|
HC TENOTOMY PERCUTANEOUS ACHILLES TENDON
|
Facility
|
IP
|
$3,812.64
|
|
| Hospital Charge Code |
36000097
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,653.60 |
| Max. Negotiated Rate |
$3,431.38 |
| Rate for Payer: Aetna Commercial |
$3,240.74
|
| Rate for Payer: BCBS Trust/PPO |
$3,148.86
|
| Rate for Payer: BCN Commercial |
$3,148.86
|
| Rate for Payer: Cash Price |
$3,050.11
|
| Rate for Payer: Cofinity Commercial |
$3,278.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,050.11
|
| Rate for Payer: Healthscope Commercial |
$3,431.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,859.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,240.74
|
| Rate for Payer: Nomi Health Commercial |
$3,126.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,859.48
|
| Rate for Payer: PHP Commercial |
$3,240.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,317.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,653.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,355.12
|
| Rate for Payer: UHC Core |
$3,183.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,859.48
|
|
|
HC TENOTOMY PERCUTANEOUS ADDUCTOR OR HAMSTRING
|
Facility
|
IP
|
$3,641.43
|
|
| Hospital Charge Code |
36000094
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,534.44 |
| Max. Negotiated Rate |
$3,277.29 |
| Rate for Payer: Aetna Commercial |
$3,095.22
|
| Rate for Payer: BCBS Trust/PPO |
$3,007.46
|
| Rate for Payer: BCN Commercial |
$3,007.46
|
| Rate for Payer: Cash Price |
$2,913.14
|
| Rate for Payer: Cofinity Commercial |
$3,131.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,913.14
|
| Rate for Payer: Healthscope Commercial |
$3,277.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,731.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,095.22
|
| Rate for Payer: Nomi Health Commercial |
$2,985.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,731.07
|
| Rate for Payer: PHP Commercial |
$3,095.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,168.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,534.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,204.46
|
| Rate for Payer: UHC Core |
$3,040.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,731.07
|
|
|
HC TENOTOMY PERCUTANEOUS ADDUCTOR OR HAMSTRING
|
Facility
|
OP
|
$3,641.43
|
|
| Hospital Charge Code |
36000094
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$641.98 |
| Max. Negotiated Rate |
$3,277.29 |
| Rate for Payer: Aetna Commercial |
$3,095.22
|
| Rate for Payer: Aetna Medicare |
$946.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,137.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,137.95
|
| Rate for Payer: BCBS Complete |
$674.03
|
| Rate for Payer: BCBS MAPPO |
$910.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,993.62
|
| Rate for Payer: BCN Commercial |
$2,993.62
|
| Rate for Payer: BCN Medicare Advantage |
$910.36
|
| Rate for Payer: Cash Price |
$2,913.14
|
| Rate for Payer: Cofinity Commercial |
$3,131.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,913.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$910.36
|
| Rate for Payer: Healthscope Commercial |
$3,277.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,731.07
|
| Rate for Payer: Mclaren Medicaid |
$641.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$955.88
|
| Rate for Payer: Meridian Medicaid |
$674.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,046.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,001.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,095.22
|
| Rate for Payer: Nomi Health Commercial |
$2,985.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,731.07
|
| Rate for Payer: PACE Senior Care Partners |
$864.84
|
| Rate for Payer: PACE SWMI |
$910.36
|
| Rate for Payer: PHP Commercial |
$3,095.22
|
| Rate for Payer: PHP Medicare Advantage |
$910.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$641.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,168.04
|
| Rate for Payer: Priority Health Medicare |
$919.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,534.44
|
| Rate for Payer: Railroad Medicare Medicare |
$910.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,204.46
|
| Rate for Payer: UHC Core |
$3,040.59
|
| Rate for Payer: UHC Exchange |
$910.36
|
| Rate for Payer: UHC Medicaid |
$641.98
|
| Rate for Payer: UHC Medicare Advantage |
$910.36
|
| Rate for Payer: UHCCP Medicaid |
$641.98
|
| Rate for Payer: VA VA |
$910.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,731.07
|
|
|
HC TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT
|
Facility
|
OP
|
$4,681.80
|
|
|
Service Code
|
CPT 26060
|
| Hospital Charge Code |
76100424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$825.40 |
| Max. Negotiated Rate |
$4,213.62 |
| Rate for Payer: Aetna Commercial |
$3,979.53
|
| Rate for Payer: Aetna Medicare |
$1,217.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,463.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,463.06
|
| Rate for Payer: BCBS Complete |
$866.60
|
| Rate for Payer: BCBS MAPPO |
$1,170.45
|
| Rate for Payer: BCBS Trust/PPO |
$3,848.91
|
| Rate for Payer: BCN Commercial |
$3,848.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,170.45
|
| Rate for Payer: Cash Price |
$3,745.44
|
| Rate for Payer: Cofinity Commercial |
$4,026.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,745.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,170.45
|
| Rate for Payer: Healthscope Commercial |
$4,213.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,511.35
|
| Rate for Payer: Mclaren Medicaid |
$825.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,228.97
|
| Rate for Payer: Meridian Medicaid |
$866.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,346.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,287.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,979.53
|
| Rate for Payer: Nomi Health Commercial |
$3,839.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,511.35
|
| Rate for Payer: PACE Senior Care Partners |
$1,111.93
|
| Rate for Payer: PACE SWMI |
$1,170.45
|
| Rate for Payer: PHP Commercial |
$3,979.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,170.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$825.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,073.17
|
| Rate for Payer: Priority Health Medicare |
$1,182.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,258.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,170.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,119.98
|
| Rate for Payer: UHC Core |
$3,909.30
|
| Rate for Payer: UHC Exchange |
$1,170.45
|
| Rate for Payer: UHC Medicaid |
$825.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,170.45
|
| Rate for Payer: UHCCP Medicaid |
$825.40
|
| Rate for Payer: VA VA |
$1,170.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,511.35
|
|
|
HC TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT
|
Facility
|
IP
|
$4,681.80
|
|
|
Service Code
|
CPT 26060
|
| Hospital Charge Code |
76100424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,258.53 |
| Max. Negotiated Rate |
$4,213.62 |
| Rate for Payer: Aetna Commercial |
$3,979.53
|
| Rate for Payer: BCBS Trust/PPO |
$3,866.70
|
| Rate for Payer: BCN Commercial |
$3,866.70
|
| Rate for Payer: Cash Price |
$3,745.44
|
| Rate for Payer: Cofinity Commercial |
$4,026.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,745.44
|
| Rate for Payer: Healthscope Commercial |
$4,213.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,511.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,979.53
|
| Rate for Payer: Nomi Health Commercial |
$3,839.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,511.35
|
| Rate for Payer: PHP Commercial |
$3,979.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,073.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,258.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,119.98
|
| Rate for Payer: UHC Core |
$3,909.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,511.35
|
|
|
HC TENOTOMY SHOULDER AREA SINGLE TENDON
|
Facility
|
IP
|
$4,922.84
|
|
| Hospital Charge Code |
36000098
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,426.30 |
| Max. Negotiated Rate |
$4,430.56 |
| Rate for Payer: Aetna Commercial |
$4,184.41
|
| Rate for Payer: BCBS Trust/PPO |
$4,065.77
|
| Rate for Payer: BCN Commercial |
$4,065.77
|
| Rate for Payer: Cash Price |
$3,938.27
|
| Rate for Payer: Cofinity Commercial |
$4,233.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,938.27
|
| Rate for Payer: Healthscope Commercial |
$4,430.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,692.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,184.41
|
| Rate for Payer: Nomi Health Commercial |
$4,036.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,692.13
|
| Rate for Payer: PHP Commercial |
$4,184.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,282.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,426.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,332.10
|
| Rate for Payer: UHC Core |
$4,110.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,692.13
|
|
|
HC TENOTOMY SHOULDER AREA SINGLE TENDON
|
Facility
|
OP
|
$4,922.84
|
|
| Hospital Charge Code |
36000098
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$867.90 |
| Max. Negotiated Rate |
$4,430.56 |
| Rate for Payer: Aetna Commercial |
$4,184.41
|
| Rate for Payer: Aetna Medicare |
$1,279.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,538.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,538.39
|
| Rate for Payer: BCBS Complete |
$911.22
|
| Rate for Payer: BCBS MAPPO |
$1,230.71
|
| Rate for Payer: BCBS Trust/PPO |
$4,047.07
|
| Rate for Payer: BCN Commercial |
$4,047.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,230.71
|
| Rate for Payer: Cash Price |
$3,938.27
|
| Rate for Payer: Cofinity Commercial |
$4,233.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,938.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,230.71
|
| Rate for Payer: Healthscope Commercial |
$4,430.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,692.13
|
| Rate for Payer: Mclaren Medicaid |
$867.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,292.25
|
| Rate for Payer: Meridian Medicaid |
$911.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,415.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,353.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,184.41
|
| Rate for Payer: Nomi Health Commercial |
$4,036.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,692.13
|
| Rate for Payer: PACE Senior Care Partners |
$1,169.17
|
| Rate for Payer: PACE SWMI |
$1,230.71
|
| Rate for Payer: PHP Commercial |
$4,184.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,230.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$867.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,282.87
|
| Rate for Payer: Priority Health Medicare |
$1,243.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,426.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1,230.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,332.10
|
| Rate for Payer: UHC Core |
$4,110.57
|
| Rate for Payer: UHC Exchange |
$1,230.71
|
| Rate for Payer: UHC Medicaid |
$867.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,230.71
|
| Rate for Payer: UHCCP Medicaid |
$867.90
|
| Rate for Payer: VA VA |
$1,230.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,692.13
|
|
|
HC TENOTOMY TOE SINGLE TENDON
|
Facility
|
OP
|
$2,263.53
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
45000092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.06 |
| Max. Negotiated Rate |
$2,037.18 |
| Rate for Payer: Aetna Commercial |
$1,924.00
|
| Rate for Payer: Aetna Medicare |
$588.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$707.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$707.35
|
| Rate for Payer: BCBS Complete |
$418.98
|
| Rate for Payer: BCBS MAPPO |
$565.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,860.85
|
| Rate for Payer: BCN Commercial |
$1,860.85
|
| Rate for Payer: BCN Medicare Advantage |
$565.88
|
| Rate for Payer: Cash Price |
$1,810.82
|
| Rate for Payer: Cofinity Commercial |
$1,946.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,810.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$565.88
|
| Rate for Payer: Healthscope Commercial |
$2,037.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,697.65
|
| Rate for Payer: Mclaren Medicaid |
$399.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$594.18
|
| Rate for Payer: Meridian Medicaid |
$418.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$650.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$622.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,924.00
|
| Rate for Payer: Nomi Health Commercial |
$1,856.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,697.65
|
| Rate for Payer: PACE Senior Care Partners |
$537.59
|
| Rate for Payer: PACE SWMI |
$565.88
|
| Rate for Payer: PHP Commercial |
$1,924.00
|
| Rate for Payer: PHP Medicare Advantage |
$565.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$399.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,969.27
|
| Rate for Payer: Priority Health Medicare |
$571.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,575.42
|
| Rate for Payer: Railroad Medicare Medicare |
$565.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,991.91
|
| Rate for Payer: UHC Core |
$1,890.05
|
| Rate for Payer: UHC Exchange |
$565.88
|
| Rate for Payer: UHC Medicaid |
$399.06
|
| Rate for Payer: UHC Medicare Advantage |
$565.88
|
| Rate for Payer: UHCCP Medicaid |
$399.06
|
| Rate for Payer: VA VA |
$565.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,697.65
|
|
|
HC TENOTOMY TOE SINGLE TENDON
|
Facility
|
IP
|
$2,263.53
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
45000092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,575.42 |
| Max. Negotiated Rate |
$2,037.18 |
| Rate for Payer: Aetna Commercial |
$1,924.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,869.45
|
| Rate for Payer: BCN Commercial |
$1,869.45
|
| Rate for Payer: Cash Price |
$1,810.82
|
| Rate for Payer: Cofinity Commercial |
$1,946.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,810.82
|
| Rate for Payer: Healthscope Commercial |
$2,037.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,697.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,924.00
|
| Rate for Payer: Nomi Health Commercial |
$1,856.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,697.65
|
| Rate for Payer: PHP Commercial |
$1,924.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,969.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,575.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,991.91
|
| Rate for Payer: UHC Core |
$1,890.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,697.65
|
|
|
HC TESTOSTERONE BIOAVAILABLE
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100429
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: BCBS Trust/PPO |
$65.73
|
| Rate for Payer: BCN Commercial |
$65.73
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.04
|
| Rate for Payer: UHC Core |
$66.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.69
|
|
|
HC TESTOSTERONE BIOAVAILABLE
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100429
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.03 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna Medicare |
$20.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.87
|
| Rate for Payer: BCBS Complete |
$14.73
|
| Rate for Payer: BCBS MAPPO |
$19.90
|
| Rate for Payer: BCBS Trust/PPO |
$65.43
|
| Rate for Payer: BCN Commercial |
$65.43
|
| Rate for Payer: BCN Medicare Advantage |
$19.90
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.90
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.69
|
| Rate for Payer: Mclaren Medicaid |
$14.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.89
|
| Rate for Payer: Meridian Medicaid |
$14.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Senior Care Partners |
$18.90
|
| Rate for Payer: PACE SWMI |
$19.90
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: PHP Medicare Advantage |
$19.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.24
|
| Rate for Payer: Priority Health Medicare |
$20.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.39
|
| Rate for Payer: Railroad Medicare Medicare |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.04
|
| Rate for Payer: UHC Core |
$66.46
|
| Rate for Payer: UHC Exchange |
$19.90
|
| Rate for Payer: UHC Medicaid |
$14.03
|
| Rate for Payer: UHC Medicare Advantage |
$19.90
|
| Rate for Payer: UHCCP Medicaid |
$14.03
|
| Rate for Payer: VA VA |
$19.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.69
|
|
|
HC TESTOSTERONE FREE
|
Facility
|
IP
|
$45.59
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100428
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.73 |
| Max. Negotiated Rate |
$41.03 |
| Rate for Payer: Aetna Commercial |
$38.75
|
| Rate for Payer: BCBS Trust/PPO |
$37.65
|
| Rate for Payer: BCN Commercial |
$37.65
|
| Rate for Payer: Cash Price |
$36.47
|
| Rate for Payer: Cofinity Commercial |
$39.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.47
|
| Rate for Payer: Healthscope Commercial |
$41.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.75
|
| Rate for Payer: Nomi Health Commercial |
$37.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.19
|
| Rate for Payer: PHP Commercial |
$38.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$39.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.12
|
| Rate for Payer: UHC Core |
$38.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.19
|
|
|
HC TESTOSTERONE FREE
|
Facility
|
OP
|
$45.59
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100428
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$41.03 |
| Rate for Payer: Aetna Commercial |
$38.75
|
| Rate for Payer: Aetna Medicare |
$11.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.25
|
| Rate for Payer: BCBS Complete |
$8.44
|
| Rate for Payer: BCBS MAPPO |
$11.40
|
| Rate for Payer: BCBS Trust/PPO |
$37.48
|
| Rate for Payer: BCN Commercial |
$37.48
|
| Rate for Payer: BCN Medicare Advantage |
$11.40
|
| Rate for Payer: Cash Price |
$36.47
|
| Rate for Payer: Cofinity Commercial |
$39.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.40
|
| Rate for Payer: Healthscope Commercial |
$41.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.19
|
| Rate for Payer: Mclaren Medicaid |
$8.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.97
|
| Rate for Payer: Meridian Medicaid |
$8.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.75
|
| Rate for Payer: Nomi Health Commercial |
$37.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.19
|
| Rate for Payer: PACE Senior Care Partners |
$10.83
|
| Rate for Payer: PACE SWMI |
$11.40
|
| Rate for Payer: PHP Commercial |
$38.75
|
| Rate for Payer: PHP Medicare Advantage |
$11.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$39.66
|
| Rate for Payer: Priority Health Medicare |
$11.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.73
|
| Rate for Payer: Railroad Medicare Medicare |
$11.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.12
|
| Rate for Payer: UHC Core |
$38.07
|
| Rate for Payer: UHC Exchange |
$11.40
|
| Rate for Payer: UHC Medicaid |
$8.04
|
| Rate for Payer: UHC Medicare Advantage |
$11.40
|
| Rate for Payer: UHCCP Medicaid |
$8.04
|
| Rate for Payer: VA VA |
$11.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.19
|
|
|
HC TESTOSTERONE, FREE & WKLY BOUND
|
Facility
|
IP
|
$83.23
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100736
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.93 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: BCBS Trust/PPO |
$68.74
|
| Rate for Payer: BCN Commercial |
$68.74
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$68.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.42
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$72.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.24
|
| Rate for Payer: UHC Core |
$69.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.42
|
|
|
HC TESTOSTERONE, FREE & WKLY BOUND
|
Facility
|
OP
|
$83.23
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100736
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.67 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: Aetna Medicare |
$21.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.01
|
| Rate for Payer: BCBS Complete |
$15.41
|
| Rate for Payer: BCBS MAPPO |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$68.42
|
| Rate for Payer: BCN Commercial |
$68.42
|
| Rate for Payer: BCN Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.42
|
| Rate for Payer: Mclaren Medicaid |
$14.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.85
|
| Rate for Payer: Meridian Medicaid |
$15.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$68.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.42
|
| Rate for Payer: PACE Senior Care Partners |
$19.77
|
| Rate for Payer: PACE SWMI |
$20.81
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: PHP Medicare Advantage |
$20.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$72.41
|
| Rate for Payer: Priority Health Medicare |
$21.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.93
|
| Rate for Payer: Railroad Medicare Medicare |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.24
|
| Rate for Payer: UHC Core |
$69.50
|
| Rate for Payer: UHC Exchange |
$20.81
|
| Rate for Payer: UHC Medicaid |
$14.67
|
| Rate for Payer: UHC Medicare Advantage |
$20.81
|
| Rate for Payer: UHCCP Medicaid |
$14.67
|
| Rate for Payer: VA VA |
$20.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.42
|
|
|
HC TESTOSTERONE LEVEL
|
Facility
|
OP
|
$88.57
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100430
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.61 |
| Max. Negotiated Rate |
$79.71 |
| Rate for Payer: Aetna Commercial |
$75.28
|
| Rate for Payer: Aetna Medicare |
$23.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.68
|
| Rate for Payer: BCBS Complete |
$16.39
|
| Rate for Payer: BCBS MAPPO |
$22.14
|
| Rate for Payer: BCBS Trust/PPO |
$72.81
|
| Rate for Payer: BCN Commercial |
$72.81
|
| Rate for Payer: BCN Medicare Advantage |
$22.14
|
| Rate for Payer: Cash Price |
$70.86
|
| Rate for Payer: Cofinity Commercial |
$76.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.14
|
| Rate for Payer: Healthscope Commercial |
$79.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.43
|
| Rate for Payer: Mclaren Medicaid |
$15.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.25
|
| Rate for Payer: Meridian Medicaid |
$16.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.28
|
| Rate for Payer: Nomi Health Commercial |
$72.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.43
|
| Rate for Payer: PACE Senior Care Partners |
$21.04
|
| Rate for Payer: PACE SWMI |
$22.14
|
| Rate for Payer: PHP Commercial |
$75.28
|
| Rate for Payer: PHP Medicare Advantage |
$22.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$77.06
|
| Rate for Payer: Priority Health Medicare |
$22.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.64
|
| Rate for Payer: Railroad Medicare Medicare |
$22.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.94
|
| Rate for Payer: UHC Core |
$73.96
|
| Rate for Payer: UHC Exchange |
$22.14
|
| Rate for Payer: UHC Medicaid |
$15.61
|
| Rate for Payer: UHC Medicare Advantage |
$22.14
|
| Rate for Payer: UHCCP Medicaid |
$15.61
|
| Rate for Payer: VA VA |
$22.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.43
|
|
|
HC TESTOSTERONE LEVEL
|
Facility
|
IP
|
$88.57
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100430
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.64 |
| Max. Negotiated Rate |
$79.71 |
| Rate for Payer: Aetna Commercial |
$75.28
|
| Rate for Payer: BCBS Trust/PPO |
$73.15
|
| Rate for Payer: BCN Commercial |
$73.15
|
| Rate for Payer: Cash Price |
$70.86
|
| Rate for Payer: Cofinity Commercial |
$76.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.86
|
| Rate for Payer: Healthscope Commercial |
$79.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.28
|
| Rate for Payer: Nomi Health Commercial |
$72.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.43
|
| Rate for Payer: PHP Commercial |
$75.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$77.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.94
|
| Rate for Payer: UHC Core |
$73.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.43
|
|
|
HC TESTOSTERONE LEVEL TOTAL
|
Facility
|
IP
|
$95.51
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100431
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.47 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$81.18
|
| Rate for Payer: BCBS Trust/PPO |
$78.88
|
| Rate for Payer: BCN Commercial |
$78.88
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cofinity Commercial |
$82.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.41
|
| Rate for Payer: Healthscope Commercial |
$85.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.18
|
| Rate for Payer: Nomi Health Commercial |
$78.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.63
|
| Rate for Payer: PHP Commercial |
$81.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.05
|
| Rate for Payer: UHC Core |
$79.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.63
|
|
|
HC TESTOSTERONE LEVEL TOTAL
|
Facility
|
OP
|
$95.51
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100431
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.84 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$81.18
|
| Rate for Payer: Aetna Medicare |
$24.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: BCBS Complete |
$17.68
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCBS Trust/PPO |
$78.52
|
| Rate for Payer: BCN Commercial |
$78.52
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cofinity Commercial |
$82.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$85.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.63
|
| Rate for Payer: Mclaren Medicaid |
$16.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$17.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.18
|
| Rate for Payer: Nomi Health Commercial |
$78.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.63
|
| Rate for Payer: PACE Senior Care Partners |
$22.68
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$81.18
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.09
|
| Rate for Payer: Priority Health Medicare |
$24.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.47
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.05
|
| Rate for Payer: UHC Core |
$79.75
|
| Rate for Payer: UHC Exchange |
$23.88
|
| Rate for Payer: UHC Medicaid |
$16.84
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$16.84
|
| Rate for Payer: VA VA |
$23.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.63
|
|
|
HC TESTOSTERONE PELLETS EACH
|
Facility
|
OP
|
$229.22
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.41 |
| Max. Negotiated Rate |
$206.30 |
| Rate for Payer: Aetna Commercial |
$194.84
|
| Rate for Payer: Aetna Medicare |
$59.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.63
|
| Rate for Payer: BCBS Complete |
$42.43
|
| Rate for Payer: BCBS MAPPO |
$57.30
|
| Rate for Payer: BCBS Trust/PPO |
$188.44
|
| Rate for Payer: BCN Commercial |
$188.44
|
| Rate for Payer: BCN Medicare Advantage |
$57.30
|
| Rate for Payer: Cash Price |
$183.38
|
| Rate for Payer: Cofinity Commercial |
$197.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.30
|
| Rate for Payer: Healthscope Commercial |
$206.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.91
|
| Rate for Payer: Mclaren Medicaid |
$40.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.17
|
| Rate for Payer: Meridian Medicaid |
$42.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$63.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.84
|
| Rate for Payer: Nomi Health Commercial |
$187.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.91
|
| Rate for Payer: PACE Senior Care Partners |
$54.44
|
| Rate for Payer: PACE SWMI |
$57.30
|
| Rate for Payer: PHP Commercial |
$194.84
|
| Rate for Payer: PHP Medicare Advantage |
$57.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$199.42
|
| Rate for Payer: Priority Health Medicare |
$57.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.54
|
| Rate for Payer: Railroad Medicare Medicare |
$57.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.71
|
| Rate for Payer: UHC Core |
$191.40
|
| Rate for Payer: UHC Exchange |
$57.30
|
| Rate for Payer: UHC Medicaid |
$40.41
|
| Rate for Payer: UHC Medicare Advantage |
$57.30
|
| Rate for Payer: UHCCP Medicaid |
$40.41
|
| Rate for Payer: VA VA |
$57.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.91
|
|
|
HC TESTOSTERONE PELLETS EACH
|
Facility
|
IP
|
$229.22
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$159.54 |
| Max. Negotiated Rate |
$206.30 |
| Rate for Payer: Aetna Commercial |
$194.84
|
| Rate for Payer: BCBS Trust/PPO |
$189.31
|
| Rate for Payer: BCN Commercial |
$189.31
|
| Rate for Payer: Cash Price |
$183.38
|
| Rate for Payer: Cofinity Commercial |
$197.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.38
|
| Rate for Payer: Healthscope Commercial |
$206.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.84
|
| Rate for Payer: Nomi Health Commercial |
$187.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.91
|
| Rate for Payer: PHP Commercial |
$194.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$199.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.71
|
| Rate for Payer: UHC Core |
$191.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.91
|
|
|
HC TESTOSTERONE, T, BIO, FREE
|
Facility
|
IP
|
$82.77
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.61 |
| Max. Negotiated Rate |
$74.49 |
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: BCBS Trust/PPO |
$68.36
|
| Rate for Payer: BCN Commercial |
$68.36
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Healthscope Commercial |
$74.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Nomi Health Commercial |
$67.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.08
|
| Rate for Payer: PHP Commercial |
$70.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$72.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.84
|
| Rate for Payer: UHC Core |
$69.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.08
|
|
|
HC TESTOSTERONE, T, BIO, FREE
|
Facility
|
OP
|
$82.77
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$74.49 |
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna Medicare |
$21.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.87
|
| Rate for Payer: BCBS Complete |
$15.32
|
| Rate for Payer: BCBS MAPPO |
$20.69
|
| Rate for Payer: BCBS Trust/PPO |
$68.05
|
| Rate for Payer: BCN Commercial |
$68.05
|
| Rate for Payer: BCN Medicare Advantage |
$20.69
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.69
|
| Rate for Payer: Healthscope Commercial |
$74.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.08
|
| Rate for Payer: Mclaren Medicaid |
$14.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.73
|
| Rate for Payer: Meridian Medicaid |
$15.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Nomi Health Commercial |
$67.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.08
|
| Rate for Payer: PACE Senior Care Partners |
$19.66
|
| Rate for Payer: PACE SWMI |
$20.69
|
| Rate for Payer: PHP Commercial |
$70.35
|
| Rate for Payer: PHP Medicare Advantage |
$20.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$72.01
|
| Rate for Payer: Priority Health Medicare |
$20.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.61
|
| Rate for Payer: Railroad Medicare Medicare |
$20.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.84
|
| Rate for Payer: UHC Core |
$69.11
|
| Rate for Payer: UHC Exchange |
$20.69
|
| Rate for Payer: UHC Medicaid |
$14.59
|
| Rate for Payer: UHC Medicare Advantage |
$20.69
|
| Rate for Payer: UHCCP Medicaid |
$14.59
|
| Rate for Payer: VA VA |
$20.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.08
|
|
|
HC TESTOSTERONE UNDECANOATE PER 1 MG
|
Facility
|
OP
|
$5.20
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$4.42
|
| Rate for Payer: Aetna Medicare |
$1.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.62
|
| Rate for Payer: BCBS Complete |
$0.96
|
| Rate for Payer: BCBS MAPPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.27
|
| Rate for Payer: BCN Commercial |
$4.27
|
| Rate for Payer: BCN Medicare Advantage |
$1.30
|
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Cofinity Commercial |
$4.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.30
|
| Rate for Payer: Healthscope Commercial |
$4.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.90
|
| Rate for Payer: Mclaren Medicaid |
$0.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.36
|
| Rate for Payer: Meridian Medicaid |
$0.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.42
|
| Rate for Payer: Nomi Health Commercial |
$4.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.90
|
| Rate for Payer: PACE Senior Care Partners |
$1.24
|
| Rate for Payer: PACE SWMI |
$1.30
|
| Rate for Payer: PHP Commercial |
$4.42
|
| Rate for Payer: PHP Medicare Advantage |
$1.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.52
|
| Rate for Payer: Priority Health Medicare |
$1.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.58
|
| Rate for Payer: UHC Core |
$4.34
|
| Rate for Payer: UHC Exchange |
$1.30
|
| Rate for Payer: UHC Medicaid |
$0.92
|
| Rate for Payer: UHC Medicare Advantage |
$1.30
|
| Rate for Payer: UHCCP Medicaid |
$0.92
|
| Rate for Payer: VA VA |
$1.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.90
|
|
|
HC TESTOSTERONE UNDECANOATE PER 1 MG
|
Facility
|
IP
|
$5.20
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$4.42
|
| Rate for Payer: BCBS Trust/PPO |
$4.29
|
| Rate for Payer: BCN Commercial |
$4.29
|
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Cofinity Commercial |
$4.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.16
|
| Rate for Payer: Healthscope Commercial |
$4.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.42
|
| Rate for Payer: Nomi Health Commercial |
$4.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.90
|
| Rate for Payer: PHP Commercial |
$4.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.58
|
| Rate for Payer: UHC Core |
$4.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.90
|
|
