|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
IP
|
$1,103.46
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$695.18 |
| Max. Negotiated Rate |
$993.11 |
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.25
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$772.42
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$772.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health SBD |
$695.18
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
OP
|
$1,103.46
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.57 |
| Max. Negotiated Rate |
$2,741.59 |
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$660.22
|
| Rate for Payer: BCN Commercial |
$660.22
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$772.42
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$772.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$1,831.81
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,741.59
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,193.27
|
| Rate for Payer: Priority Health SBD |
$695.18
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.57
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$491.10
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
IP
|
$1,103.46
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$695.18 |
| Max. Negotiated Rate |
$993.11 |
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.25
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$772.42
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$772.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health SBD |
$695.18
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
OP
|
$1,103.46
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.19 |
| Max. Negotiated Rate |
$2,741.59 |
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$660.22
|
| Rate for Payer: BCN Commercial |
$660.22
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$772.42
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$772.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$1,831.81
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,741.59
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,193.27
|
| Rate for Payer: Priority Health SBD |
$695.18
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.19
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$491.10
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
IP
|
$1,103.46
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$695.18 |
| Max. Negotiated Rate |
$993.11 |
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.25
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$772.42
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$772.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health SBD |
$695.18
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
OP
|
$1,103.46
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.98 |
| Max. Negotiated Rate |
$2,741.59 |
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$660.22
|
| Rate for Payer: BCN Commercial |
$660.22
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$772.42
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$772.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$1,831.81
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,741.59
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,193.27
|
| Rate for Payer: Priority Health SBD |
$695.18
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.98
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$491.10
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.10
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: Priority Health SBD |
$41.77
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$212.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna Medicare |
$73.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.61
|
| Rate for Payer: BCBS Complete |
$39.90
|
| Rate for Payer: BCBS MAPPO |
$70.89
|
| Rate for Payer: BCBS Trust/PPO |
$201.01
|
| Rate for Payer: BCN Commercial |
$201.01
|
| Rate for Payer: BCN Medicare Advantage |
$70.89
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.89
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Mclaren Medicaid |
$38.00
|
| Rate for Payer: Mclaren Medicare |
$70.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.43
|
| Rate for Payer: Meridian Medicaid |
$39.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$212.67
|
| Rate for Payer: PACE Medicare |
$67.35
|
| Rate for Payer: PACE SWMI |
$70.89
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: PHP Medicare Advantage |
$70.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.79
|
| Rate for Payer: Priority Health Medicare |
$70.89
|
| Rate for Payer: Priority Health Narrow Network |
$163.83
|
| Rate for Payer: Priority Health SBD |
$41.77
|
| Rate for Payer: Railroad Medicare Medicare |
$70.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.89
|
| Rate for Payer: UHC Medicare Advantage |
$70.89
|
| Rate for Payer: UHCCP Medicaid |
$39.91
|
| Rate for Payer: VA VA |
$70.89
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
OP
|
$361.02
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.75 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$306.87
|
| Rate for Payer: Aetna Medicare |
$247.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: BCBS Complete |
$134.11
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$93.20
|
| Rate for Payer: BCN Commercial |
$93.20
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Cash Price |
$288.82
|
| Rate for Payer: Cash Price |
$288.82
|
| Rate for Payer: Cash Price |
$288.82
|
| Rate for Payer: Cofinity Commercial |
$310.48
|
| Rate for Payer: Cofinity Commercial |
$252.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Healthscope Commercial |
$324.92
|
| Rate for Payer: Mclaren Medicaid |
$127.72
|
| Rate for Payer: Mclaren Medicare |
$238.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: Meridian Medicaid |
$134.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.87
|
| Rate for Payer: Nomi Health Commercial |
$500.41
|
| Rate for Payer: PACE Medicare |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Commercial |
$306.87
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.94
|
| Rate for Payer: Priority Health Medicare |
$238.29
|
| Rate for Payer: Priority Health Narrow Network |
$599.15
|
| Rate for Payer: Priority Health SBD |
$227.44
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.75
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: UHCCP Medicaid |
$134.16
|
| Rate for Payer: VA VA |
$238.29
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
IP
|
$361.02
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.44 |
| Max. Negotiated Rate |
$324.92 |
| Rate for Payer: Aetna Commercial |
$306.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.66
|
| Rate for Payer: Cash Price |
$288.82
|
| Rate for Payer: Cofinity Commercial |
$252.71
|
| Rate for Payer: Cofinity Commercial |
$310.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.82
|
| Rate for Payer: Healthscope Commercial |
$324.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.87
|
| Rate for Payer: PHP Commercial |
$306.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.66
|
| Rate for Payer: Priority Health SBD |
$227.44
|
|
|
HC INJ DAXIBOTULINUMTOXINA-LANM, 1 UNIT
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
HCPCS J0589
|
| Hospital Charge Code |
63600257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$12.64 |
| Rate for Payer: Aetna Commercial |
$9.35
|
| Rate for Payer: Aetna Medicare |
$3.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.91
|
| Rate for Payer: BCBS Complete |
$1.76
|
| Rate for Payer: BCBS MAPPO |
$3.13
|
| Rate for Payer: BCBS Trust/PPO |
$12.64
|
| Rate for Payer: BCN Commercial |
$12.64
|
| Rate for Payer: BCN Medicare Advantage |
$3.13
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$9.46
|
| Rate for Payer: Cofinity Commercial |
$7.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.13
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Mclaren Medicaid |
$1.68
|
| Rate for Payer: Mclaren Medicare |
$3.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.29
|
| Rate for Payer: Meridian Medicaid |
$1.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.35
|
| Rate for Payer: Nomi Health Commercial |
$9.39
|
| Rate for Payer: PACE Medicare |
$2.97
|
| Rate for Payer: PACE SWMI |
$3.13
|
| Rate for Payer: PHP Commercial |
$9.35
|
| Rate for Payer: PHP Medicare Advantage |
$3.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.98
|
| Rate for Payer: Priority Health Medicare |
$3.13
|
| Rate for Payer: Priority Health Narrow Network |
$7.18
|
| Rate for Payer: Priority Health SBD |
$6.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.13
|
| Rate for Payer: UHC Medicare Advantage |
$3.13
|
| Rate for Payer: UHCCP Medicaid |
$1.76
|
| Rate for Payer: VA VA |
$3.13
|
|
|
HC INJ DAXIBOTULINUMTOXINA-LANM, 1 UNIT
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
HCPCS J0589
|
| Hospital Charge Code |
63600257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$9.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.15
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$7.70
|
| Rate for Payer: Cofinity Commercial |
$9.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.80
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.35
|
| Rate for Payer: PHP Commercial |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: Priority Health SBD |
$6.93
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$876.34
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$113.05 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Commercial |
$744.89
|
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$670.98
|
| Rate for Payer: BCN Commercial |
$670.98
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$701.07
|
| Rate for Payer: Cash Price |
$701.07
|
| Rate for Payer: Cash Price |
$701.07
|
| Rate for Payer: Cofinity Commercial |
$613.44
|
| Rate for Payer: Cofinity Commercial |
$753.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$613.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$788.71
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$744.89
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$744.89
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Priority Health SBD |
$552.09
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.05
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$382.01
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$876.34
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$552.09 |
| Max. Negotiated Rate |
$788.71 |
| Rate for Payer: Aetna Commercial |
$744.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.62
|
| Rate for Payer: Cash Price |
$701.07
|
| Rate for Payer: Cofinity Commercial |
$613.44
|
| Rate for Payer: Cofinity Commercial |
$753.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$613.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.07
|
| Rate for Payer: Healthscope Commercial |
$788.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$744.89
|
| Rate for Payer: PHP Commercial |
$744.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.62
|
| Rate for Payer: Priority Health SBD |
$552.09
|
|
|
HC INJ DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$920.16
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.60 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Commercial |
$782.14
|
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$621.89
|
| Rate for Payer: BCN Commercial |
$621.89
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$736.13
|
| Rate for Payer: Cash Price |
$736.13
|
| Rate for Payer: Cash Price |
$736.13
|
| Rate for Payer: Cofinity Commercial |
$644.11
|
| Rate for Payer: Cofinity Commercial |
$791.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$644.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$828.14
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.14
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$782.14
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Priority Health SBD |
$579.70
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.60
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$382.01
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC INJ DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$920.16
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$579.70 |
| Max. Negotiated Rate |
$828.14 |
| Rate for Payer: Aetna Commercial |
$782.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.10
|
| Rate for Payer: Cash Price |
$736.13
|
| Rate for Payer: Cofinity Commercial |
$644.11
|
| Rate for Payer: Cofinity Commercial |
$791.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$644.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.13
|
| Rate for Payer: Healthscope Commercial |
$828.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.14
|
| Rate for Payer: PHP Commercial |
$782.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.10
|
| Rate for Payer: Priority Health SBD |
$579.70
|
|
|
HC INJECT CARPAL TUNNEL
|
Facility
|
OP
|
$386.21
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$175.02
|
| Rate for Payer: BCN Commercial |
$175.02
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$332.14
|
| Rate for Payer: Cofinity Commercial |
$270.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$347.59
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: Nomi Health Commercial |
$607.36
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$328.28
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$909.03
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$727.22
|
| Rate for Payer: Priority Health SBD |
$243.31
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.40
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$162.83
|
| Rate for Payer: VA VA |
$289.22
|
|
|
HC INJECT CARPAL TUNNEL
|
Facility
|
IP
|
$386.21
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.31 |
| Max. Negotiated Rate |
$347.59 |
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.04
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$270.35
|
| Rate for Payer: Cofinity Commercial |
$332.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Healthscope Commercial |
$347.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: PHP Commercial |
$328.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: Priority Health SBD |
$243.31
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
IP
|
$775.20
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$488.38 |
| Max. Negotiated Rate |
$697.68 |
| Rate for Payer: Aetna Commercial |
$658.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.88
|
| Rate for Payer: Cash Price |
$620.16
|
| Rate for Payer: Cofinity Commercial |
$542.64
|
| Rate for Payer: Cofinity Commercial |
$666.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$542.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.16
|
| Rate for Payer: Healthscope Commercial |
$697.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.92
|
| Rate for Payer: PHP Commercial |
$658.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.88
|
| Rate for Payer: Priority Health SBD |
$488.38
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
OP
|
$775.20
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.41 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Commercial |
$658.92
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$75.01
|
| Rate for Payer: BCN Commercial |
$75.01
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$620.16
|
| Rate for Payer: Cash Price |
$620.16
|
| Rate for Payer: Cash Price |
$620.16
|
| Rate for Payer: Cofinity Commercial |
$666.67
|
| Rate for Payer: Cofinity Commercial |
$542.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$542.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$697.68
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.92
|
| Rate for Payer: Nomi Health Commercial |
$607.36
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$658.92
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$909.03
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$727.22
|
| Rate for Payer: Priority Health SBD |
$488.38
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.41
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$162.83
|
| Rate for Payer: VA VA |
$289.22
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
IP
|
$3,121.20
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,966.36 |
| Max. Negotiated Rate |
$2,809.08 |
| Rate for Payer: Aetna Commercial |
$2,653.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,028.78
|
| Rate for Payer: Cash Price |
$2,496.96
|
| Rate for Payer: Cofinity Commercial |
$2,184.84
|
| Rate for Payer: Cofinity Commercial |
$2,684.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,184.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,496.96
|
| Rate for Payer: Healthscope Commercial |
$2,809.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,653.02
|
| Rate for Payer: PHP Commercial |
$2,653.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,028.78
|
| Rate for Payer: Priority Health SBD |
$1,966.36
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
OP
|
$3,121.20
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$2,809.08 |
| Rate for Payer: Aetna Commercial |
$2,653.02
|
| Rate for Payer: Aetna Medicare |
$45.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,028.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.75
|
| Rate for Payer: BCBS Complete |
$24.65
|
| Rate for Payer: BCBS MAPPO |
$43.80
|
| Rate for Payer: BCBS Trust/PPO |
$153.26
|
| Rate for Payer: BCN Commercial |
$153.26
|
| Rate for Payer: BCN Medicare Advantage |
$43.80
|
| Rate for Payer: Cash Price |
$2,496.96
|
| Rate for Payer: Cash Price |
$2,496.96
|
| Rate for Payer: Cofinity Commercial |
$2,684.23
|
| Rate for Payer: Cofinity Commercial |
$2,184.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,184.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,496.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.80
|
| Rate for Payer: Healthscope Commercial |
$2,809.08
|
| Rate for Payer: Mclaren Medicaid |
$23.48
|
| Rate for Payer: Mclaren Medicare |
$43.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.99
|
| Rate for Payer: Meridian Medicaid |
$24.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,653.02
|
| Rate for Payer: Nomi Health Commercial |
$131.40
|
| Rate for Payer: PACE Medicare |
$41.61
|
| Rate for Payer: PACE SWMI |
$43.80
|
| Rate for Payer: PHP Commercial |
$2,653.02
|
| Rate for Payer: PHP Medicare Advantage |
$43.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,028.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.00
|
| Rate for Payer: Priority Health Medicare |
$43.80
|
| Rate for Payer: Priority Health Narrow Network |
$100.00
|
| Rate for Payer: Priority Health SBD |
$1,966.36
|
| Rate for Payer: Railroad Medicare Medicare |
$43.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.80
|
| Rate for Payer: UHC Medicare Advantage |
$43.80
|
| Rate for Payer: UHCCP Medicaid |
$24.66
|
| Rate for Payer: VA VA |
$43.80
|
|
|
HC INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health SBD |
$39.32
|
|
|
HC INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: BCBS Complete |
$24.97
|
| Rate for Payer: BCBS Trust/PPO |
$1.25
|
| Rate for Payer: BCN Commercial |
$1.25
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health SBD |
$39.32
|
|
