|
HC INJECT/IRRIGATE CORPORA CAVERNOSA
|
Facility
|
IP
|
$380.84
|
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$239.93 |
| Max. Negotiated Rate |
$342.76 |
| Rate for Payer: Aetna Commercial |
$323.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.55
|
| Rate for Payer: Cash Price |
$304.67
|
| Rate for Payer: Cofinity Advantage |
$266.59
|
| Rate for Payer: Cofinity Commercial |
$327.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.67
|
| Rate for Payer: Healthscope Commercial |
$342.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.63
|
| Rate for Payer: PHP Commercial |
$323.71
|
| Rate for Payer: Priority Health SBD |
$239.93
|
|
|
HC INJECT/IRRIGATE CORPORA CAVERNOSA
|
Facility
|
OP
|
$380.84
|
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$342.76 |
| Rate for Payer: Aetna Commercial |
$323.71
|
| Rate for Payer: Aetna Medicare |
$190.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.55
|
| Rate for Payer: BCBS Complete |
$152.34
|
| Rate for Payer: Cash Price |
$304.67
|
| Rate for Payer: Cash Price |
$304.67
|
| Rate for Payer: Cofinity Advantage |
$266.59
|
| Rate for Payer: Cofinity Commercial |
$327.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.67
|
| Rate for Payer: Healthscope Commercial |
$342.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$304.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.63
|
| Rate for Payer: PHP Commercial |
$323.71
|
| Rate for Payer: Priority Health SBD |
$239.93
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC INJECT PORTAL VEIN
|
Facility
|
IP
|
$2,836.51
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
36100543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,787.00 |
| Max. Negotiated Rate |
$2,552.86 |
| Rate for Payer: Aetna Commercial |
$2,411.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,843.73
|
| Rate for Payer: Cash Price |
$2,269.21
|
| Rate for Payer: Cofinity Advantage |
$1,985.56
|
| Rate for Payer: Cofinity Commercial |
$2,439.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,269.21
|
| Rate for Payer: Healthscope Commercial |
$2,552.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,411.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,127.38
|
| Rate for Payer: PHP Commercial |
$2,411.03
|
| Rate for Payer: Priority Health SBD |
$1,787.00
|
|
|
HC INJECT PORTAL VEIN
|
Facility
|
OP
|
$2,836.51
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
36100543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,134.60 |
| Max. Negotiated Rate |
$5,165.01 |
| Rate for Payer: Aetna Commercial |
$2,411.03
|
| Rate for Payer: Aetna Medicare |
$1,418.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,843.73
|
| Rate for Payer: BCBS Complete |
$1,134.60
|
| Rate for Payer: BCBS Trust/PPO |
$5,165.01
|
| Rate for Payer: BCN Commercial |
$5,165.01
|
| Rate for Payer: Cash Price |
$2,269.21
|
| Rate for Payer: Cash Price |
$2,269.21
|
| Rate for Payer: Cofinity Advantage |
$1,985.56
|
| Rate for Payer: Cofinity Commercial |
$2,439.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,269.21
|
| Rate for Payer: Healthscope Commercial |
$2,552.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,269.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,411.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,127.38
|
| Rate for Payer: PHP Commercial |
$2,411.03
|
| Rate for Payer: Priority Health SBD |
$1,787.00
|
|
|
HC INJECT PROC PENILE PLAQUE
|
Facility
|
OP
|
$368.37
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$805.08 |
| Rate for Payer: Aetna Commercial |
$313.11
|
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.44
|
| 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 |
$177.16
|
| Rate for Payer: BCN Commercial |
$177.16
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cofinity Advantage |
$257.86
|
| Rate for Payer: Cofinity Commercial |
$316.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$331.53
|
| 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 |
$313.11
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.28
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$313.11
|
| 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 |
$232.07
|
| 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) |
$239.44
|
| Rate for Payer: UHC Core |
$191.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Exchange |
$144.77
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
HC INJECT PROC PENILE PLAQUE
|
Facility
|
IP
|
$368.37
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.07 |
| Max. Negotiated Rate |
$331.53 |
| Rate for Payer: Aetna Commercial |
$313.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.44
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cofinity Advantage |
$257.86
|
| Rate for Payer: Cofinity Commercial |
$316.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.70
|
| Rate for Payer: Healthscope Commercial |
$331.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.28
|
| Rate for Payer: PHP Commercial |
$313.11
|
| Rate for Payer: Priority Health SBD |
$232.07
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 1 OR 2 MUSCLES
|
Facility
|
IP
|
$381.62
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
36100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.42 |
| Max. Negotiated Rate |
$343.46 |
| Rate for Payer: Aetna Commercial |
$324.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.05
|
| Rate for Payer: Cash Price |
$305.30
|
| Rate for Payer: Cofinity Advantage |
$267.13
|
| Rate for Payer: Cofinity Commercial |
$328.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.30
|
| Rate for Payer: Healthscope Commercial |
$343.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$286.21
|
| Rate for Payer: PHP Commercial |
$324.38
|
| Rate for Payer: Priority Health SBD |
$240.42
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 1 OR 2 MUSCLES
|
Facility
|
OP
|
$381.62
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
36100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.98 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Commercial |
$324.38
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.05
|
| 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 |
$305.30
|
| Rate for Payer: Cash Price |
$305.30
|
| Rate for Payer: Cash Price |
$305.30
|
| Rate for Payer: Cofinity Advantage |
$267.13
|
| Rate for Payer: Cofinity Commercial |
$328.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$343.46
|
| 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 |
$324.38
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$286.21
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$324.38
|
| 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 |
$240.42
|
| 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) |
$248.05
|
| Rate for Payer: UHC Core |
$198.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$149.98
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 3 OR MORE MUSCLES
|
Facility
|
OP
|
$497.42
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
36100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Commercial |
$422.81
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.32
|
| 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 |
$397.94
|
| Rate for Payer: Cash Price |
$397.94
|
| Rate for Payer: Cash Price |
$397.94
|
| Rate for Payer: Cofinity Advantage |
$348.19
|
| Rate for Payer: Cofinity Commercial |
$427.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$447.68
|
| 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 |
$422.81
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.06
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$422.81
|
| 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 |
$313.37
|
| 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) |
$323.32
|
| Rate for Payer: UHC Core |
$259.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$195.49
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 3 OR MORE MUSCLES
|
Facility
|
IP
|
$497.42
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
36100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$313.37 |
| Max. Negotiated Rate |
$447.68 |
| Rate for Payer: Aetna Commercial |
$422.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.32
|
| Rate for Payer: Cash Price |
$397.94
|
| Rate for Payer: Cofinity Advantage |
$348.19
|
| Rate for Payer: Cofinity Commercial |
$427.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.94
|
| Rate for Payer: Healthscope Commercial |
$447.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$422.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.06
|
| Rate for Payer: PHP Commercial |
$422.81
|
| Rate for Payer: Priority Health SBD |
$313.37
|
|
|
HC INJ ENOXAPARIN SODIUM PER 10 MG
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63600151
|
|
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 INJ ENOXAPARIN SODIUM PER 10 MG
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63600151
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| 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 |
$1.33
|
| Rate for Payer: BCN Commercial |
$1.33
|
| 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) |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
|
|
HC INJ ENZYME PALMAR FASCIAL CORD
|
Facility
|
OP
|
$346.44
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.59 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Commercial |
$294.47
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.19
|
| 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 |
$42.59
|
| Rate for Payer: BCN Commercial |
$42.59
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$277.15
|
| Rate for Payer: Cash Price |
$277.15
|
| Rate for Payer: Cash Price |
$277.15
|
| Rate for Payer: Cofinity Advantage |
$242.51
|
| Rate for Payer: Cofinity Commercial |
$297.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$311.80
|
| 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 |
$294.47
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.83
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$294.47
|
| 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 |
$218.26
|
| 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) |
$225.19
|
| Rate for Payer: UHC Core |
$180.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$136.15
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC INJ ENZYME PALMAR FASCIAL CORD
|
Facility
|
IP
|
$346.44
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.26 |
| Max. Negotiated Rate |
$311.80 |
| Rate for Payer: Aetna Commercial |
$294.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.19
|
| Rate for Payer: Cash Price |
$277.15
|
| Rate for Payer: Cofinity Advantage |
$242.51
|
| Rate for Payer: Cofinity Commercial |
$297.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.15
|
| Rate for Payer: Healthscope Commercial |
$311.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.83
|
| Rate for Payer: PHP Commercial |
$294.47
|
| Rate for Payer: Priority Health SBD |
$218.26
|
|
|
HC INJ HEPARIN SODIUM PER 1000U
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.69
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Cofinity Advantage |
$0.74
|
| Rate for Payer: Cofinity Commercial |
$0.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.85
|
| Rate for Payer: Healthscope Commercial |
$0.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.80
|
| Rate for Payer: PHP Commercial |
$0.90
|
| Rate for Payer: Priority Health SBD |
$0.67
|
|
|
HC INJ HEPARIN SODIUM PER 1000U
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Medicare |
$0.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.69
|
| Rate for Payer: BCBS Complete |
$0.42
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: BCN Commercial |
$0.44
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Cofinity Advantage |
$0.74
|
| Rate for Payer: Cofinity Commercial |
$0.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.85
|
| Rate for Payer: Healthscope Commercial |
$0.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.80
|
| Rate for Payer: PHP Commercial |
$0.90
|
| Rate for Payer: Priority Health SBD |
$0.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.30
|
| Rate for Payer: UHC Core |
$0.30
|
| Rate for Payer: UHC Exchange |
$0.30
|
|
|
HC INJ HYDROCORTISONE NA SUCCINATE, UP TO 100MG
|
Facility
|
IP
|
$43.70
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
63600241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.53 |
| Max. Negotiated Rate |
$39.33 |
| Rate for Payer: Aetna Commercial |
$37.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.41
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Advantage |
$30.59
|
| Rate for Payer: Cofinity Commercial |
$37.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$39.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.77
|
| Rate for Payer: PHP Commercial |
$37.15
|
| Rate for Payer: Priority Health SBD |
$27.53
|
|
|
HC INJ HYDROCORTISONE NA SUCCINATE, UP TO 100MG
|
Facility
|
OP
|
$43.70
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
63600241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.48 |
| Max. Negotiated Rate |
$55.33 |
| Rate for Payer: Aetna Commercial |
$37.15
|
| Rate for Payer: Aetna Medicare |
$21.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.41
|
| Rate for Payer: BCBS Complete |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$55.33
|
| Rate for Payer: BCN Commercial |
$55.33
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Advantage |
$30.59
|
| Rate for Payer: Cofinity Commercial |
$37.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$39.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.77
|
| Rate for Payer: PHP Commercial |
$37.15
|
| Rate for Payer: Priority Health SBD |
$27.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.40
|
| Rate for Payer: UHC Core |
$36.40
|
| Rate for Payer: UHC Exchange |
$36.40
|
|
|
HC INJ KNEE ARTHROGRAM CT/MRI
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
36100562
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$233.30 |
| Max. Negotiated Rate |
$583.20 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: Aetna Medicare |
$324.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$421.20
|
| Rate for Payer: BCBS Complete |
$259.20
|
| Rate for Payer: BCBS Trust/PPO |
$233.30
|
| Rate for Payer: BCN Commercial |
$233.30
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cofinity Advantage |
$453.60
|
| Rate for Payer: Cofinity Commercial |
$557.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.40
|
| Rate for Payer: Healthscope Commercial |
$583.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$518.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$486.00
|
| Rate for Payer: PHP Commercial |
$550.80
|
| Rate for Payer: Priority Health SBD |
$408.24
|
|
|
HC INJ KNEE ARTHROGRAM CT/MRI
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
36100562
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$408.24 |
| Max. Negotiated Rate |
$583.20 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$421.20
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cofinity Advantage |
$453.60
|
| Rate for Payer: Cofinity Commercial |
$557.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.40
|
| Rate for Payer: Healthscope Commercial |
$583.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$486.00
|
| Rate for Payer: PHP Commercial |
$550.80
|
| Rate for Payer: Priority Health SBD |
$408.24
|
|
|
HC INJ LIDOCAINE HYDROCHLORIDE 1 MG
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
63600262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: Aetna Medicare |
$0.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.66
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Advantage |
$0.71
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$0.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.77
|
| Rate for Payer: PHP Commercial |
$0.87
|
| Rate for Payer: Priority Health SBD |
$0.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
|
|
HC INJ LIDOCAINE HYDROCHLORIDE 1 MG
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
63600262
|
|
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 Advantage |
$0.71
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$0.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.77
|
| Rate for Payer: PHP Commercial |
$0.87
|
| Rate for Payer: Priority Health SBD |
$0.64
|
|
|
HC INJ LUMB W MYELO 2+REG SAME MD
|
Facility
|
OP
|
$2,201.80
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
36100463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$2,526.00 |
| Rate for Payer: Aetna Commercial |
$1,871.53
|
| Rate for Payer: Aetna Medicare |
$812.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,431.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$728.13
|
| Rate for Payer: BCN Commercial |
$728.13
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,761.44
|
| Rate for Payer: Cash Price |
$1,761.44
|
| Rate for Payer: Cash Price |
$1,761.44
|
| Rate for Payer: Cofinity Advantage |
$1,541.26
|
| Rate for Payer: Cofinity Commercial |
$1,893.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,761.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$1,981.62
|
| Rate for Payer: Mclaren Medicaid |
$408.52
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$820.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,871.53
|
| Rate for Payer: Nomi Health Commercial |
$2,343.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,651.35
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$1,871.53
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,526.00
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health SBD |
$1,387.13
|
| Rate for Payer: Priority Health Tiered Network |
$2,020.80
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC INJ LUMB W MYELO 2+REG SAME MD
|
Facility
|
IP
|
$2,201.80
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
36100463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,387.13 |
| Max. Negotiated Rate |
$1,981.62 |
| Rate for Payer: Aetna Commercial |
$1,871.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,431.17
|
| Rate for Payer: Cash Price |
$1,761.44
|
| Rate for Payer: Cofinity Advantage |
$1,541.26
|
| Rate for Payer: Cofinity Commercial |
$1,893.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,761.44
|
| Rate for Payer: Healthscope Commercial |
$1,981.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,871.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,651.35
|
| Rate for Payer: PHP Commercial |
$1,871.53
|
| Rate for Payer: Priority Health SBD |
$1,387.13
|
|
|
HC INJ LUMB W MYELO CERV SAME MD
|
Facility
|
OP
|
$2,248.62
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
36100460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$2,526.00 |
| Rate for Payer: Aetna Commercial |
$1,911.33
|
| Rate for Payer: Aetna Medicare |
$812.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,461.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$578.86
|
| Rate for Payer: BCN Commercial |
$578.86
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cofinity Advantage |
$1,574.03
|
| Rate for Payer: Cofinity Commercial |
$1,933.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,798.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$2,023.76
|
| Rate for Payer: Mclaren Medicaid |
$408.52
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$820.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,911.33
|
| Rate for Payer: Nomi Health Commercial |
$2,343.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,686.46
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$1,911.33
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,526.00
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health SBD |
$1,416.63
|
| Rate for Payer: Priority Health Tiered Network |
$2,020.80
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
