|
HC TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT
|
Facility
|
IP
|
$4,590.00
|
|
|
Service Code
|
CPT 26060
|
| Hospital Charge Code |
76100424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,891.70 |
| Max. Negotiated Rate |
$4,131.00 |
| Rate for Payer: Aetna Commercial |
$3,901.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,983.50
|
| Rate for Payer: Cash Price |
$3,672.00
|
| Rate for Payer: Cofinity Commercial |
$3,213.00
|
| Rate for Payer: Cofinity Commercial |
$3,947.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,213.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,672.00
|
| Rate for Payer: Healthscope Commercial |
$4,131.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,901.50
|
| Rate for Payer: PHP Commercial |
$3,901.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,983.50
|
| Rate for Payer: Priority Health SBD |
$2,891.70
|
|
|
HC TENOTOMY SHOULDER AREA SINGLE TENDON
|
Facility
|
IP
|
$4,826.31
|
|
| Hospital Charge Code |
36000098
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,040.58 |
| Max. Negotiated Rate |
$4,343.68 |
| Rate for Payer: Aetna Commercial |
$4,102.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,137.10
|
| Rate for Payer: Cash Price |
$3,861.05
|
| Rate for Payer: Cofinity Commercial |
$3,378.42
|
| Rate for Payer: Cofinity Commercial |
$4,150.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,378.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,861.05
|
| Rate for Payer: Healthscope Commercial |
$4,343.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,102.36
|
| Rate for Payer: PHP Commercial |
$4,102.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,137.10
|
| Rate for Payer: Priority Health SBD |
$3,040.58
|
|
|
HC TENOTOMY SHOULDER AREA SINGLE TENDON
|
Facility
|
OP
|
$4,826.31
|
|
| Hospital Charge Code |
36000098
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,930.52 |
| Max. Negotiated Rate |
$4,343.68 |
| Rate for Payer: Aetna Commercial |
$4,102.36
|
| Rate for Payer: Aetna Medicare |
$2,413.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,137.10
|
| Rate for Payer: BCBS Complete |
$1,930.52
|
| Rate for Payer: Cash Price |
$3,861.05
|
| Rate for Payer: Cofinity Commercial |
$3,378.42
|
| Rate for Payer: Cofinity Commercial |
$4,150.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,378.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,861.05
|
| Rate for Payer: Healthscope Commercial |
$4,343.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,102.36
|
| Rate for Payer: PHP Commercial |
$4,102.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,137.10
|
| Rate for Payer: Priority Health SBD |
$3,040.58
|
|
|
HC TENOTOMY TOE SINGLE TENDON
|
Facility
|
OP
|
$2,219.15
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
45000092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$836.62 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna Commercial |
$1,886.28
|
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,442.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Cash Price |
$1,775.32
|
| Rate for Payer: Cash Price |
$1,775.32
|
| Rate for Payer: Cofinity Commercial |
$1,908.47
|
| Rate for Payer: Cofinity Commercial |
$1,553.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,553.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,775.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Healthscope Commercial |
$1,997.23
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,886.28
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Commercial |
$1,886.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,442.45
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Priority Health SBD |
$1,398.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,393.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$878.76
|
| Rate for Payer: VA VA |
$1,560.85
|
|
|
HC TENOTOMY TOE SINGLE TENDON
|
Facility
|
IP
|
$2,219.15
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
45000092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,398.06 |
| Max. Negotiated Rate |
$1,997.23 |
| Rate for Payer: Aetna Commercial |
$1,886.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,442.45
|
| Rate for Payer: Cash Price |
$1,775.32
|
| Rate for Payer: Cofinity Commercial |
$1,553.40
|
| Rate for Payer: Cofinity Commercial |
$1,908.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,553.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,775.32
|
| Rate for Payer: Healthscope Commercial |
$1,997.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,886.28
|
| Rate for Payer: PHP Commercial |
$1,886.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,442.45
|
| Rate for Payer: Priority Health SBD |
$1,398.06
|
|
|
HC TESTOSTERONE BIOAVAILABLE
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100429
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$71.70 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$26.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.84
|
| Rate for Payer: BCBS Complete |
$14.33
|
| Rate for Payer: BCBS MAPPO |
$25.47
|
| Rate for Payer: BCN Medicare Advantage |
$25.47
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.47
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$13.65
|
| Rate for Payer: Mclaren Medicare |
$25.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.74
|
| Rate for Payer: Meridian Medicaid |
$14.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PACE Medicare |
$24.20
|
| Rate for Payer: PACE SWMI |
$25.47
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$25.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health Medicare |
$25.47
|
| Rate for Payer: Priority Health SBD |
$49.16
|
| Rate for Payer: Railroad Medicare Medicare |
$25.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.47
|
| Rate for Payer: UHC Medicare Advantage |
$25.47
|
| Rate for Payer: UHCCP Medicaid |
$14.34
|
| Rate for Payer: VA VA |
$25.47
|
|
|
HC TESTOSTERONE BIOAVAILABLE
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100429
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health SBD |
$49.16
|
|
|
HC TESTOSTERONE FREE
|
Facility
|
IP
|
$44.79
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100428
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$40.31 |
| Rate for Payer: Aetna Commercial |
$38.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.11
|
| Rate for Payer: Cash Price |
$35.83
|
| Rate for Payer: Cofinity Commercial |
$31.35
|
| Rate for Payer: Cofinity Commercial |
$38.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.83
|
| Rate for Payer: Healthscope Commercial |
$40.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.07
|
| Rate for Payer: PHP Commercial |
$38.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.11
|
| Rate for Payer: Priority Health SBD |
$28.22
|
|
|
HC TESTOSTERONE FREE
|
Facility
|
OP
|
$44.79
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100428
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$71.70 |
| Rate for Payer: Aetna Commercial |
$38.07
|
| Rate for Payer: Aetna Medicare |
$26.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.84
|
| Rate for Payer: BCBS Complete |
$14.33
|
| Rate for Payer: BCBS MAPPO |
$25.47
|
| Rate for Payer: BCN Medicare Advantage |
$25.47
|
| Rate for Payer: Cash Price |
$35.83
|
| Rate for Payer: Cash Price |
$35.83
|
| Rate for Payer: Cofinity Commercial |
$38.52
|
| Rate for Payer: Cofinity Commercial |
$31.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.47
|
| Rate for Payer: Healthscope Commercial |
$40.31
|
| Rate for Payer: Mclaren Medicaid |
$13.65
|
| Rate for Payer: Mclaren Medicare |
$25.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.74
|
| Rate for Payer: Meridian Medicaid |
$14.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.07
|
| Rate for Payer: PACE Medicare |
$24.20
|
| Rate for Payer: PACE SWMI |
$25.47
|
| Rate for Payer: PHP Commercial |
$38.07
|
| Rate for Payer: PHP Medicare Advantage |
$25.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.11
|
| Rate for Payer: Priority Health Medicare |
$25.47
|
| Rate for Payer: Priority Health SBD |
$28.22
|
| Rate for Payer: Railroad Medicare Medicare |
$25.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.47
|
| Rate for Payer: UHC Medicare Advantage |
$25.47
|
| Rate for Payer: UHCCP Medicaid |
$14.34
|
| Rate for Payer: VA VA |
$25.47
|
|
|
HC TESTOSTERONE, FREE & WKLY BOUND
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100736
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.41 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.04
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health SBD |
$51.41
|
|
|
HC TESTOSTERONE, FREE & WKLY BOUND
|
Facility
|
OP
|
$81.60
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100736
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.49 |
| Max. Negotiated Rate |
$144.35 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna Medicare |
$53.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.10
|
| Rate for Payer: BCBS Complete |
$28.86
|
| Rate for Payer: BCBS MAPPO |
$51.28
|
| Rate for Payer: BCN Medicare Advantage |
$51.28
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$57.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.28
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Mclaren Medicaid |
$27.49
|
| Rate for Payer: Mclaren Medicare |
$51.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.84
|
| Rate for Payer: Meridian Medicaid |
$28.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: PACE Medicare |
$48.72
|
| Rate for Payer: PACE SWMI |
$51.28
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: PHP Medicare Advantage |
$51.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health Medicare |
$51.28
|
| Rate for Payer: Priority Health SBD |
$51.41
|
| Rate for Payer: Railroad Medicare Medicare |
$51.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.28
|
| Rate for Payer: UHC Medicare Advantage |
$51.28
|
| Rate for Payer: UHCCP Medicaid |
$28.87
|
| Rate for Payer: VA VA |
$51.28
|
|
|
HC TESTOSTERONE LEVEL
|
Facility
|
OP
|
$86.83
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100430
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$78.15 |
| Rate for Payer: Aetna Commercial |
$73.81
|
| Rate for Payer: Aetna Medicare |
$26.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.26
|
| Rate for Payer: BCBS Complete |
$14.53
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCN Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$69.46
|
| Rate for Payer: Cash Price |
$69.46
|
| Rate for Payer: Cofinity Commercial |
$74.67
|
| Rate for Payer: Cofinity Commercial |
$60.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$78.15
|
| Rate for Payer: Mclaren Medicaid |
$13.83
|
| Rate for Payer: Mclaren Medicare |
$25.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.10
|
| Rate for Payer: Meridian Medicaid |
$14.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.81
|
| Rate for Payer: PACE Medicare |
$24.52
|
| Rate for Payer: PACE SWMI |
$25.81
|
| Rate for Payer: PHP Commercial |
$73.81
|
| Rate for Payer: PHP Medicare Advantage |
$25.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.44
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health SBD |
$54.70
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.81
|
| Rate for Payer: UHC Medicare Advantage |
$25.81
|
| Rate for Payer: UHCCP Medicaid |
$14.53
|
| Rate for Payer: VA VA |
$25.81
|
|
|
HC TESTOSTERONE LEVEL
|
Facility
|
IP
|
$86.83
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100430
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.70 |
| Max. Negotiated Rate |
$78.15 |
| Rate for Payer: Aetna Commercial |
$73.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.44
|
| Rate for Payer: Cash Price |
$69.46
|
| Rate for Payer: Cofinity Commercial |
$60.78
|
| Rate for Payer: Cofinity Commercial |
$74.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.46
|
| Rate for Payer: Healthscope Commercial |
$78.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.81
|
| Rate for Payer: PHP Commercial |
$73.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.44
|
| Rate for Payer: Priority Health SBD |
$54.70
|
|
|
HC TESTOSTERONE LEVEL TOTAL
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100431
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.99 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health SBD |
$58.99
|
|
|
HC TESTOSTERONE LEVEL TOTAL
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100431
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$26.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.26
|
| Rate for Payer: BCBS Complete |
$14.53
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCN Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Cofinity Commercial |
$65.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Mclaren Medicaid |
$13.83
|
| Rate for Payer: Mclaren Medicare |
$25.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.10
|
| Rate for Payer: Meridian Medicaid |
$14.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: PACE Medicare |
$24.52
|
| Rate for Payer: PACE SWMI |
$25.81
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: PHP Medicare Advantage |
$25.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.81
|
| Rate for Payer: UHC Medicare Advantage |
$25.81
|
| Rate for Payer: UHCCP Medicaid |
$14.53
|
| Rate for Payer: VA VA |
$25.81
|
|
|
HC TESTOSTERONE PELLETS EACH
|
Facility
|
IP
|
$224.73
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$141.58 |
| Max. Negotiated Rate |
$202.26 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.07
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$193.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$202.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: PHP Commercial |
$191.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: Priority Health SBD |
$141.58
|
|
|
HC TESTOSTERONE PELLETS EACH
|
Facility
|
OP
|
$224.73
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.89 |
| Max. Negotiated Rate |
$202.26 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: Aetna Medicare |
$112.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.07
|
| Rate for Payer: BCBS Complete |
$89.89
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$193.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$202.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: PHP Commercial |
$191.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: Priority Health SBD |
$141.58
|
|
|
HC TESTOSTERONE, T, BIO, FREE
|
Facility
|
OP
|
$81.15
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$73.03 |
| Rate for Payer: Aetna Commercial |
$68.98
|
| Rate for Payer: Aetna Medicare |
$26.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.26
|
| Rate for Payer: BCBS Complete |
$14.53
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCN Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$69.79
|
| Rate for Payer: Cofinity Commercial |
$56.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$73.03
|
| Rate for Payer: Mclaren Medicaid |
$13.83
|
| Rate for Payer: Mclaren Medicare |
$25.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.10
|
| Rate for Payer: Meridian Medicaid |
$14.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: PACE Medicare |
$24.52
|
| Rate for Payer: PACE SWMI |
$25.81
|
| Rate for Payer: PHP Commercial |
$68.98
|
| Rate for Payer: PHP Medicare Advantage |
$25.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.75
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health SBD |
$51.12
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.81
|
| Rate for Payer: UHC Medicare Advantage |
$25.81
|
| Rate for Payer: UHCCP Medicaid |
$14.53
|
| Rate for Payer: VA VA |
$25.81
|
|
|
HC TESTOSTERONE, T, BIO, FREE
|
Facility
|
IP
|
$81.15
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$73.03 |
| Rate for Payer: Aetna Commercial |
$68.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.75
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$69.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Healthscope Commercial |
$73.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: PHP Commercial |
$68.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.75
|
| Rate for Payer: Priority Health SBD |
$51.12
|
|
|
HC TESTOSTERONE UNDECANOATE PER 1 MG
|
Facility
|
IP
|
$5.10
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$4.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.31
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.08
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.33
|
| Rate for Payer: PHP Commercial |
$4.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.31
|
| Rate for Payer: Priority Health SBD |
$3.21
|
|
|
HC TESTOSTERONE UNDECANOATE PER 1 MG
|
Facility
|
OP
|
$5.10
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna Commercial |
$4.33
|
| Rate for Payer: Aetna Medicare |
$2.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.59
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: BCBS MAPPO |
$2.07
|
| Rate for Payer: BCN Medicare Advantage |
$2.07
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: Mclaren Medicaid |
$1.11
|
| Rate for Payer: Mclaren Medicare |
$2.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.17
|
| Rate for Payer: Meridian Medicaid |
$1.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.33
|
| Rate for Payer: PACE Medicare |
$1.97
|
| Rate for Payer: PACE SWMI |
$2.07
|
| Rate for Payer: PHP Commercial |
$4.33
|
| Rate for Payer: PHP Medicare Advantage |
$2.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.31
|
| Rate for Payer: Priority Health Medicare |
$2.07
|
| Rate for Payer: Priority Health SBD |
$3.21
|
| Rate for Payer: Railroad Medicare Medicare |
$2.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.07
|
| Rate for Payer: UHC Medicare Advantage |
$2.07
|
| Rate for Payer: UHCCP Medicaid |
$1.17
|
| Rate for Payer: VA VA |
$2.07
|
|
|
HC TESTOSTERONE UNLISTED CHEMISTRY
|
Facility
|
IP
|
$83.88
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100642
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.84 |
| Max. Negotiated Rate |
$75.49 |
| Rate for Payer: Aetna Commercial |
$71.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.52
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cofinity Commercial |
$58.72
|
| Rate for Payer: Cofinity Commercial |
$72.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.10
|
| Rate for Payer: Healthscope Commercial |
$75.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.30
|
| Rate for Payer: PHP Commercial |
$71.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.52
|
| Rate for Payer: Priority Health SBD |
$52.84
|
|
|
HC TESTOSTERONE UNLISTED CHEMISTRY
|
Facility
|
OP
|
$83.88
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100642
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.49 |
| Max. Negotiated Rate |
$144.35 |
| Rate for Payer: Aetna Commercial |
$71.30
|
| Rate for Payer: Aetna Medicare |
$53.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.10
|
| Rate for Payer: BCBS Complete |
$28.86
|
| Rate for Payer: BCBS MAPPO |
$51.28
|
| Rate for Payer: BCN Medicare Advantage |
$51.28
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cofinity Commercial |
$72.14
|
| Rate for Payer: Cofinity Commercial |
$58.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.28
|
| Rate for Payer: Healthscope Commercial |
$75.49
|
| Rate for Payer: Mclaren Medicaid |
$27.49
|
| Rate for Payer: Mclaren Medicare |
$51.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.84
|
| Rate for Payer: Meridian Medicaid |
$28.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.30
|
| Rate for Payer: PACE Medicare |
$48.72
|
| Rate for Payer: PACE SWMI |
$51.28
|
| Rate for Payer: PHP Commercial |
$71.30
|
| Rate for Payer: PHP Medicare Advantage |
$51.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.52
|
| Rate for Payer: Priority Health Medicare |
$51.28
|
| Rate for Payer: Priority Health SBD |
$52.84
|
| Rate for Payer: Railroad Medicare Medicare |
$51.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.28
|
| Rate for Payer: UHC Medicare Advantage |
$51.28
|
| Rate for Payer: UHCCP Medicaid |
$28.87
|
| Rate for Payer: VA VA |
$51.28
|
|
|
HC TETANUS AND DIPTHERIA TOXOIDS ADSORDED (TD), PF, 7 YRS OR OLDER IM
|
Facility
|
IP
|
$39.54
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
63600083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$35.59 |
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.70
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$27.68
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: PHP Commercial |
$33.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health SBD |
$24.91
|
|
|
HC TETANUS AND DIPTHERIA TOXOIDS ADSORDED (TD), PF, 7 YRS OR OLDER IM
|
Facility
|
OP
|
$39.54
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
63600083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.82 |
| Max. Negotiated Rate |
$35.59 |
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna Medicare |
$19.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.70
|
| Rate for Payer: BCBS Complete |
$15.82
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$27.68
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: PHP Commercial |
$33.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health SBD |
$24.91
|
|
