|
HC TENOTOMY SHOULDER AREA SINGLE TENDON
|
Facility
|
IP
|
$4,826.31
|
|
| Hospital Charge Code |
36000098
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,137.10 |
| Max. Negotiated Rate |
$4,826.31 |
| Rate for Payer: Aetna Commercial |
$4,343.68
|
| Rate for Payer: ASR ASR |
$4,681.52
|
| Rate for Payer: ASR Commercial |
$4,681.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,932.96
|
| Rate for Payer: BCN Commercial |
$3,741.84
|
| Rate for Payer: Cash Price |
$3,861.05
|
| Rate for Payer: Cofinity Commercial |
$4,536.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,861.05
|
| Rate for Payer: Healthscope Commercial |
$4,826.31
|
| Rate for Payer: Healthscope Whirlpool |
$4,681.52
|
| Rate for Payer: Mclaren Commercial |
$4,343.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,102.36
|
| Rate for Payer: Nomi Health Commercial |
$3,957.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,137.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,247.15
|
|
|
HC TENOTOMY SHOULDER AREA SINGLE TENDON
|
Facility
|
OP
|
$4,826.31
|
|
| Hospital Charge Code |
36000098
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,930.52 |
| Max. Negotiated Rate |
$4,826.31 |
| Rate for Payer: Aetna Commercial |
$4,343.68
|
| Rate for Payer: Aetna Medicare |
$2,413.16
|
| Rate for Payer: ASR ASR |
$4,681.52
|
| Rate for Payer: ASR Commercial |
$4,681.52
|
| Rate for Payer: BCBS Complete |
$1,930.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,952.27
|
| Rate for Payer: BCN Commercial |
$3,741.84
|
| Rate for Payer: Cash Price |
$3,861.05
|
| Rate for Payer: Cofinity Commercial |
$4,536.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,861.05
|
| Rate for Payer: Healthscope Commercial |
$4,826.31
|
| Rate for Payer: Healthscope Whirlpool |
$4,681.52
|
| Rate for Payer: Mclaren Commercial |
$4,343.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,102.36
|
| Rate for Payer: Nomi Health Commercial |
$3,957.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,137.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,228.81
|
| Rate for Payer: Priority Health Narrow Network |
$3,383.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,247.15
|
|
|
HC TENOTOMY TOE SINGLE TENDON
|
Facility
|
IP
|
$2,219.15
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
45000092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,442.45 |
| Max. Negotiated Rate |
$2,219.15 |
| Rate for Payer: Aetna Commercial |
$1,997.24
|
| Rate for Payer: ASR ASR |
$2,152.58
|
| Rate for Payer: ASR Commercial |
$2,152.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,808.39
|
| Rate for Payer: BCN Commercial |
$1,720.51
|
| Rate for Payer: Cash Price |
$1,775.32
|
| Rate for Payer: Cofinity Commercial |
$2,086.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,775.32
|
| Rate for Payer: Healthscope Commercial |
$2,219.15
|
| Rate for Payer: Healthscope Whirlpool |
$2,152.58
|
| Rate for Payer: Mclaren Commercial |
$1,997.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,886.28
|
| Rate for Payer: Nomi Health Commercial |
$1,819.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,442.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,952.85
|
|
|
HC TENOTOMY TOE SINGLE TENDON
|
Facility
|
OP
|
$2,219.15
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
45000092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$840.47 |
| Max. Negotiated Rate |
$2,430.48 |
| Rate for Payer: Aetna Commercial |
$1,997.24
|
| Rate for Payer: Aetna Medicare |
$1,568.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: ASR ASR |
$2,152.58
|
| Rate for Payer: ASR Commercial |
$2,152.58
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,817.26
|
| Rate for Payer: BCN Commercial |
$1,720.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Cash Price |
$1,775.32
|
| Rate for Payer: Cash Price |
$1,775.32
|
| Rate for Payer: Cofinity Commercial |
$2,086.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,775.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Healthscope Commercial |
$2,219.15
|
| Rate for Payer: Healthscope Whirlpool |
$2,152.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,568.05
|
| Rate for Payer: Mclaren Commercial |
$1,997.24
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,886.28
|
| Rate for Payer: Nomi Health Commercial |
$1,819.70
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Commercial |
$1,724.86
|
| Rate for Payer: PHP Medicaid |
$840.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,442.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,944.42
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,555.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,952.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$2,430.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP DNSP |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
HC TESTOSTERONE BIOAVAILABLE
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100429
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$63.59
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
|
|
HC TESTOSTERONE BIOAVAILABLE
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100429
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$92.23 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna Medicare |
$25.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.84
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Complete |
$14.33
|
| Rate for Payer: BCBS MAPPO |
$25.47
|
| Rate for Payer: BCBS Trust/PPO |
$63.90
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: BCN Medicare Advantage |
$25.47
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.47
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.47
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| 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 |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PACE Medicare |
$24.20
|
| Rate for Payer: PACE SWMI |
$25.47
|
| Rate for Payer: PHP Commercial |
$28.02
|
| Rate for Payer: PHP Medicaid |
$13.65
|
| 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 |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.23
|
| Rate for Payer: Priority Health Medicare |
$25.47
|
| Rate for Payer: Priority Health Narrow Network |
$73.78
|
| Rate for Payer: Railroad Medicare Medicare |
$25.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.47
|
| Rate for Payer: UHC Exchange |
$39.48
|
| Rate for Payer: UHC Medicare Advantage |
$25.47
|
| Rate for Payer: UHCCP DNSP |
$25.47
|
| Rate for Payer: UHCCP Medicaid |
$13.65
|
| Rate for Payer: VA VA |
$25.47
|
|
|
HC TESTOSTERONE FREE
|
Facility
|
IP
|
$44.79
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
30100428
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.11 |
| Max. Negotiated Rate |
$44.79 |
| Rate for Payer: Aetna Commercial |
$40.31
|
| Rate for Payer: ASR ASR |
$43.45
|
| Rate for Payer: ASR Commercial |
$43.45
|
| Rate for Payer: BCBS Trust/PPO |
$36.50
|
| Rate for Payer: BCN Commercial |
$34.73
|
| Rate for Payer: Cash Price |
$35.83
|
| Rate for Payer: Cofinity Commercial |
$42.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.83
|
| Rate for Payer: Healthscope Commercial |
$44.79
|
| Rate for Payer: Healthscope Whirlpool |
$43.45
|
| Rate for Payer: Mclaren Commercial |
$40.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.07
|
| Rate for Payer: Nomi Health Commercial |
$36.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.42
|
|
|
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 |
$92.23 |
| Rate for Payer: Aetna Commercial |
$40.31
|
| Rate for Payer: Aetna Medicare |
$25.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.84
|
| Rate for Payer: ASR ASR |
$43.45
|
| Rate for Payer: ASR Commercial |
$43.45
|
| Rate for Payer: BCBS Complete |
$14.33
|
| Rate for Payer: BCBS MAPPO |
$25.47
|
| Rate for Payer: BCBS Trust/PPO |
$36.68
|
| Rate for Payer: BCN Commercial |
$34.73
|
| 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 |
$42.10
|
| 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 |
$44.79
|
| Rate for Payer: Healthscope Whirlpool |
$43.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.47
|
| Rate for Payer: Mclaren Commercial |
$40.31
|
| 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 |
$36.73
|
| Rate for Payer: PACE Medicare |
$24.20
|
| Rate for Payer: PACE SWMI |
$25.47
|
| Rate for Payer: PHP Commercial |
$28.02
|
| Rate for Payer: PHP Medicaid |
$13.65
|
| 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 |
$92.23
|
| Rate for Payer: Priority Health Medicare |
$25.47
|
| Rate for Payer: Priority Health Narrow Network |
$73.78
|
| Rate for Payer: Railroad Medicare Medicare |
$25.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.47
|
| Rate for Payer: UHC Exchange |
$39.48
|
| Rate for Payer: UHC Medicare Advantage |
$25.47
|
| Rate for Payer: UHCCP DNSP |
$25.47
|
| Rate for Payer: UHCCP Medicaid |
$13.65
|
| Rate for Payer: VA VA |
$25.47
|
|
|
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 |
$81.60 |
| Rate for Payer: Aetna Commercial |
$73.44
|
| 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 |
$79.15
|
| Rate for Payer: ASR Commercial |
$79.15
|
| Rate for Payer: BCBS Complete |
$28.86
|
| Rate for Payer: BCBS MAPPO |
$51.28
|
| Rate for Payer: BCBS Trust/PPO |
$66.82
|
| Rate for Payer: BCN Commercial |
$63.26
|
| 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 |
$76.70
|
| 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 |
$81.60
|
| Rate for Payer: Healthscope Whirlpool |
$79.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.28
|
| Rate for Payer: Mclaren Commercial |
$73.44
|
| 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 |
$66.91
|
| 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 |
$27.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.50
|
| Rate for Payer: Priority Health Medicare |
$51.28
|
| Rate for Payer: Priority Health Narrow Network |
$57.20
|
| Rate for Payer: Railroad Medicare Medicare |
$51.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.28
|
| Rate for Payer: UHC Exchange |
$79.48
|
| Rate for Payer: UHC Medicare Advantage |
$51.28
|
| Rate for Payer: UHCCP DNSP |
$51.28
|
| Rate for Payer: UHCCP Medicaid |
$27.49
|
| Rate for Payer: VA VA |
$51.28
|
|
|
HC TESTOSTERONE, FREE & WKLY BOUND
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100736
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$73.44
|
| Rate for Payer: ASR ASR |
$79.15
|
| Rate for Payer: ASR Commercial |
$79.15
|
| Rate for Payer: BCBS Trust/PPO |
$66.50
|
| Rate for Payer: BCN Commercial |
$63.26
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$76.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$81.60
|
| Rate for Payer: Healthscope Whirlpool |
$79.15
|
| Rate for Payer: Mclaren Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: Nomi Health Commercial |
$66.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.81
|
|
|
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 |
$86.83 |
| Rate for Payer: Aetna Commercial |
$78.15
|
| 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 |
$84.23
|
| Rate for Payer: ASR Commercial |
$84.23
|
| Rate for Payer: BCBS Complete |
$14.53
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCBS Trust/PPO |
$71.11
|
| Rate for Payer: BCN Commercial |
$67.32
|
| 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 |
$81.62
|
| 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 |
$86.83
|
| Rate for Payer: Healthscope Whirlpool |
$84.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.81
|
| Rate for Payer: Mclaren Commercial |
$78.15
|
| 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 |
$71.20
|
| 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 |
$13.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.15
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health Narrow Network |
$64.12
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.81
|
| Rate for Payer: UHC Exchange |
$40.01
|
| Rate for Payer: UHC Medicare Advantage |
$25.81
|
| Rate for Payer: UHCCP DNSP |
$25.81
|
| Rate for Payer: UHCCP Medicaid |
$13.83
|
| Rate for Payer: VA VA |
$25.81
|
|
|
HC TESTOSTERONE LEVEL
|
Facility
|
IP
|
$86.83
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100430
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.44 |
| Max. Negotiated Rate |
$86.83 |
| Rate for Payer: Aetna Commercial |
$78.15
|
| Rate for Payer: ASR ASR |
$84.23
|
| Rate for Payer: ASR Commercial |
$84.23
|
| Rate for Payer: BCBS Trust/PPO |
$70.76
|
| Rate for Payer: BCN Commercial |
$67.32
|
| Rate for Payer: Cash Price |
$69.46
|
| Rate for Payer: Cofinity Commercial |
$81.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.46
|
| Rate for Payer: Healthscope Commercial |
$86.83
|
| Rate for Payer: Healthscope Whirlpool |
$84.23
|
| Rate for Payer: Mclaren Commercial |
$78.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.81
|
| Rate for Payer: Nomi Health Commercial |
$71.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.41
|
|
|
HC TESTOSTERONE LEVEL TOTAL
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100431
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.87 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| Rate for Payer: ASR ASR |
$90.83
|
| Rate for Payer: ASR Commercial |
$90.83
|
| Rate for Payer: BCBS Trust/PPO |
$76.31
|
| Rate for Payer: BCN Commercial |
$72.60
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$88.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Healthscope Whirlpool |
$90.83
|
| Rate for Payer: Mclaren Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.40
|
|
|
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 |
$93.64 |
| Rate for Payer: Aetna Commercial |
$84.28
|
| 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 |
$90.83
|
| Rate for Payer: ASR Commercial |
$90.83
|
| Rate for Payer: BCBS Complete |
$14.53
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCBS Trust/PPO |
$76.68
|
| Rate for Payer: BCN Commercial |
$72.60
|
| 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 |
$88.02
|
| 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 |
$93.64
|
| Rate for Payer: Healthscope Whirlpool |
$90.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.81
|
| Rate for Payer: Mclaren Commercial |
$84.28
|
| 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 |
$76.78
|
| 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 |
$13.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.15
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health Narrow Network |
$64.12
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.81
|
| Rate for Payer: UHC Exchange |
$40.01
|
| Rate for Payer: UHC Medicare Advantage |
$25.81
|
| Rate for Payer: UHCCP DNSP |
$25.81
|
| Rate for Payer: UHCCP Medicaid |
$13.83
|
| Rate for Payer: VA VA |
$25.81
|
|
|
HC TESTOSTERONE PELLETS EACH
|
Facility
|
OP
|
$224.73
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.89 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna Commercial |
$202.26
|
| Rate for Payer: Aetna Medicare |
$112.36
|
| Rate for Payer: ASR ASR |
$217.99
|
| Rate for Payer: ASR Commercial |
$217.99
|
| Rate for Payer: BCBS Complete |
$89.89
|
| Rate for Payer: BCBS Trust/PPO |
$184.03
|
| Rate for Payer: BCN Commercial |
$174.23
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$211.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$224.73
|
| Rate for Payer: Healthscope Whirlpool |
$217.99
|
| Rate for Payer: Mclaren Commercial |
$202.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Nomi Health Commercial |
$184.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.91
|
| Rate for Payer: Priority Health Narrow Network |
$157.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.76
|
|
|
HC TESTOSTERONE PELLETS EACH
|
Facility
|
IP
|
$224.73
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.07 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: Aetna Commercial |
$202.26
|
| Rate for Payer: ASR ASR |
$217.99
|
| Rate for Payer: ASR Commercial |
$217.99
|
| Rate for Payer: BCBS Trust/PPO |
$183.13
|
| Rate for Payer: BCN Commercial |
$174.23
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$211.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$224.73
|
| Rate for Payer: Healthscope Whirlpool |
$217.99
|
| Rate for Payer: Mclaren Commercial |
$202.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Nomi Health Commercial |
$184.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.76
|
|
|
HC TESTOSTERONE, T, BIO, FREE
|
Facility
|
IP
|
$81.15
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
30100608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.75 |
| Max. Negotiated Rate |
$81.15 |
| Rate for Payer: Aetna Commercial |
$73.04
|
| Rate for Payer: ASR ASR |
$78.72
|
| Rate for Payer: ASR Commercial |
$78.72
|
| Rate for Payer: BCBS Trust/PPO |
$66.13
|
| Rate for Payer: BCN Commercial |
$62.92
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$76.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Healthscope Commercial |
$81.15
|
| Rate for Payer: Healthscope Whirlpool |
$78.72
|
| Rate for Payer: Mclaren Commercial |
$73.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: Nomi Health Commercial |
$66.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.41
|
|
|
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 |
$81.15 |
| Rate for Payer: Aetna Commercial |
$73.04
|
| 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 |
$78.72
|
| Rate for Payer: ASR Commercial |
$78.72
|
| Rate for Payer: BCBS Complete |
$14.53
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCBS Trust/PPO |
$66.45
|
| Rate for Payer: BCN Commercial |
$62.92
|
| Rate for Payer: BCN Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$76.28
|
| 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 |
$81.15
|
| Rate for Payer: Healthscope Whirlpool |
$78.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$25.81
|
| Rate for Payer: Mclaren Commercial |
$73.04
|
| 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 |
$66.54
|
| 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 |
$13.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.15
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health Narrow Network |
$64.12
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.81
|
| Rate for Payer: UHC Exchange |
$40.01
|
| Rate for Payer: UHC Medicare Advantage |
$25.81
|
| Rate for Payer: UHCCP DNSP |
$25.81
|
| Rate for Payer: UHCCP Medicaid |
$13.83
|
| Rate for Payer: VA VA |
$25.81
|
|
|
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 |
$5.10 |
| Rate for Payer: Aetna Commercial |
$4.59
|
| Rate for Payer: Aetna Medicare |
$1.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.40
|
| Rate for Payer: ASR ASR |
$4.95
|
| Rate for Payer: ASR Commercial |
$4.95
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: BCBS MAPPO |
$1.92
|
| Rate for Payer: BCBS Trust/PPO |
$4.18
|
| Rate for Payer: BCN Commercial |
$3.95
|
| 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 |
$4.79
|
| 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 |
$5.10
|
| Rate for Payer: Healthscope Whirlpool |
$4.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$1.92
|
| Rate for Payer: Mclaren Commercial |
$4.59
|
| 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 |
$4.18
|
| Rate for Payer: PACE Medicare |
$1.82
|
| Rate for Payer: PACE SWMI |
$1.92
|
| Rate for Payer: PHP Commercial |
$2.11
|
| Rate for Payer: PHP Medicaid |
$1.03
|
| 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 |
$2.10
|
| Rate for Payer: Priority Health Medicare |
$1.92
|
| Rate for Payer: Priority Health Narrow Network |
$1.68
|
| Rate for Payer: Railroad Medicare Medicare |
$1.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.92
|
| Rate for Payer: UHC Exchange |
$2.98
|
| Rate for Payer: UHC Medicare Advantage |
$1.92
|
| Rate for Payer: UHCCP DNSP |
$1.92
|
| Rate for Payer: UHCCP Medicaid |
$1.03
|
| Rate for Payer: VA VA |
$1.92
|
|
|
HC TESTOSTERONE UNDECANOATE PER 1 MG
|
Facility
|
IP
|
$5.10
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Aetna Commercial |
$4.59
|
| Rate for Payer: ASR ASR |
$4.95
|
| Rate for Payer: ASR Commercial |
$4.95
|
| Rate for Payer: BCBS Trust/PPO |
$4.16
|
| Rate for Payer: BCN Commercial |
$3.95
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$4.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.08
|
| Rate for Payer: Healthscope Commercial |
$5.10
|
| Rate for Payer: Healthscope Whirlpool |
$4.95
|
| Rate for Payer: Mclaren Commercial |
$4.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.34
|
| Rate for Payer: Nomi Health Commercial |
$4.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.49
|
|
|
HC TESTOSTERONE UNLISTED CHEMISTRY
|
Facility
|
IP
|
$83.88
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100642
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.52 |
| Max. Negotiated Rate |
$83.88 |
| Rate for Payer: Aetna Commercial |
$75.49
|
| Rate for Payer: ASR ASR |
$81.36
|
| Rate for Payer: ASR Commercial |
$81.36
|
| Rate for Payer: BCBS Trust/PPO |
$68.35
|
| Rate for Payer: BCN Commercial |
$65.03
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cofinity Commercial |
$78.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.10
|
| Rate for Payer: Healthscope Commercial |
$83.88
|
| Rate for Payer: Healthscope Whirlpool |
$81.36
|
| Rate for Payer: Mclaren Commercial |
$75.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.30
|
| Rate for Payer: Nomi Health Commercial |
$68.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.81
|
|
|
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 |
$83.88 |
| Rate for Payer: Aetna Commercial |
$75.49
|
| 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 |
$81.36
|
| Rate for Payer: ASR Commercial |
$81.36
|
| Rate for Payer: BCBS Complete |
$28.86
|
| Rate for Payer: BCBS MAPPO |
$51.28
|
| Rate for Payer: BCBS Trust/PPO |
$68.69
|
| Rate for Payer: BCN Commercial |
$65.03
|
| 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 |
$78.85
|
| 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 |
$83.88
|
| Rate for Payer: Healthscope Whirlpool |
$81.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$51.28
|
| Rate for Payer: Mclaren Commercial |
$75.49
|
| 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 |
$68.78
|
| 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 |
$27.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.50
|
| Rate for Payer: Priority Health Medicare |
$51.28
|
| Rate for Payer: Priority Health Narrow Network |
$58.80
|
| Rate for Payer: Railroad Medicare Medicare |
$51.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.28
|
| Rate for Payer: UHC Exchange |
$79.48
|
| Rate for Payer: UHC Medicare Advantage |
$51.28
|
| Rate for Payer: UHCCP DNSP |
$51.28
|
| Rate for Payer: UHCCP Medicaid |
$27.49
|
| Rate for Payer: VA VA |
$51.28
|
|
|
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 |
$15.82 |
| Max. Negotiated Rate |
$45.67 |
| Rate for Payer: Aetna Commercial |
$35.59
|
| Rate for Payer: Aetna Medicare |
$19.77
|
| Rate for Payer: ASR ASR |
$38.35
|
| Rate for Payer: ASR Commercial |
$38.35
|
| Rate for Payer: BCBS Complete |
$15.82
|
| Rate for Payer: BCBS Trust/PPO |
$32.38
|
| Rate for Payer: BCN Commercial |
$30.66
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$37.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Healthscope Commercial |
$39.54
|
| Rate for Payer: Healthscope Whirlpool |
$38.35
|
| Rate for Payer: Mclaren Commercial |
$35.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: Nomi Health Commercial |
$32.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.67
|
| Rate for Payer: Priority Health Narrow Network |
$36.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.80
|
|
|
HC TETANUS AND DIPTHERIA TOXOIDS ADSORDED (TD), PF, 7 YRS OR OLDER IM
|
Facility
|
IP
|
$39.54
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
63600083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$39.54 |
| Rate for Payer: Aetna Commercial |
$35.59
|
| Rate for Payer: ASR ASR |
$38.35
|
| Rate for Payer: ASR Commercial |
$38.35
|
| Rate for Payer: BCBS Trust/PPO |
$32.22
|
| Rate for Payer: BCN Commercial |
$30.66
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$37.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Healthscope Commercial |
$39.54
|
| Rate for Payer: Healthscope Whirlpool |
$38.35
|
| Rate for Payer: Mclaren Commercial |
$35.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: Nomi Health Commercial |
$32.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.80
|
|
|
HC TETANUS ANTIBODIES
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
30200320
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: ASR Commercial |
$59.36
|
| Rate for Payer: BCBS Trust/PPO |
$49.87
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
