|
HC INJECTION, PROMETHAZINE HCL, UP TO 50 MG
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
CPT J2550
|
| Hospital Charge Code |
63600100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.35
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Advantage |
$11.14
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$14.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: PHP Commercial |
$13.53
|
| Rate for Payer: Priority Health SBD |
$10.03
|
|
|
HC INJECTION, PROMETHAZINE HCL, UP TO 50 MG
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
CPT J2550
|
| Hospital Charge Code |
63600100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.35
|
| Rate for Payer: BCBS Complete |
$6.37
|
| Rate for Payer: BCBS Trust/PPO |
$9.95
|
| Rate for Payer: BCN Commercial |
$9.95
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Advantage |
$11.14
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$14.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: PHP Commercial |
$13.53
|
| Rate for Payer: Priority Health SBD |
$10.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.55
|
| Rate for Payer: UHC Core |
$6.55
|
| Rate for Payer: UHC Exchange |
$6.55
|
|
|
HC INJECTION PUDENDAL NERVE
|
Facility
|
OP
|
$1,217.48
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
36100570
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna Commercial |
$1,034.86
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$791.36
|
| 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 |
$649.07
|
| Rate for Payer: BCN Commercial |
$649.07
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$973.98
|
| Rate for Payer: Cash Price |
$973.98
|
| Rate for Payer: Cash Price |
$973.98
|
| Rate for Payer: Cofinity Advantage |
$852.24
|
| Rate for Payer: Cofinity Commercial |
$1,047.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$973.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,095.73
|
| 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 |
$1,034.86
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$913.11
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$1,034.86
|
| 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 |
$767.01
|
| 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 INJECTION PUDENDAL NERVE
|
Facility
|
IP
|
$1,217.48
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
36100570
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$767.01 |
| Max. Negotiated Rate |
$1,095.73 |
| Rate for Payer: Aetna Commercial |
$1,034.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$791.36
|
| Rate for Payer: Cash Price |
$973.98
|
| Rate for Payer: Cofinity Advantage |
$852.24
|
| Rate for Payer: Cofinity Commercial |
$1,047.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$973.98
|
| Rate for Payer: Healthscope Commercial |
$1,095.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,034.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$913.11
|
| Rate for Payer: PHP Commercial |
$1,034.86
|
| Rate for Payer: Priority Health SBD |
$767.01
|
|
|
HC INJECTION SCLEROSING SOL MULTIPLE
|
Facility
|
OP
|
$335.88
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$285.50
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$227.33
|
| Rate for Payer: BCN Commercial |
$227.33
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$268.70
|
| Rate for Payer: Cash Price |
$268.70
|
| Rate for Payer: Cash Price |
$268.70
|
| Rate for Payer: Cofinity Advantage |
$235.12
|
| Rate for Payer: Cofinity Commercial |
$288.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$302.29
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.50
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.91
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$285.50
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$211.60
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.32
|
| Rate for Payer: UHC Core |
$174.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$132.00
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC INJECTION SCLEROSING SOL MULTIPLE
|
Facility
|
IP
|
$335.88
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.60 |
| Max. Negotiated Rate |
$302.29 |
| Rate for Payer: Aetna Commercial |
$285.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.32
|
| Rate for Payer: Cash Price |
$268.70
|
| Rate for Payer: Cofinity Advantage |
$235.12
|
| Rate for Payer: Cofinity Commercial |
$288.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.70
|
| Rate for Payer: Healthscope Commercial |
$302.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.91
|
| Rate for Payer: PHP Commercial |
$285.50
|
| Rate for Payer: Priority Health SBD |
$211.60
|
|
|
HC INJECTION SCLEROSING SOL SINGLE
|
Facility
|
IP
|
$257.88
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
36100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.46 |
| Max. Negotiated Rate |
$232.09 |
| Rate for Payer: Aetna Commercial |
$219.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.62
|
| Rate for Payer: Cash Price |
$206.30
|
| Rate for Payer: Cofinity Advantage |
$180.52
|
| Rate for Payer: Cofinity Commercial |
$221.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.30
|
| Rate for Payer: Healthscope Commercial |
$232.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.41
|
| Rate for Payer: PHP Commercial |
$219.20
|
| Rate for Payer: Priority Health SBD |
$162.46
|
|
|
HC INJECTION SCLEROSING SOL SINGLE
|
Facility
|
OP
|
$257.88
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
36100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.87 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$219.20
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$100.87
|
| Rate for Payer: BCN Commercial |
$100.87
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$206.30
|
| Rate for Payer: Cash Price |
$206.30
|
| Rate for Payer: Cash Price |
$206.30
|
| Rate for Payer: Cofinity Advantage |
$180.52
|
| Rate for Payer: Cofinity Commercial |
$221.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$232.09
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.20
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.41
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$219.20
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$162.46
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.62
|
| Rate for Payer: UHC Core |
$134.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$101.35
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC INJECTION SHOULDER ARTHROGRAM
|
Facility
|
OP
|
$880.72
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
36100037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$233.27 |
| Max. Negotiated Rate |
$792.65 |
| Rate for Payer: Aetna Commercial |
$748.61
|
| Rate for Payer: Aetna Medicare |
$440.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$572.47
|
| Rate for Payer: BCBS Complete |
$352.29
|
| Rate for Payer: BCBS Trust/PPO |
$233.27
|
| Rate for Payer: BCN Commercial |
$233.27
|
| Rate for Payer: Cash Price |
$704.58
|
| Rate for Payer: Cash Price |
$704.58
|
| Rate for Payer: Cofinity Advantage |
$616.50
|
| Rate for Payer: Cofinity Commercial |
$757.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$704.58
|
| Rate for Payer: Healthscope Commercial |
$792.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$704.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$748.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$660.54
|
| Rate for Payer: PHP Commercial |
$748.61
|
| Rate for Payer: Priority Health SBD |
$554.85
|
|
|
HC INJECTION SHOULDER ARTHROGRAM
|
Facility
|
IP
|
$880.72
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
36100037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$554.85 |
| Max. Negotiated Rate |
$792.65 |
| Rate for Payer: Aetna Commercial |
$748.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$572.47
|
| Rate for Payer: Cash Price |
$704.58
|
| Rate for Payer: Cofinity Advantage |
$616.50
|
| Rate for Payer: Cofinity Commercial |
$757.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$704.58
|
| Rate for Payer: Healthscope Commercial |
$792.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$748.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$660.54
|
| Rate for Payer: PHP Commercial |
$748.61
|
| Rate for Payer: Priority Health SBD |
$554.85
|
|
|
HC INJECTION SHUNTOGRAM
|
Facility
|
IP
|
$396.48
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
36100224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.78 |
| Max. Negotiated Rate |
$356.83 |
| Rate for Payer: Aetna Commercial |
$337.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.71
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Advantage |
$277.54
|
| Rate for Payer: Cofinity Commercial |
$340.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$356.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: PHP Commercial |
$337.01
|
| Rate for Payer: Priority Health SBD |
$249.78
|
|
|
HC INJECTION SHUNTOGRAM
|
Facility
|
OP
|
$396.48
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
36100224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$123.52 |
| Max. Negotiated Rate |
$356.83 |
| Rate for Payer: Aetna Commercial |
$337.01
|
| Rate for Payer: Aetna Medicare |
$198.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.71
|
| Rate for Payer: BCBS Complete |
$158.59
|
| Rate for Payer: BCBS Trust/PPO |
$123.52
|
| Rate for Payer: BCN Commercial |
$123.52
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Advantage |
$277.54
|
| Rate for Payer: Cofinity Commercial |
$340.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$356.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: PHP Commercial |
$337.01
|
| Rate for Payer: Priority Health SBD |
$249.78
|
|
|
HC INJECTION SIALOGRAM
|
Facility
|
OP
|
$297.68
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
36100190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$359.46 |
| Rate for Payer: Aetna Commercial |
$253.03
|
| Rate for Payer: Aetna Medicare |
$148.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.49
|
| Rate for Payer: BCBS Complete |
$119.07
|
| Rate for Payer: BCBS Trust/PPO |
$359.46
|
| Rate for Payer: BCN Commercial |
$359.46
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cofinity Advantage |
$208.38
|
| Rate for Payer: Cofinity Commercial |
$256.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.14
|
| Rate for Payer: Healthscope Commercial |
$267.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$238.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.26
|
| Rate for Payer: PHP Commercial |
$253.03
|
| Rate for Payer: Priority Health SBD |
$187.54
|
|
|
HC INJECTION SIALOGRAM
|
Facility
|
IP
|
$297.68
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
36100190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$187.54 |
| Max. Negotiated Rate |
$267.91 |
| Rate for Payer: Aetna Commercial |
$253.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.49
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cofinity Advantage |
$208.38
|
| Rate for Payer: Cofinity Commercial |
$256.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.14
|
| Rate for Payer: Healthscope Commercial |
$267.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.26
|
| Rate for Payer: PHP Commercial |
$253.03
|
| Rate for Payer: Priority Health SBD |
$187.54
|
|
|
HC INJECTION SI JOINT ANESTHESIA/STEROID
|
Facility
|
IP
|
$1,031.48
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$649.83 |
| Max. Negotiated Rate |
$928.33 |
| Rate for Payer: Aetna Commercial |
$876.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.46
|
| Rate for Payer: Cash Price |
$825.18
|
| Rate for Payer: Cofinity Advantage |
$722.04
|
| Rate for Payer: Cofinity Commercial |
$887.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.18
|
| Rate for Payer: Healthscope Commercial |
$928.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$773.61
|
| Rate for Payer: PHP Commercial |
$876.76
|
| Rate for Payer: Priority Health SBD |
$649.83
|
|
|
HC INJECTION SI JOINT ANESTHESIA/STEROID
|
Facility
|
OP
|
$1,031.48
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.82 |
| Max. Negotiated Rate |
$928.33 |
| Rate for Payer: Aetna Commercial |
$876.76
|
| Rate for Payer: Aetna Medicare |
$515.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.46
|
| Rate for Payer: BCBS Complete |
$412.59
|
| Rate for Payer: BCBS Trust/PPO |
$565.76
|
| Rate for Payer: BCN Commercial |
$565.76
|
| Rate for Payer: Cash Price |
$825.18
|
| Rate for Payer: Cash Price |
$825.18
|
| Rate for Payer: Cash Price |
$825.18
|
| Rate for Payer: Cofinity Advantage |
$722.04
|
| Rate for Payer: Cofinity Commercial |
$887.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.18
|
| Rate for Payer: Healthscope Commercial |
$928.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$825.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$773.61
|
| Rate for Payer: PHP Commercial |
$876.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$323.52
|
| Rate for Payer: Priority Health SBD |
$649.83
|
| Rate for Payer: Priority Health Tiered Network |
$258.82
|
|
|
HC INJECTION SI JOINT BIL ANESTHESIA/STEROID
|
Facility
|
IP
|
$1,068.81
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$673.35 |
| Max. Negotiated Rate |
$961.93 |
| Rate for Payer: Aetna Commercial |
$908.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$694.73
|
| Rate for Payer: Cash Price |
$855.05
|
| Rate for Payer: Cofinity Advantage |
$748.17
|
| Rate for Payer: Cofinity Commercial |
$919.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$855.05
|
| Rate for Payer: Healthscope Commercial |
$961.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$908.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$801.61
|
| Rate for Payer: PHP Commercial |
$908.49
|
| Rate for Payer: Priority Health SBD |
$673.35
|
|
|
HC INJECTION SI JOINT BIL ANESTHESIA/STEROID
|
Facility
|
OP
|
$1,068.81
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.82 |
| Max. Negotiated Rate |
$961.93 |
| Rate for Payer: Aetna Commercial |
$908.49
|
| Rate for Payer: Aetna Medicare |
$534.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$694.73
|
| Rate for Payer: BCBS Complete |
$427.52
|
| Rate for Payer: BCBS Trust/PPO |
$565.76
|
| Rate for Payer: BCN Commercial |
$565.76
|
| Rate for Payer: Cash Price |
$855.05
|
| Rate for Payer: Cash Price |
$855.05
|
| Rate for Payer: Cash Price |
$855.05
|
| Rate for Payer: Cofinity Advantage |
$748.17
|
| Rate for Payer: Cofinity Commercial |
$919.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$855.05
|
| Rate for Payer: Healthscope Commercial |
$961.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$855.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$908.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$801.61
|
| Rate for Payer: PHP Commercial |
$908.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$323.52
|
| Rate for Payer: Priority Health SBD |
$673.35
|
| Rate for Payer: Priority Health Tiered Network |
$258.82
|
|
|
HC INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$284.95
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
36100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.99 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Commercial |
$242.21
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.22
|
| 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 |
$227.96
|
| Rate for Payer: Cash Price |
$227.96
|
| Rate for Payer: Cash Price |
$227.96
|
| Rate for Payer: Cofinity Advantage |
$199.47
|
| Rate for Payer: Cofinity Commercial |
$245.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$256.45
|
| 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 |
$242.21
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.71
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$242.21
|
| 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 |
$179.52
|
| 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) |
$185.22
|
| Rate for Payer: UHC Core |
$148.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$111.99
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$284.95
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
36100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.52 |
| Max. Negotiated Rate |
$256.45 |
| Rate for Payer: Aetna Commercial |
$242.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.22
|
| Rate for Payer: Cash Price |
$227.96
|
| Rate for Payer: Cofinity Advantage |
$199.47
|
| Rate for Payer: Cofinity Commercial |
$245.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.96
|
| Rate for Payer: Healthscope Commercial |
$256.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.71
|
| Rate for Payer: PHP Commercial |
$242.21
|
| Rate for Payer: Priority Health SBD |
$179.52
|
|
|
HC INJECTION SPLENOPOTOGRAM SPLENOPORTOG
|
Facility
|
IP
|
$446.38
|
|
|
Service Code
|
CPT 38200
|
| Hospital Charge Code |
36100183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$281.22 |
| Max. Negotiated Rate |
$401.74 |
| Rate for Payer: Aetna Commercial |
$379.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.15
|
| Rate for Payer: Cash Price |
$357.10
|
| Rate for Payer: Cofinity Advantage |
$312.47
|
| Rate for Payer: Cofinity Commercial |
$383.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.10
|
| Rate for Payer: Healthscope Commercial |
$401.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.79
|
| Rate for Payer: PHP Commercial |
$379.42
|
| Rate for Payer: Priority Health SBD |
$281.22
|
|
|
HC INJECTION SPLENOPOTOGRAM SPLENOPORTOG
|
Facility
|
OP
|
$446.38
|
|
|
Service Code
|
CPT 38200
|
| Hospital Charge Code |
36100183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$178.55 |
| Max. Negotiated Rate |
$401.74 |
| Rate for Payer: Aetna Commercial |
$379.42
|
| Rate for Payer: Aetna Medicare |
$223.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.15
|
| Rate for Payer: BCBS Complete |
$178.55
|
| Rate for Payer: BCBS Trust/PPO |
$364.09
|
| Rate for Payer: BCN Commercial |
$364.09
|
| Rate for Payer: Cash Price |
$357.10
|
| Rate for Payer: Cash Price |
$357.10
|
| Rate for Payer: Cofinity Advantage |
$312.47
|
| Rate for Payer: Cofinity Commercial |
$383.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.10
|
| Rate for Payer: Healthscope Commercial |
$401.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$357.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.79
|
| Rate for Payer: PHP Commercial |
$379.42
|
| Rate for Payer: Priority Health SBD |
$281.22
|
|
|
HC INJECTIONS SCLEROSANT FOR SPIDER VEINS /TRNK
|
Facility
|
IP
|
$1,106.99
|
|
|
Service Code
|
CPT 36468
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$697.40 |
| Max. Negotiated Rate |
$996.29 |
| Rate for Payer: Aetna Commercial |
$940.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.54
|
| Rate for Payer: Cash Price |
$885.59
|
| Rate for Payer: Cofinity Advantage |
$774.89
|
| Rate for Payer: Cofinity Commercial |
$952.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.59
|
| Rate for Payer: Healthscope Commercial |
$996.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$940.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$830.24
|
| Rate for Payer: PHP Commercial |
$940.94
|
| Rate for Payer: Priority Health SBD |
$697.40
|
|
|
HC INJECTIONS SCLEROSANT FOR SPIDER VEINS /TRNK
|
Facility
|
OP
|
$1,106.99
|
|
|
Service Code
|
CPT 36468
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.13 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$940.94
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$105.13
|
| Rate for Payer: BCN Commercial |
$105.13
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$885.59
|
| Rate for Payer: Cash Price |
$885.59
|
| Rate for Payer: Cash Price |
$885.59
|
| Rate for Payer: Cofinity Advantage |
$774.89
|
| Rate for Payer: Cofinity Commercial |
$952.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$996.29
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$940.94
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$830.24
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$940.94
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$697.40
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$719.54
|
| Rate for Payer: UHC Core |
$576.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$435.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC INJECTION, TESTOSTERONE CYPIONATE, 1 MG
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
CPT J1071
|
| Hospital Charge Code |
63600109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.10
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cofinity Advantage |
$0.11
|
| Rate for Payer: Cofinity Commercial |
$0.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.13
|
| Rate for Payer: Healthscope Commercial |
$0.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.12
|
| Rate for Payer: PHP Commercial |
$0.14
|
| Rate for Payer: Priority Health SBD |
$0.10
|
|
