|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
IP
|
$1,125.53
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$709.08 |
| Max. Negotiated Rate |
$1,012.98 |
| Rate for Payer: Aetna Commercial |
$956.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$731.59
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cofinity Advantage |
$787.87
|
| Rate for Payer: Cofinity Commercial |
$967.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.42
|
| Rate for Payer: Healthscope Commercial |
$1,012.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$844.15
|
| Rate for Payer: PHP Commercial |
$956.70
|
| Rate for Payer: Priority Health SBD |
$709.08
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
OP
|
$1,125.53
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna Commercial |
$956.70
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$731.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$461.20
|
| Rate for Payer: BCN Commercial |
$461.20
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cofinity Advantage |
$787.87
|
| Rate for Payer: Cofinity Commercial |
$967.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,012.98
|
| Rate for Payer: Mclaren Medicaid |
$460.91
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.70
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$844.15
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$956.70
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health SBD |
$709.08
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
IP
|
$1,125.53
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$709.08 |
| Max. Negotiated Rate |
$1,012.98 |
| Rate for Payer: Aetna Commercial |
$956.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$731.59
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cofinity Advantage |
$787.87
|
| Rate for Payer: Cofinity Commercial |
$967.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.42
|
| Rate for Payer: Healthscope Commercial |
$1,012.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$844.15
|
| Rate for Payer: PHP Commercial |
$956.70
|
| Rate for Payer: Priority Health SBD |
$709.08
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
OP
|
$1,125.53
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna Commercial |
$956.70
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$731.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$461.20
|
| Rate for Payer: BCN Commercial |
$461.20
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cofinity Advantage |
$787.87
|
| Rate for Payer: Cofinity Commercial |
$967.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,012.98
|
| Rate for Payer: Mclaren Medicaid |
$460.91
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.70
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$844.15
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$956.70
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health SBD |
$709.08
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Advantage |
$47.34
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: Priority Health SBD |
$42.61
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$239.39 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna Medicare |
$81.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.94
|
| Rate for Payer: BCBS Complete |
$43.03
|
| Rate for Payer: BCBS MAPPO |
$78.35
|
| Rate for Payer: BCBS Trust/PPO |
$190.02
|
| Rate for Payer: BCN Commercial |
$190.02
|
| Rate for Payer: BCN Medicare Advantage |
$78.35
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Advantage |
$47.34
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.35
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Mclaren Medicaid |
$40.98
|
| Rate for Payer: Mclaren Medicare |
$78.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.27
|
| Rate for Payer: Meridian Medicaid |
$82.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$235.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PACE Medicare |
$74.43
|
| Rate for Payer: PACE SWMI |
$78.35
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: PHP Medicare Advantage |
$78.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$239.39
|
| Rate for Payer: Priority Health Medicare |
$78.35
|
| Rate for Payer: Priority Health SBD |
$42.61
|
| Rate for Payer: Priority Health Tiered Network |
$191.51
|
| Rate for Payer: Railroad Medicare Medicare |
$78.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.33
|
| Rate for Payer: UHC Core |
$83.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$78.35
|
| Rate for Payer: UHC Exchange |
$83.33
|
| Rate for Payer: UHC Medicaid |
$40.98
|
| Rate for Payer: UHCCP Medicaid |
$40.98
|
| Rate for Payer: VA VA |
$78.35
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
OP
|
$368.24
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.38 |
| Max. Negotiated Rate |
$805.08 |
| Rate for Payer: Aetna Commercial |
$313.00
|
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$119.38
|
| Rate for Payer: BCN Commercial |
$119.38
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$294.59
|
| Rate for Payer: Cash Price |
$294.59
|
| Rate for Payer: Cash Price |
$294.59
|
| Rate for Payer: Cofinity Advantage |
$257.77
|
| Rate for Payer: Cofinity Commercial |
$316.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$331.42
|
| Rate for Payer: Mclaren Medicaid |
$130.20
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$261.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.00
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.18
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$313.00
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$805.08
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health SBD |
$231.99
|
| Rate for Payer: Priority Health Tiered Network |
$644.06
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.36
|
| Rate for Payer: UHC Core |
$191.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Exchange |
$144.72
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
IP
|
$368.24
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.99 |
| Max. Negotiated Rate |
$331.42 |
| Rate for Payer: Aetna Commercial |
$313.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.36
|
| Rate for Payer: Cash Price |
$294.59
|
| Rate for Payer: Cofinity Advantage |
$257.77
|
| Rate for Payer: Cofinity Commercial |
$316.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.59
|
| Rate for Payer: Healthscope Commercial |
$331.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.18
|
| Rate for Payer: PHP Commercial |
$313.00
|
| Rate for Payer: Priority Health SBD |
$231.99
|
|
|
HC INJ DAXIBOTULINUMTOXINA-LANM, 1 UNIT
|
Facility
|
IP
|
$11.22
|
|
|
Service Code
|
HCPCS J0589
|
| Hospital Charge Code |
63600257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$10.10 |
| Rate for Payer: Aetna Commercial |
$9.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.29
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Cofinity Advantage |
$7.85
|
| Rate for Payer: Cofinity Commercial |
$9.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.98
|
| Rate for Payer: Healthscope Commercial |
$10.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.41
|
| Rate for Payer: PHP Commercial |
$9.54
|
| Rate for Payer: Priority Health SBD |
$7.07
|
|
|
HC INJ DAXIBOTULINUMTOXINA-LANM, 1 UNIT
|
Facility
|
OP
|
$11.22
|
|
|
Service Code
|
HCPCS J0589
|
| Hospital Charge Code |
63600257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$10.10 |
| Rate for Payer: Aetna Commercial |
$9.54
|
| Rate for Payer: Aetna Medicare |
$3.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.86
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: BCBS MAPPO |
$3.09
|
| Rate for Payer: BCBS Trust/PPO |
$7.81
|
| Rate for Payer: BCN Commercial |
$7.81
|
| Rate for Payer: BCN Medicare Advantage |
$3.09
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Cofinity Advantage |
$7.85
|
| Rate for Payer: Cofinity Commercial |
$9.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.09
|
| Rate for Payer: Healthscope Commercial |
$10.10
|
| Rate for Payer: Mclaren Medicaid |
$1.62
|
| Rate for Payer: Mclaren Medicare |
$3.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.24
|
| Rate for Payer: Meridian Medicaid |
$3.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.54
|
| Rate for Payer: Nomi Health Commercial |
$9.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.41
|
| Rate for Payer: PACE Medicare |
$2.94
|
| Rate for Payer: PACE SWMI |
$3.09
|
| Rate for Payer: PHP Commercial |
$9.54
|
| Rate for Payer: PHP Medicare Advantage |
$3.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.92
|
| Rate for Payer: Priority Health Medicare |
$3.09
|
| Rate for Payer: Priority Health SBD |
$7.07
|
| Rate for Payer: Priority Health Tiered Network |
$7.94
|
| Rate for Payer: Railroad Medicare Medicare |
$3.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.13
|
| Rate for Payer: UHC Core |
$5.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.09
|
| Rate for Payer: UHC Exchange |
$5.13
|
| Rate for Payer: UHC Medicaid |
$1.62
|
| Rate for Payer: UHCCP Medicaid |
$1.62
|
| Rate for Payer: VA VA |
$3.09
|
|
|
HC INJ, DENOSUMAB-BMWO, 1 MG
|
Facility
|
OP
|
$24.17
|
|
|
Service Code
|
HCPCS Q5157
|
| Hospital Charge Code |
63600286
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$88.72 |
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna Medicare |
$27.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.76
|
| Rate for Payer: BCBS Complete |
$14.39
|
| Rate for Payer: BCBS MAPPO |
$26.21
|
| Rate for Payer: BCBS Trust/PPO |
$67.22
|
| Rate for Payer: BCN Commercial |
$67.22
|
| Rate for Payer: BCN Medicare Advantage |
$26.21
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cofinity Advantage |
$16.92
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.21
|
| Rate for Payer: Healthscope Commercial |
$21.75
|
| Rate for Payer: Mclaren Medicaid |
$13.71
|
| Rate for Payer: Mclaren Medicare |
$26.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.52
|
| Rate for Payer: Meridian Medicaid |
$27.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: Nomi Health Commercial |
$78.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.13
|
| Rate for Payer: PACE Medicare |
$24.90
|
| Rate for Payer: PACE SWMI |
$26.21
|
| Rate for Payer: PHP Commercial |
$20.54
|
| Rate for Payer: PHP Medicare Advantage |
$26.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$88.72
|
| Rate for Payer: Priority Health Medicare |
$26.21
|
| Rate for Payer: Priority Health SBD |
$15.23
|
| Rate for Payer: Priority Health Tiered Network |
$70.98
|
| Rate for Payer: Railroad Medicare Medicare |
$26.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.41
|
| Rate for Payer: UHC Core |
$46.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.21
|
| Rate for Payer: UHC Exchange |
$46.41
|
| Rate for Payer: UHC Medicaid |
$13.71
|
| Rate for Payer: UHCCP Medicaid |
$13.71
|
| Rate for Payer: VA VA |
$26.21
|
|
|
HC INJ, DENOSUMAB-BMWO, 1 MG
|
Facility
|
IP
|
$24.17
|
|
|
Service Code
|
HCPCS Q5157
|
| Hospital Charge Code |
63600286
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.23 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.71
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cofinity Advantage |
$16.92
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Healthscope Commercial |
$21.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.13
|
| Rate for Payer: PHP Commercial |
$20.54
|
| Rate for Payer: Priority Health SBD |
$15.23
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$893.87
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Commercial |
$759.79
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$468.71
|
| Rate for Payer: BCN Commercial |
$468.71
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$715.10
|
| Rate for Payer: Cash Price |
$715.10
|
| Rate for Payer: Cash Price |
$715.10
|
| Rate for Payer: Cofinity Advantage |
$625.71
|
| Rate for Payer: Cofinity Commercial |
$768.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$804.48
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.79
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$670.40
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$759.79
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health SBD |
$563.14
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$893.87
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$563.14 |
| Max. Negotiated Rate |
$804.48 |
| Rate for Payer: Aetna Commercial |
$759.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.02
|
| Rate for Payer: Cash Price |
$715.10
|
| Rate for Payer: Cofinity Advantage |
$625.71
|
| Rate for Payer: Cofinity Commercial |
$768.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.10
|
| Rate for Payer: Healthscope Commercial |
$804.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$670.40
|
| Rate for Payer: PHP Commercial |
$759.79
|
| Rate for Payer: Priority Health SBD |
$563.14
|
|
|
HC INJ DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$966.17
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$608.69 |
| Max. Negotiated Rate |
$869.55 |
| Rate for Payer: Aetna Commercial |
$821.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.01
|
| Rate for Payer: Cash Price |
$772.94
|
| Rate for Payer: Cofinity Advantage |
$676.32
|
| Rate for Payer: Cofinity Commercial |
$830.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.94
|
| Rate for Payer: Healthscope Commercial |
$869.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$821.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$724.63
|
| Rate for Payer: PHP Commercial |
$821.24
|
| Rate for Payer: Priority Health SBD |
$608.69
|
|
|
HC INJ DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$966.17
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Commercial |
$821.24
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$434.42
|
| Rate for Payer: BCN Commercial |
$434.42
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$772.94
|
| Rate for Payer: Cash Price |
$772.94
|
| Rate for Payer: Cash Price |
$772.94
|
| Rate for Payer: Cofinity Advantage |
$676.32
|
| Rate for Payer: Cofinity Commercial |
$830.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$869.55
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$821.24
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$724.63
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$821.24
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health SBD |
$608.69
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC INJECT CARPAL TUNNEL
|
Facility
|
IP
|
$393.93
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.18 |
| Max. Negotiated Rate |
$354.54 |
| Rate for Payer: Aetna Commercial |
$334.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.05
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cofinity Advantage |
$275.75
|
| Rate for Payer: Cofinity Commercial |
$338.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.14
|
| Rate for Payer: Healthscope Commercial |
$354.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.45
|
| Rate for Payer: PHP Commercial |
$334.84
|
| Rate for Payer: Priority Health SBD |
$248.18
|
|
|
HC INJECT CARPAL TUNNEL
|
Facility
|
OP
|
$393.93
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.81 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Commercial |
$334.84
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$224.17
|
| Rate for Payer: BCN Commercial |
$224.17
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cofinity Advantage |
$275.75
|
| Rate for Payer: Cofinity Commercial |
$338.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$354.54
|
| Rate for Payer: Mclaren Medicaid |
$159.96
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.84
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.45
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$334.84
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health SBD |
$248.18
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.05
|
| Rate for Payer: UHC Core |
$205.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$154.81
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
IP
|
$1,186.06
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$747.22 |
| Max. Negotiated Rate |
$1,067.45 |
| Rate for Payer: Aetna Commercial |
$1,008.15
|
| Rate for Payer: Aetna Commercial |
$672.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$770.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.96
|
| Rate for Payer: Cash Price |
$948.85
|
| Rate for Payer: Cash Price |
$632.56
|
| Rate for Payer: Cofinity Advantage |
$830.24
|
| Rate for Payer: Cofinity Advantage |
$553.49
|
| Rate for Payer: Cofinity Commercial |
$1,020.01
|
| Rate for Payer: Cofinity Commercial |
$680.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.85
|
| Rate for Payer: Healthscope Commercial |
$711.63
|
| Rate for Payer: Healthscope Commercial |
$1,067.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,008.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$889.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.02
|
| Rate for Payer: PHP Commercial |
$1,008.15
|
| Rate for Payer: PHP Commercial |
$672.10
|
| Rate for Payer: Priority Health SBD |
$747.22
|
| Rate for Payer: Priority Health SBD |
$498.14
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
OP
|
$1,186.06
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.08 |
| Max. Negotiated Rate |
$1,067.45 |
| Rate for Payer: Aetna Commercial |
$1,008.15
|
| Rate for Payer: Aetna Commercial |
$672.10
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$770.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$96.08
|
| Rate for Payer: BCBS Trust/PPO |
$96.08
|
| Rate for Payer: BCN Commercial |
$96.08
|
| Rate for Payer: BCN Commercial |
$96.08
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$948.85
|
| Rate for Payer: Cash Price |
$948.85
|
| Rate for Payer: Cash Price |
$632.56
|
| Rate for Payer: Cash Price |
$632.56
|
| Rate for Payer: Cash Price |
$632.56
|
| Rate for Payer: Cash Price |
$948.85
|
| Rate for Payer: Cofinity Advantage |
$553.49
|
| Rate for Payer: Cofinity Advantage |
$830.24
|
| Rate for Payer: Cofinity Commercial |
$1,020.01
|
| Rate for Payer: Cofinity Commercial |
$680.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$1,067.45
|
| Rate for Payer: Healthscope Commercial |
$711.63
|
| Rate for Payer: Mclaren Medicaid |
$159.96
|
| Rate for Payer: Mclaren Medicaid |
$159.96
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,008.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.10
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$889.54
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$1,008.15
|
| Rate for Payer: PHP Commercial |
$672.10
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health SBD |
$498.14
|
| Rate for Payer: Priority Health SBD |
$747.22
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$770.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$513.96
|
| Rate for Payer: UHC Core |
$411.95
|
| Rate for Payer: UHC Core |
$617.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$310.75
|
| Rate for Payer: UHC Exchange |
$466.12
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
OP
|
$3,183.62
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.39 |
| Max. Negotiated Rate |
$2,865.26 |
| Rate for Payer: Aetna Commercial |
$2,706.08
|
| Rate for Payer: Aetna Medicare |
$46.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,069.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.90
|
| Rate for Payer: BCBS Complete |
$24.56
|
| Rate for Payer: BCBS MAPPO |
$44.72
|
| Rate for Payer: BCBS Trust/PPO |
$144.12
|
| Rate for Payer: BCN Commercial |
$144.12
|
| Rate for Payer: BCN Medicare Advantage |
$44.72
|
| Rate for Payer: Cash Price |
$2,546.90
|
| Rate for Payer: Cash Price |
$2,546.90
|
| Rate for Payer: Cofinity Advantage |
$2,228.53
|
| Rate for Payer: Cofinity Commercial |
$2,737.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,546.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.72
|
| Rate for Payer: Healthscope Commercial |
$2,865.26
|
| Rate for Payer: Mclaren Medicaid |
$23.39
|
| Rate for Payer: Mclaren Medicare |
$44.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.96
|
| Rate for Payer: Meridian Medicaid |
$46.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,706.08
|
| Rate for Payer: Nomi Health Commercial |
$134.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,387.72
|
| Rate for Payer: PACE Medicare |
$42.48
|
| Rate for Payer: PACE SWMI |
$44.72
|
| Rate for Payer: PHP Commercial |
$2,706.08
|
| Rate for Payer: PHP Medicare Advantage |
$44.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$139.11
|
| Rate for Payer: Priority Health Medicare |
$44.72
|
| Rate for Payer: Priority Health SBD |
$2,005.68
|
| Rate for Payer: Priority Health Tiered Network |
$111.29
|
| Rate for Payer: Railroad Medicare Medicare |
$44.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.87
|
| Rate for Payer: UHC Core |
$73.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44.72
|
| Rate for Payer: UHC Exchange |
$73.87
|
| Rate for Payer: UHC Medicaid |
$23.39
|
| Rate for Payer: UHCCP Medicaid |
$23.39
|
| Rate for Payer: VA VA |
$44.72
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
IP
|
$3,183.62
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,005.68 |
| Max. Negotiated Rate |
$2,865.26 |
| Rate for Payer: Aetna Commercial |
$2,706.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,069.35
|
| Rate for Payer: Cash Price |
$2,546.90
|
| Rate for Payer: Cofinity Advantage |
$2,228.53
|
| Rate for Payer: Cofinity Commercial |
$2,737.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,546.90
|
| Rate for Payer: Healthscope Commercial |
$2,865.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,706.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,387.72
|
| Rate for Payer: PHP Commercial |
$2,706.08
|
| Rate for Payer: Priority Health SBD |
$2,005.68
|
|
|
HC INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
IP
|
$63.67
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.11 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.39
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Advantage |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: Priority Health SBD |
$40.11
|
|
|
HC INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
OP
|
$63.67
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna Medicare |
$31.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.39
|
| Rate for Payer: BCBS Complete |
$25.47
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Advantage |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: Priority Health SBD |
$40.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
|
|
HC INJECTION, CERTOLIZUMAB PEGOL, 1 MG
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$12.34 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.74
|
| Rate for Payer: BCBS Complete |
$2.08
|
| Rate for Payer: BCBS MAPPO |
$3.79
|
| Rate for Payer: BCBS Trust/PPO |
$9.68
|
| Rate for Payer: BCN Commercial |
$9.68
|
| Rate for Payer: BCN Medicare Advantage |
$3.79
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Advantage |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.79
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Mclaren Medicaid |
$1.98
|
| Rate for Payer: Mclaren Medicare |
$3.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.98
|
| Rate for Payer: Meridian Medicaid |
$3.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$11.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.80
|
| Rate for Payer: PACE Medicare |
$3.60
|
| Rate for Payer: PACE SWMI |
$3.79
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: PHP Medicare Advantage |
$3.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.34
|
| Rate for Payer: Priority Health Medicare |
$3.79
|
| Rate for Payer: Priority Health SBD |
$6.55
|
| Rate for Payer: Priority Health Tiered Network |
$9.87
|
| Rate for Payer: Railroad Medicare Medicare |
$3.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.39
|
| Rate for Payer: UHC Core |
$6.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.79
|
| Rate for Payer: UHC Exchange |
$6.39
|
| Rate for Payer: UHC Medicaid |
$1.98
|
| Rate for Payer: UHCCP Medicaid |
$1.98
|
| Rate for Payer: VA VA |
$3.79
|
|
