|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
IP
|
$1,283.57
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$808.65 |
| Max. Negotiated Rate |
$1,155.21 |
| Rate for Payer: Aetna Commercial |
$1,091.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$834.32
|
| Rate for Payer: Cash Price |
$1,026.86
|
| Rate for Payer: Cofinity Commercial |
$1,103.87
|
| Rate for Payer: Cofinity Commercial |
$898.50
|
| Rate for Payer: Healthscope Commercial |
$1,155.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,091.03
|
| Rate for Payer: PHP Commercial |
$1,091.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$898.50
|
| Rate for Payer: Priority Health SBD |
$808.65
|
|
|
HC INJECTION HIP ARTHROGRAM BIL
|
Facility
|
OP
|
$1,190.22
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.82 |
| Max. Negotiated Rate |
$1,071.20 |
| Rate for Payer: Aetna Commercial |
$1,011.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$773.64
|
| Rate for Payer: BCBS Complete |
$476.09
|
| Rate for Payer: BCBS Trust/PPO |
$240.28
|
| Rate for Payer: Cash Price |
$952.18
|
| Rate for Payer: Cash Price |
$952.18
|
| Rate for Payer: Cofinity Commercial |
$833.15
|
| Rate for Payer: Cofinity Commercial |
$1,023.59
|
| Rate for Payer: Healthscope Commercial |
$1,071.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,011.69
|
| Rate for Payer: PHP Commercial |
$1,011.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$833.15
|
| Rate for Payer: Priority Health SBD |
$749.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.40
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$65.82
|
|
|
HC INJECTION HIP ARTHROGRAM BIL
|
Facility
|
IP
|
$1,190.22
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$749.84 |
| Max. Negotiated Rate |
$1,071.20 |
| Rate for Payer: Aetna Commercial |
$1,011.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$773.64
|
| Rate for Payer: Cash Price |
$952.18
|
| Rate for Payer: Cofinity Commercial |
$1,023.59
|
| Rate for Payer: Cofinity Commercial |
$833.15
|
| Rate for Payer: Healthscope Commercial |
$1,071.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,011.69
|
| Rate for Payer: PHP Commercial |
$1,011.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$833.15
|
| Rate for Payer: Priority Health SBD |
$749.84
|
|
|
HC INJECTION INTRALESIONAL UP TO 7 LESIONS
|
Facility
|
IP
|
$144.23
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
76100134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.86 |
| Max. Negotiated Rate |
$129.81 |
| Rate for Payer: Aetna Commercial |
$122.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.75
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cofinity Commercial |
$100.96
|
| Rate for Payer: Cofinity Commercial |
$124.04
|
| Rate for Payer: Healthscope Commercial |
$129.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.60
|
| Rate for Payer: PHP Commercial |
$122.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.96
|
| Rate for Payer: Priority Health SBD |
$90.86
|
|
|
HC INJECTION INTRALESIONAL UP TO 7 LESIONS
|
Facility
|
OP
|
$144.23
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
76100134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$541.49 |
| Rate for Payer: Aetna Commercial |
$122.60
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$124.58
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cofinity Commercial |
$100.96
|
| Rate for Payer: Cofinity Commercial |
$124.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$129.81
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.60
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$122.60
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Priority Health SBD |
$90.86
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$29.14
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
HC INJECTION, IRON DEXTRAN, 50 MG
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT J1750
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$18.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.66
|
| Rate for Payer: BCBS Complete |
$9.95
|
| Rate for Payer: BCBS MAPPO |
$17.32
|
| Rate for Payer: BCBS Trust/PPO |
$51.29
|
| Rate for Payer: BCN Medicare Advantage |
$17.32
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$9.48
|
| Rate for Payer: Mclaren Medicare |
$17.32
|
| Rate for Payer: Meridian Medicaid |
$9.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PACE Medicare |
$16.46
|
| Rate for Payer: PACE SWMI |
$17.32
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$17.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health Medicare |
$17.32
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: Railroad Medicare Medicare |
$17.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.32
|
| Rate for Payer: UHC Medicare Advantage |
$17.84
|
| Rate for Payer: VA VA |
$17.32
|
|
|
HC INJECTION, IRON DEXTRAN, 50 MG
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT J1750
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.56 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health SBD |
$38.56
|
|
|
HC INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
63600098
|
|
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 |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| 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 INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
63600098
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.42 |
| 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: BCBS Complete |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$1.42
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| 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 INJECTION, LINCOMYCIN HCL, UP TO 300 MG
|
Facility
|
OP
|
$44.88
|
|
|
Service Code
|
CPT J2010
|
| Hospital Charge Code |
63600099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$40.39 |
| Rate for Payer: Aetna Commercial |
$38.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| Rate for Payer: BCBS Complete |
$17.95
|
| Rate for Payer: BCBS Trust/PPO |
$29.12
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$31.42
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Healthscope Commercial |
$40.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.15
|
| Rate for Payer: PHP Commercial |
$38.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.42
|
| Rate for Payer: Priority Health SBD |
$28.27
|
|
|
HC INJECTION, LINCOMYCIN HCL, UP TO 300 MG
|
Facility
|
IP
|
$44.88
|
|
|
Service Code
|
CPT J2010
|
| Hospital Charge Code |
63600099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$40.39 |
| Rate for Payer: Aetna Commercial |
$38.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$31.42
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Healthscope Commercial |
$40.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.15
|
| Rate for Payer: PHP Commercial |
$38.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.42
|
| Rate for Payer: Priority Health SBD |
$28.27
|
|
|
HC INJECTION LUMBAR DISKOGRAPHY
|
Facility
|
IP
|
$2,303.46
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
36100282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,451.18 |
| Max. Negotiated Rate |
$2,073.11 |
| Rate for Payer: Aetna Commercial |
$1,957.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,497.25
|
| Rate for Payer: Cash Price |
$1,842.77
|
| Rate for Payer: Cofinity Commercial |
$1,612.42
|
| Rate for Payer: Cofinity Commercial |
$1,980.98
|
| Rate for Payer: Healthscope Commercial |
$2,073.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,957.94
|
| Rate for Payer: PHP Commercial |
$1,957.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,612.42
|
| Rate for Payer: Priority Health SBD |
$1,451.18
|
|
|
HC INJECTION LUMBAR DISKOGRAPHY
|
Facility
|
OP
|
$2,303.46
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
36100282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$151.61 |
| Max. Negotiated Rate |
$2,073.11 |
| Rate for Payer: Aetna Commercial |
$1,957.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,497.25
|
| Rate for Payer: BCBS Complete |
$921.38
|
| Rate for Payer: BCBS Trust/PPO |
$659.10
|
| Rate for Payer: Cash Price |
$1,842.77
|
| Rate for Payer: Cash Price |
$1,842.77
|
| Rate for Payer: Cofinity Commercial |
$1,980.98
|
| Rate for Payer: Cofinity Commercial |
$1,612.42
|
| Rate for Payer: Healthscope Commercial |
$2,073.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,957.94
|
| Rate for Payer: PHP Commercial |
$1,957.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,612.42
|
| Rate for Payer: Priority Health SBD |
$1,451.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.77
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$151.61
|
|
|
HC INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
63600096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.66
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS Trust/PPO |
$0.41
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.71
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Healthscope Commercial |
$0.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.87
|
| Rate for Payer: PHP Commercial |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.71
|
| Rate for Payer: Priority Health SBD |
$0.64
|
|
|
HC INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
63600096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.66
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.71
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Healthscope Commercial |
$0.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.87
|
| Rate for Payer: PHP Commercial |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.71
|
| Rate for Payer: Priority Health SBD |
$0.64
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.63
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.67
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.14
|
| Rate for Payer: Priority Health SBD |
$6.43
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.63
|
| Rate for Payer: BCBS Complete |
$4.08
|
| Rate for Payer: BCBS Trust/PPO |
$20.83
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.67
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.14
|
| Rate for Payer: Priority Health SBD |
$6.43
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
63600094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: BCBS Complete |
$6.12
|
| Rate for Payer: BCBS Trust/PPO |
$19.00
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$9.64
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
63600094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$9.64
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
63600095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
63600095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$29.00
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
|
|
HC INJECTION MYELOGRAM
|
Facility
|
IP
|
$1,046.41
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
36100281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$659.24 |
| Max. Negotiated Rate |
$941.77 |
| Rate for Payer: Aetna Commercial |
$889.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$680.17
|
| Rate for Payer: Cash Price |
$837.13
|
| Rate for Payer: Cofinity Commercial |
$732.49
|
| Rate for Payer: Cofinity Commercial |
$899.91
|
| Rate for Payer: Healthscope Commercial |
$941.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$889.45
|
| Rate for Payer: PHP Commercial |
$889.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$732.49
|
| Rate for Payer: Priority Health SBD |
$659.24
|
|
|
HC INJECTION MYELOGRAM
|
Facility
|
OP
|
$1,046.41
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
36100281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$80.55 |
| Max. Negotiated Rate |
$941.77 |
| Rate for Payer: Aetna Commercial |
$889.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$680.17
|
| Rate for Payer: BCBS Complete |
$418.56
|
| Rate for Payer: BCBS Trust/PPO |
$428.49
|
| Rate for Payer: Cash Price |
$837.13
|
| Rate for Payer: Cash Price |
$837.13
|
| Rate for Payer: Cofinity Commercial |
$899.91
|
| Rate for Payer: Cofinity Commercial |
$732.49
|
| Rate for Payer: Healthscope Commercial |
$941.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$889.45
|
| Rate for Payer: PHP Commercial |
$889.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$732.49
|
| Rate for Payer: Priority Health SBD |
$659.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.60
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$80.55
|
|
|
HC INJECTION PLANTAR DIGIT
|
Facility
|
IP
|
$344.76
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$310.28 |
| Rate for Payer: Aetna Commercial |
$293.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.09
|
| Rate for Payer: Cash Price |
$275.81
|
| Rate for Payer: Cofinity Commercial |
$241.33
|
| Rate for Payer: Cofinity Commercial |
$296.49
|
| Rate for Payer: Healthscope Commercial |
$310.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$293.05
|
| Rate for Payer: PHP Commercial |
$293.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.33
|
| Rate for Payer: Priority Health SBD |
$217.20
|
|
|
HC INJECTION PLANTAR DIGIT
|
Facility
|
OP
|
$344.76
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$329.42 |
| Rate for Payer: Aetna Commercial |
$293.05
|
| Rate for Payer: Aetna Medicare |
$274.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.42
|
| Rate for Payer: BCBS Complete |
$151.38
|
| Rate for Payer: BCBS MAPPO |
$263.54
|
| Rate for Payer: BCBS Trust/PPO |
$169.96
|
| Rate for Payer: BCN Medicare Advantage |
$263.54
|
| Rate for Payer: Cash Price |
$275.81
|
| Rate for Payer: Cash Price |
$275.81
|
| Rate for Payer: Cofinity Commercial |
$296.49
|
| Rate for Payer: Cofinity Commercial |
$241.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.54
|
| Rate for Payer: Healthscope Commercial |
$310.28
|
| Rate for Payer: Mclaren Medicaid |
$144.16
|
| Rate for Payer: Mclaren Medicare |
$263.54
|
| Rate for Payer: Meridian Medicaid |
$151.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$293.05
|
| Rate for Payer: PACE Medicare |
$250.36
|
| Rate for Payer: PACE SWMI |
$263.54
|
| Rate for Payer: PHP Commercial |
$293.05
|
| Rate for Payer: PHP Medicare Advantage |
$263.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.33
|
| Rate for Payer: Priority Health Medicare |
$263.54
|
| Rate for Payer: Priority Health SBD |
$217.20
|
| Rate for Payer: Railroad Medicare Medicare |
$263.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.54
|
| Rate for Payer: UHC Exchange |
$32.42
|
| Rate for Payer: UHC Medicare Advantage |
$271.45
|
| Rate for Payer: VA VA |
$263.54
|
|
