|
HC INJ ANESTHETIC FEMORAL
|
Facility
|
IP
|
$1,504.19
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
36100391
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$947.64 |
| Max. Negotiated Rate |
$1,353.77 |
| Rate for Payer: Aetna Commercial |
$1,278.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$977.72
|
| Rate for Payer: Cash Price |
$1,203.35
|
| Rate for Payer: Cofinity Commercial |
$1,052.93
|
| Rate for Payer: Cofinity Commercial |
$1,293.60
|
| Rate for Payer: Healthscope Commercial |
$1,353.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,278.56
|
| Rate for Payer: PHP Commercial |
$1,278.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,052.93
|
| Rate for Payer: Priority Health SBD |
$947.64
|
|
|
HC INJ ANESTHETIC FEMORAL
|
Facility
|
OP
|
$1,504.19
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
36100391
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$1,353.77 |
| Rate for Payer: Aetna Commercial |
$1,278.56
|
| Rate for Payer: Aetna Medicare |
$639.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$977.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.16
|
| Rate for Payer: BCBS Complete |
$353.45
|
| Rate for Payer: BCBS MAPPO |
$615.33
|
| Rate for Payer: BCBS Trust/PPO |
$46.57
|
| Rate for Payer: BCN Medicare Advantage |
$615.33
|
| Rate for Payer: Cash Price |
$1,203.35
|
| Rate for Payer: Cash Price |
$1,203.35
|
| Rate for Payer: Cofinity Commercial |
$1,293.60
|
| Rate for Payer: Cofinity Commercial |
$1,052.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.33
|
| Rate for Payer: Healthscope Commercial |
$1,353.77
|
| Rate for Payer: Mclaren Medicaid |
$336.59
|
| Rate for Payer: Mclaren Medicare |
$615.33
|
| Rate for Payer: Meridian Medicaid |
$353.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,278.56
|
| Rate for Payer: PACE Medicare |
$584.56
|
| Rate for Payer: PACE SWMI |
$615.33
|
| Rate for Payer: PHP Commercial |
$1,278.56
|
| Rate for Payer: PHP Medicare Advantage |
$615.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,052.93
|
| Rate for Payer: Priority Health Medicare |
$615.33
|
| Rate for Payer: Priority Health SBD |
$947.64
|
| Rate for Payer: Railroad Medicare Medicare |
$615.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.33
|
| Rate for Payer: UHC Exchange |
$61.23
|
| Rate for Payer: UHC Medicare Advantage |
$633.79
|
| Rate for Payer: VA VA |
$615.33
|
|
|
HC INJ ANESTH PERIPH NERVE
|
Facility
|
IP
|
$872.87
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
36100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$549.91 |
| Max. Negotiated Rate |
$785.58 |
| Rate for Payer: Aetna Commercial |
$741.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$567.37
|
| Rate for Payer: Cash Price |
$698.30
|
| Rate for Payer: Cofinity Commercial |
$611.01
|
| Rate for Payer: Cofinity Commercial |
$750.67
|
| Rate for Payer: Healthscope Commercial |
$785.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$741.94
|
| Rate for Payer: PHP Commercial |
$741.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.01
|
| Rate for Payer: Priority Health SBD |
$549.91
|
|
|
HC INJ ANESTH PERIPH NERVE
|
Facility
|
OP
|
$872.87
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
36100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$785.58 |
| Rate for Payer: Aetna Commercial |
$741.94
|
| Rate for Payer: Aetna Medicare |
$639.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$567.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.16
|
| Rate for Payer: BCBS Complete |
$353.45
|
| Rate for Payer: BCBS MAPPO |
$615.33
|
| Rate for Payer: BCBS Trust/PPO |
$402.78
|
| Rate for Payer: BCN Medicare Advantage |
$615.33
|
| Rate for Payer: Cash Price |
$698.30
|
| Rate for Payer: Cash Price |
$698.30
|
| Rate for Payer: Cofinity Commercial |
$750.67
|
| Rate for Payer: Cofinity Commercial |
$611.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.33
|
| Rate for Payer: Healthscope Commercial |
$785.58
|
| Rate for Payer: Mclaren Medicaid |
$336.59
|
| Rate for Payer: Mclaren Medicare |
$615.33
|
| Rate for Payer: Meridian Medicaid |
$353.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$741.94
|
| Rate for Payer: PACE Medicare |
$584.56
|
| Rate for Payer: PACE SWMI |
$615.33
|
| Rate for Payer: PHP Commercial |
$741.94
|
| Rate for Payer: PHP Medicare Advantage |
$615.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.01
|
| Rate for Payer: Priority Health Medicare |
$615.33
|
| Rate for Payer: Priority Health SBD |
$549.91
|
| Rate for Payer: Railroad Medicare Medicare |
$615.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.33
|
| Rate for Payer: UHC Exchange |
$40.93
|
| Rate for Payer: UHC Medicare Advantage |
$633.79
|
| Rate for Payer: VA VA |
$615.33
|
|
|
HC INJ ANESTH/STEROID BRACHIAL PLEXUS CONT
|
Facility
|
IP
|
$3,109.92
|
|
|
Service Code
|
CPT 64416
|
| Hospital Charge Code |
37100010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,959.25 |
| Max. Negotiated Rate |
$2,798.93 |
| Rate for Payer: Aetna Commercial |
$2,643.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,021.45
|
| Rate for Payer: Cash Price |
$2,487.94
|
| Rate for Payer: Cofinity Commercial |
$2,176.94
|
| Rate for Payer: Cofinity Commercial |
$2,674.53
|
| Rate for Payer: Healthscope Commercial |
$2,798.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,643.43
|
| Rate for Payer: PHP Commercial |
$2,643.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,176.94
|
| Rate for Payer: Priority Health SBD |
$1,959.25
|
|
|
HC INJ ANESTH/STEROID BRACHIAL PLEXUS CONT
|
Facility
|
OP
|
$3,109.92
|
|
|
Service Code
|
CPT 64416
|
| Hospital Charge Code |
37100010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$74.66 |
| Max. Negotiated Rate |
$2,798.93 |
| Rate for Payer: Aetna Commercial |
$2,643.43
|
| Rate for Payer: Aetna Medicare |
$843.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,021.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,013.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,013.79
|
| Rate for Payer: BCBS Complete |
$465.86
|
| Rate for Payer: BCBS MAPPO |
$811.03
|
| Rate for Payer: BCBS Trust/PPO |
$387.12
|
| Rate for Payer: BCN Medicare Advantage |
$811.03
|
| Rate for Payer: Cash Price |
$2,487.94
|
| Rate for Payer: Cash Price |
$2,487.94
|
| Rate for Payer: Cofinity Commercial |
$2,674.53
|
| Rate for Payer: Cofinity Commercial |
$2,176.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.03
|
| Rate for Payer: Healthscope Commercial |
$2,798.93
|
| Rate for Payer: Mclaren Medicaid |
$443.63
|
| Rate for Payer: Mclaren Medicare |
$811.03
|
| Rate for Payer: Meridian Medicaid |
$465.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$851.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$932.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,643.43
|
| Rate for Payer: PACE Medicare |
$770.48
|
| Rate for Payer: PACE SWMI |
$811.03
|
| Rate for Payer: PHP Commercial |
$2,643.43
|
| Rate for Payer: PHP Medicare Advantage |
$811.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,176.94
|
| Rate for Payer: Priority Health Medicare |
$811.03
|
| Rate for Payer: Priority Health SBD |
$1,959.25
|
| Rate for Payer: Railroad Medicare Medicare |
$811.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.03
|
| Rate for Payer: UHC Exchange |
$74.66
|
| Rate for Payer: UHC Medicare Advantage |
$835.36
|
| Rate for Payer: VA VA |
$811.03
|
|
|
HC INJ ANESTH/STEROID SCIATIC NERVE CONT
|
Facility
|
IP
|
$3,118.20
|
|
|
Service Code
|
CPT 64446
|
| Hospital Charge Code |
37000020
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,964.47 |
| Max. Negotiated Rate |
$2,806.38 |
| Rate for Payer: Aetna Commercial |
$2,650.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,026.83
|
| Rate for Payer: Cash Price |
$2,494.56
|
| Rate for Payer: Cofinity Commercial |
$2,182.74
|
| Rate for Payer: Cofinity Commercial |
$2,681.65
|
| Rate for Payer: Healthscope Commercial |
$2,806.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,650.47
|
| Rate for Payer: PHP Commercial |
$2,650.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,182.74
|
| Rate for Payer: Priority Health SBD |
$1,964.47
|
|
|
HC INJ ANESTH/STEROID SCIATIC NERVE CONT
|
Facility
|
OP
|
$3,118.20
|
|
|
Service Code
|
CPT 64446
|
| Hospital Charge Code |
37000020
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$73.02 |
| Max. Negotiated Rate |
$2,806.38 |
| Rate for Payer: Aetna Commercial |
$2,650.47
|
| Rate for Payer: Aetna Medicare |
$843.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,026.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,013.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,013.79
|
| Rate for Payer: BCBS Complete |
$465.86
|
| Rate for Payer: BCBS MAPPO |
$811.03
|
| Rate for Payer: BCBS Trust/PPO |
$410.46
|
| Rate for Payer: BCN Medicare Advantage |
$811.03
|
| Rate for Payer: Cash Price |
$2,494.56
|
| Rate for Payer: Cash Price |
$2,494.56
|
| Rate for Payer: Cofinity Commercial |
$2,681.65
|
| Rate for Payer: Cofinity Commercial |
$2,182.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.03
|
| Rate for Payer: Healthscope Commercial |
$2,806.38
|
| Rate for Payer: Mclaren Medicaid |
$443.63
|
| Rate for Payer: Mclaren Medicare |
$811.03
|
| Rate for Payer: Meridian Medicaid |
$465.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$851.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$932.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,650.47
|
| Rate for Payer: PACE Medicare |
$770.48
|
| Rate for Payer: PACE SWMI |
$811.03
|
| Rate for Payer: PHP Commercial |
$2,650.47
|
| Rate for Payer: PHP Medicare Advantage |
$811.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,182.74
|
| Rate for Payer: Priority Health Medicare |
$811.03
|
| Rate for Payer: Priority Health SBD |
$1,964.47
|
| Rate for Payer: Railroad Medicare Medicare |
$811.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.03
|
| Rate for Payer: UHC Exchange |
$73.02
|
| Rate for Payer: UHC Medicare Advantage |
$835.36
|
| Rate for Payer: VA VA |
$811.03
|
|
|
HC INJ ANEST/STEROID ILIOING ILIOHYPOGAST NRV
|
Facility
|
OP
|
$956.33
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
76100270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.05 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Aetna Commercial |
$812.88
|
| Rate for Payer: Aetna Medicare |
$639.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$621.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.16
|
| Rate for Payer: BCBS Complete |
$353.45
|
| Rate for Payer: BCBS MAPPO |
$615.33
|
| Rate for Payer: BCBS Trust/PPO |
$402.78
|
| Rate for Payer: BCN Medicare Advantage |
$615.33
|
| Rate for Payer: Cash Price |
$765.06
|
| Rate for Payer: Cash Price |
$765.06
|
| Rate for Payer: Cofinity Commercial |
$669.43
|
| Rate for Payer: Cofinity Commercial |
$822.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.33
|
| Rate for Payer: Healthscope Commercial |
$860.70
|
| Rate for Payer: Mclaren Medicaid |
$336.59
|
| Rate for Payer: Mclaren Medicare |
$615.33
|
| Rate for Payer: Meridian Medicaid |
$353.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$812.88
|
| Rate for Payer: PACE Medicare |
$584.56
|
| Rate for Payer: PACE SWMI |
$615.33
|
| Rate for Payer: PHP Commercial |
$812.88
|
| Rate for Payer: PHP Medicare Advantage |
$615.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$669.43
|
| Rate for Payer: Priority Health Medicare |
$615.33
|
| Rate for Payer: Priority Health SBD |
$602.49
|
| Rate for Payer: Railroad Medicare Medicare |
$615.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.33
|
| Rate for Payer: UHC Exchange |
$53.05
|
| Rate for Payer: UHC Medicare Advantage |
$633.79
|
| Rate for Payer: VA VA |
$615.33
|
|
|
HC INJ ANEST/STEROID ILIOING ILIOHYPOGAST NRV
|
Facility
|
IP
|
$956.33
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
76100270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.49 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Aetna Commercial |
$812.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$621.61
|
| Rate for Payer: Cash Price |
$765.06
|
| Rate for Payer: Cofinity Commercial |
$822.44
|
| Rate for Payer: Cofinity Commercial |
$669.43
|
| Rate for Payer: Healthscope Commercial |
$860.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$812.88
|
| Rate for Payer: PHP Commercial |
$812.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$669.43
|
| Rate for Payer: Priority Health SBD |
$602.49
|
|
|
HC INJ BEBTELOVIMAB
|
Facility
|
OP
|
$475.49
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
77100034
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$179.04 |
| Max. Negotiated Rate |
$427.94 |
| Rate for Payer: Aetna Commercial |
$404.17
|
| Rate for Payer: Aetna Medicare |
$340.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$409.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$409.15
|
| Rate for Payer: BCBS Complete |
$188.01
|
| Rate for Payer: BCBS MAPPO |
$327.32
|
| Rate for Payer: BCN Medicare Advantage |
$327.32
|
| Rate for Payer: Cash Price |
$380.39
|
| Rate for Payer: Cash Price |
$380.39
|
| Rate for Payer: Cofinity Commercial |
$408.92
|
| Rate for Payer: Cofinity Commercial |
$332.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.32
|
| Rate for Payer: Healthscope Commercial |
$427.94
|
| Rate for Payer: Mclaren Medicaid |
$179.04
|
| Rate for Payer: Mclaren Medicare |
$327.32
|
| Rate for Payer: Meridian Medicaid |
$188.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$343.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$404.17
|
| Rate for Payer: PACE Medicare |
$310.95
|
| Rate for Payer: PACE SWMI |
$327.32
|
| Rate for Payer: PHP Commercial |
$404.17
|
| Rate for Payer: PHP Medicare Advantage |
$327.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.84
|
| Rate for Payer: Priority Health Medicare |
$327.32
|
| Rate for Payer: Priority Health SBD |
$299.56
|
| Rate for Payer: Railroad Medicare Medicare |
$327.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.32
|
| Rate for Payer: UHC Medicare Advantage |
$337.14
|
| Rate for Payer: VA VA |
$327.32
|
|
|
HC INJ BEBTELOVIMAB
|
Facility
|
IP
|
$475.49
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
77100034
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$299.56 |
| Max. Negotiated Rate |
$427.94 |
| Rate for Payer: Aetna Commercial |
$404.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.07
|
| Rate for Payer: Cash Price |
$380.39
|
| Rate for Payer: Cofinity Commercial |
$332.84
|
| Rate for Payer: Cofinity Commercial |
$408.92
|
| Rate for Payer: Healthscope Commercial |
$427.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$404.17
|
| Rate for Payer: PHP Commercial |
$404.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.84
|
| Rate for Payer: Priority Health SBD |
$299.56
|
|
|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$20.17 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: BCBS Complete |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$20.17
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
OP
|
$1,081.82
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$107.40 |
| Max. Negotiated Rate |
$2,555.29 |
| Rate for Payer: Aetna Commercial |
$919.55
|
| Rate for Payer: Aetna Medicare |
$843.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$703.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,013.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,013.79
|
| Rate for Payer: BCBS Complete |
$465.86
|
| Rate for Payer: BCBS MAPPO |
$811.03
|
| Rate for Payer: BCBS Trust/PPO |
$584.04
|
| Rate for Payer: BCN Medicare Advantage |
$811.03
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cofinity Commercial |
$757.27
|
| Rate for Payer: Cofinity Commercial |
$930.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.03
|
| Rate for Payer: Healthscope Commercial |
$973.64
|
| Rate for Payer: Mclaren Medicaid |
$443.63
|
| Rate for Payer: Mclaren Medicare |
$811.03
|
| Rate for Payer: Meridian Medicaid |
$465.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$851.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$932.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.55
|
| Rate for Payer: PACE Medicare |
$770.48
|
| Rate for Payer: PACE SWMI |
$811.03
|
| Rate for Payer: PHP Commercial |
$919.55
|
| Rate for Payer: PHP Medicare Advantage |
$811.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,555.29
|
| Rate for Payer: Priority Health Medicare |
$811.03
|
| Rate for Payer: Priority Health Narrow Network |
$2,044.23
|
| Rate for Payer: Priority Health SBD |
$681.55
|
| Rate for Payer: Railroad Medicare Medicare |
$811.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.14
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.03
|
| Rate for Payer: UHC Exchange |
$107.40
|
| Rate for Payer: UHC Medicare Advantage |
$835.36
|
| Rate for Payer: VA VA |
$811.03
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
IP
|
$1,081.82
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$681.55 |
| Max. Negotiated Rate |
$973.64 |
| Rate for Payer: Aetna Commercial |
$919.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$703.18
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cofinity Commercial |
$930.37
|
| Rate for Payer: Cofinity Commercial |
$757.27
|
| Rate for Payer: Healthscope Commercial |
$973.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.55
|
| Rate for Payer: PHP Commercial |
$919.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.27
|
| Rate for Payer: Priority Health SBD |
$681.55
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
OP
|
$1,081.82
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.44 |
| Max. Negotiated Rate |
$2,555.29 |
| Rate for Payer: Aetna Commercial |
$919.55
|
| Rate for Payer: Aetna Medicare |
$843.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$703.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,013.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,013.79
|
| Rate for Payer: BCBS Complete |
$465.86
|
| Rate for Payer: BCBS MAPPO |
$811.03
|
| Rate for Payer: BCBS Trust/PPO |
$584.04
|
| Rate for Payer: BCN Medicare Advantage |
$811.03
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cofinity Commercial |
$757.27
|
| Rate for Payer: Cofinity Commercial |
$930.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.03
|
| Rate for Payer: Healthscope Commercial |
$973.64
|
| Rate for Payer: Mclaren Medicaid |
$443.63
|
| Rate for Payer: Mclaren Medicare |
$811.03
|
| Rate for Payer: Meridian Medicaid |
$465.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$851.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$932.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.55
|
| Rate for Payer: PACE Medicare |
$770.48
|
| Rate for Payer: PACE SWMI |
$811.03
|
| Rate for Payer: PHP Commercial |
$919.55
|
| Rate for Payer: PHP Medicare Advantage |
$811.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,555.29
|
| Rate for Payer: Priority Health Medicare |
$811.03
|
| Rate for Payer: Priority Health Narrow Network |
$2,044.23
|
| Rate for Payer: Priority Health SBD |
$681.55
|
| Rate for Payer: Railroad Medicare Medicare |
$811.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.08
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.03
|
| Rate for Payer: UHC Exchange |
$86.44
|
| Rate for Payer: UHC Medicare Advantage |
$835.36
|
| Rate for Payer: VA VA |
$811.03
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
IP
|
$1,081.82
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$681.55 |
| Max. Negotiated Rate |
$973.64 |
| Rate for Payer: Aetna Commercial |
$919.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$703.18
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cofinity Commercial |
$757.27
|
| Rate for Payer: Cofinity Commercial |
$930.37
|
| Rate for Payer: Healthscope Commercial |
$973.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.55
|
| Rate for Payer: PHP Commercial |
$919.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.27
|
| Rate for Payer: Priority Health SBD |
$681.55
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
OP
|
$1,081.82
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.78 |
| Max. Negotiated Rate |
$2,555.29 |
| Rate for Payer: Aetna Commercial |
$919.55
|
| Rate for Payer: Aetna Medicare |
$843.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$703.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,013.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,013.79
|
| Rate for Payer: BCBS Complete |
$465.86
|
| Rate for Payer: BCBS MAPPO |
$811.03
|
| Rate for Payer: BCBS Trust/PPO |
$584.04
|
| Rate for Payer: BCN Medicare Advantage |
$811.03
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cofinity Commercial |
$930.37
|
| Rate for Payer: Cofinity Commercial |
$757.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.03
|
| Rate for Payer: Healthscope Commercial |
$973.64
|
| Rate for Payer: Mclaren Medicaid |
$443.63
|
| Rate for Payer: Mclaren Medicare |
$811.03
|
| Rate for Payer: Meridian Medicaid |
$465.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$851.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$932.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.55
|
| Rate for Payer: PACE Medicare |
$770.48
|
| Rate for Payer: PACE SWMI |
$811.03
|
| Rate for Payer: PHP Commercial |
$919.55
|
| Rate for Payer: PHP Medicare Advantage |
$811.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,555.29
|
| Rate for Payer: Priority Health Medicare |
$811.03
|
| Rate for Payer: Priority Health Narrow Network |
$2,044.23
|
| Rate for Payer: Priority Health SBD |
$681.55
|
| Rate for Payer: Railroad Medicare Medicare |
$811.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.26
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.03
|
| Rate for Payer: UHC Exchange |
$104.78
|
| Rate for Payer: UHC Medicare Advantage |
$835.36
|
| Rate for Payer: VA VA |
$811.03
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
IP
|
$1,081.82
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$681.55 |
| Max. Negotiated Rate |
$973.64 |
| Rate for Payer: Aetna Commercial |
$919.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$703.18
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cofinity Commercial |
$757.27
|
| Rate for Payer: Cofinity Commercial |
$930.37
|
| Rate for Payer: Healthscope Commercial |
$973.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.55
|
| Rate for Payer: PHP Commercial |
$919.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.27
|
| Rate for Payer: Priority Health SBD |
$681.55
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$45.50
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health SBD |
$40.95
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.25 |
| Max. Negotiated Rate |
$196.16 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna Medicare |
$68.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.84
|
| Rate for Payer: BCBS Complete |
$38.06
|
| Rate for Payer: BCBS MAPPO |
$66.27
|
| Rate for Payer: BCBS Trust/PPO |
$196.16
|
| Rate for Payer: BCN Medicare Advantage |
$66.27
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$45.50
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.27
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Mclaren Medicaid |
$36.25
|
| Rate for Payer: Mclaren Medicare |
$66.27
|
| Rate for Payer: Meridian Medicaid |
$38.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$69.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PACE Medicare |
$62.96
|
| Rate for Payer: PACE SWMI |
$66.27
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: PHP Medicare Advantage |
$66.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health Medicare |
$66.27
|
| Rate for Payer: Priority Health SBD |
$40.95
|
| Rate for Payer: Railroad Medicare Medicare |
$66.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.27
|
| Rate for Payer: UHC Medicare Advantage |
$68.26
|
| Rate for Payer: VA VA |
$66.27
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
OP
|
$353.94
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.36 |
| Max. Negotiated Rate |
$644.30 |
| Rate for Payer: Aetna Commercial |
$300.85
|
| Rate for Payer: Aetna Medicare |
$228.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.89
|
| Rate for Payer: BCBS Complete |
$126.32
|
| Rate for Payer: BCBS MAPPO |
$219.91
|
| Rate for Payer: BCBS Trust/PPO |
$90.51
|
| Rate for Payer: BCN Medicare Advantage |
$219.91
|
| Rate for Payer: Cash Price |
$283.15
|
| Rate for Payer: Cash Price |
$283.15
|
| Rate for Payer: Cofinity Commercial |
$304.39
|
| Rate for Payer: Cofinity Commercial |
$247.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.91
|
| Rate for Payer: Healthscope Commercial |
$318.55
|
| Rate for Payer: Mclaren Medicaid |
$120.29
|
| Rate for Payer: Mclaren Medicare |
$219.91
|
| Rate for Payer: Meridian Medicaid |
$126.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.85
|
| Rate for Payer: PACE Medicare |
$208.91
|
| Rate for Payer: PACE SWMI |
$219.91
|
| Rate for Payer: PHP Commercial |
$300.85
|
| Rate for Payer: PHP Medicare Advantage |
$219.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$644.30
|
| Rate for Payer: Priority Health Medicare |
$219.91
|
| Rate for Payer: Priority Health Narrow Network |
$515.44
|
| Rate for Payer: Priority Health SBD |
$222.98
|
| Rate for Payer: Railroad Medicare Medicare |
$219.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.91
|
| Rate for Payer: UHC Exchange |
$72.36
|
| Rate for Payer: UHC Medicare Advantage |
$226.51
|
| Rate for Payer: VA VA |
$219.91
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
IP
|
$353.94
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$222.98 |
| Max. Negotiated Rate |
$318.55 |
| Rate for Payer: Aetna Commercial |
$300.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.06
|
| Rate for Payer: Cash Price |
$283.15
|
| Rate for Payer: Cofinity Commercial |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$304.39
|
| Rate for Payer: Healthscope Commercial |
$318.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.85
|
| Rate for Payer: PHP Commercial |
$300.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.76
|
| Rate for Payer: Priority Health SBD |
$222.98
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$859.16
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.78 |
| Max. Negotiated Rate |
$1,932.06 |
| Rate for Payer: Aetna Commercial |
$730.29
|
| Rate for Payer: Aetna Medicare |
$639.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$558.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.16
|
| Rate for Payer: BCBS Complete |
$353.45
|
| Rate for Payer: BCBS MAPPO |
$615.33
|
| Rate for Payer: BCBS Trust/PPO |
$593.55
|
| Rate for Payer: BCN Medicare Advantage |
$615.33
|
| Rate for Payer: Cash Price |
$687.33
|
| Rate for Payer: Cash Price |
$687.33
|
| Rate for Payer: Cofinity Commercial |
$601.41
|
| Rate for Payer: Cofinity Commercial |
$738.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.33
|
| Rate for Payer: Healthscope Commercial |
$773.24
|
| Rate for Payer: Mclaren Medicaid |
$336.59
|
| Rate for Payer: Mclaren Medicare |
$615.33
|
| Rate for Payer: Meridian Medicaid |
$353.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.29
|
| Rate for Payer: PACE Medicare |
$584.56
|
| Rate for Payer: PACE SWMI |
$615.33
|
| Rate for Payer: PHP Commercial |
$730.29
|
| Rate for Payer: PHP Medicare Advantage |
$615.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,932.06
|
| Rate for Payer: Priority Health Medicare |
$615.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,545.65
|
| Rate for Payer: Priority Health SBD |
$541.27
|
| Rate for Payer: Railroad Medicare Medicare |
$615.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.26
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.33
|
| Rate for Payer: UHC Exchange |
$104.78
|
| Rate for Payer: UHC Medicare Advantage |
$633.79
|
| Rate for Payer: VA VA |
$615.33
|
|
