|
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 |
$76.08
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health Narrow Network |
$60.87
|
| 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
|
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 |
$82.05
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health Narrow Network |
$65.64
|
| 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 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 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 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, 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 |
$73.03
|
| 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 |
$73.03
|
| 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 |
$73.03
|
| 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 |
$73.03
|
| 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 |
$71.10
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health Narrow Network |
$56.89
|
| 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 |
$1.11 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Aetna Commercial |
$4.59
|
| Rate for Payer: Aetna Medicare |
$2.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.59
|
| Rate for Payer: ASR ASR |
$4.95
|
| Rate for Payer: ASR Commercial |
$4.95
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: BCBS MAPPO |
$2.07
|
| Rate for Payer: BCBS Trust/PPO |
$4.18
|
| Rate for Payer: BCN Commercial |
$3.95
|
| Rate for Payer: BCN Medicare Advantage |
$2.07
|
| 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 |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$5.10
|
| Rate for Payer: Healthscope Whirlpool |
$4.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.07
|
| Rate for Payer: Mclaren Commercial |
$4.59
|
| Rate for Payer: Mclaren Medicaid |
$1.11
|
| Rate for Payer: Mclaren Medicare |
$2.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.17
|
| Rate for Payer: Meridian Medicaid |
$1.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.33
|
| Rate for Payer: Nomi Health Commercial |
$4.18
|
| Rate for Payer: PACE Medicare |
$1.97
|
| Rate for Payer: PACE SWMI |
$2.07
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: PHP Medicaid |
$1.11
|
| Rate for Payer: PHP Medicare Advantage |
$2.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.47
|
| Rate for Payer: Priority Health Medicare |
$2.07
|
| Rate for Payer: Priority Health Narrow Network |
$3.58
|
| Rate for Payer: Railroad Medicare Medicare |
$2.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.07
|
| Rate for Payer: UHC Exchange |
$3.21
|
| Rate for Payer: UHC Medicare Advantage |
$2.07
|
| Rate for Payer: UHCCP DNSP |
$2.07
|
| Rate for Payer: UHCCP Medicaid |
$1.11
|
| Rate for Payer: VA VA |
$2.07
|
|
|
HC TESTOSTERONE UNDECANOATE PER 1 MG
|
Facility
|
IP
|
$5.10
|
|
|
Service Code
|
HCPCS J3145
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$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 |
$4.33
|
| Rate for Payer: Nomi Health Commercial |
$4.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.49
|
|
|
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 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 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 |
$39.54 |
| 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: 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 |
$34.64
|
| Rate for Payer: Priority Health Narrow Network |
$27.72
|
| 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
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
30200320
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| 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 |
$59.36
|
| Rate for Payer: ASR Commercial |
$59.36
|
| Rate for Payer: BCBS Complete |
$8.33
|
| Rate for Payer: BCBS MAPPO |
$14.80
|
| Rate for Payer: BCBS Trust/PPO |
$50.12
|
| Rate for Payer: BCN Commercial |
$47.45
|
| 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 |
$57.53
|
| 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 |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.80
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| 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 |
$50.18
|
| 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 |
$7.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.62
|
| Rate for Payer: Priority Health Medicare |
$14.80
|
| Rate for Payer: Priority Health Narrow Network |
$42.90
|
| Rate for Payer: Railroad Medicare Medicare |
$14.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.80
|
| Rate for Payer: UHC Exchange |
$22.94
|
| Rate for Payer: UHC Medicare Advantage |
$14.80
|
| Rate for Payer: UHCCP DNSP |
$14.80
|
| Rate for Payer: UHCCP Medicaid |
$7.93
|
| Rate for Payer: VA VA |
$14.80
|
|
|
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
|
|
|
HC TETANUS/DIPHTHERIA/PERTUSIS VACCINE
|
Facility
|
IP
|
$124.62
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$124.62 |
| Rate for Payer: Aetna Commercial |
$112.16
|
| Rate for Payer: ASR ASR |
$120.88
|
| Rate for Payer: ASR Commercial |
$120.88
|
| Rate for Payer: BCBS Trust/PPO |
$101.55
|
| Rate for Payer: BCN Commercial |
$96.62
|
| Rate for Payer: Cash Price |
$99.70
|
| Rate for Payer: Cofinity Commercial |
$117.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.70
|
| Rate for Payer: Healthscope Commercial |
$124.62
|
| Rate for Payer: Healthscope Whirlpool |
$120.88
|
| Rate for Payer: Mclaren Commercial |
$112.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.93
|
| Rate for Payer: Nomi Health Commercial |
$102.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.67
|
|
|
HC TETANUS/DIPHTHERIA/PERTUSIS VACCINE
|
Facility
|
OP
|
$124.62
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.85 |
| Max. Negotiated Rate |
$124.62 |
| Rate for Payer: Aetna Commercial |
$112.16
|
| Rate for Payer: Aetna Medicare |
$62.31
|
| Rate for Payer: ASR ASR |
$120.88
|
| Rate for Payer: ASR Commercial |
$120.88
|
| Rate for Payer: BCBS Complete |
$49.85
|
| Rate for Payer: BCBS Trust/PPO |
$102.05
|
| Rate for Payer: BCN Commercial |
$96.62
|
| Rate for Payer: Cash Price |
$99.70
|
| Rate for Payer: Cofinity Commercial |
$117.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.70
|
| Rate for Payer: Healthscope Commercial |
$124.62
|
| Rate for Payer: Healthscope Whirlpool |
$120.88
|
| Rate for Payer: Mclaren Commercial |
$112.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.93
|
| Rate for Payer: Nomi Health Commercial |
$102.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.19
|
| Rate for Payer: Priority Health Narrow Network |
$87.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.67
|
|
|
HC THC URINE CONFIRM
|
Facility
|
IP
|
$63.24
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100568
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$63.24 |
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: ASR ASR |
$61.34
|
| Rate for Payer: ASR Commercial |
$61.34
|
| Rate for Payer: BCBS Trust/PPO |
$51.53
|
| Rate for Payer: BCN Commercial |
$49.03
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$63.24
|
| Rate for Payer: Healthscope Whirlpool |
$61.34
|
| Rate for Payer: Mclaren Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.65
|
|
|
HC THC URINE CONFIRM
|
Facility
|
OP
|
$63.24
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100568
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$63.24 |
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: ASR ASR |
$61.34
|
| Rate for Payer: ASR Commercial |
$61.34
|
| Rate for Payer: BCBS Complete |
$25.30
|
| Rate for Payer: BCBS Trust/PPO |
$51.79
|
| Rate for Payer: BCN Commercial |
$49.03
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$63.24
|
| Rate for Payer: Healthscope Whirlpool |
$61.34
|
| Rate for Payer: Mclaren Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.41
|
| Rate for Payer: Priority Health Narrow Network |
$44.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.65
|
|
|
HC THEOPHYLLINE LEVEL
|
Facility
|
IP
|
$92.21
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
30100048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.94 |
| Max. Negotiated Rate |
$92.21 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: ASR ASR |
$89.44
|
| Rate for Payer: ASR Commercial |
$89.44
|
| Rate for Payer: BCBS Trust/PPO |
$75.14
|
| Rate for Payer: BCN Commercial |
$71.49
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$86.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Healthscope Commercial |
$92.21
|
| Rate for Payer: Healthscope Whirlpool |
$89.44
|
| Rate for Payer: Mclaren Commercial |
$82.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: Nomi Health Commercial |
$75.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.14
|
|
|
HC THEOPHYLLINE LEVEL
|
Facility
|
OP
|
$92.21
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
30100048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$92.21 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| 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 |
$89.44
|
| Rate for Payer: ASR Commercial |
$89.44
|
| Rate for Payer: BCBS Complete |
$7.96
|
| Rate for Payer: BCBS MAPPO |
$14.14
|
| Rate for Payer: BCBS Trust/PPO |
$75.51
|
| Rate for Payer: BCN Commercial |
$71.49
|
| Rate for Payer: BCN Medicare Advantage |
$14.14
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$86.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.14
|
| Rate for Payer: Healthscope Commercial |
$92.21
|
| Rate for Payer: Healthscope Whirlpool |
$89.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$14.14
|
| Rate for Payer: Mclaren Commercial |
$82.99
|
| Rate for Payer: Mclaren Medicaid |
$7.58
|
| 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 |
$7.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: Nomi Health Commercial |
$75.61
|
| 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 |
$7.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.79
|
| Rate for Payer: Priority Health Medicare |
$14.14
|
| Rate for Payer: Priority Health Narrow Network |
$64.64
|
| Rate for Payer: Railroad Medicare Medicare |
$14.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.14
|
| Rate for Payer: UHC Exchange |
$21.92
|
| Rate for Payer: UHC Medicare Advantage |
$14.14
|
| Rate for Payer: UHCCP DNSP |
$14.14
|
| Rate for Payer: UHCCP Medicaid |
$7.58
|
| Rate for Payer: VA VA |
$14.14
|
|
|
HC THERAPEUTIC ACTIVITIES EA 15 MIN
|
Facility
|
IP
|
$98.84
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.25 |
| Max. Negotiated Rate |
$98.84 |
| Rate for Payer: Aetna Commercial |
$88.96
|
| Rate for Payer: ASR ASR |
$95.87
|
| Rate for Payer: ASR Commercial |
$95.87
|
| Rate for Payer: BCBS Trust/PPO |
$80.54
|
| Rate for Payer: BCN Commercial |
$76.63
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cofinity Commercial |
$92.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.07
|
| Rate for Payer: Healthscope Commercial |
$98.84
|
| Rate for Payer: Healthscope Whirlpool |
$95.87
|
| Rate for Payer: Mclaren Commercial |
$88.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.01
|
| Rate for Payer: Nomi Health Commercial |
$81.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.98
|
|
|
HC THERAPEUTIC ACTIVITIES EA 15 MIN
|
Facility
|
OP
|
$98.84
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.54 |
| Max. Negotiated Rate |
$98.84 |
| Rate for Payer: Aetna Commercial |
$88.96
|
| Rate for Payer: Aetna Medicare |
$49.42
|
| Rate for Payer: ASR ASR |
$95.87
|
| Rate for Payer: ASR Commercial |
$95.87
|
| Rate for Payer: BCBS Complete |
$39.54
|
| Rate for Payer: BCBS Trust/PPO |
$80.94
|
| Rate for Payer: BCN Commercial |
$76.63
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cofinity Commercial |
$92.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.07
|
| Rate for Payer: Healthscope Commercial |
$98.84
|
| Rate for Payer: Healthscope Whirlpool |
$95.87
|
| Rate for Payer: Mclaren Commercial |
$88.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.01
|
| Rate for Payer: Nomi Health Commercial |
$81.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.60
|
| Rate for Payer: Priority Health Narrow Network |
$69.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.98
|
|
|
HC THERAPEUTIC APHERESIS PLASMA PHERESIS
|
Facility
|
OP
|
$2,555.49
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
36100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$856.94 |
| Max. Negotiated Rate |
$2,555.49 |
| Rate for Payer: Aetna Commercial |
$2,299.94
|
| Rate for Payer: Aetna Medicare |
$1,598.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,998.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,998.45
|
| Rate for Payer: ASR ASR |
$2,478.83
|
| Rate for Payer: ASR Commercial |
$2,478.83
|
| Rate for Payer: BCBS Complete |
$899.78
|
| Rate for Payer: BCBS MAPPO |
$1,598.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,092.69
|
| Rate for Payer: BCN Commercial |
$1,981.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,598.76
|
| Rate for Payer: Cash Price |
$2,044.39
|
| Rate for Payer: Cash Price |
$2,044.39
|
| Rate for Payer: Cofinity Commercial |
$2,402.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,044.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,598.76
|
| Rate for Payer: Healthscope Commercial |
$2,555.49
|
| Rate for Payer: Healthscope Whirlpool |
$2,478.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,598.76
|
| Rate for Payer: Mclaren Commercial |
$2,299.94
|
| Rate for Payer: Mclaren Medicaid |
$856.94
|
| Rate for Payer: Mclaren Medicare |
$1,598.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,678.70
|
| Rate for Payer: Meridian Medicaid |
$899.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,838.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,172.17
|
| Rate for Payer: Nomi Health Commercial |
$2,095.50
|
| Rate for Payer: PACE Medicare |
$1,518.82
|
| Rate for Payer: PACE SWMI |
$1,598.76
|
| Rate for Payer: PHP Commercial |
$1,758.64
|
| Rate for Payer: PHP Medicaid |
$856.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,598.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$856.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,661.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,239.12
|
| Rate for Payer: Priority Health Medicare |
$1,598.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,791.40
|
| Rate for Payer: Railroad Medicare Medicare |
$1,598.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,248.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,598.76
|
| Rate for Payer: UHC Exchange |
$2,478.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,598.76
|
| Rate for Payer: UHCCP DNSP |
$1,598.76
|
| Rate for Payer: UHCCP Medicaid |
$856.94
|
| Rate for Payer: VA VA |
$1,598.76
|
|
