|
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
|
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 & 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, 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 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
|
OP
|
$224.73
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.37 |
| Max. Negotiated Rate |
$202.26 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: Aetna Medicare |
$58.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.23
|
| Rate for Payer: BCBS Complete |
$89.89
|
| Rate for Payer: BCBS MAPPO |
$56.18
|
| Rate for Payer: BCBS Trust/PPO |
$184.75
|
| Rate for Payer: BCN Commercial |
$174.73
|
| Rate for Payer: BCN Medicare Advantage |
$56.18
|
| 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: Health Alliance Plan Medicare Advantage |
$56.18
|
| Rate for Payer: Healthscope Commercial |
$202.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Nomi Health Commercial |
$184.28
|
| Rate for Payer: PACE Senior Care Partners |
$53.37
|
| Rate for Payer: PACE SWMI |
$56.18
|
| Rate for Payer: PHP Commercial |
$191.02
|
| Rate for Payer: PHP Medicare Advantage |
$56.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: Priority Health HMO/PPO |
$195.52
|
| Rate for Payer: Priority Health Medicare |
$56.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.57
|
| Rate for Payer: Railroad Medicare Medicare |
$56.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.76
|
| Rate for Payer: UHC Core |
$187.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.18
|
| Rate for Payer: UHC Exchange |
$56.18
|
| Rate for Payer: UHC Medicare Advantage |
$56.18
|
| Rate for Payer: VA VA |
$56.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.55
|
|
|
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
|
|
|
HC TESTOSTERONE, T, BIO, FREE
|
Facility
|
OP
|
$81.15
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.66 |
| Max. Negotiated Rate |
$73.04 |
| Rate for Payer: Aetna Commercial |
$68.98
|
| Rate for Payer: Aetna Medicare |
$21.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.36
|
| Rate for Payer: BCBS Complete |
$19.59
|
| Rate for Payer: BCBS MAPPO |
$20.29
|
| Rate for Payer: BCBS Trust/PPO |
$66.71
|
| Rate for Payer: BCN Commercial |
$63.09
|
| Rate for Payer: BCN Medicare Advantage |
$20.29
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$69.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.29
|
| Rate for Payer: Healthscope Commercial |
$73.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.86
|
| Rate for Payer: Mclaren Medicaid |
$18.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.30
|
| Rate for Payer: Meridian Medicaid |
$19.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: Nomi Health Commercial |
$66.54
|
| Rate for Payer: PACE Senior Care Partners |
$19.27
|
| Rate for Payer: PACE SWMI |
$20.29
|
| Rate for Payer: PHP Commercial |
$68.98
|
| Rate for Payer: PHP Medicare Advantage |
$20.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.75
|
| Rate for Payer: Priority Health HMO/PPO |
$70.60
|
| Rate for Payer: Priority Health Medicare |
$20.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.37
|
| Rate for Payer: Railroad Medicare Medicare |
$20.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.41
|
| Rate for Payer: UHC Core |
$67.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.29
|
| Rate for Payer: UHC Exchange |
$20.29
|
| Rate for Payer: UHC Medicare Advantage |
$20.29
|
| Rate for Payer: UHCCP Medicaid |
$18.66
|
| Rate for Payer: VA VA |
$20.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.86
|
|
|
HC TESTOSTERONE, T, BIO, FREE
|
Facility
|
IP
|
$81.15
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.75 |
| Max. Negotiated Rate |
$73.04 |
| Rate for Payer: Aetna Commercial |
$68.98
|
| Rate for Payer: BCBS Trust/PPO |
$66.24
|
| Rate for Payer: BCN Commercial |
$62.71
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$69.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Healthscope Commercial |
$73.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: Nomi Health Commercial |
$66.54
|
| Rate for Payer: PHP Commercial |
$68.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.75
|
| Rate for Payer: Priority Health HMO/PPO |
$70.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.41
|
| Rate for Payer: UHC Core |
$67.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.86
|
|
|
HC TESTOSTERONE UNDECANOATE PER 1 MG
|
Facility
|
IP
|
$5.10
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: BCBS Trust/PPO |
$4.16
|
| Rate for Payer: BCN Commercial |
$3.94
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.08
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.34
|
| Rate for Payer: Nomi Health Commercial |
$4.18
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health HMO/PPO |
$4.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.49
|
| Rate for Payer: UHC Core |
$4.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.82
|
|
|
HC TESTOSTERONE UNDECANOATE PER 1 MG
|
Facility
|
OP
|
$5.10
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.59
|
| Rate for Payer: BCBS Complete |
$1.46
|
| Rate for Payer: BCBS MAPPO |
$1.28
|
| Rate for Payer: BCBS Trust/PPO |
$4.19
|
| Rate for Payer: BCN Commercial |
$3.97
|
| Rate for Payer: BCN Medicare Advantage |
$1.28
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.28
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.82
|
| Rate for Payer: Mclaren Medicaid |
$1.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.34
|
| Rate for Payer: Meridian Medicaid |
$1.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.34
|
| Rate for Payer: Nomi Health Commercial |
$4.18
|
| Rate for Payer: PACE Senior Care Partners |
$1.21
|
| Rate for Payer: PACE SWMI |
$1.28
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: PHP Medicare Advantage |
$1.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health HMO/PPO |
$4.44
|
| Rate for Payer: Priority Health Medicare |
$1.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.42
|
| Rate for Payer: Railroad Medicare Medicare |
$1.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.49
|
| Rate for Payer: UHC Core |
$4.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.28
|
| Rate for Payer: UHC Exchange |
$1.28
|
| Rate for Payer: UHC Medicare Advantage |
$1.28
|
| Rate for Payer: UHCCP Medicaid |
$1.39
|
| Rate for Payer: VA VA |
$1.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.82
|
|
|
HC TESTOSTERONE UNLISTED CHEMISTRY
|
Facility
|
OP
|
$83.88
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100642
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.92 |
| Max. Negotiated Rate |
$75.49 |
| Rate for Payer: Aetna Commercial |
$71.30
|
| Rate for Payer: Aetna Medicare |
$21.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.21
|
| Rate for Payer: BCBS Complete |
$38.93
|
| Rate for Payer: BCBS MAPPO |
$20.97
|
| Rate for Payer: BCBS Trust/PPO |
$68.96
|
| Rate for Payer: BCN Commercial |
$65.22
|
| Rate for Payer: BCN Medicare Advantage |
$20.97
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cofinity Commercial |
$72.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.97
|
| Rate for Payer: Healthscope Commercial |
$75.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.91
|
| Rate for Payer: Mclaren Medicaid |
$37.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.02
|
| Rate for Payer: Meridian Medicaid |
$38.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.30
|
| Rate for Payer: Nomi Health Commercial |
$68.78
|
| Rate for Payer: PACE Senior Care Partners |
$19.92
|
| Rate for Payer: PACE SWMI |
$20.97
|
| Rate for Payer: PHP Commercial |
$71.30
|
| Rate for Payer: PHP Medicare Advantage |
$20.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.52
|
| Rate for Payer: Priority Health HMO/PPO |
$72.98
|
| Rate for Payer: Priority Health Medicare |
$21.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.20
|
| Rate for Payer: Railroad Medicare Medicare |
$20.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.81
|
| Rate for Payer: UHC Core |
$70.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.97
|
| Rate for Payer: UHC Exchange |
$20.97
|
| Rate for Payer: UHC Medicare Advantage |
$20.97
|
| Rate for Payer: UHCCP Medicaid |
$37.08
|
| Rate for Payer: VA VA |
$20.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.91
|
|
|
HC TESTOSTERONE UNLISTED CHEMISTRY
|
Facility
|
IP
|
$83.88
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100642
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.52 |
| Max. Negotiated Rate |
$75.49 |
| Rate for Payer: Aetna Commercial |
$71.30
|
| Rate for Payer: BCBS Trust/PPO |
$68.47
|
| Rate for Payer: BCN Commercial |
$64.82
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cofinity Commercial |
$72.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.10
|
| Rate for Payer: Healthscope Commercial |
$75.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.30
|
| Rate for Payer: Nomi Health Commercial |
$68.78
|
| Rate for Payer: PHP Commercial |
$71.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.52
|
| Rate for Payer: Priority Health HMO/PPO |
$72.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.81
|
| Rate for Payer: UHC Core |
$70.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.91
|
|
|
HC TETANUS AND DIPTHERIA TOXOIDS ADSORDED (TD), PF, 7 YRS OR OLDER IM
|
Facility
|
OP
|
$39.54
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
63600083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$35.59 |
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna Medicare |
$10.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.36
|
| Rate for Payer: BCBS Complete |
$15.82
|
| Rate for Payer: BCBS MAPPO |
$9.88
|
| Rate for Payer: BCBS Trust/PPO |
$32.51
|
| Rate for Payer: BCN Commercial |
$30.74
|
| Rate for Payer: BCN Medicare Advantage |
$9.88
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.88
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: Nomi Health Commercial |
$32.42
|
| Rate for Payer: PACE Senior Care Partners |
$9.39
|
| Rate for Payer: PACE SWMI |
$9.88
|
| Rate for Payer: PHP Commercial |
$33.61
|
| Rate for Payer: PHP Medicare Advantage |
$9.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health HMO/PPO |
$34.40
|
| Rate for Payer: Priority Health Medicare |
$9.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.49
|
| Rate for Payer: Railroad Medicare Medicare |
$9.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.80
|
| Rate for Payer: UHC Core |
$33.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.88
|
| Rate for Payer: UHC Exchange |
$9.88
|
| Rate for Payer: UHC Medicare Advantage |
$9.88
|
| Rate for Payer: VA VA |
$9.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.66
|
|
|
HC TETANUS AND DIPTHERIA TOXOIDS ADSORDED (TD), PF, 7 YRS OR OLDER IM
|
Facility
|
IP
|
$39.54
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
63600083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$35.59 |
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: BCBS Trust/PPO |
$32.28
|
| Rate for Payer: BCN Commercial |
$30.56
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: Nomi Health Commercial |
$32.42
|
| Rate for Payer: PHP Commercial |
$33.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health HMO/PPO |
$34.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.80
|
| Rate for Payer: UHC Core |
$33.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.66
|
|
|
HC TETANUS ANTIBODIES
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
30200320
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$49.96
|
| Rate for Payer: BCN Commercial |
$47.30
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health HMO/PPO |
$53.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.86
|
| Rate for Payer: UHC Core |
$51.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC TETANUS ANTIBODIES
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
30200320
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: BCBS Complete |
$11.24
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$50.31
|
| Rate for Payer: BCN Commercial |
$47.58
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$10.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.06
|
| Rate for Payer: Meridian Medicaid |
$11.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: PACE Senior Care Partners |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health HMO/PPO |
$53.24
|
| Rate for Payer: Priority Health Medicare |
$15.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.00
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.86
|
| Rate for Payer: UHC Core |
$51.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.30
|
| Rate for Payer: UHC Exchange |
$15.30
|
| Rate for Payer: UHC Medicare Advantage |
$15.30
|
| Rate for Payer: UHCCP Medicaid |
$10.70
|
| Rate for Payer: VA VA |
$15.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC TETANUS/DIPHTHERIA/PERTUSIS VACCINE
|
Facility
|
IP
|
$124.62
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$112.16 |
| Rate for Payer: Aetna Commercial |
$105.93
|
| Rate for Payer: BCBS Trust/PPO |
$101.73
|
| Rate for Payer: BCN Commercial |
$96.31
|
| Rate for Payer: Cash Price |
$99.70
|
| Rate for Payer: Cofinity Commercial |
$107.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.70
|
| Rate for Payer: Healthscope Commercial |
$112.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.93
|
| Rate for Payer: Nomi Health Commercial |
$102.19
|
| Rate for Payer: PHP Commercial |
$105.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.00
|
| Rate for Payer: Priority Health HMO/PPO |
$108.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.67
|
| Rate for Payer: UHC Core |
$104.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.46
|
|
|
HC TETANUS/DIPHTHERIA/PERTUSIS VACCINE
|
Facility
|
OP
|
$124.62
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$112.16 |
| Rate for Payer: Aetna Commercial |
$105.93
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.94
|
| Rate for Payer: BCBS Complete |
$49.85
|
| Rate for Payer: BCBS MAPPO |
$31.16
|
| Rate for Payer: BCBS Trust/PPO |
$102.45
|
| Rate for Payer: BCN Commercial |
$96.89
|
| Rate for Payer: BCN Medicare Advantage |
$31.16
|
| Rate for Payer: Cash Price |
$99.70
|
| Rate for Payer: Cofinity Commercial |
$107.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.16
|
| Rate for Payer: Healthscope Commercial |
$112.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.93
|
| Rate for Payer: Nomi Health Commercial |
$102.19
|
| Rate for Payer: PACE Senior Care Partners |
$29.60
|
| Rate for Payer: PACE SWMI |
$31.16
|
| Rate for Payer: PHP Commercial |
$105.93
|
| Rate for Payer: PHP Medicare Advantage |
$31.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.00
|
| Rate for Payer: Priority Health HMO/PPO |
$108.42
|
| Rate for Payer: Priority Health Medicare |
$31.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.50
|
| Rate for Payer: Railroad Medicare Medicare |
$31.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.67
|
| Rate for Payer: UHC Core |
$104.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.16
|
| Rate for Payer: UHC Exchange |
$31.16
|
| Rate for Payer: UHC Medicare Advantage |
$31.16
|
| Rate for Payer: VA VA |
$31.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.46
|
|
|
HC THC URINE CONFIRM
|
Facility
|
OP
|
$63.24
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100568
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna Medicare |
$16.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.76
|
| Rate for Payer: BCBS Complete |
$25.30
|
| Rate for Payer: BCBS MAPPO |
$15.81
|
| Rate for Payer: BCBS Trust/PPO |
$51.99
|
| Rate for Payer: BCN Commercial |
$49.17
|
| Rate for Payer: BCN Medicare Advantage |
$15.81
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.81
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: PACE Senior Care Partners |
$15.02
|
| Rate for Payer: PACE SWMI |
$15.81
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: PHP Medicare Advantage |
$15.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health HMO/PPO |
$55.02
|
| Rate for Payer: Priority Health Medicare |
$15.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.37
|
| Rate for Payer: Railroad Medicare Medicare |
$15.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.65
|
| Rate for Payer: UHC Core |
$52.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.81
|
| Rate for Payer: UHC Exchange |
$15.81
|
| Rate for Payer: UHC Medicare Advantage |
$15.81
|
| Rate for Payer: VA VA |
$15.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.43
|
|
|
HC THC URINE CONFIRM
|
Facility
|
IP
|
$63.24
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100568
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: BCBS Trust/PPO |
$51.62
|
| Rate for Payer: BCN Commercial |
$48.87
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health HMO/PPO |
$55.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.65
|
| Rate for Payer: UHC Core |
$52.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.43
|
|
|
HC THEOPHYLLINE LEVEL
|
Facility
|
OP
|
$92.21
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
30100048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Aetna Commercial |
$78.38
|
| Rate for Payer: Aetna Medicare |
$23.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.82
|
| Rate for Payer: BCBS Complete |
$10.74
|
| Rate for Payer: BCBS MAPPO |
$23.05
|
| Rate for Payer: BCBS Trust/PPO |
$75.81
|
| Rate for Payer: BCN Commercial |
$71.69
|
| Rate for Payer: BCN Medicare Advantage |
$23.05
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$79.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.05
|
| Rate for Payer: Healthscope Commercial |
$82.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.16
|
| Rate for Payer: Mclaren Medicaid |
$10.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.21
|
| Rate for Payer: Meridian Medicaid |
$10.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: Nomi Health Commercial |
$75.61
|
| Rate for Payer: PACE Senior Care Partners |
$21.90
|
| Rate for Payer: PACE SWMI |
$23.05
|
| Rate for Payer: PHP Commercial |
$78.38
|
| Rate for Payer: PHP Medicare Advantage |
$23.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: Priority Health HMO/PPO |
$80.22
|
| Rate for Payer: Priority Health Medicare |
$23.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.78
|
| Rate for Payer: Railroad Medicare Medicare |
$23.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.14
|
| Rate for Payer: UHC Core |
$77.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.05
|
| Rate for Payer: UHC Exchange |
$23.05
|
| Rate for Payer: UHC Medicare Advantage |
$23.05
|
| Rate for Payer: UHCCP Medicaid |
$10.22
|
| Rate for Payer: VA VA |
$23.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.16
|
|
