|
HC TESTOSTERONE LEVEL
|
Facility
|
OP
|
$85.13
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100430
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.05 |
| Max. Negotiated Rate |
$76.62 |
| Rate for Payer: Aetna Commercial |
$72.36
|
| Rate for Payer: Aetna Medicare |
$22.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.60
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$21.28
|
| Rate for Payer: BCBS Trust/PPO |
$66.19
|
| Rate for Payer: BCN Commercial |
$66.19
|
| Rate for Payer: BCN Medicare Advantage |
$21.28
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cofinity Commercial |
$73.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.28
|
| Rate for Payer: Healthscope Commercial |
$76.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.85
|
| Rate for Payer: Mclaren Medicaid |
$19.05
|
| Rate for Payer: Meridian Medicaid |
$20.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.36
|
| Rate for Payer: PACE Senior Care Partners |
$20.22
|
| Rate for Payer: PACE SWMI |
$21.28
|
| Rate for Payer: PHP Commercial |
$72.36
|
| Rate for Payer: PHP Medicare Advantage |
$21.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.06
|
| Rate for Payer: Priority Health Medicare |
$21.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.92
|
| Rate for Payer: Railroad Medicare Medicare |
$21.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.91
|
| Rate for Payer: UHC Core |
$71.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.28
|
| Rate for Payer: UHC Medicare Advantage |
$21.92
|
| Rate for Payer: VA VA |
$21.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.85
|
|
|
HC TESTOSTERONE LEVEL TOTAL
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100431
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.99 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$70.94
|
| Rate for Payer: BCN Commercial |
$70.94
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC TESTOSTERONE LEVEL TOTAL
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100431
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.05 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.69
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$22.95
|
| Rate for Payer: BCBS Trust/PPO |
$71.37
|
| Rate for Payer: BCN Commercial |
$71.37
|
| Rate for Payer: BCN Medicare Advantage |
$22.95
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.95
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$19.05
|
| Rate for Payer: Meridian Medicaid |
$20.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.03
|
| Rate for Payer: PACE Senior Care Partners |
$21.80
|
| Rate for Payer: PACE SWMI |
$22.95
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Medicare Advantage |
$22.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.87
|
| Rate for Payer: Priority Health Medicare |
$22.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.99
|
| Rate for Payer: Railroad Medicare Medicare |
$22.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.95
|
| Rate for Payer: UHC Medicare Advantage |
$23.64
|
| Rate for Payer: VA VA |
$22.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC TESTOSTERONE PELLETS EACH
|
Facility
|
IP
|
$220.32
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.37 |
| Max. Negotiated Rate |
$198.29 |
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: BCBS Trust/PPO |
$170.26
|
| Rate for Payer: BCN Commercial |
$170.26
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$189.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Healthscope Commercial |
$198.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.27
|
| Rate for Payer: PHP Commercial |
$187.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.88
|
| Rate for Payer: UHC Core |
$183.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.24
|
|
|
HC TESTOSTERONE PELLETS EACH
|
Facility
|
OP
|
$220.32
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.33 |
| Max. Negotiated Rate |
$198.29 |
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: Aetna Medicare |
$57.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.85
|
| Rate for Payer: BCBS Complete |
$88.13
|
| Rate for Payer: BCBS MAPPO |
$55.08
|
| Rate for Payer: BCBS Trust/PPO |
$171.30
|
| Rate for Payer: BCN Commercial |
$171.30
|
| Rate for Payer: BCN Medicare Advantage |
$55.08
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$189.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.08
|
| Rate for Payer: Healthscope Commercial |
$198.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.27
|
| Rate for Payer: PACE Senior Care Partners |
$52.33
|
| Rate for Payer: PACE SWMI |
$55.08
|
| Rate for Payer: PHP Commercial |
$187.27
|
| Rate for Payer: PHP Medicare Advantage |
$55.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.68
|
| Rate for Payer: Priority Health Medicare |
$55.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.37
|
| Rate for Payer: Railroad Medicare Medicare |
$55.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.88
|
| Rate for Payer: UHC Core |
$183.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.08
|
| Rate for Payer: UHC Medicare Advantage |
$56.73
|
| Rate for Payer: VA VA |
$55.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.24
|
|
|
HC TESTOSTERONE, T, BIO, FREE
|
Facility
|
IP
|
$79.56
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.52 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna Commercial |
$67.63
|
| Rate for Payer: BCBS Trust/PPO |
$61.48
|
| Rate for Payer: BCN Commercial |
$61.48
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$68.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$71.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.63
|
| Rate for Payer: PHP Commercial |
$67.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.01
|
| Rate for Payer: UHC Core |
$66.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.67
|
|
|
HC TESTOSTERONE, T, BIO, FREE
|
Facility
|
OP
|
$79.56
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna Commercial |
$67.63
|
| Rate for Payer: Aetna Medicare |
$20.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.86
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$19.89
|
| Rate for Payer: BCBS Trust/PPO |
$61.86
|
| Rate for Payer: BCN Commercial |
$61.86
|
| Rate for Payer: BCN Medicare Advantage |
$19.89
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$68.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.89
|
| Rate for Payer: Healthscope Commercial |
$71.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.67
|
| Rate for Payer: Mclaren Medicaid |
$19.05
|
| Rate for Payer: Meridian Medicaid |
$20.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.63
|
| Rate for Payer: PACE Senior Care Partners |
$18.90
|
| Rate for Payer: PACE SWMI |
$19.89
|
| Rate for Payer: PHP Commercial |
$67.63
|
| Rate for Payer: PHP Medicare Advantage |
$19.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.22
|
| Rate for Payer: Priority Health Medicare |
$19.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.52
|
| Rate for Payer: Railroad Medicare Medicare |
$19.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.01
|
| Rate for Payer: UHC Core |
$66.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.89
|
| Rate for Payer: UHC Medicare Advantage |
$20.49
|
| Rate for Payer: VA VA |
$19.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.67
|
|
|
HC TESTOSTERONE UNDECANOATE PER 1 MG
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$4.25
|
| Rate for Payer: BCBS Trust/PPO |
$3.86
|
| Rate for Payer: BCN Commercial |
$3.86
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$4.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.00
|
| Rate for Payer: Healthscope Commercial |
$4.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.25
|
| Rate for Payer: PHP Commercial |
$4.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.40
|
| Rate for Payer: UHC Core |
$4.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.75
|
|
|
HC TESTOSTERONE UNDECANOATE PER 1 MG
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$4.25
|
| Rate for Payer: Aetna Medicare |
$1.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.56
|
| Rate for Payer: BCBS Complete |
$1.42
|
| Rate for Payer: BCBS MAPPO |
$1.25
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| Rate for Payer: BCN Commercial |
$3.89
|
| Rate for Payer: BCN Medicare Advantage |
$1.25
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$4.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.25
|
| Rate for Payer: Healthscope Commercial |
$4.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.75
|
| Rate for Payer: Mclaren Medicaid |
$1.36
|
| Rate for Payer: Meridian Medicaid |
$1.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.25
|
| Rate for Payer: PACE Senior Care Partners |
$1.19
|
| Rate for Payer: PACE SWMI |
$1.25
|
| Rate for Payer: PHP Commercial |
$4.25
|
| Rate for Payer: PHP Medicare Advantage |
$1.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.35
|
| Rate for Payer: Priority Health Medicare |
$1.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.40
|
| Rate for Payer: UHC Core |
$4.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.25
|
| Rate for Payer: UHC Medicare Advantage |
$1.29
|
| Rate for Payer: VA VA |
$1.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.75
|
|
|
HC TESTOSTERONE UNLISTED CHEMISTRY
|
Facility
|
OP
|
$81.02
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100642
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$72.92 |
| Rate for Payer: Aetna Commercial |
$68.87
|
| Rate for Payer: Aetna Medicare |
$21.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.32
|
| Rate for Payer: BCBS Complete |
$39.74
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCBS Trust/PPO |
$62.99
|
| Rate for Payer: BCN Commercial |
$62.99
|
| Rate for Payer: BCN Medicare Advantage |
$20.26
|
| Rate for Payer: Cash Price |
$64.82
|
| Rate for Payer: Cash Price |
$64.82
|
| Rate for Payer: Cofinity Commercial |
$69.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$72.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.76
|
| Rate for Payer: Mclaren Medicaid |
$37.84
|
| Rate for Payer: Meridian Medicaid |
$39.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.87
|
| Rate for Payer: PACE Senior Care Partners |
$19.24
|
| Rate for Payer: PACE SWMI |
$20.26
|
| Rate for Payer: PHP Commercial |
$68.87
|
| Rate for Payer: PHP Medicare Advantage |
$20.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.49
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.41
|
| Rate for Payer: Railroad Medicare Medicare |
$20.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.30
|
| Rate for Payer: UHC Core |
$67.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.26
|
| Rate for Payer: UHC Medicare Advantage |
$20.86
|
| Rate for Payer: VA VA |
$20.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.76
|
|
|
HC TESTOSTERONE UNLISTED CHEMISTRY
|
Facility
|
IP
|
$81.02
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100642
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$72.92 |
| Rate for Payer: Aetna Commercial |
$68.87
|
| Rate for Payer: BCBS Trust/PPO |
$62.61
|
| Rate for Payer: BCN Commercial |
$62.61
|
| Rate for Payer: Cash Price |
$64.82
|
| Rate for Payer: Cofinity Commercial |
$69.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.82
|
| Rate for Payer: Healthscope Commercial |
$72.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.87
|
| Rate for Payer: PHP Commercial |
$68.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.30
|
| Rate for Payer: UHC Core |
$67.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.76
|
|
|
HC TETANUS AND DIPTHERIA TOXOIDS ADSORDED (TD), PF, 7 YRS OR OLDER IM
|
Facility
|
OP
|
$38.76
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
63600083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna Commercial |
$32.95
|
| Rate for Payer: Aetna Medicare |
$10.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.11
|
| Rate for Payer: BCBS Complete |
$15.50
|
| Rate for Payer: BCBS MAPPO |
$9.69
|
| Rate for Payer: BCBS Trust/PPO |
$30.14
|
| Rate for Payer: BCN Commercial |
$30.14
|
| Rate for Payer: BCN Medicare Advantage |
$9.69
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.69
|
| Rate for Payer: Healthscope Commercial |
$34.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.95
|
| Rate for Payer: PACE Senior Care Partners |
$9.21
|
| Rate for Payer: PACE SWMI |
$9.69
|
| Rate for Payer: PHP Commercial |
$32.95
|
| Rate for Payer: PHP Medicare Advantage |
$9.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.72
|
| Rate for Payer: Priority Health Medicare |
$9.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.64
|
| Rate for Payer: Railroad Medicare Medicare |
$9.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.11
|
| Rate for Payer: UHC Core |
$32.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.69
|
| Rate for Payer: UHC Medicare Advantage |
$9.98
|
| Rate for Payer: VA VA |
$9.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.07
|
|
|
HC TETANUS AND DIPTHERIA TOXOIDS ADSORDED (TD), PF, 7 YRS OR OLDER IM
|
Facility
|
IP
|
$38.76
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
63600083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna Commercial |
$32.95
|
| Rate for Payer: BCBS Trust/PPO |
$29.95
|
| Rate for Payer: BCN Commercial |
$29.95
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.01
|
| Rate for Payer: Healthscope Commercial |
$34.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.95
|
| Rate for Payer: PHP Commercial |
$32.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.11
|
| Rate for Payer: UHC Core |
$32.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.07
|
|
|
HC TETANUS ANTIBODIES
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
30200320
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare |
$15.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.75
|
| Rate for Payer: BCBS Complete |
$11.47
|
| Rate for Payer: BCBS MAPPO |
$15.00
|
| Rate for Payer: BCBS Trust/PPO |
$46.65
|
| Rate for Payer: BCN Commercial |
$46.65
|
| Rate for Payer: BCN Medicare Advantage |
$15.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Mclaren Medicaid |
$10.92
|
| Rate for Payer: Meridian Medicaid |
$11.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PACE Senior Care Partners |
$14.25
|
| Rate for Payer: PACE SWMI |
$15.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: PHP Medicare Advantage |
$15.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.20
|
| Rate for Payer: Priority Health Medicare |
$15.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.59
|
| Rate for Payer: Railroad Medicare Medicare |
$15.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.80
|
| Rate for Payer: UHC Core |
$50.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.00
|
| Rate for Payer: UHC Medicare Advantage |
$15.45
|
| Rate for Payer: VA VA |
$15.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC TETANUS ANTIBODIES
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
30200320
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.59 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: BCBS Trust/PPO |
$46.37
|
| Rate for Payer: BCN Commercial |
$46.37
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.80
|
| Rate for Payer: UHC Core |
$50.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC TETANUS/DIPHTHERIA/PERTUSIS VACCINE
|
Facility
|
OP
|
$122.18
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.02 |
| Max. Negotiated Rate |
$109.96 |
| Rate for Payer: Aetna Commercial |
$103.85
|
| Rate for Payer: Aetna Medicare |
$31.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.18
|
| Rate for Payer: BCBS Complete |
$48.87
|
| Rate for Payer: BCBS MAPPO |
$30.54
|
| Rate for Payer: BCBS Trust/PPO |
$94.99
|
| Rate for Payer: BCN Commercial |
$94.99
|
| Rate for Payer: BCN Medicare Advantage |
$30.54
|
| Rate for Payer: Cash Price |
$97.74
|
| Rate for Payer: Cofinity Commercial |
$105.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.54
|
| Rate for Payer: Healthscope Commercial |
$109.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.85
|
| Rate for Payer: PACE Senior Care Partners |
$29.02
|
| Rate for Payer: PACE SWMI |
$30.54
|
| Rate for Payer: PHP Commercial |
$103.85
|
| Rate for Payer: PHP Medicare Advantage |
$30.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.30
|
| Rate for Payer: Priority Health Medicare |
$30.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.52
|
| Rate for Payer: Railroad Medicare Medicare |
$30.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.52
|
| Rate for Payer: UHC Core |
$102.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.54
|
| Rate for Payer: UHC Medicare Advantage |
$31.46
|
| Rate for Payer: VA VA |
$30.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.64
|
|
|
HC TETANUS/DIPHTHERIA/PERTUSIS VACCINE
|
Facility
|
IP
|
$122.18
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.52 |
| Max. Negotiated Rate |
$109.96 |
| Rate for Payer: Aetna Commercial |
$103.85
|
| Rate for Payer: BCBS Trust/PPO |
$94.42
|
| Rate for Payer: BCN Commercial |
$94.42
|
| Rate for Payer: Cash Price |
$97.74
|
| Rate for Payer: Cofinity Commercial |
$105.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.74
|
| Rate for Payer: Healthscope Commercial |
$109.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.85
|
| Rate for Payer: PHP Commercial |
$103.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.52
|
| Rate for Payer: UHC Core |
$102.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.64
|
|
|
HC THC URINE CONFIRM
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100568
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: Aetna Medicare |
$16.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.38
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCBS MAPPO |
$15.50
|
| Rate for Payer: BCBS Trust/PPO |
$48.20
|
| Rate for Payer: BCN Commercial |
$48.20
|
| Rate for Payer: BCN Medicare Advantage |
$15.50
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.50
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PACE Senior Care Partners |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.50
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: PHP Medicare Advantage |
$15.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.94
|
| Rate for Payer: Priority Health Medicare |
$15.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.81
|
| Rate for Payer: Railroad Medicare Medicare |
$15.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.56
|
| Rate for Payer: UHC Core |
$51.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.50
|
| Rate for Payer: UHC Medicare Advantage |
$15.96
|
| Rate for Payer: VA VA |
$15.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.50
|
|
|
HC THC URINE CONFIRM
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100568
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.81 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: BCBS Trust/PPO |
$47.91
|
| Rate for Payer: BCN Commercial |
$47.91
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.56
|
| Rate for Payer: UHC Core |
$51.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.50
|
|
|
HC THEOPHYLLINE LEVEL
|
Facility
|
OP
|
$90.40
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
30100048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$81.36 |
| Rate for Payer: Aetna Commercial |
$76.84
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.25
|
| Rate for Payer: BCBS Complete |
$10.96
|
| Rate for Payer: BCBS MAPPO |
$22.60
|
| Rate for Payer: BCBS Trust/PPO |
$70.29
|
| Rate for Payer: BCN Commercial |
$70.29
|
| Rate for Payer: BCN Medicare Advantage |
$22.60
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$77.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$81.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.80
|
| Rate for Payer: Mclaren Medicaid |
$10.44
|
| Rate for Payer: Meridian Medicaid |
$10.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.84
|
| Rate for Payer: PACE Senior Care Partners |
$21.47
|
| Rate for Payer: PACE SWMI |
$22.60
|
| Rate for Payer: PHP Commercial |
$76.84
|
| Rate for Payer: PHP Medicare Advantage |
$22.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.65
|
| Rate for Payer: Priority Health Medicare |
$22.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.13
|
| Rate for Payer: Railroad Medicare Medicare |
$22.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.55
|
| Rate for Payer: UHC Core |
$75.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.60
|
| Rate for Payer: UHC Medicare Advantage |
$23.28
|
| Rate for Payer: VA VA |
$22.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.80
|
|
|
HC THEOPHYLLINE LEVEL
|
Facility
|
IP
|
$90.40
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
30100048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.13 |
| Max. Negotiated Rate |
$81.36 |
| Rate for Payer: Aetna Commercial |
$76.84
|
| Rate for Payer: BCBS Trust/PPO |
$69.86
|
| Rate for Payer: BCN Commercial |
$69.86
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$77.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.32
|
| Rate for Payer: Healthscope Commercial |
$81.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.84
|
| Rate for Payer: PHP Commercial |
$76.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.55
|
| Rate for Payer: UHC Core |
$75.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.80
|
|
|
HC THERAPEUTIC ACTIVITIES EA 15 MIN
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.01 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna Medicare |
$25.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.28
|
| Rate for Payer: BCBS Complete |
$38.76
|
| Rate for Payer: BCBS MAPPO |
$24.22
|
| Rate for Payer: BCBS Trust/PPO |
$75.34
|
| Rate for Payer: BCN Commercial |
$75.34
|
| Rate for Payer: BCN Medicare Advantage |
$24.22
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.22
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.36
|
| Rate for Payer: PACE Senior Care Partners |
$23.01
|
| Rate for Payer: PACE SWMI |
$24.22
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: PHP Medicare Advantage |
$24.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.30
|
| Rate for Payer: Priority Health Medicare |
$24.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.10
|
| Rate for Payer: Railroad Medicare Medicare |
$24.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.27
|
| Rate for Payer: UHC Core |
$80.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.22
|
| Rate for Payer: UHC Medicare Advantage |
$24.95
|
| Rate for Payer: VA VA |
$24.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.68
|
|
|
HC THERAPEUTIC ACTIVITIES EA 15 MIN
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.10 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: BCBS Trust/PPO |
$74.88
|
| Rate for Payer: BCN Commercial |
$74.88
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.36
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.27
|
| Rate for Payer: UHC Core |
$80.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.68
|
|
|
HC THERAPEUTIC APHERESIS PLASMA PHERESIS
|
Facility
|
IP
|
$2,505.38
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
36100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,528.03 |
| Max. Negotiated Rate |
$2,254.84 |
| Rate for Payer: Aetna Commercial |
$2,129.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,936.16
|
| Rate for Payer: BCN Commercial |
$1,936.16
|
| Rate for Payer: Cash Price |
$2,004.30
|
| Rate for Payer: Cofinity Commercial |
$2,154.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,004.30
|
| Rate for Payer: Healthscope Commercial |
$2,254.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,879.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,129.57
|
| Rate for Payer: PHP Commercial |
$2,129.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,179.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,528.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,204.73
|
| Rate for Payer: UHC Core |
$2,091.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,879.04
|
|
|
HC THERAPEUTIC APHERESIS PLASMA PHERESIS
|
Facility
|
OP
|
$2,505.38
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
36100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.03 |
| Max. Negotiated Rate |
$2,254.84 |
| Rate for Payer: Aetna Commercial |
$2,129.57
|
| Rate for Payer: Aetna Medicare |
$651.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$782.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$782.93
|
| Rate for Payer: BCBS Complete |
$1,056.83
|
| Rate for Payer: BCBS MAPPO |
$626.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,947.93
|
| Rate for Payer: BCN Commercial |
$1,947.93
|
| Rate for Payer: BCN Medicare Advantage |
$626.34
|
| Rate for Payer: Cash Price |
$2,004.30
|
| Rate for Payer: Cash Price |
$2,004.30
|
| Rate for Payer: Cofinity Commercial |
$2,154.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,004.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.34
|
| Rate for Payer: Healthscope Commercial |
$2,254.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,879.04
|
| Rate for Payer: Mclaren Medicaid |
$1,006.51
|
| Rate for Payer: Meridian Medicaid |
$1,056.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$657.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$720.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,129.57
|
| Rate for Payer: PACE Senior Care Partners |
$595.03
|
| Rate for Payer: PACE SWMI |
$626.34
|
| Rate for Payer: PHP Commercial |
$2,129.57
|
| Rate for Payer: PHP Medicare Advantage |
$626.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,006.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,179.68
|
| Rate for Payer: Priority Health Medicare |
$626.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,528.03
|
| Rate for Payer: Railroad Medicare Medicare |
$626.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,204.73
|
| Rate for Payer: UHC Core |
$2,091.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$626.34
|
| Rate for Payer: UHC Medicare Advantage |
$645.14
|
| Rate for Payer: VA VA |
$626.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,879.04
|
|
