetna Commercial |
$414.94
|
| Rate for Payer: Aetna Medicare |
$180.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$225.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$225.99
|
| Rate for Payer: ASR ASR |
$447.21
|
| Rate for Payer: ASR Commercial |
$447.21
|
| Rate for Payer: BCBS Complete |
$101.75
|
| Rate for Payer: BCBS MAPPO |
$180.79
|
| Rate for Payer: BCBS Trust/PPO |
$377.55
|
| Rate for Payer: BCN Commercial |
$357.44
|
| Rate for Payer: BCN Medicare Advantage |
$180.79
|
| 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 |
$180.79
|
| Rate for Payer: Healthscope Commercial |
$461.04
|
| Rate for Payer: Healthscope Whirlpool |
$447.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$180.79
|
| Rate for Payer: Mclaren Commercial |
$414.94
|
| Rate for Payer: Mclaren Medicaid |
$96.90
|
| Rate for Payer: Mclaren Medicare |
$180.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.83
|
| Rate for Payer: Meridian Medicaid |
$101.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.88
|
| Rate for Payer: Nomi Health Commercial |
$378.05
|
| Rate for Payer: PACE Medicare |
$171.75
|
| Rate for Payer: PACE SWMI |
$180.79
|
| Rate for Payer: PHP Commercial |
$198.87
|
| Rate for Payer: PHP Medicaid |
$96.90
|
| Rate for Payer: PHP Medicare Advantage |
$180.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.79
|
| Rate for Payer: Priority Health Medicare |
$180.79
|
| Rate for Payer: Priority Health Narrow Network |
$143.03
|
| Rate for Payer: Railroad Medicare Medicare |
$180.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$405.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.79
|
| Rate for Payer: UHC Exchange |
$280.22
|
| Rate for Payer: UHC Medicare Advantage |
$180.79
|
| Rate for Payer: UHCCP DNSP |
$180.79
|
| Rate for Payer: UHCCP Medicaid |
$96.90
|
| Rate for Payer: VA VA |
$180.79
|
|
