|
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 |
$73.03 |
| 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 |
$73.03
|
| 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 |
$73.03 |
| 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 |
$73.03
|
| 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
|
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 |
$4.33
|
| 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 |
$1.57
|
| Rate for Payer: BCBS MAPPO |
$1.27
|
| Rate for Payer: BCBS Trust/PPO |
$4.19
|
| Rate for Payer: BCN Commercial |
$3.97
|
| Rate for Payer: BCN Medicare Advantage |
$1.27
|
| 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 |
$1.27
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.83
|
| Rate for Payer: Mclaren Medicaid |
$1.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.34
|
| Rate for Payer: Meridian Medicaid |
$1.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.33
|
| Rate for Payer: Nomi Health Commercial |
$4.18
|
| Rate for Payer: PACE Senior Care Partners |
$1.21
|
| Rate for Payer: PACE SWMI |
$1.27
|
| Rate for Payer: PHP Commercial |
$4.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.31
|
| 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 |
$1.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.49
|
| Rate for Payer: UHC Core |
$4.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.27
|
| Rate for Payer: UHC Exchange |
$1.27
|
| Rate for Payer: UHC Medicare Advantage |
$1.27
|
| Rate for Payer: UHCCP Medicaid |
$1.50
|
| Rate for Payer: VA VA |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.83
|
|
|
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 |
$3.31 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$4.33
|
| 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 |
$3.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.33
|
| Rate for Payer: Nomi Health Commercial |
$4.18
|
| Rate for Payer: PHP Commercial |
$4.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.31
|
| 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 |
$3.83
|
|
|
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 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 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
|
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 |
$16.07
|
| Rate for Payer: Meridian Medicaid |
$11.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.59
|
| 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 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/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 |
$93.47
|
| 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 |
$93.47
|
|
|
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 |
$93.47
|
| 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 |
$93.47
|
|
|
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 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 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
|
|
|
HC THEOPHYLLINE LEVEL
|
Facility
|
IP
|
$92.21
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
30100048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.94 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Aetna Commercial |
$78.38
|
| Rate for Payer: BCBS Trust/PPO |
$75.27
|
| Rate for Payer: BCN Commercial |
$71.26
|
| 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: Healthscope Commercial |
$82.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: Nomi Health Commercial |
$75.61
|
| Rate for Payer: PHP Commercial |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: Priority Health HMO/PPO |
$80.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.14
|
| Rate for Payer: UHC Core |
$77.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.16
|
|
|
HC THERAPEUTIC ACTIVITIES EA 15 MIN
|
Facility
|
OP
|
$98.84
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.47 |
| Max. Negotiated Rate |
$88.96 |
| Rate for Payer: Aetna Commercial |
$84.01
|
| Rate for Payer: Aetna Medicare |
$25.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.89
|
| Rate for Payer: BCBS Complete |
$39.54
|
| Rate for Payer: BCBS MAPPO |
$24.71
|
| Rate for Payer: BCBS Trust/PPO |
$81.26
|
| Rate for Payer: BCN Commercial |
$76.85
|
| Rate for Payer: BCN Medicare Advantage |
$24.71
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cofinity Commercial |
$85.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.71
|
| Rate for Payer: Healthscope Commercial |
$88.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.01
|
| Rate for Payer: Nomi Health Commercial |
$81.05
|
| Rate for Payer: PACE Senior Care Partners |
$23.47
|
| Rate for Payer: PACE SWMI |
$24.71
|
| Rate for Payer: PHP Commercial |
$84.01
|
| Rate for Payer: PHP Medicare Advantage |
$24.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.25
|
| Rate for Payer: Priority Health HMO/PPO |
$85.99
|
| Rate for Payer: Priority Health Medicare |
$24.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.22
|
| Rate for Payer: Railroad Medicare Medicare |
$24.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.98
|
| Rate for Payer: UHC Core |
$82.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.71
|
| Rate for Payer: UHC Exchange |
$24.71
|
| Rate for Payer: UHC Medicare Advantage |
$24.71
|
| Rate for Payer: VA VA |
$24.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.13
|
|
|
HC THERAPEUTIC ACTIVITIES EA 15 MIN
|
Facility
|
IP
|
$98.84
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.25 |
| Max. Negotiated Rate |
$88.96 |
| Rate for Payer: Aetna Commercial |
$84.01
|
| Rate for Payer: BCBS Trust/PPO |
$80.68
|
| Rate for Payer: BCN Commercial |
$76.38
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cofinity Commercial |
$85.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.07
|
| Rate for Payer: Healthscope Commercial |
$88.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.01
|
| Rate for Payer: Nomi Health Commercial |
$81.05
|
| Rate for Payer: PHP Commercial |
$84.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.25
|
| Rate for Payer: Priority Health HMO/PPO |
$85.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.98
|
| Rate for Payer: UHC Core |
$82.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.13
|
|
|
HC THERAPEUTIC APHERESIS PLASMA PHERESIS
|
Facility
|
OP
|
$2,555.49
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
36100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$606.93 |
| Max. Negotiated Rate |
$2,299.94 |
| Rate for Payer: Aetna Commercial |
$2,172.17
|
| Rate for Payer: Aetna Medicare |
$664.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$798.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$798.59
|
| Rate for Payer: BCBS Complete |
$1,244.54
|
| Rate for Payer: BCBS MAPPO |
$638.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,100.87
|
| Rate for Payer: BCN Commercial |
$1,986.89
|
| Rate for Payer: BCN Medicare Advantage |
$638.87
|
| Rate for Payer: Cash Price |
$2,044.39
|
| Rate for Payer: Cash Price |
$2,044.39
|
| Rate for Payer: Cofinity Commercial |
$2,197.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,044.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$638.87
|
| Rate for Payer: Healthscope Commercial |
$2,299.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,916.62
|
| Rate for Payer: Mclaren Medicaid |
$1,185.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$670.82
|
| Rate for Payer: Meridian Medicaid |
$1,244.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$734.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,172.17
|
| Rate for Payer: Nomi Health Commercial |
$2,095.50
|
| Rate for Payer: PACE Senior Care Partners |
$606.93
|
| Rate for Payer: PACE SWMI |
$638.87
|
| Rate for Payer: PHP Commercial |
$2,172.17
|
| Rate for Payer: PHP Medicare Advantage |
$638.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,185.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,661.07
|
| Rate for Payer: Priority Health HMO/PPO |
$2,223.28
|
| Rate for Payer: Priority Health Medicare |
$645.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,712.18
|
| Rate for Payer: Railroad Medicare Medicare |
$638.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,248.83
|
| Rate for Payer: UHC Core |
$2,133.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$638.87
|
| Rate for Payer: UHC Exchange |
$638.87
|
| Rate for Payer: UHC Medicare Advantage |
$638.87
|
| Rate for Payer: UHCCP Medicaid |
$1,185.20
|
| Rate for Payer: VA VA |
$638.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,916.62
|
|
|
HC THERAPEUTIC APHERESIS PLASMA PHERESIS
|
Facility
|
IP
|
$2,555.49
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
36100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,661.07 |
| Max. Negotiated Rate |
$2,299.94 |
| Rate for Payer: Aetna Commercial |
$2,172.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,086.05
|
| Rate for Payer: BCN Commercial |
$1,974.88
|
| Rate for Payer: Cash Price |
$2,044.39
|
| Rate for Payer: Cofinity Commercial |
$2,197.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,044.39
|
| Rate for Payer: Healthscope Commercial |
$2,299.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,916.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,172.17
|
| Rate for Payer: Nomi Health Commercial |
$2,095.50
|
| Rate for Payer: PHP Commercial |
$2,172.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,661.07
|
| Rate for Payer: Priority Health HMO/PPO |
$2,223.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,712.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,248.83
|
| Rate for Payer: UHC Core |
$2,133.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,916.62
|
|
|
HC THERAPEUTIC APHERESIS RED BLOOD CELLS
|
Facility
|
OP
|
$2,481.05
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$589.25 |
| Max. Negotiated Rate |
$2,232.95 |
| Rate for Payer: Aetna Commercial |
$2,108.89
|
| Rate for Payer: Aetna Medicare |
$645.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$775.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$775.33
|
| Rate for Payer: BCBS Complete |
$1,244.54
|
| Rate for Payer: BCBS MAPPO |
$620.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,039.67
|
| Rate for Payer: BCN Commercial |
$1,929.02
|
| Rate for Payer: BCN Medicare Advantage |
$620.26
|
| Rate for Payer: Cash Price |
$1,984.84
|
| Rate for Payer: Cash Price |
$1,984.84
|
| Rate for Payer: Cofinity Commercial |
$2,133.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,984.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$620.26
|
| Rate for Payer: Healthscope Commercial |
$2,232.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,860.79
|
| Rate for Payer: Mclaren Medicaid |
$1,185.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$651.28
|
| Rate for Payer: Meridian Medicaid |
$1,244.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$713.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,108.89
|
| Rate for Payer: Nomi Health Commercial |
$2,034.46
|
| Rate for Payer: PACE Senior Care Partners |
$589.25
|
| Rate for Payer: PACE SWMI |
$620.26
|
| Rate for Payer: PHP Commercial |
$2,108.89
|
| Rate for Payer: PHP Medicare Advantage |
$620.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,185.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,612.68
|
| Rate for Payer: Priority Health HMO/PPO |
$2,158.51
|
| Rate for Payer: Priority Health Medicare |
$626.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,662.30
|
| Rate for Payer: Railroad Medicare Medicare |
$620.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,183.32
|
| Rate for Payer: UHC Core |
$2,071.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$620.26
|
| Rate for Payer: UHC Exchange |
$620.26
|
| Rate for Payer: UHC Medicare Advantage |
$620.26
|
| Rate for Payer: UHCCP Medicaid |
$1,185.20
|
| Rate for Payer: VA VA |
$620.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,860.79
|
|
|
HC THERAPEUTIC APHERESIS RED BLOOD CELLS
|
Facility
|
IP
|
$2,481.05
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,612.68 |
| Max. Negotiated Rate |
$2,232.95 |
| Rate for Payer: Aetna Commercial |
$2,108.89
|
| Rate for Payer: BCBS Trust/PPO |
$2,025.28
|
| Rate for Payer: BCN Commercial |
$1,917.36
|
| Rate for Payer: Cash Price |
$1,984.84
|
| Rate for Payer: Cofinity Commercial |
$2,133.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,984.84
|
| Rate for Payer: Healthscope Commercial |
$2,232.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,860.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,108.89
|
| Rate for Payer: Nomi Health Commercial |
$2,034.46
|
| Rate for Payer: PHP Commercial |
$2,108.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,612.68
|
| Rate for Payer: Priority Health HMO/PPO |
$2,158.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,662.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,183.32
|
| Rate for Payer: UHC Core |
$2,071.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,860.79
|
|
|
HC THERAPEUTIC APHERESIS WHITE BLOOD CELL
|
Facility
|
OP
|
$2,481.05
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
76100327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$589.25 |
| Max. Negotiated Rate |
$2,232.95 |
| Rate for Payer: Aetna Commercial |
$2,108.89
|
| Rate for Payer: Aetna Medicare |
$645.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$775.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$775.33
|
| Rate for Payer: BCBS Complete |
$1,244.54
|
| Rate for Payer: BCBS MAPPO |
$620.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,039.67
|
| Rate for Payer: BCN Commercial |
$1,929.02
|
| Rate for Payer: BCN Medicare Advantage |
$620.26
|
| Rate for Payer: Cash Price |
$1,984.84
|
| Rate for Payer: Cash Price |
$1,984.84
|
| Rate for Payer: Cofinity Commercial |
$2,133.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,984.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$620.26
|
| Rate for Payer: Healthscope Commercial |
$2,232.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,860.79
|
| Rate for Payer: Mclaren Medicaid |
$1,185.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$651.28
|
| Rate for Payer: Meridian Medicaid |
$1,244.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$713.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,108.89
|
| Rate for Payer: Nomi Health Commercial |
$2,034.46
|
| Rate for Payer: PACE Senior Care Partners |
$589.25
|
| Rate for Payer: PACE SWMI |
$620.26
|
| Rate for Payer: PHP Commercial |
$2,108.89
|
| Rate for Payer: PHP Medicare Advantage |
$620.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,185.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,612.68
|
| Rate for Payer: Priority Health HMO/PPO |
$2,158.51
|
| Rate for Payer: Priority Health Medicare |
$626.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,662.30
|
| Rate for Payer: Railroad Medicare Medicare |
$620.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,183.32
|
| Rate for Payer: UHC Core |
$2,071.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$620.26
|
| Rate for Payer: UHC Exchange |
$620.26
|
| Rate for Payer: UHC Medicare Advantage |
$620.26
|
| Rate for Payer: UHCCP Medicaid |
$1,185.20
|
| Rate for Payer: VA VA |
$620.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,860.79
|
|
|
HC THERAPEUTIC APHERESIS WHITE BLOOD CELL
|
Facility
|
IP
|
$2,481.05
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
76100327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,612.68 |
| Max. Negotiated Rate |
$2,232.95 |
| Rate for Payer: Aetna Commercial |
$2,108.89
|
| Rate for Payer: BCBS Trust/PPO |
$2,025.28
|
| Rate for Payer: BCN Commercial |
$1,917.36
|
| Rate for Payer: Cash Price |
$1,984.84
|
| Rate for Payer: Cofinity Commercial |
$2,133.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,984.84
|
| Rate for Payer: Healthscope Commercial |
$2,232.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,860.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,108.89
|
| Rate for Payer: Nomi Health Commercial |
$2,034.46
|
| Rate for Payer: PHP Commercial |
$2,108.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,612.68
|
| Rate for Payer: Priority Health HMO/PPO |
$2,158.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,662.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,183.32
|
| Rate for Payer: UHC Core |
$2,071.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,860.79
|
|
