|
HC TENOTOMY ELBOW LATERAL OR MEDIAL
|
Facility
|
IP
|
$4,494.21
|
|
| Hospital Charge Code |
36000093
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,921.24 |
| Max. Negotiated Rate |
$4,044.79 |
| Rate for Payer: Aetna Commercial |
$3,820.08
|
| Rate for Payer: BCBS Trust/PPO |
$3,668.62
|
| Rate for Payer: BCN Commercial |
$3,473.13
|
| Rate for Payer: Cash Price |
$3,595.37
|
| Rate for Payer: Cofinity Commercial |
$3,865.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,595.37
|
| Rate for Payer: Healthscope Commercial |
$4,044.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,370.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,820.08
|
| Rate for Payer: Nomi Health Commercial |
$3,685.25
|
| Rate for Payer: PHP Commercial |
$3,820.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,921.24
|
| Rate for Payer: Priority Health HMO/PPO |
$3,909.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,011.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,954.90
|
| Rate for Payer: UHC Core |
$3,752.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,370.66
|
|
|
HC TENOTOMY ELBOW LATERAL OR MEDIAL
|
Facility
|
OP
|
$4,494.21
|
|
| Hospital Charge Code |
36000093
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,067.37 |
| Max. Negotiated Rate |
$4,044.79 |
| Rate for Payer: Aetna Commercial |
$3,820.08
|
| Rate for Payer: Aetna Medicare |
$1,168.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,404.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,404.44
|
| Rate for Payer: BCBS Complete |
$1,797.68
|
| Rate for Payer: BCBS MAPPO |
$1,123.55
|
| Rate for Payer: BCBS Trust/PPO |
$3,694.69
|
| Rate for Payer: BCN Commercial |
$3,494.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,123.55
|
| Rate for Payer: Cash Price |
$3,595.37
|
| Rate for Payer: Cofinity Commercial |
$3,865.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,595.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,123.55
|
| Rate for Payer: Healthscope Commercial |
$4,044.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,370.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,179.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,292.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,820.08
|
| Rate for Payer: Nomi Health Commercial |
$3,685.25
|
| Rate for Payer: PACE Senior Care Partners |
$1,067.37
|
| Rate for Payer: PACE SWMI |
$1,123.55
|
| Rate for Payer: PHP Commercial |
$3,820.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,123.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,921.24
|
| Rate for Payer: Priority Health HMO/PPO |
$3,909.96
|
| Rate for Payer: Priority Health Medicare |
$1,134.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,011.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,123.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,954.90
|
| Rate for Payer: UHC Core |
$3,752.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,123.55
|
| Rate for Payer: UHC Exchange |
$1,123.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,123.55
|
| Rate for Payer: VA VA |
$1,123.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,370.66
|
|
|
HC TENOTOMY MULTIPLE TENDONS
|
Facility
|
OP
|
$5,235.97
|
|
| Hospital Charge Code |
36000095
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,243.54 |
| Max. Negotiated Rate |
$4,712.37 |
| Rate for Payer: Aetna Commercial |
$4,450.57
|
| Rate for Payer: Aetna Medicare |
$1,361.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,636.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,636.24
|
| Rate for Payer: BCBS Complete |
$2,094.39
|
| Rate for Payer: BCBS MAPPO |
$1,308.99
|
| Rate for Payer: BCBS Trust/PPO |
$4,304.49
|
| Rate for Payer: BCN Commercial |
$4,070.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,308.99
|
| Rate for Payer: Cash Price |
$4,188.78
|
| Rate for Payer: Cofinity Commercial |
$4,502.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,188.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,308.99
|
| Rate for Payer: Healthscope Commercial |
$4,712.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,926.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,374.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,505.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,450.57
|
| Rate for Payer: Nomi Health Commercial |
$4,293.50
|
| Rate for Payer: PACE Senior Care Partners |
$1,243.54
|
| Rate for Payer: PACE SWMI |
$1,308.99
|
| Rate for Payer: PHP Commercial |
$4,450.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,308.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,403.38
|
| Rate for Payer: Priority Health HMO/PPO |
$4,555.29
|
| Rate for Payer: Priority Health Medicare |
$1,322.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,508.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,308.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,607.65
|
| Rate for Payer: UHC Core |
$4,372.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,308.99
|
| Rate for Payer: UHC Exchange |
$1,308.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,308.99
|
| Rate for Payer: VA VA |
$1,308.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,926.98
|
|
|
HC TENOTOMY MULTIPLE TENDONS
|
Facility
|
IP
|
$5,235.97
|
|
| Hospital Charge Code |
36000095
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,403.38 |
| Max. Negotiated Rate |
$4,712.37 |
| Rate for Payer: Aetna Commercial |
$4,450.57
|
| Rate for Payer: BCBS Trust/PPO |
$4,274.12
|
| Rate for Payer: BCN Commercial |
$4,046.36
|
| Rate for Payer: Cash Price |
$4,188.78
|
| Rate for Payer: Cofinity Commercial |
$4,502.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,188.78
|
| Rate for Payer: Healthscope Commercial |
$4,712.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,926.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,450.57
|
| Rate for Payer: Nomi Health Commercial |
$4,293.50
|
| Rate for Payer: PHP Commercial |
$4,450.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,403.38
|
| Rate for Payer: Priority Health HMO/PPO |
$4,555.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,508.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,607.65
|
| Rate for Payer: UHC Core |
$4,372.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,926.98
|
|
|
HC TENOTOMY PERCUTANEOUS ACHILLES TENDON
|
Facility
|
OP
|
$3,737.88
|
|
| Hospital Charge Code |
36000097
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$887.75 |
| Max. Negotiated Rate |
$3,364.09 |
| Rate for Payer: Aetna Commercial |
$3,177.20
|
| Rate for Payer: Aetna Medicare |
$971.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,168.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,168.09
|
| Rate for Payer: BCBS Complete |
$1,495.15
|
| Rate for Payer: BCBS MAPPO |
$934.47
|
| Rate for Payer: BCBS Trust/PPO |
$3,072.91
|
| Rate for Payer: BCN Commercial |
$2,906.20
|
| Rate for Payer: BCN Medicare Advantage |
$934.47
|
| Rate for Payer: Cash Price |
$2,990.30
|
| Rate for Payer: Cofinity Commercial |
$3,214.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,990.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$934.47
|
| Rate for Payer: Healthscope Commercial |
$3,364.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,803.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$981.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,074.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,177.20
|
| Rate for Payer: Nomi Health Commercial |
$3,065.06
|
| Rate for Payer: PACE Senior Care Partners |
$887.75
|
| Rate for Payer: PACE SWMI |
$934.47
|
| Rate for Payer: PHP Commercial |
$3,177.20
|
| Rate for Payer: PHP Medicare Advantage |
$934.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,429.62
|
| Rate for Payer: Priority Health HMO/PPO |
$3,251.96
|
| Rate for Payer: Priority Health Medicare |
$943.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,504.38
|
| Rate for Payer: Railroad Medicare Medicare |
$934.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,289.33
|
| Rate for Payer: UHC Core |
$3,121.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$934.47
|
| Rate for Payer: UHC Exchange |
$934.47
|
| Rate for Payer: UHC Medicare Advantage |
$934.47
|
| Rate for Payer: VA VA |
$934.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,803.41
|
|
|
HC TENOTOMY PERCUTANEOUS ACHILLES TENDON
|
Facility
|
IP
|
$3,737.88
|
|
| Hospital Charge Code |
36000097
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,429.62 |
| Max. Negotiated Rate |
$3,364.09 |
| Rate for Payer: Aetna Commercial |
$3,177.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,051.23
|
| Rate for Payer: BCN Commercial |
$2,888.63
|
| Rate for Payer: Cash Price |
$2,990.30
|
| Rate for Payer: Cofinity Commercial |
$3,214.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,990.30
|
| Rate for Payer: Healthscope Commercial |
$3,364.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,803.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,177.20
|
| Rate for Payer: Nomi Health Commercial |
$3,065.06
|
| Rate for Payer: PHP Commercial |
$3,177.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,429.62
|
| Rate for Payer: Priority Health HMO/PPO |
$3,251.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,504.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,289.33
|
| Rate for Payer: UHC Core |
$3,121.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,803.41
|
|
|
HC TENOTOMY PERCUTANEOUS ADDUCTOR OR HAMSTRING
|
Facility
|
IP
|
$3,570.03
|
|
| Hospital Charge Code |
36000094
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,320.52 |
| Max. Negotiated Rate |
$3,213.03 |
| Rate for Payer: Aetna Commercial |
$3,034.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,914.22
|
| Rate for Payer: BCN Commercial |
$2,758.92
|
| Rate for Payer: Cash Price |
$2,856.02
|
| Rate for Payer: Cofinity Commercial |
$3,070.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,856.02
|
| Rate for Payer: Healthscope Commercial |
$3,213.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,677.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,034.53
|
| Rate for Payer: Nomi Health Commercial |
$2,927.42
|
| Rate for Payer: PHP Commercial |
$3,034.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,320.52
|
| Rate for Payer: Priority Health HMO/PPO |
$3,105.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,391.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,141.63
|
| Rate for Payer: UHC Core |
$2,980.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,677.52
|
|
|
HC TENOTOMY PERCUTANEOUS ADDUCTOR OR HAMSTRING
|
Facility
|
OP
|
$3,570.03
|
|
| Hospital Charge Code |
36000094
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$847.88 |
| Max. Negotiated Rate |
$3,213.03 |
| Rate for Payer: Aetna Commercial |
$3,034.53
|
| Rate for Payer: Aetna Medicare |
$928.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,115.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,115.63
|
| Rate for Payer: BCBS Complete |
$1,428.01
|
| Rate for Payer: BCBS MAPPO |
$892.51
|
| Rate for Payer: BCBS Trust/PPO |
$2,934.92
|
| Rate for Payer: BCN Commercial |
$2,775.70
|
| Rate for Payer: BCN Medicare Advantage |
$892.51
|
| Rate for Payer: Cash Price |
$2,856.02
|
| Rate for Payer: Cofinity Commercial |
$3,070.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,856.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$892.51
|
| Rate for Payer: Healthscope Commercial |
$3,213.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,677.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$937.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,026.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,034.53
|
| Rate for Payer: Nomi Health Commercial |
$2,927.42
|
| Rate for Payer: PACE Senior Care Partners |
$847.88
|
| Rate for Payer: PACE SWMI |
$892.51
|
| Rate for Payer: PHP Commercial |
$3,034.53
|
| Rate for Payer: PHP Medicare Advantage |
$892.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,320.52
|
| Rate for Payer: Priority Health HMO/PPO |
$3,105.93
|
| Rate for Payer: Priority Health Medicare |
$901.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,391.92
|
| Rate for Payer: Railroad Medicare Medicare |
$892.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,141.63
|
| Rate for Payer: UHC Core |
$2,980.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$892.51
|
| Rate for Payer: UHC Exchange |
$892.51
|
| Rate for Payer: UHC Medicare Advantage |
$892.51
|
| Rate for Payer: VA VA |
$892.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,677.52
|
|
|
HC TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT
|
Facility
|
OP
|
$4,590.00
|
|
|
Service Code
|
CPT 26060
|
| Hospital Charge Code |
76100424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,090.12 |
| Max. Negotiated Rate |
$4,131.00 |
| Rate for Payer: Aetna Commercial |
$3,901.50
|
| Rate for Payer: Aetna Medicare |
$1,193.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,434.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,434.38
|
| Rate for Payer: BCBS Complete |
$1,215.03
|
| Rate for Payer: BCBS MAPPO |
$1,147.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,773.44
|
| Rate for Payer: BCN Commercial |
$3,568.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,147.50
|
| Rate for Payer: Cash Price |
$3,672.00
|
| Rate for Payer: Cash Price |
$3,672.00
|
| Rate for Payer: Cofinity Commercial |
$3,947.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,672.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,147.50
|
| Rate for Payer: Healthscope Commercial |
$4,131.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,442.50
|
| Rate for Payer: Mclaren Medicaid |
$1,157.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,204.88
|
| Rate for Payer: Meridian Medicaid |
$1,215.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,319.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,901.50
|
| Rate for Payer: Nomi Health Commercial |
$3,763.80
|
| Rate for Payer: PACE Senior Care Partners |
$1,090.12
|
| Rate for Payer: PACE SWMI |
$1,147.50
|
| Rate for Payer: PHP Commercial |
$3,901.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,147.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,157.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,983.50
|
| Rate for Payer: Priority Health HMO/PPO |
$3,993.30
|
| Rate for Payer: Priority Health Medicare |
$1,158.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,075.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1,147.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,039.20
|
| Rate for Payer: UHC Core |
$3,832.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,147.50
|
| Rate for Payer: UHC Exchange |
$1,147.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,147.50
|
| Rate for Payer: UHCCP Medicaid |
$1,157.10
|
| Rate for Payer: VA VA |
$1,147.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,442.50
|
|
|
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 |
$2,983.50 |
| Max. Negotiated Rate |
$4,131.00 |
| Rate for Payer: Aetna Commercial |
$3,901.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,746.82
|
| Rate for Payer: BCN Commercial |
$3,547.15
|
| Rate for Payer: Cash Price |
$3,672.00
|
| Rate for Payer: Cofinity Commercial |
$3,947.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,672.00
|
| Rate for Payer: Healthscope Commercial |
$4,131.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,442.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,901.50
|
| Rate for Payer: Nomi Health Commercial |
$3,763.80
|
| Rate for Payer: PHP Commercial |
$3,901.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,983.50
|
| Rate for Payer: Priority Health HMO/PPO |
$3,993.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,075.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,039.20
|
| Rate for Payer: UHC Core |
$3,832.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,442.50
|
|
|
HC TENOTOMY SHOULDER AREA SINGLE TENDON
|
Facility
|
OP
|
$4,826.31
|
|
| Hospital Charge Code |
36000098
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,146.25 |
| Max. Negotiated Rate |
$4,343.68 |
| Rate for Payer: Aetna Commercial |
$4,102.36
|
| Rate for Payer: Aetna Medicare |
$1,254.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,508.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,508.22
|
| Rate for Payer: BCBS Complete |
$1,930.52
|
| Rate for Payer: BCBS MAPPO |
$1,206.58
|
| Rate for Payer: BCBS Trust/PPO |
$3,967.71
|
| Rate for Payer: BCN Commercial |
$3,752.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,206.58
|
| Rate for Payer: Cash Price |
$3,861.05
|
| Rate for Payer: Cofinity Commercial |
$4,150.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,861.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,206.58
|
| Rate for Payer: Healthscope Commercial |
$4,343.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,619.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,266.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,387.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,102.36
|
| Rate for Payer: Nomi Health Commercial |
$3,957.57
|
| Rate for Payer: PACE Senior Care Partners |
$1,146.25
|
| Rate for Payer: PACE SWMI |
$1,206.58
|
| Rate for Payer: PHP Commercial |
$4,102.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,206.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,137.10
|
| Rate for Payer: Priority Health HMO/PPO |
$4,198.89
|
| Rate for Payer: Priority Health Medicare |
$1,218.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,233.63
|
| Rate for Payer: Railroad Medicare Medicare |
$1,206.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,247.15
|
| Rate for Payer: UHC Core |
$4,029.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,206.58
|
| Rate for Payer: UHC Exchange |
$1,206.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,206.58
|
| Rate for Payer: VA VA |
$1,206.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,619.73
|
|
|
HC TENOTOMY SHOULDER AREA SINGLE TENDON
|
Facility
|
IP
|
$4,826.31
|
|
| Hospital Charge Code |
36000098
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,137.10 |
| Max. Negotiated Rate |
$4,343.68 |
| Rate for Payer: Aetna Commercial |
$4,102.36
|
| Rate for Payer: BCBS Trust/PPO |
$3,939.72
|
| Rate for Payer: BCN Commercial |
$3,729.77
|
| Rate for Payer: Cash Price |
$3,861.05
|
| Rate for Payer: Cofinity Commercial |
$4,150.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,861.05
|
| Rate for Payer: Healthscope Commercial |
$4,343.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,619.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,102.36
|
| Rate for Payer: Nomi Health Commercial |
$3,957.57
|
| Rate for Payer: PHP Commercial |
$4,102.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,137.10
|
| Rate for Payer: Priority Health HMO/PPO |
$4,198.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,233.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,247.15
|
| Rate for Payer: UHC Core |
$4,029.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,619.73
|
|
|
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 |
$527.05 |
| Max. Negotiated Rate |
$1,997.23 |
| Rate for Payer: Aetna Commercial |
$1,886.28
|
| Rate for Payer: Aetna Medicare |
$576.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$693.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$693.48
|
| Rate for Payer: BCBS Complete |
$1,215.03
|
| Rate for Payer: BCBS MAPPO |
$554.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,824.36
|
| Rate for Payer: BCN Commercial |
$1,725.39
|
| Rate for Payer: BCN Medicare Advantage |
$554.79
|
| 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: Encore Health Key Benefits Commercial |
$1,775.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$554.79
|
| Rate for Payer: Healthscope Commercial |
$1,997.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,664.36
|
| Rate for Payer: Mclaren Medicaid |
$1,157.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$582.53
|
| Rate for Payer: Meridian Medicaid |
$1,215.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$638.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,886.28
|
| Rate for Payer: Nomi Health Commercial |
$1,819.70
|
| Rate for Payer: PACE Senior Care Partners |
$527.05
|
| Rate for Payer: PACE SWMI |
$554.79
|
| Rate for Payer: PHP Commercial |
$1,886.28
|
| Rate for Payer: PHP Medicare Advantage |
$554.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,157.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,442.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,930.66
|
| Rate for Payer: Priority Health Medicare |
$560.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,486.83
|
| Rate for Payer: Railroad Medicare Medicare |
$554.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,952.85
|
| Rate for Payer: UHC Core |
$1,852.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$554.79
|
| Rate for Payer: UHC Exchange |
$554.79
|
| Rate for Payer: UHC Medicare Advantage |
$554.79
|
| Rate for Payer: UHCCP Medicaid |
$1,157.10
|
| Rate for Payer: VA VA |
$554.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,664.36
|
|
|
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 |
$1,442.45 |
| Max. Negotiated Rate |
$1,997.23 |
| Rate for Payer: Aetna Commercial |
$1,886.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,811.49
|
| Rate for Payer: BCN Commercial |
$1,714.96
|
| Rate for Payer: Cash Price |
$1,775.32
|
| Rate for Payer: Cofinity Commercial |
$1,908.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,775.32
|
| Rate for Payer: Healthscope Commercial |
$1,997.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,664.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,886.28
|
| Rate for Payer: Nomi Health Commercial |
$1,819.70
|
| Rate for Payer: PHP Commercial |
$1,886.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,442.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,930.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,486.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,952.85
|
| Rate for Payer: UHC Core |
$1,852.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,664.36
|
|
|
HC TESTOSTERONE BIOAVAILABLE
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100429
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.41 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$20.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.38
|
| Rate for Payer: BCBS Complete |
$19.34
|
| Rate for Payer: BCBS MAPPO |
$19.51
|
| Rate for Payer: BCBS Trust/PPO |
$64.15
|
| Rate for Payer: BCN Commercial |
$60.67
|
| Rate for Payer: BCN Medicare Advantage |
$19.51
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.51
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Mclaren Medicaid |
$18.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.48
|
| Rate for Payer: Meridian Medicaid |
$19.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PACE Senior Care Partners |
$18.53
|
| Rate for Payer: PACE SWMI |
$19.51
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$19.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Medicare |
$19.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: Railroad Medicare Medicare |
$19.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.51
|
| Rate for Payer: UHC Exchange |
$19.51
|
| Rate for Payer: UHC Medicare Advantage |
$19.51
|
| Rate for Payer: UHCCP Medicaid |
$18.41
|
| Rate for Payer: VA VA |
$19.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC TESTOSTERONE BIOAVAILABLE
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100429
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: BCBS Trust/PPO |
$63.70
|
| Rate for Payer: BCN Commercial |
$60.30
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC TESTOSTERONE FREE
|
Facility
|
OP
|
$44.79
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100428
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$40.31 |
| Rate for Payer: Aetna Commercial |
$38.07
|
| Rate for Payer: Aetna Medicare |
$11.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.00
|
| Rate for Payer: BCBS Complete |
$19.34
|
| Rate for Payer: BCBS MAPPO |
$11.20
|
| Rate for Payer: BCBS Trust/PPO |
$36.82
|
| Rate for Payer: BCN Commercial |
$34.82
|
| Rate for Payer: BCN Medicare Advantage |
$11.20
|
| Rate for Payer: Cash Price |
$35.83
|
| Rate for Payer: Cash Price |
$35.83
|
| Rate for Payer: Cofinity Commercial |
$38.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.20
|
| Rate for Payer: Healthscope Commercial |
$40.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.59
|
| Rate for Payer: Mclaren Medicaid |
$18.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.76
|
| Rate for Payer: Meridian Medicaid |
$19.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.07
|
| Rate for Payer: Nomi Health Commercial |
$36.73
|
| Rate for Payer: PACE Senior Care Partners |
$10.64
|
| Rate for Payer: PACE SWMI |
$11.20
|
| Rate for Payer: PHP Commercial |
$38.07
|
| Rate for Payer: PHP Medicare Advantage |
$11.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.11
|
| Rate for Payer: Priority Health HMO/PPO |
$38.97
|
| Rate for Payer: Priority Health Medicare |
$11.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.01
|
| Rate for Payer: Railroad Medicare Medicare |
$11.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.42
|
| Rate for Payer: UHC Core |
$37.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.20
|
| Rate for Payer: UHC Exchange |
$11.20
|
| Rate for Payer: UHC Medicare Advantage |
$11.20
|
| Rate for Payer: UHCCP Medicaid |
$18.41
|
| Rate for Payer: VA VA |
$11.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.59
|
|
|
HC TESTOSTERONE FREE
|
Facility
|
IP
|
$44.79
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100428
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.11 |
| Max. Negotiated Rate |
$40.31 |
| Rate for Payer: Aetna Commercial |
$38.07
|
| Rate for Payer: BCBS Trust/PPO |
$36.56
|
| Rate for Payer: BCN Commercial |
$34.61
|
| Rate for Payer: Cash Price |
$35.83
|
| Rate for Payer: Cofinity Commercial |
$38.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.83
|
| Rate for Payer: Healthscope Commercial |
$40.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.07
|
| Rate for Payer: Nomi Health Commercial |
$36.73
|
| Rate for Payer: PHP Commercial |
$38.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.11
|
| Rate for Payer: Priority Health HMO/PPO |
$38.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.42
|
| Rate for Payer: UHC Core |
$37.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.59
|
|
|
HC TESTOSTERONE, FREE & WKLY BOUND
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100736
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: BCBS Trust/PPO |
$66.61
|
| Rate for Payer: BCN Commercial |
$63.06
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: Nomi Health Commercial |
$66.91
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health HMO/PPO |
$70.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.81
|
| Rate for Payer: UHC Core |
$68.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.20
|
|
|
HC TESTOSTERONE, FREE & WKLY BOUND
|
Facility
|
OP
|
$81.60
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100736
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna Medicare |
$21.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.50
|
| Rate for Payer: BCBS Complete |
$38.93
|
| Rate for Payer: BCBS MAPPO |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$67.08
|
| Rate for Payer: BCN Commercial |
$63.44
|
| Rate for Payer: BCN Medicare Advantage |
$20.40
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.20
|
| Rate for Payer: Mclaren Medicaid |
$37.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.42
|
| Rate for Payer: Meridian Medicaid |
$38.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: Nomi Health Commercial |
$66.91
|
| Rate for Payer: PACE Senior Care Partners |
$19.38
|
| Rate for Payer: PACE SWMI |
$20.40
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: PHP Medicare Advantage |
$20.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health HMO/PPO |
$70.99
|
| Rate for Payer: Priority Health Medicare |
$20.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.67
|
| Rate for Payer: Railroad Medicare Medicare |
$20.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.81
|
| Rate for Payer: UHC Core |
$68.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.40
|
| Rate for Payer: UHC Exchange |
$20.40
|
| Rate for Payer: UHC Medicare Advantage |
$20.40
|
| Rate for Payer: UHCCP Medicaid |
$37.08
|
| Rate for Payer: VA VA |
$20.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.20
|
|
|
HC TESTOSTERONE LEVEL
|
Facility
|
IP
|
$86.83
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100430
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.44 |
| Max. Negotiated Rate |
$78.15 |
| Rate for Payer: Aetna Commercial |
$73.81
|
| Rate for Payer: BCBS Trust/PPO |
$70.88
|
| Rate for Payer: BCN Commercial |
$67.10
|
| Rate for Payer: Cash Price |
$69.46
|
| Rate for Payer: Cofinity Commercial |
$74.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.46
|
| Rate for Payer: Healthscope Commercial |
$78.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.81
|
| Rate for Payer: Nomi Health Commercial |
$71.20
|
| Rate for Payer: PHP Commercial |
$73.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.44
|
| Rate for Payer: Priority Health HMO/PPO |
$75.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.41
|
| Rate for Payer: UHC Core |
$72.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.12
|
|
|
HC TESTOSTERONE LEVEL
|
Facility
|
OP
|
$86.83
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100430
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.66 |
| Max. Negotiated Rate |
$78.15 |
| Rate for Payer: Aetna Commercial |
$73.81
|
| Rate for Payer: Aetna Medicare |
$22.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.13
|
| Rate for Payer: BCBS Complete |
$19.59
|
| Rate for Payer: BCBS MAPPO |
$21.71
|
| Rate for Payer: BCBS Trust/PPO |
$71.38
|
| Rate for Payer: BCN Commercial |
$67.51
|
| Rate for Payer: BCN Medicare Advantage |
$21.71
|
| Rate for Payer: Cash Price |
$69.46
|
| Rate for Payer: Cash Price |
$69.46
|
| Rate for Payer: Cofinity Commercial |
$74.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.71
|
| Rate for Payer: Healthscope Commercial |
$78.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.12
|
| Rate for Payer: Mclaren Medicaid |
$18.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.79
|
| Rate for Payer: Meridian Medicaid |
$19.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.81
|
| Rate for Payer: Nomi Health Commercial |
$71.20
|
| Rate for Payer: PACE Senior Care Partners |
$20.62
|
| Rate for Payer: PACE SWMI |
$21.71
|
| Rate for Payer: PHP Commercial |
$73.81
|
| Rate for Payer: PHP Medicare Advantage |
$21.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.44
|
| Rate for Payer: Priority Health HMO/PPO |
$75.54
|
| Rate for Payer: Priority Health Medicare |
$21.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.18
|
| Rate for Payer: Railroad Medicare Medicare |
$21.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.41
|
| Rate for Payer: UHC Core |
$72.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.71
|
| Rate for Payer: UHC Exchange |
$21.71
|
| Rate for Payer: UHC Medicare Advantage |
$21.71
|
| Rate for Payer: UHCCP Medicaid |
$18.66
|
| Rate for Payer: VA VA |
$21.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.12
|
|
|
HC TESTOSTERONE LEVEL TOTAL
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100431
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.66 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$24.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.26
|
| Rate for Payer: BCBS Complete |
$19.59
|
| Rate for Payer: BCBS MAPPO |
$23.41
|
| Rate for Payer: BCBS Trust/PPO |
$76.98
|
| Rate for Payer: BCN Commercial |
$72.81
|
| Rate for Payer: BCN Medicare Advantage |
$23.41
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.41
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$18.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.58
|
| Rate for Payer: Meridian Medicaid |
$19.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: PACE Senior Care Partners |
$22.24
|
| Rate for Payer: PACE SWMI |
$23.41
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: PHP Medicare Advantage |
$23.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health HMO/PPO |
$81.47
|
| Rate for Payer: Priority Health Medicare |
$23.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.74
|
| Rate for Payer: Railroad Medicare Medicare |
$23.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.40
|
| Rate for Payer: UHC Core |
$78.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.41
|
| Rate for Payer: UHC Exchange |
$23.41
|
| Rate for Payer: UHC Medicare Advantage |
$23.41
|
| Rate for Payer: UHCCP Medicaid |
$18.66
|
| Rate for Payer: VA VA |
$23.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC TESTOSTERONE LEVEL TOTAL
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100431
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.87 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: BCBS Trust/PPO |
$76.44
|
| Rate for Payer: BCN Commercial |
$72.36
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health HMO/PPO |
$81.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.40
|
| Rate for Payer: UHC Core |
$78.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC TESTOSTERONE PELLETS EACH
|
Facility
|
IP
|
$224.73
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.07 |
| Max. Negotiated Rate |
$202.26 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: BCBS Trust/PPO |
$183.45
|
| Rate for Payer: BCN Commercial |
$173.67
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$193.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$202.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Nomi Health Commercial |
$184.28
|
| Rate for Payer: PHP Commercial |
$191.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: Priority Health HMO/PPO |
$195.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.76
|
| Rate for Payer: UHC Core |
$187.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.55
|
|
