|
HC TESTOSTERONE LEVEL
|
Facility
|
OP
|
$88.57
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100430
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$88.57 |
| Rate for Payer: Aetna Commercial |
$79.71
|
| Rate for Payer: Aetna Medicare |
$25.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.26
|
| Rate for Payer: ASR ASR |
$85.91
|
| Rate for Payer: BCBS Complete |
$14.17
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCBS Trust/PPO |
$73.03
|
| Rate for Payer: BCN Commercial |
$73.03
|
| Rate for Payer: BCN Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$70.86
|
| Rate for Payer: Cash Price |
$70.86
|
| Rate for Payer: Cofinity Commercial |
$83.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$85.91
|
| Rate for Payer: Healthscope Whirlpool |
$88.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.81
|
| Rate for Payer: Mclaren Commercial |
$79.71
|
| Rate for Payer: Mclaren Medicaid |
$25.81
|
| 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 |
$14.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.28
|
| Rate for Payer: Nomi Health Commercial |
$72.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.43
|
| Rate for Payer: PACE Medicare |
$24.52
|
| Rate for Payer: PACE SWMI |
$25.81
|
| Rate for Payer: PHP Commercial |
$28.39
|
| Rate for Payer: PHP Medicaid |
$13.83
|
| Rate for Payer: PHP Medicare Advantage |
$25.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$88.37
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health Narrow Network |
$70.69
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.81
|
| Rate for Payer: UHC Exchange |
$40.01
|
| Rate for Payer: UHC Medicaid |
$13.50
|
| Rate for Payer: UHCCP DNSP |
$25.81
|
| Rate for Payer: UHCCP Medicaid |
$13.50
|
| Rate for Payer: VA VA |
$25.81
|
|
|
HC TESTOSTERONE LEVEL
|
Facility
|
IP
|
$88.57
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100430
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.43 |
| Max. Negotiated Rate |
$88.57 |
| Rate for Payer: Aetna Commercial |
$79.71
|
| Rate for Payer: ASR ASR |
$85.91
|
| Rate for Payer: BCBS Trust/PPO |
$72.73
|
| Rate for Payer: BCN Commercial |
$72.73
|
| Rate for Payer: Cash Price |
$70.86
|
| Rate for Payer: Cofinity Commercial |
$83.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.86
|
| Rate for Payer: Healthscope Commercial |
$85.91
|
| Rate for Payer: Healthscope Whirlpool |
$88.57
|
| Rate for Payer: Mclaren Commercial |
$79.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.28
|
| Rate for Payer: Nomi Health Commercial |
$72.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.94
|
|
|
HC TESTOSTERONE LEVEL TOTAL
|
Facility
|
IP
|
$95.51
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100431
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna Commercial |
$85.96
|
| Rate for Payer: ASR ASR |
$92.64
|
| Rate for Payer: BCBS Trust/PPO |
$78.43
|
| Rate for Payer: BCN Commercial |
$78.43
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cofinity Commercial |
$89.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.41
|
| Rate for Payer: Healthscope Commercial |
$92.64
|
| Rate for Payer: Healthscope Whirlpool |
$95.51
|
| Rate for Payer: Mclaren Commercial |
$85.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.18
|
| Rate for Payer: Nomi Health Commercial |
$78.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.05
|
|
|
HC TESTOSTERONE LEVEL TOTAL
|
Facility
|
OP
|
$95.51
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100431
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna Commercial |
$85.96
|
| Rate for Payer: Aetna Medicare |
$25.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.26
|
| Rate for Payer: ASR ASR |
$92.64
|
| Rate for Payer: BCBS Complete |
$14.17
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCBS Trust/PPO |
$78.75
|
| Rate for Payer: BCN Commercial |
$78.75
|
| Rate for Payer: BCN Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cofinity Commercial |
$89.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$92.64
|
| Rate for Payer: Healthscope Whirlpool |
$95.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.81
|
| Rate for Payer: Mclaren Commercial |
$85.96
|
| Rate for Payer: Mclaren Medicaid |
$25.81
|
| 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 |
$14.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.18
|
| Rate for Payer: Nomi Health Commercial |
$78.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.63
|
| Rate for Payer: PACE Medicare |
$24.52
|
| Rate for Payer: PACE SWMI |
$25.81
|
| Rate for Payer: PHP Commercial |
$28.39
|
| Rate for Payer: PHP Medicaid |
$13.83
|
| Rate for Payer: PHP Medicare Advantage |
$25.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$88.37
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health Narrow Network |
$70.69
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.81
|
| Rate for Payer: UHC Exchange |
$40.01
|
| Rate for Payer: UHC Medicaid |
$13.50
|
| Rate for Payer: UHCCP DNSP |
$25.81
|
| Rate for Payer: UHCCP Medicaid |
$13.50
|
| Rate for Payer: VA VA |
$25.81
|
|
|
HC TESTOSTERONE PELLETS EACH
|
Facility
|
OP
|
$229.22
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.81 |
| Max. Negotiated Rate |
$229.22 |
| Rate for Payer: Aetna Commercial |
$206.30
|
| Rate for Payer: Aetna Medicare |
$84.81
|
| Rate for Payer: ASR ASR |
$222.34
|
| Rate for Payer: BCBS Complete |
$91.69
|
| Rate for Payer: BCBS Trust/PPO |
$188.99
|
| Rate for Payer: BCN Commercial |
$188.99
|
| Rate for Payer: Cash Price |
$183.38
|
| Rate for Payer: Cofinity Commercial |
$215.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.38
|
| Rate for Payer: Healthscope Commercial |
$222.34
|
| Rate for Payer: Healthscope Whirlpool |
$229.22
|
| Rate for Payer: Mclaren Commercial |
$206.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$183.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.84
|
| Rate for Payer: Nomi Health Commercial |
$187.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$200.84
|
| Rate for Payer: Priority Health Narrow Network |
$160.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.71
|
|
|
HC TESTOSTERONE PELLETS EACH
|
Facility
|
IP
|
$229.22
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.91 |
| Max. Negotiated Rate |
$229.22 |
| Rate for Payer: Aetna Commercial |
$206.30
|
| Rate for Payer: ASR ASR |
$222.34
|
| Rate for Payer: BCBS Trust/PPO |
$188.24
|
| Rate for Payer: BCN Commercial |
$188.24
|
| Rate for Payer: Cash Price |
$183.38
|
| Rate for Payer: Cofinity Commercial |
$215.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.38
|
| Rate for Payer: Healthscope Commercial |
$222.34
|
| Rate for Payer: Healthscope Whirlpool |
$229.22
|
| Rate for Payer: Mclaren Commercial |
$206.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.84
|
| Rate for Payer: Nomi Health Commercial |
$187.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.71
|
|
|
HC TESTOSTERONE, T, BIO, FREE
|
Facility
|
IP
|
$82.77
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.08 |
| Max. Negotiated Rate |
$82.77 |
| Rate for Payer: Aetna Commercial |
$74.49
|
| Rate for Payer: ASR ASR |
$80.29
|
| Rate for Payer: BCBS Trust/PPO |
$67.97
|
| Rate for Payer: BCN Commercial |
$67.97
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Commercial |
$77.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Healthscope Commercial |
$80.29
|
| Rate for Payer: Healthscope Whirlpool |
$82.77
|
| Rate for Payer: Mclaren Commercial |
$74.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Nomi Health Commercial |
$67.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.84
|
|
|
HC TESTOSTERONE, T, BIO, FREE
|
Facility
|
OP
|
$82.77
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$88.37 |
| Rate for Payer: Aetna Commercial |
$74.49
|
| Rate for Payer: Aetna Medicare |
$25.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.26
|
| Rate for Payer: ASR ASR |
$80.29
|
| Rate for Payer: BCBS Complete |
$14.17
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCBS Trust/PPO |
$68.24
|
| Rate for Payer: BCN Commercial |
$68.24
|
| Rate for Payer: BCN Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Commercial |
$77.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$80.29
|
| Rate for Payer: Healthscope Whirlpool |
$82.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.81
|
| Rate for Payer: Mclaren Commercial |
$74.49
|
| Rate for Payer: Mclaren Medicaid |
$25.81
|
| 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 |
$14.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Nomi Health Commercial |
$67.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.08
|
| Rate for Payer: PACE Medicare |
$24.52
|
| Rate for Payer: PACE SWMI |
$25.81
|
| Rate for Payer: PHP Commercial |
$28.39
|
| Rate for Payer: PHP Medicaid |
$13.83
|
| Rate for Payer: PHP Medicare Advantage |
$25.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$88.37
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health Narrow Network |
$70.69
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.81
|
| Rate for Payer: UHC Exchange |
$40.01
|
| Rate for Payer: UHC Medicaid |
$13.50
|
| Rate for Payer: UHCCP DNSP |
$25.81
|
| Rate for Payer: UHCCP Medicaid |
$13.50
|
| Rate for Payer: VA VA |
$25.81
|
|
|
HC TESTOSTERONE UNDECANOATE PER 1 MG
|
Facility
|
OP
|
$5.20
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Medicare |
$2.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.66
|
| Rate for Payer: ASR ASR |
$5.04
|
| Rate for Payer: BCBS Complete |
$1.17
|
| Rate for Payer: BCBS MAPPO |
$2.13
|
| Rate for Payer: BCBS Trust/PPO |
$4.29
|
| Rate for Payer: BCN Commercial |
$4.29
|
| Rate for Payer: BCN Medicare Advantage |
$2.13
|
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Cofinity Commercial |
$4.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$5.04
|
| Rate for Payer: Healthscope Whirlpool |
$5.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.13
|
| Rate for Payer: Mclaren Commercial |
$4.68
|
| Rate for Payer: Mclaren Medicaid |
$2.13
|
| Rate for Payer: Mclaren Medicare |
$2.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.24
|
| Rate for Payer: Meridian Medicaid |
$1.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.42
|
| Rate for Payer: Nomi Health Commercial |
$4.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.90
|
| Rate for Payer: PACE Medicare |
$2.02
|
| Rate for Payer: PACE SWMI |
$2.13
|
| Rate for Payer: PHP Commercial |
$2.34
|
| Rate for Payer: PHP Medicaid |
$1.14
|
| Rate for Payer: PHP Medicare Advantage |
$2.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.15
|
| Rate for Payer: Priority Health Medicare |
$2.13
|
| Rate for Payer: Priority Health Narrow Network |
$1.72
|
| Rate for Payer: Railroad Medicare Medicare |
$2.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.13
|
| Rate for Payer: UHC Exchange |
$3.30
|
| Rate for Payer: UHC Medicaid |
$1.11
|
| Rate for Payer: UHCCP DNSP |
$2.13
|
| Rate for Payer: UHCCP Medicaid |
$1.11
|
| Rate for Payer: VA VA |
$2.13
|
|
|
HC TESTOSTERONE UNDECANOATE PER 1 MG
|
Facility
|
IP
|
$5.20
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: ASR ASR |
$5.04
|
| Rate for Payer: BCBS Trust/PPO |
$4.27
|
| Rate for Payer: BCN Commercial |
$4.27
|
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Cofinity Commercial |
$4.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.16
|
| Rate for Payer: Healthscope Commercial |
$5.04
|
| Rate for Payer: Healthscope Whirlpool |
$5.20
|
| Rate for Payer: Mclaren Commercial |
$4.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.42
|
| Rate for Payer: Nomi Health Commercial |
$4.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.58
|
|
|
HC TESTOSTERONE UNLISTED CHEMISTRY
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100642
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: BCBS Trust/PPO |
$75.39
|
| Rate for Payer: BCN Commercial |
$75.39
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$89.05
|
| Rate for Payer: Healthscope Whirlpool |
$91.80
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
|
|
HC TESTOSTERONE UNLISTED CHEMISTRY
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100642
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.82 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$82.62
|
| Rate for Payer: Aetna Medicare |
$51.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.10
|
| Rate for Payer: ASR ASR |
$89.05
|
| Rate for Payer: BCBS Complete |
$28.16
|
| Rate for Payer: BCBS MAPPO |
$51.28
|
| Rate for Payer: BCBS Trust/PPO |
$75.69
|
| Rate for Payer: BCN Commercial |
$75.69
|
| Rate for Payer: BCN Medicare Advantage |
$51.28
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$86.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.28
|
| Rate for Payer: Healthscope Commercial |
$89.05
|
| Rate for Payer: Healthscope Whirlpool |
$91.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.28
|
| Rate for Payer: Mclaren Commercial |
$82.62
|
| Rate for Payer: Mclaren Medicaid |
$51.28
|
| 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 |
$28.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PACE Medicare |
$48.72
|
| Rate for Payer: PACE SWMI |
$51.28
|
| Rate for Payer: PHP Commercial |
$56.41
|
| Rate for Payer: PHP Medicaid |
$27.49
|
| Rate for Payer: PHP Medicare Advantage |
$51.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$80.44
|
| Rate for Payer: Priority Health Medicare |
$51.28
|
| Rate for Payer: Priority Health Narrow Network |
$64.35
|
| Rate for Payer: Railroad Medicare Medicare |
$51.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.28
|
| Rate for Payer: UHC Exchange |
$79.48
|
| Rate for Payer: UHC Medicaid |
$26.82
|
| Rate for Payer: UHCCP DNSP |
$51.28
|
| Rate for Payer: UHCCP Medicaid |
$26.82
|
| Rate for Payer: VA VA |
$51.28
|
|
|
HC TETANUS AND DIPTHERIA TOXOIDS ADSORDED (TD), PF, 7 YRS OR OLDER IM
|
Facility
|
OP
|
$40.33
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
63600083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.92 |
| Max. Negotiated Rate |
$52.06 |
| Rate for Payer: Aetna Commercial |
$36.30
|
| Rate for Payer: Aetna Medicare |
$14.92
|
| Rate for Payer: ASR ASR |
$39.12
|
| Rate for Payer: BCBS Complete |
$16.13
|
| Rate for Payer: BCBS Trust/PPO |
$33.25
|
| Rate for Payer: BCN Commercial |
$33.25
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$37.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$39.12
|
| Rate for Payer: Healthscope Whirlpool |
$40.33
|
| Rate for Payer: Mclaren Commercial |
$36.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Nomi Health Commercial |
$33.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$52.06
|
| Rate for Payer: Priority Health Narrow Network |
$41.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.49
|
|
|
HC TETANUS AND DIPTHERIA TOXOIDS ADSORDED (TD), PF, 7 YRS OR OLDER IM
|
Facility
|
IP
|
$40.33
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
63600083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.25 |
| Max. Negotiated Rate |
$40.33 |
| Rate for Payer: Aetna Commercial |
$36.30
|
| Rate for Payer: ASR ASR |
$39.12
|
| Rate for Payer: BCBS Trust/PPO |
$33.12
|
| Rate for Payer: BCN Commercial |
$33.12
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$37.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$39.12
|
| Rate for Payer: Healthscope Whirlpool |
$40.33
|
| Rate for Payer: Mclaren Commercial |
$36.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Nomi Health Commercial |
$33.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.49
|
|
|
HC TETANUS ANTIBODIES
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
30200320
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna Medicare |
$14.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.50
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: BCBS Complete |
$8.13
|
| Rate for Payer: BCBS MAPPO |
$14.80
|
| Rate for Payer: BCBS Trust/PPO |
$51.47
|
| Rate for Payer: BCN Commercial |
$51.47
|
| Rate for Payer: BCN Medicare Advantage |
$14.80
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$60.55
|
| Rate for Payer: Healthscope Whirlpool |
$62.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.80
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$14.80
|
| 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 |
$8.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PACE Medicare |
$14.06
|
| Rate for Payer: PACE SWMI |
$14.80
|
| Rate for Payer: PHP Commercial |
$16.28
|
| Rate for Payer: PHP Medicaid |
$7.93
|
| Rate for Payer: PHP Medicare Advantage |
$14.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$54.69
|
| Rate for Payer: Priority Health Medicare |
$14.80
|
| Rate for Payer: Priority Health Narrow Network |
$43.76
|
| Rate for Payer: Railroad Medicare Medicare |
$14.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.80
|
| Rate for Payer: UHC Exchange |
$22.94
|
| Rate for Payer: UHC Medicaid |
$7.74
|
| Rate for Payer: UHCCP DNSP |
$14.80
|
| Rate for Payer: UHCCP Medicaid |
$7.74
|
| Rate for Payer: VA VA |
$14.80
|
|
|
HC TETANUS ANTIBODIES
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
30200320
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: BCBS Trust/PPO |
$51.26
|
| Rate for Payer: BCN Commercial |
$51.26
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$60.55
|
| Rate for Payer: Healthscope Whirlpool |
$62.42
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
|
|
HC TETANUS/DIPHTHERIA/PERTUSIS VACCINE
|
Facility
|
IP
|
$127.11
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.33 |
| Max. Negotiated Rate |
$127.11 |
| Rate for Payer: Aetna Commercial |
$114.40
|
| Rate for Payer: ASR ASR |
$123.30
|
| Rate for Payer: BCBS Trust/PPO |
$104.38
|
| Rate for Payer: BCN Commercial |
$104.38
|
| Rate for Payer: Cash Price |
$101.69
|
| Rate for Payer: Cofinity Commercial |
$119.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.69
|
| Rate for Payer: Healthscope Commercial |
$123.30
|
| Rate for Payer: Healthscope Whirlpool |
$127.11
|
| Rate for Payer: Mclaren Commercial |
$114.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.04
|
| Rate for Payer: Nomi Health Commercial |
$104.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.86
|
|
|
HC TETANUS/DIPHTHERIA/PERTUSIS VACCINE
|
Facility
|
OP
|
$127.11
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.12 |
| Max. Negotiated Rate |
$127.11 |
| Rate for Payer: Aetna Commercial |
$114.40
|
| Rate for Payer: Aetna Medicare |
$47.03
|
| Rate for Payer: ASR ASR |
$123.30
|
| Rate for Payer: BCBS Complete |
$50.84
|
| Rate for Payer: BCBS Trust/PPO |
$104.80
|
| Rate for Payer: BCN Commercial |
$104.80
|
| Rate for Payer: Cash Price |
$101.69
|
| Rate for Payer: Cash Price |
$101.69
|
| Rate for Payer: Cofinity Commercial |
$119.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.69
|
| Rate for Payer: Healthscope Commercial |
$123.30
|
| Rate for Payer: Healthscope Whirlpool |
$127.11
|
| Rate for Payer: Mclaren Commercial |
$114.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.04
|
| Rate for Payer: Nomi Health Commercial |
$104.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$55.15
|
| Rate for Payer: Priority Health Narrow Network |
$44.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.86
|
|
|
HC THC URINE CONFIRM
|
Facility
|
IP
|
$64.50
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100568
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.38 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$58.05
|
| Rate for Payer: ASR ASR |
$62.56
|
| Rate for Payer: BCBS Trust/PPO |
$52.97
|
| Rate for Payer: BCN Commercial |
$52.97
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$62.56
|
| Rate for Payer: Healthscope Whirlpool |
$64.50
|
| Rate for Payer: Mclaren Commercial |
$58.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Nomi Health Commercial |
$52.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.76
|
|
|
HC THC URINE CONFIRM
|
Facility
|
OP
|
$64.50
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100568
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Aetna Commercial |
$58.05
|
| Rate for Payer: Aetna Medicare |
$23.86
|
| Rate for Payer: ASR ASR |
$62.56
|
| Rate for Payer: BCBS Complete |
$25.80
|
| Rate for Payer: BCBS Trust/PPO |
$53.18
|
| Rate for Payer: BCN Commercial |
$53.18
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$62.56
|
| Rate for Payer: Healthscope Whirlpool |
$64.50
|
| Rate for Payer: Mclaren Commercial |
$58.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Nomi Health Commercial |
$52.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$56.51
|
| Rate for Payer: Priority Health Narrow Network |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.76
|
|
|
HC THEOPHYLLINE LEVEL
|
Facility
|
OP
|
$94.05
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
30100048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Aetna Commercial |
$84.64
|
| Rate for Payer: Aetna Medicare |
$14.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.68
|
| Rate for Payer: ASR ASR |
$91.23
|
| Rate for Payer: BCBS Complete |
$7.77
|
| Rate for Payer: BCBS MAPPO |
$14.14
|
| Rate for Payer: BCBS Trust/PPO |
$77.54
|
| Rate for Payer: BCN Commercial |
$77.54
|
| Rate for Payer: BCN Medicare Advantage |
$14.14
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Commercial |
$88.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.14
|
| Rate for Payer: Healthscope Commercial |
$91.23
|
| Rate for Payer: Healthscope Whirlpool |
$94.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.14
|
| Rate for Payer: Mclaren Commercial |
$84.64
|
| Rate for Payer: Mclaren Medicaid |
$14.14
|
| Rate for Payer: Mclaren Medicare |
$14.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.85
|
| Rate for Payer: Meridian Medicaid |
$7.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Nomi Health Commercial |
$77.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.54
|
| Rate for Payer: PACE Medicare |
$13.43
|
| Rate for Payer: PACE SWMI |
$14.14
|
| Rate for Payer: PHP Commercial |
$15.55
|
| Rate for Payer: PHP Medicaid |
$7.58
|
| Rate for Payer: PHP Medicare Advantage |
$14.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$82.33
|
| Rate for Payer: Priority Health Medicare |
$14.14
|
| Rate for Payer: Priority Health Narrow Network |
$65.86
|
| Rate for Payer: Railroad Medicare Medicare |
$14.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.14
|
| Rate for Payer: UHC Exchange |
$21.92
|
| Rate for Payer: UHC Medicaid |
$7.40
|
| Rate for Payer: UHCCP DNSP |
$14.14
|
| Rate for Payer: UHCCP Medicaid |
$7.40
|
| Rate for Payer: VA VA |
$14.14
|
|
|
HC THEOPHYLLINE LEVEL
|
Facility
|
IP
|
$94.05
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
30100048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.54 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: Aetna Commercial |
$84.64
|
| Rate for Payer: ASR ASR |
$91.23
|
| Rate for Payer: BCBS Trust/PPO |
$77.23
|
| Rate for Payer: BCN Commercial |
$77.23
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Commercial |
$88.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Healthscope Commercial |
$91.23
|
| Rate for Payer: Healthscope Whirlpool |
$94.05
|
| Rate for Payer: Mclaren Commercial |
$84.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Nomi Health Commercial |
$77.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.76
|
|
|
HC THERAPEUTIC ACTIVITIES EA 15 MIN
|
Facility
|
IP
|
$100.82
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$75.61 |
| Max. Negotiated Rate |
$100.82 |
| Rate for Payer: Aetna Commercial |
$90.74
|
| Rate for Payer: ASR ASR |
$97.80
|
| Rate for Payer: BCBS Trust/PPO |
$82.79
|
| Rate for Payer: BCN Commercial |
$82.79
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Commercial |
$94.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Healthscope Commercial |
$97.80
|
| Rate for Payer: Healthscope Whirlpool |
$100.82
|
| Rate for Payer: Mclaren Commercial |
$90.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Nomi Health Commercial |
$82.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.72
|
|
|
HC THERAPEUTIC ACTIVITIES EA 15 MIN
|
Facility
|
OP
|
$100.82
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.30 |
| Max. Negotiated Rate |
$100.82 |
| Rate for Payer: Aetna Commercial |
$90.74
|
| Rate for Payer: Aetna Medicare |
$37.30
|
| Rate for Payer: ASR ASR |
$97.80
|
| Rate for Payer: BCBS Complete |
$40.33
|
| Rate for Payer: BCBS Trust/PPO |
$83.13
|
| Rate for Payer: BCN Commercial |
$83.13
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Commercial |
$94.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Healthscope Commercial |
$97.80
|
| Rate for Payer: Healthscope Whirlpool |
$100.82
|
| Rate for Payer: Mclaren Commercial |
$90.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Nomi Health Commercial |
$82.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$87.15
|
| Rate for Payer: Priority Health Narrow Network |
$69.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.72
|
|
|
HC THERAPEUTIC APHERESIS PLASMA PHERESIS
|
Facility
|
OP
|
$2,606.60
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
36100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$811.61 |
| Max. Negotiated Rate |
$2,606.60 |
| Rate for Payer: Aetna Commercial |
$2,345.94
|
| Rate for Payer: Aetna Medicare |
$1,551.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,939.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,939.79
|
| Rate for Payer: ASR ASR |
$2,528.40
|
| Rate for Payer: BCBS Complete |
$852.27
|
| Rate for Payer: BCBS MAPPO |
$1,551.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,149.14
|
| Rate for Payer: BCN Commercial |
$2,149.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,551.83
|
| Rate for Payer: Cash Price |
$2,085.28
|
| Rate for Payer: Cash Price |
$2,085.28
|
| Rate for Payer: Cofinity Commercial |
$2,450.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,085.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,551.83
|
| Rate for Payer: Healthscope Commercial |
$2,528.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,606.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,551.83
|
| Rate for Payer: Mclaren Commercial |
$2,345.94
|
| Rate for Payer: Mclaren Medicaid |
$1,551.83
|
| Rate for Payer: Mclaren Medicare |
$1,551.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,629.42
|
| Rate for Payer: Meridian Medicaid |
$852.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,784.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,707.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,215.61
|
| Rate for Payer: Nomi Health Commercial |
$2,137.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,954.95
|
| Rate for Payer: PACE Medicare |
$1,474.24
|
| Rate for Payer: PACE SWMI |
$1,551.83
|
| Rate for Payer: PHP Commercial |
$1,707.01
|
| Rate for Payer: PHP Medicaid |
$831.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,551.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$811.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,065.21
|
| Rate for Payer: Priority Health Medicare |
$1,551.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,652.17
|
| Rate for Payer: Railroad Medicare Medicare |
$1,551.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,293.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,551.83
|
| Rate for Payer: UHC Exchange |
$2,405.34
|
| Rate for Payer: UHC Medicaid |
$811.61
|
| Rate for Payer: UHCCP DNSP |
$1,551.83
|
| Rate for Payer: UHCCP Medicaid |
$811.61
|
| Rate for Payer: VA VA |
$1,551.83
|
|
