|
HC TESTOSTERONE FREE
|
Facility
|
IP
|
$44.79
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100428
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.71 |
| Max. Negotiated Rate |
$40.31 |
| Rate for Payer: Aetna American Axle |
$29.11
|
| Rate for Payer: Aetna Commercial |
$38.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.11
|
| Rate for Payer: Cash Price |
$35.83
|
| Rate for Payer: Cofinity Commercial |
$31.35
|
| Rate for Payer: Cofinity Commercial |
$38.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.83
|
| Rate for Payer: Healthscope Commercial |
$40.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.07
|
| Rate for Payer: PHP Commercial |
$38.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.11
|
| Rate for Payer: Priority Health SBD |
$28.22
|
| Rate for Payer: UMR Bronson Commercial |
$19.71
|
| 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 |
$13.65 |
| Max. Negotiated Rate |
$40.31 |
| Rate for Payer: Aetna American Axle |
$29.11
|
| Rate for Payer: Aetna Commercial |
$38.07
|
| Rate for Payer: Aetna Medicare |
$26.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.11
|
| 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 |
$14.33
|
| Rate for Payer: BCBS MAPPO |
$25.47
|
| Rate for Payer: BCBS Trust/PPO |
$24.54
|
| Rate for Payer: BCN Commercial |
$24.54
|
| Rate for Payer: BCN Medicare Advantage |
$25.47
|
| Rate for Payer: Cash Price |
$35.83
|
| Rate for Payer: Cash Price |
$35.83
|
| Rate for Payer: Cofinity Commercial |
$38.52
|
| Rate for Payer: Cofinity Commercial |
$31.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.47
|
| Rate for Payer: Healthscope Commercial |
$40.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.59
|
| Rate for Payer: Mclaren Medicaid |
$13.65
|
| Rate for Payer: Mclaren Medicare |
$25.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.74
|
| Rate for Payer: Meridian Medicaid |
$14.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.07
|
| Rate for Payer: Nomi Health Commercial |
$38.20
|
| Rate for Payer: PACE Medicare |
$24.20
|
| Rate for Payer: PACE SWMI |
$25.47
|
| Rate for Payer: PHP Commercial |
$38.07
|
| Rate for Payer: PHP Medicare Advantage |
$25.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.21
|
| Rate for Payer: Priority Health Medicare |
$25.47
|
| Rate for Payer: Priority Health Narrow Network |
$20.97
|
| Rate for Payer: Priority Health SBD |
$28.22
|
| Rate for Payer: Railroad Medicare Medicare |
$25.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.47
|
| Rate for Payer: UHC Exchange |
$25.47
|
| Rate for Payer: UHC Medicare Advantage |
$25.47
|
| Rate for Payer: UHCCP Medicaid |
$13.65
|
| Rate for Payer: UMR Bronson Commercial |
$16.57
|
| Rate for Payer: VA VA |
$25.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.59
|
|
|
HC TESTOSTERONE, FREE & WKLY BOUND
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100736
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna American Axle |
$53.04
|
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.04
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health SBD |
$51.41
|
| Rate for Payer: UMR Bronson Commercial |
$35.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.20
|
|
|
HC TESTOSTERONE, FREE & WKLY BOUND
|
Facility
|
OP
|
$81.60
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100736
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.49 |
| Max. Negotiated Rate |
$76.92 |
| Rate for Payer: Aetna American Axle |
$53.04
|
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna Medicare |
$53.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.04
|
| 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 |
$28.86
|
| Rate for Payer: BCBS MAPPO |
$51.28
|
| Rate for Payer: BCBS Trust/PPO |
$49.41
|
| Rate for Payer: BCN Commercial |
$49.41
|
| Rate for Payer: BCN Medicare Advantage |
$51.28
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$57.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.28
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.20
|
| Rate for Payer: Mclaren Medicaid |
$27.49
|
| Rate for Payer: Mclaren Medicare |
$51.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.84
|
| Rate for Payer: Meridian Medicaid |
$28.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: Nomi Health Commercial |
$76.92
|
| Rate for Payer: PACE Medicare |
$48.72
|
| Rate for Payer: PACE SWMI |
$51.28
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: PHP Medicare Advantage |
$51.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.41
|
| Rate for Payer: Priority Health Medicare |
$51.28
|
| Rate for Payer: Priority Health Narrow Network |
$43.53
|
| Rate for Payer: Priority Health SBD |
$51.41
|
| Rate for Payer: Railroad Medicare Medicare |
$51.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.28
|
| Rate for Payer: UHC Exchange |
$51.28
|
| Rate for Payer: UHC Medicare Advantage |
$51.28
|
| Rate for Payer: UHCCP Medicaid |
$27.49
|
| Rate for Payer: UMR Bronson Commercial |
$30.19
|
| Rate for Payer: VA VA |
$51.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.20
|
|
|
HC TESTOSTERONE LEVEL
|
Facility
|
OP
|
$86.83
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100430
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$78.15 |
| Rate for Payer: Aetna American Axle |
$56.44
|
| Rate for Payer: Aetna Commercial |
$73.81
|
| Rate for Payer: Aetna Medicare |
$26.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.44
|
| 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 |
$14.53
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCBS Trust/PPO |
$24.87
|
| Rate for Payer: BCN Commercial |
$24.87
|
| Rate for Payer: BCN Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$69.46
|
| Rate for Payer: Cash Price |
$69.46
|
| Rate for Payer: Cofinity Commercial |
$74.67
|
| Rate for Payer: Cofinity Commercial |
$60.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$78.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.12
|
| Rate for Payer: Mclaren Medicaid |
$13.83
|
| Rate for Payer: Mclaren Medicare |
$25.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.10
|
| Rate for Payer: Meridian Medicaid |
$14.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.81
|
| Rate for Payer: Nomi Health Commercial |
$38.72
|
| Rate for Payer: PACE Medicare |
$24.52
|
| Rate for Payer: PACE SWMI |
$25.81
|
| Rate for Payer: PHP Commercial |
$73.81
|
| Rate for Payer: PHP Medicare Advantage |
$25.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.56
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health Narrow Network |
$21.25
|
| Rate for Payer: Priority Health SBD |
$54.70
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.81
|
| Rate for Payer: UHC Exchange |
$25.81
|
| Rate for Payer: UHC Medicare Advantage |
$25.81
|
| Rate for Payer: UHCCP Medicaid |
$13.83
|
| Rate for Payer: UMR Bronson Commercial |
$32.13
|
| Rate for Payer: VA VA |
$25.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.12
|
|
|
HC TESTOSTERONE LEVEL
|
Facility
|
IP
|
$86.83
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100430
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.21 |
| Max. Negotiated Rate |
$78.15 |
| Rate for Payer: Aetna American Axle |
$56.44
|
| Rate for Payer: Aetna Commercial |
$73.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.44
|
| Rate for Payer: Cash Price |
$69.46
|
| Rate for Payer: Cofinity Commercial |
$60.78
|
| Rate for Payer: Cofinity Commercial |
$74.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.46
|
| Rate for Payer: Healthscope Commercial |
$78.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.81
|
| Rate for Payer: PHP Commercial |
$73.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.44
|
| Rate for Payer: Priority Health SBD |
$54.70
|
| Rate for Payer: UMR Bronson Commercial |
$38.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.12
|
|
|
HC TESTOSTERONE LEVEL TOTAL
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100431
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Cofinity Medicare Advantage |
$65.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: UMR Bronson Commercial |
$41.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
| Rate for Payer: Aetna American Axle |
$60.87
|
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
|
|
HC TESTOSTERONE LEVEL TOTAL
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100431
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna American Axle |
$60.87
|
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$26.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| 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 |
$14.53
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCBS Trust/PPO |
$24.87
|
| Rate for Payer: BCN Commercial |
$24.87
|
| Rate for Payer: BCN Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Cofinity Commercial |
$65.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$13.83
|
| Rate for Payer: Mclaren Medicare |
$25.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.10
|
| Rate for Payer: Meridian Medicaid |
$14.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$38.72
|
| Rate for Payer: PACE Medicare |
$24.52
|
| Rate for Payer: PACE SWMI |
$25.81
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: PHP Medicare Advantage |
$25.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.56
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health Narrow Network |
$21.25
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.81
|
| Rate for Payer: UHC Exchange |
$25.81
|
| Rate for Payer: UHC Medicare Advantage |
$25.81
|
| Rate for Payer: UHCCP Medicaid |
$13.83
|
| Rate for Payer: UMR Bronson Commercial |
$34.65
|
| Rate for Payer: VA VA |
$25.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC TESTOSTERONE PELLETS EACH
|
Facility
|
IP
|
$224.73
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.88 |
| Max. Negotiated Rate |
$202.26 |
| Rate for Payer: Aetna American Axle |
$146.07
|
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.07
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$193.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$202.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: PHP Commercial |
$191.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: Priority Health SBD |
$141.58
|
| Rate for Payer: UMR Bronson Commercial |
$98.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.55
|
|
|
HC TESTOSTERONE PELLETS EACH
|
Facility
|
OP
|
$224.73
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.15 |
| Max. Negotiated Rate |
$202.26 |
| Rate for Payer: Aetna American Axle |
$146.07
|
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: Aetna Medicare |
$112.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.07
|
| Rate for Payer: BCBS Complete |
$89.89
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$157.31
|
| Rate for Payer: Cofinity Commercial |
$193.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$202.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: PHP Commercial |
$191.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: Priority Health SBD |
$141.58
|
| Rate for Payer: UMR Bronson Commercial |
$83.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.55
|
|
|
HC TESTOSTERONE, T, BIO, FREE
|
Facility
|
IP
|
$81.15
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.71 |
| Max. Negotiated Rate |
$73.04 |
| Rate for Payer: Aetna American Axle |
$52.75
|
| Rate for Payer: Aetna Commercial |
$68.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.75
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$69.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Healthscope Commercial |
$73.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: PHP Commercial |
$68.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.75
|
| Rate for Payer: Priority Health SBD |
$51.12
|
| Rate for Payer: UMR Bronson Commercial |
$35.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.86
|
|
|
HC TESTOSTERONE, T, BIO, FREE
|
Facility
|
OP
|
$81.15
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$73.04 |
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$69.79
|
| Rate for Payer: Cofinity Commercial |
$56.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$73.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.86
|
| Rate for Payer: Mclaren Medicaid |
$13.83
|
| Rate for Payer: Mclaren Medicare |
$25.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.10
|
| Rate for Payer: Meridian Medicaid |
$14.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: Nomi Health Commercial |
$38.72
|
| Rate for Payer: PACE Medicare |
$24.52
|
| Rate for Payer: PACE SWMI |
$25.81
|
| Rate for Payer: PHP Commercial |
$68.98
|
| Rate for Payer: PHP Medicare Advantage |
$25.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.56
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health Narrow Network |
$21.25
|
| Rate for Payer: Priority Health SBD |
$51.12
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.81
|
| Rate for Payer: UHC Exchange |
$25.81
|
| Rate for Payer: UHC Medicare Advantage |
$25.81
|
| Rate for Payer: UHCCP Medicaid |
$13.83
|
| Rate for Payer: UMR Bronson Commercial |
$30.03
|
| Rate for Payer: VA VA |
$25.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.86
|
| Rate for Payer: Aetna American Axle |
$52.75
|
| Rate for Payer: Aetna Commercial |
$68.98
|
| Rate for Payer: Aetna Medicare |
$26.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.75
|
| 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 |
$14.53
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCBS Trust/PPO |
$24.87
|
| Rate for Payer: BCN Commercial |
$24.87
|
| Rate for Payer: BCN Medicare Advantage |
$25.81
|
|
|
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 |
$2.24 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna American Axle |
$3.32
|
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.32
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.08
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.34
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health SBD |
$3.21
|
| Rate for Payer: UMR Bronson Commercial |
$2.24
|
| 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 |
$1.03 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: Aetna American Axle |
$3.32
|
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.40
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: BCBS MAPPO |
$1.92
|
| Rate for Payer: BCBS Trust/PPO |
$5.24
|
| Rate for Payer: BCN Commercial |
$5.24
|
| Rate for Payer: BCN Medicare Advantage |
$1.92
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.92
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.82
|
| Rate for Payer: Mclaren Medicaid |
$1.03
|
| Rate for Payer: Mclaren Medicare |
$1.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.02
|
| Rate for Payer: Meridian Medicaid |
$1.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.34
|
| Rate for Payer: Nomi Health Commercial |
$5.76
|
| Rate for Payer: PACE Medicare |
$1.82
|
| Rate for Payer: PACE SWMI |
$1.92
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: PHP Medicare Advantage |
$1.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.59
|
| Rate for Payer: Priority Health Medicare |
$1.92
|
| Rate for Payer: Priority Health Narrow Network |
$4.47
|
| Rate for Payer: Priority Health SBD |
$3.21
|
| Rate for Payer: Railroad Medicare Medicare |
$1.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.92
|
| Rate for Payer: UHC Exchange |
$3.67
|
| Rate for Payer: UHC Medicare Advantage |
$1.92
|
| Rate for Payer: UHCCP Medicaid |
$1.03
|
| Rate for Payer: UMR Bronson Commercial |
$1.89
|
| Rate for Payer: VA VA |
$1.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.82
|
|
|
HC TESTOSTERONE UNLISTED CHEMISTRY
|
Facility
|
IP
|
$83.88
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100642
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.91 |
| Max. Negotiated Rate |
$75.49 |
| Rate for Payer: Aetna American Axle |
$54.52
|
| Rate for Payer: Aetna Commercial |
$71.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.52
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cofinity Commercial |
$58.72
|
| Rate for Payer: Cofinity Commercial |
$72.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.10
|
| Rate for Payer: Healthscope Commercial |
$75.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.30
|
| Rate for Payer: PHP Commercial |
$71.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.52
|
| Rate for Payer: Priority Health SBD |
$52.84
|
| Rate for Payer: UMR Bronson Commercial |
$36.91
|
| 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 |
$27.49 |
| Max. Negotiated Rate |
$76.92 |
| Rate for Payer: Aetna American Axle |
$54.52
|
| Rate for Payer: Aetna Commercial |
$71.30
|
| Rate for Payer: Aetna Medicare |
$53.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.52
|
| 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 |
$28.86
|
| Rate for Payer: BCBS MAPPO |
$51.28
|
| Rate for Payer: BCBS Trust/PPO |
$49.41
|
| Rate for Payer: BCN Commercial |
$49.41
|
| Rate for Payer: BCN Medicare Advantage |
$51.28
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cofinity Commercial |
$72.14
|
| Rate for Payer: Cofinity Commercial |
$58.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.28
|
| Rate for Payer: Healthscope Commercial |
$75.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.91
|
| Rate for Payer: Mclaren Medicaid |
$27.49
|
| Rate for Payer: Mclaren Medicare |
$51.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.84
|
| Rate for Payer: Meridian Medicaid |
$28.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.30
|
| Rate for Payer: Nomi Health Commercial |
$76.92
|
| Rate for Payer: PACE Medicare |
$48.72
|
| Rate for Payer: PACE SWMI |
$51.28
|
| Rate for Payer: PHP Commercial |
$71.30
|
| Rate for Payer: PHP Medicare Advantage |
$51.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.41
|
| Rate for Payer: Priority Health Medicare |
$51.28
|
| Rate for Payer: Priority Health Narrow Network |
$43.53
|
| Rate for Payer: Priority Health SBD |
$52.84
|
| Rate for Payer: Railroad Medicare Medicare |
$51.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.28
|
| Rate for Payer: UHC Exchange |
$51.28
|
| Rate for Payer: UHC Medicare Advantage |
$51.28
|
| Rate for Payer: UHCCP Medicaid |
$27.49
|
| Rate for Payer: UMR Bronson Commercial |
$31.04
|
| Rate for Payer: VA VA |
$51.28
|
| 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 |
$14.63 |
| Max. Negotiated Rate |
$117.71 |
| Rate for Payer: Aetna American Axle |
$25.70
|
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna Medicare |
$19.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.70
|
| Rate for Payer: BCBS Complete |
$15.82
|
| Rate for Payer: BCBS Trust/PPO |
$117.71
|
| Rate for Payer: BCN Commercial |
$117.71
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$27.68
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: PHP Commercial |
$33.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health SBD |
$24.91
|
| Rate for Payer: UMR Bronson Commercial |
$14.63
|
| 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 |
$17.40 |
| Max. Negotiated Rate |
$35.59 |
| Rate for Payer: Aetna American Axle |
$25.70
|
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.70
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$27.68
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: PHP Commercial |
$33.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health SBD |
$24.91
|
| Rate for Payer: UMR Bronson Commercial |
$17.40
|
| 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 |
$7.93 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna American Axle |
$39.78
|
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$15.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.50
|
| Rate for Payer: BCBS Complete |
$8.33
|
| Rate for Payer: BCBS MAPPO |
$14.80
|
| Rate for Payer: BCBS Trust/PPO |
$14.26
|
| Rate for Payer: BCN Commercial |
$14.26
|
| Rate for Payer: BCN Medicare Advantage |
$14.80
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$7.93
|
| Rate for Payer: Mclaren Medicare |
$14.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.54
|
| Rate for Payer: Meridian Medicaid |
$8.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$22.20
|
| Rate for Payer: PACE Medicare |
$14.06
|
| Rate for Payer: PACE SWMI |
$14.80
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$14.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.80
|
| Rate for Payer: Priority Health Medicare |
$14.80
|
| Rate for Payer: Priority Health Narrow Network |
$11.84
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: Railroad Medicare Medicare |
$14.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.80
|
| Rate for Payer: UHC Exchange |
$14.80
|
| Rate for Payer: UHC Medicare Advantage |
$14.80
|
| Rate for Payer: UHCCP Medicaid |
$7.93
|
| Rate for Payer: UMR Bronson Commercial |
$22.64
|
| Rate for Payer: VA VA |
$14.80
|
| 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 |
$26.93 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna American Axle |
$39.78
|
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: UMR Bronson Commercial |
$26.93
|
| 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 |
$54.83 |
| Max. Negotiated Rate |
$112.16 |
| Rate for Payer: Aetna American Axle |
$81.00
|
| Rate for Payer: Aetna Commercial |
$105.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.00
|
| Rate for Payer: Cash Price |
$99.70
|
| Rate for Payer: Cofinity Commercial |
$107.17
|
| Rate for Payer: Cofinity Commercial |
$87.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.70
|
| Rate for Payer: Healthscope Commercial |
$112.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.93
|
| Rate for Payer: PHP Commercial |
$105.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.00
|
| Rate for Payer: Priority Health SBD |
$78.51
|
| Rate for Payer: UMR Bronson Commercial |
$54.83
|
| 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 |
$46.11 |
| Max. Negotiated Rate |
$127.13 |
| Rate for Payer: Aetna American Axle |
$81.00
|
| Rate for Payer: Aetna Commercial |
$105.93
|
| Rate for Payer: Aetna Medicare |
$62.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.00
|
| Rate for Payer: BCBS Complete |
$49.85
|
| Rate for Payer: BCBS Trust/PPO |
$127.13
|
| Rate for Payer: BCN Commercial |
$127.13
|
| Rate for Payer: Cash Price |
$99.70
|
| Rate for Payer: Cash Price |
$99.70
|
| Rate for Payer: Cofinity Commercial |
$107.17
|
| Rate for Payer: Cofinity Commercial |
$87.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.70
|
| Rate for Payer: Healthscope Commercial |
$112.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.93
|
| Rate for Payer: PHP Commercial |
$105.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.00
|
| Rate for Payer: Priority Health SBD |
$78.51
|
| Rate for Payer: UMR Bronson Commercial |
$46.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.46
|
|
|
HC THC URINE CONFIRM
|
Facility
|
IP
|
$63.24
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100568
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.83 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna American Axle |
$41.11
|
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$44.27
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health SBD |
$39.84
|
| Rate for Payer: UMR Bronson Commercial |
$27.83
|
| 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 |
$22.37 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna American Axle |
$41.11
|
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| Rate for Payer: BCBS Complete |
$25.30
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Cofinity Commercial |
$44.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health SBD |
$39.84
|
| Rate for Payer: UHC Core |
$22.37
|
| Rate for Payer: UMR Bronson Commercial |
$23.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.43
|
|
|
HC THEOPHYLLINE LEVEL
|
Facility
|
IP
|
$92.21
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
30100048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Aetna American Axle |
$59.94
|
| Rate for Payer: Aetna Commercial |
$78.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.94
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Cofinity Commercial |
$79.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Healthscope Commercial |
$82.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: PHP Commercial |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: Priority Health SBD |
$58.09
|
| Rate for Payer: UMR Bronson Commercial |
$40.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.16
|
|
