|
HC TENOTOMY PERCUTANEOUS ACHILLES TENDON
|
Facility
|
IP
|
$3,664.59
|
|
| Hospital Charge Code |
36000097
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,612.42 |
| Max. Negotiated Rate |
$3,298.13 |
| Rate for Payer: Aetna American Axle |
$2,381.98
|
| Rate for Payer: Aetna Commercial |
$3,114.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,381.98
|
| Rate for Payer: Cash Price |
$2,931.67
|
| Rate for Payer: Cofinity Commercial |
$2,565.21
|
| Rate for Payer: Cofinity Commercial |
$3,151.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,931.67
|
| Rate for Payer: Healthscope Commercial |
$3,298.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,565.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,748.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,114.90
|
| Rate for Payer: PHP Commercial |
$3,114.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,565.21
|
| Rate for Payer: Priority Health SBD |
$2,308.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,612.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,748.44
|
|
|
HC TENOTOMY PERCUTANEOUS ADDUCTOR OR HAMSTRING
|
Facility
|
IP
|
$3,500.03
|
|
| Hospital Charge Code |
36000094
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,540.01 |
| Max. Negotiated Rate |
$3,150.03 |
| Rate for Payer: Aetna American Axle |
$2,275.02
|
| Rate for Payer: Aetna Commercial |
$2,975.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,275.02
|
| Rate for Payer: Cash Price |
$2,800.02
|
| Rate for Payer: Cofinity Commercial |
$2,450.02
|
| Rate for Payer: Cofinity Commercial |
$3,010.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,800.02
|
| Rate for Payer: Healthscope Commercial |
$3,150.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,450.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,625.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,975.03
|
| Rate for Payer: PHP Commercial |
$2,975.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,450.02
|
| Rate for Payer: Priority Health SBD |
$2,205.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,540.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,625.02
|
|
|
HC TENOTOMY PERCUTANEOUS ADDUCTOR OR HAMSTRING
|
Facility
|
OP
|
$3,500.03
|
|
| Hospital Charge Code |
36000094
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,295.01 |
| Max. Negotiated Rate |
$3,150.03 |
| Rate for Payer: Aetna American Axle |
$2,275.02
|
| Rate for Payer: Aetna Commercial |
$2,975.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,275.02
|
| Rate for Payer: BCBS Complete |
$1,400.01
|
| Rate for Payer: Cash Price |
$2,800.02
|
| Rate for Payer: Cofinity Commercial |
$2,450.02
|
| Rate for Payer: Cofinity Commercial |
$3,010.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,800.02
|
| Rate for Payer: Healthscope Commercial |
$3,150.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,450.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,625.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,975.03
|
| Rate for Payer: PHP Commercial |
$2,975.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,450.02
|
| Rate for Payer: Priority Health SBD |
$2,205.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,295.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,625.02
|
|
|
HC TENOTOMY SHOULDER AREA SINGLE TENDON
|
Facility
|
OP
|
$4,731.68
|
|
| Hospital Charge Code |
36000098
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,750.72 |
| Max. Negotiated Rate |
$4,258.51 |
| Rate for Payer: Aetna American Axle |
$3,075.59
|
| Rate for Payer: Aetna Commercial |
$4,021.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,075.59
|
| Rate for Payer: BCBS Complete |
$1,892.67
|
| Rate for Payer: Cash Price |
$3,785.34
|
| Rate for Payer: Cofinity Commercial |
$3,312.18
|
| Rate for Payer: Cofinity Commercial |
$4,069.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,785.34
|
| Rate for Payer: Healthscope Commercial |
$4,258.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,312.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,548.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,021.93
|
| Rate for Payer: PHP Commercial |
$4,021.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,312.18
|
| Rate for Payer: Priority Health SBD |
$2,980.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,750.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,548.76
|
|
|
HC TENOTOMY SHOULDER AREA SINGLE TENDON
|
Facility
|
IP
|
$4,731.68
|
|
| Hospital Charge Code |
36000098
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,081.94 |
| Max. Negotiated Rate |
$4,258.51 |
| Rate for Payer: Aetna American Axle |
$3,075.59
|
| Rate for Payer: Aetna Commercial |
$4,021.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,075.59
|
| Rate for Payer: Cash Price |
$3,785.34
|
| Rate for Payer: Cofinity Commercial |
$3,312.18
|
| Rate for Payer: Cofinity Commercial |
$4,069.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,785.34
|
| Rate for Payer: Healthscope Commercial |
$4,258.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,312.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,548.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,021.93
|
| Rate for Payer: PHP Commercial |
$4,021.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,312.18
|
| Rate for Payer: Priority Health SBD |
$2,980.96
|
| Rate for Payer: UMR Bronson Commercial |
$2,081.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,548.76
|
|
|
HC TENOTOMY TOE SINGLE TENDON
|
Facility
|
IP
|
$2,175.64
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
45000092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$957.28 |
| Max. Negotiated Rate |
$1,958.08 |
| Rate for Payer: Aetna American Axle |
$1,414.17
|
| Rate for Payer: Aetna Commercial |
$1,849.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,414.17
|
| Rate for Payer: Cash Price |
$1,740.51
|
| Rate for Payer: Cofinity Commercial |
$1,871.05
|
| Rate for Payer: Cofinity Commercial |
$1,522.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,740.51
|
| Rate for Payer: Healthscope Commercial |
$1,958.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,522.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,631.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,849.29
|
| Rate for Payer: PHP Commercial |
$1,849.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,522.95
|
| Rate for Payer: Priority Health SBD |
$1,370.65
|
| Rate for Payer: UMR Bronson Commercial |
$957.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,631.73
|
|
|
HC TENOTOMY TOE SINGLE TENDON
|
Facility
|
OP
|
$2,175.64
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
45000092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.21 |
| Max. Negotiated Rate |
$4,497.31 |
| Rate for Payer: Aetna American Axle |
$1,414.17
|
| Rate for Payer: Aetna Commercial |
$1,849.29
|
| Rate for Payer: Aetna Medicare |
$1,485.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,414.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,785.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,785.76
|
| Rate for Payer: BCBS Complete |
$820.59
|
| Rate for Payer: BCBS MAPPO |
$1,428.61
|
| Rate for Payer: BCBS Trust/PPO |
$156.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,428.61
|
| Rate for Payer: Cash Price |
$1,740.51
|
| Rate for Payer: Cash Price |
$1,740.51
|
| Rate for Payer: Cofinity Commercial |
$1,522.95
|
| Rate for Payer: Cofinity Commercial |
$1,871.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,740.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,428.61
|
| Rate for Payer: Healthscope Commercial |
$1,958.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,522.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,631.73
|
| Rate for Payer: Mclaren Medicaid |
$781.45
|
| Rate for Payer: Mclaren Medicare |
$1,428.61
|
| Rate for Payer: Meridian Medicaid |
$820.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,500.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,642.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,849.29
|
| Rate for Payer: PACE Medicare |
$1,357.18
|
| Rate for Payer: PACE SWMI |
$1,428.61
|
| Rate for Payer: PHP Commercial |
$1,849.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,428.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$781.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,522.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,497.31
|
| Rate for Payer: Priority Health Medicare |
$1,428.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,597.85
|
| Rate for Payer: Priority Health SBD |
$1,370.65
|
| Rate for Payer: Railroad Medicare Medicare |
$1,428.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,428.61
|
| Rate for Payer: UHC Exchange |
$206.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,471.47
|
| Rate for Payer: UMR Bronson Commercial |
$804.99
|
| Rate for Payer: VA VA |
$1,428.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,631.73
|
|
|
HC TESTOSTERONE BIOAVAILABLE
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100429
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna American Axle |
$49.72
|
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$26.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.84
|
| Rate for Payer: BCBS Complete |
$14.63
|
| Rate for Payer: BCBS MAPPO |
$25.47
|
| Rate for Payer: BCBS Trust/PPO |
$22.90
|
| Rate for Payer: BCN Medicare Advantage |
$25.47
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.47
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Mclaren Medicaid |
$13.93
|
| Rate for Payer: Mclaren Medicare |
$25.47
|
| Rate for Payer: Meridian Medicaid |
$14.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$24.20
|
| Rate for Payer: PACE SWMI |
$25.47
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$25.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.94
|
| Rate for Payer: Priority Health Medicare |
$25.47
|
| Rate for Payer: Priority Health Narrow Network |
$27.95
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: Railroad Medicare Medicare |
$25.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.56
|
| Rate for Payer: UHC Core |
$42.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.47
|
| Rate for Payer: UHC Exchange |
$25.47
|
| Rate for Payer: UHC Medicare Advantage |
$26.23
|
| Rate for Payer: UMR Bronson Commercial |
$28.30
|
| Rate for Payer: VA VA |
$25.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC TESTOSTERONE BIOAVAILABLE
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100429
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna American Axle |
$49.72
|
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: UMR Bronson Commercial |
$33.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC TESTOSTERONE FREE
|
Facility
|
IP
|
$43.91
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100428
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$39.52 |
| Rate for Payer: Aetna American Axle |
$28.54
|
| Rate for Payer: Aetna Commercial |
$37.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.54
|
| Rate for Payer: Cash Price |
$35.13
|
| Rate for Payer: Cofinity Commercial |
$37.76
|
| Rate for Payer: Cofinity Commercial |
$30.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.13
|
| Rate for Payer: Healthscope Commercial |
$39.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.32
|
| Rate for Payer: PHP Commercial |
$37.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.74
|
| Rate for Payer: Priority Health SBD |
$27.66
|
| Rate for Payer: UMR Bronson Commercial |
$19.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.93
|
|
|
HC TESTOSTERONE FREE
|
Facility
|
OP
|
$43.91
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100428
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna American Axle |
$28.54
|
| Rate for Payer: Aetna Commercial |
$37.32
|
| Rate for Payer: Aetna Medicare |
$26.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.84
|
| Rate for Payer: BCBS Complete |
$14.63
|
| Rate for Payer: BCBS MAPPO |
$25.47
|
| Rate for Payer: BCBS Trust/PPO |
$22.90
|
| Rate for Payer: BCN Medicare Advantage |
$25.47
|
| Rate for Payer: Cash Price |
$35.13
|
| Rate for Payer: Cash Price |
$35.13
|
| Rate for Payer: Cofinity Commercial |
$37.76
|
| Rate for Payer: Cofinity Commercial |
$30.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.47
|
| Rate for Payer: Healthscope Commercial |
$39.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.93
|
| Rate for Payer: Mclaren Medicaid |
$13.93
|
| Rate for Payer: Mclaren Medicare |
$25.47
|
| Rate for Payer: Meridian Medicaid |
$14.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.32
|
| Rate for Payer: PACE Medicare |
$24.20
|
| Rate for Payer: PACE SWMI |
$25.47
|
| Rate for Payer: PHP Commercial |
$37.32
|
| Rate for Payer: PHP Medicare Advantage |
$25.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.94
|
| Rate for Payer: Priority Health Medicare |
$25.47
|
| Rate for Payer: Priority Health Narrow Network |
$27.95
|
| Rate for Payer: Priority Health SBD |
$27.66
|
| Rate for Payer: Railroad Medicare Medicare |
$25.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.56
|
| Rate for Payer: UHC Core |
$42.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.47
|
| Rate for Payer: UHC Exchange |
$25.47
|
| Rate for Payer: UHC Medicare Advantage |
$26.23
|
| Rate for Payer: UMR Bronson Commercial |
$16.25
|
| Rate for Payer: VA VA |
$25.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.93
|
|
|
HC TESTOSTERONE, FREE & WKLY BOUND
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100736
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna American Axle |
$52.00
|
| Rate for Payer: Aetna Commercial |
$68.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$68.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.00
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.00
|
| Rate for Payer: PHP Commercial |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health SBD |
$50.40
|
| Rate for Payer: UMR Bronson Commercial |
$35.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.00
|
|
|
HC TESTOSTERONE, FREE & WKLY BOUND
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100736
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$87.06 |
| Rate for Payer: Aetna American Axle |
$52.00
|
| Rate for Payer: Aetna Commercial |
$68.00
|
| Rate for Payer: Aetna Medicare |
$53.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.10
|
| Rate for Payer: BCBS Complete |
$29.46
|
| Rate for Payer: BCBS MAPPO |
$51.28
|
| Rate for Payer: BCBS Trust/PPO |
$46.12
|
| Rate for Payer: BCN Medicare Advantage |
$51.28
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$68.80
|
| Rate for Payer: Cofinity Commercial |
$56.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.28
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.00
|
| Rate for Payer: Mclaren Medicaid |
$28.05
|
| Rate for Payer: Mclaren Medicare |
$51.28
|
| Rate for Payer: Meridian Medicaid |
$29.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.00
|
| Rate for Payer: PACE Medicare |
$48.72
|
| Rate for Payer: PACE SWMI |
$51.28
|
| Rate for Payer: PHP Commercial |
$68.00
|
| Rate for Payer: PHP Medicare Advantage |
$51.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.55
|
| Rate for Payer: Priority Health Medicare |
$51.28
|
| Rate for Payer: Priority Health Narrow Network |
$58.04
|
| Rate for Payer: Priority Health SBD |
$50.40
|
| Rate for Payer: Railroad Medicare Medicare |
$51.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.54
|
| Rate for Payer: UHC Core |
$87.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.28
|
| Rate for Payer: UHC Exchange |
$51.28
|
| Rate for Payer: UHC Medicare Advantage |
$52.82
|
| Rate for Payer: UMR Bronson Commercial |
$29.60
|
| Rate for Payer: VA VA |
$51.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.00
|
|
|
HC TESTOSTERONE LEVEL
|
Facility
|
OP
|
$85.13
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100430
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$76.62 |
| Rate for Payer: Aetna American Axle |
$55.33
|
| Rate for Payer: Aetna Commercial |
$72.36
|
| Rate for Payer: Aetna Medicare |
$26.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.26
|
| Rate for Payer: BCBS Complete |
$14.83
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCBS Trust/PPO |
$23.21
|
| Rate for Payer: BCN Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cofinity Commercial |
$59.59
|
| Rate for Payer: Cofinity Commercial |
$73.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$76.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.85
|
| Rate for Payer: Mclaren Medicaid |
$14.12
|
| Rate for Payer: Mclaren Medicare |
$25.81
|
| Rate for Payer: Meridian Medicaid |
$14.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.36
|
| Rate for Payer: PACE Medicare |
$24.52
|
| Rate for Payer: PACE SWMI |
$25.81
|
| Rate for Payer: PHP Commercial |
$72.36
|
| Rate for Payer: PHP Medicare Advantage |
$25.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.41
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health Narrow Network |
$28.33
|
| Rate for Payer: Priority Health SBD |
$53.63
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.97
|
| Rate for Payer: UHC Core |
$42.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.81
|
| Rate for Payer: UHC Exchange |
$25.81
|
| Rate for Payer: UHC Medicare Advantage |
$26.58
|
| Rate for Payer: UMR Bronson Commercial |
$31.50
|
| Rate for Payer: VA VA |
$25.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.85
|
|
|
HC TESTOSTERONE LEVEL
|
Facility
|
IP
|
$85.13
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100430
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.46 |
| Max. Negotiated Rate |
$76.62 |
| Rate for Payer: Aetna American Axle |
$55.33
|
| Rate for Payer: Aetna Commercial |
$72.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.33
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cofinity Commercial |
$73.21
|
| Rate for Payer: Cofinity Commercial |
$59.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.10
|
| Rate for Payer: Healthscope Commercial |
$76.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.36
|
| Rate for Payer: PHP Commercial |
$72.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.59
|
| Rate for Payer: Priority Health SBD |
$53.63
|
| Rate for Payer: UMR Bronson Commercial |
$37.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.85
|
|
|
HC TESTOSTERONE LEVEL TOTAL
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100431
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$26.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.26
|
| Rate for Payer: BCBS Complete |
$14.83
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCBS Trust/PPO |
$23.21
|
| Rate for Payer: BCN Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$14.12
|
| Rate for Payer: Mclaren Medicare |
$25.81
|
| Rate for Payer: Meridian Medicaid |
$14.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.03
|
| Rate for Payer: PACE Medicare |
$24.52
|
| Rate for Payer: PACE SWMI |
$25.81
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Medicare Advantage |
$25.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.41
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health Narrow Network |
$28.33
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.97
|
| Rate for Payer: UHC Core |
$42.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.81
|
| Rate for Payer: UHC Exchange |
$25.81
|
| Rate for Payer: UHC Medicare Advantage |
$26.58
|
| Rate for Payer: UMR Bronson Commercial |
$33.97
|
| Rate for Payer: VA VA |
$25.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC TESTOSTERONE LEVEL TOTAL
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100431
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.26
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: UMR Bronson Commercial |
$40.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC TESTOSTERONE PELLETS EACH
|
Facility
|
IP
|
$220.32
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.94 |
| Max. Negotiated Rate |
$198.29 |
| Rate for Payer: Aetna American Axle |
$143.21
|
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.21
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$154.22
|
| Rate for Payer: Cofinity Commercial |
$189.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Healthscope Commercial |
$198.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.27
|
| Rate for Payer: PHP Commercial |
$187.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.22
|
| Rate for Payer: Priority Health SBD |
$138.80
|
| Rate for Payer: UMR Bronson Commercial |
$96.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.24
|
|
|
HC TESTOSTERONE PELLETS EACH
|
Facility
|
OP
|
$220.32
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.52 |
| Max. Negotiated Rate |
$198.29 |
| Rate for Payer: Aetna American Axle |
$143.21
|
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.21
|
| Rate for Payer: BCBS Complete |
$88.13
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$154.22
|
| Rate for Payer: Cofinity Commercial |
$189.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Healthscope Commercial |
$198.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.27
|
| Rate for Payer: PHP Commercial |
$187.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.22
|
| Rate for Payer: Priority Health SBD |
$138.80
|
| Rate for Payer: UMR Bronson Commercial |
$81.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.24
|
|
|
HC TESTOSTERONE, T, BIO, FREE
|
Facility
|
OP
|
$79.56
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna American Axle |
$51.71
|
| Rate for Payer: Aetna Commercial |
$67.63
|
| Rate for Payer: Aetna Medicare |
$26.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.26
|
| Rate for Payer: BCBS Complete |
$14.83
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCBS Trust/PPO |
$23.21
|
| Rate for Payer: BCN Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Cofinity Commercial |
$68.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$71.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.67
|
| Rate for Payer: Mclaren Medicaid |
$14.12
|
| Rate for Payer: Mclaren Medicare |
$25.81
|
| Rate for Payer: Meridian Medicaid |
$14.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.63
|
| Rate for Payer: PACE Medicare |
$24.52
|
| Rate for Payer: PACE SWMI |
$25.81
|
| Rate for Payer: PHP Commercial |
$67.63
|
| Rate for Payer: PHP Medicare Advantage |
$25.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.41
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health Narrow Network |
$28.33
|
| Rate for Payer: Priority Health SBD |
$50.12
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.97
|
| Rate for Payer: UHC Core |
$42.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.81
|
| Rate for Payer: UHC Exchange |
$25.81
|
| Rate for Payer: UHC Medicare Advantage |
$26.58
|
| Rate for Payer: UMR Bronson Commercial |
$29.44
|
| Rate for Payer: VA VA |
$25.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.67
|
|
|
HC TESTOSTERONE, T, BIO, FREE
|
Facility
|
IP
|
$79.56
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna American Axle |
$51.71
|
| Rate for Payer: Aetna Commercial |
$67.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.71
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$68.42
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$71.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.63
|
| Rate for Payer: PHP Commercial |
$67.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: Priority Health SBD |
$50.12
|
| Rate for Payer: UMR Bronson Commercial |
$35.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.67
|
|
|
HC TESTOSTERONE UNDECANOATE PER 1 MG
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$5.93 |
| Rate for Payer: Aetna American Axle |
$3.25
|
| Rate for Payer: Aetna Commercial |
$4.25
|
| Rate for Payer: Aetna Medicare |
$1.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.30
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS MAPPO |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$5.93
|
| Rate for Payer: BCN Medicare Advantage |
$1.84
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$4.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.84
|
| Rate for Payer: Healthscope Commercial |
$4.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.75
|
| Rate for Payer: Mclaren Medicaid |
$1.00
|
| Rate for Payer: Mclaren Medicare |
$1.84
|
| Rate for Payer: Meridian Medicaid |
$1.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.25
|
| Rate for Payer: PACE Medicare |
$1.75
|
| Rate for Payer: PACE SWMI |
$1.84
|
| Rate for Payer: PHP Commercial |
$4.25
|
| Rate for Payer: PHP Medicare Advantage |
$1.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.11
|
| Rate for Payer: Priority Health Medicare |
$1.84
|
| Rate for Payer: Priority Health Narrow Network |
$4.09
|
| Rate for Payer: Priority Health SBD |
$3.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.84
|
| Rate for Payer: UHC Medicare Advantage |
$1.89
|
| Rate for Payer: UMR Bronson Commercial |
$1.85
|
| Rate for Payer: VA VA |
$1.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.75
|
|
|
HC TESTOSTERONE UNDECANOATE PER 1 MG
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna American Axle |
$3.25
|
| Rate for Payer: Aetna Commercial |
$4.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.25
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$4.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.00
|
| Rate for Payer: Healthscope Commercial |
$4.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.25
|
| Rate for Payer: PHP Commercial |
$4.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health SBD |
$3.15
|
| Rate for Payer: UMR Bronson Commercial |
$2.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.75
|
|
|
HC TESTOSTERONE UNLISTED CHEMISTRY
|
Facility
|
OP
|
$81.02
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100642
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$87.06 |
| Rate for Payer: Aetna American Axle |
$52.66
|
| Rate for Payer: Aetna Commercial |
$68.87
|
| Rate for Payer: Aetna Medicare |
$53.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.10
|
| Rate for Payer: BCBS Complete |
$29.46
|
| Rate for Payer: BCBS MAPPO |
$51.28
|
| Rate for Payer: BCBS Trust/PPO |
$46.12
|
| Rate for Payer: BCN Medicare Advantage |
$51.28
|
| Rate for Payer: Cash Price |
$64.82
|
| Rate for Payer: Cash Price |
$64.82
|
| Rate for Payer: Cofinity Commercial |
$56.71
|
| Rate for Payer: Cofinity Commercial |
$69.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.28
|
| Rate for Payer: Healthscope Commercial |
$72.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.76
|
| Rate for Payer: Mclaren Medicaid |
$28.05
|
| Rate for Payer: Mclaren Medicare |
$51.28
|
| Rate for Payer: Meridian Medicaid |
$29.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.87
|
| Rate for Payer: PACE Medicare |
$48.72
|
| Rate for Payer: PACE SWMI |
$51.28
|
| Rate for Payer: PHP Commercial |
$68.87
|
| Rate for Payer: PHP Medicare Advantage |
$51.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.55
|
| Rate for Payer: Priority Health Medicare |
$51.28
|
| Rate for Payer: Priority Health Narrow Network |
$58.04
|
| Rate for Payer: Priority Health SBD |
$51.04
|
| Rate for Payer: Railroad Medicare Medicare |
$51.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.54
|
| Rate for Payer: UHC Core |
$87.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.28
|
| Rate for Payer: UHC Exchange |
$51.28
|
| Rate for Payer: UHC Medicare Advantage |
$52.82
|
| Rate for Payer: UMR Bronson Commercial |
$29.98
|
| Rate for Payer: VA VA |
$51.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.76
|
|
|
HC TESTOSTERONE UNLISTED CHEMISTRY
|
Facility
|
IP
|
$81.02
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100642
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.65 |
| Max. Negotiated Rate |
$72.92 |
| Rate for Payer: Aetna American Axle |
$52.66
|
| Rate for Payer: Aetna Commercial |
$68.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.66
|
| Rate for Payer: Cash Price |
$64.82
|
| Rate for Payer: Cofinity Commercial |
$56.71
|
| Rate for Payer: Cofinity Commercial |
$69.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.82
|
| Rate for Payer: Healthscope Commercial |
$72.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.87
|
| Rate for Payer: PHP Commercial |
$68.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.71
|
| Rate for Payer: Priority Health SBD |
$51.04
|
| Rate for Payer: UMR Bronson Commercial |
$35.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.76
|
|
