|
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
|
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 INJECT CARPAL TUNNEL
|
Facility
|
OP
|
$386.21
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$810.38 |
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna Medicare |
$299.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| 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 |
$287.89
|
| Rate for Payer: Healthscope Commercial |
$347.59
|
| Rate for Payer: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Commercial |
$328.28
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Priority Health SBD |
$243.31
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$162.08
|
| Rate for Payer: VA VA |
$287.89
|
|
|
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 |
$154.31 |
| Max. Negotiated Rate |
$810.38 |
| Rate for Payer: Aetna Commercial |
$658.92
|
| Rate for Payer: Aetna Medicare |
$299.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| 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 |
$287.89
|
| Rate for Payer: Healthscope Commercial |
$697.68
|
| Rate for Payer: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.92
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Commercial |
$658.92
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.88
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Priority Health SBD |
$488.38
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$162.08
|
| Rate for Payer: VA VA |
$287.89
|
|
|
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, 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 |
$23.64 |
| Max. Negotiated Rate |
$2,809.08 |
| Rate for Payer: Aetna Commercial |
$2,653.02
|
| Rate for Payer: Aetna Medicare |
$45.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,028.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.14
|
| Rate for Payer: BCBS Complete |
$24.83
|
| Rate for Payer: BCBS MAPPO |
$44.11
|
| Rate for Payer: BCN Medicare Advantage |
$44.11
|
| Rate for Payer: Cash Price |
$2,496.96
|
| 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: Health Alliance Plan Medicare Advantage |
$44.11
|
| Rate for Payer: Healthscope Commercial |
$2,809.08
|
| Rate for Payer: Mclaren Medicaid |
$23.64
|
| Rate for Payer: Mclaren Medicare |
$44.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.32
|
| Rate for Payer: Meridian Medicaid |
$24.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,653.02
|
| Rate for Payer: PACE Medicare |
$41.90
|
| Rate for Payer: PACE SWMI |
$44.11
|
| Rate for Payer: PHP Commercial |
$2,653.02
|
| Rate for Payer: PHP Medicare Advantage |
$44.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,028.78
|
| Rate for Payer: Priority Health Medicare |
$44.11
|
| Rate for Payer: Priority Health SBD |
$1,966.36
|
| Rate for Payer: Railroad Medicare Medicare |
$44.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.11
|
| Rate for Payer: UHC Medicare Advantage |
$44.11
|
| Rate for Payer: UHCCP Medicaid |
$24.83
|
| Rate for Payer: VA VA |
$44.11
|
|
|
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 |
$24.97 |
| 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: 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, CERTOLIZUMAB PEGOL, 1 MG
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$11.01 |
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna Medicare |
$4.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.89
|
| Rate for Payer: BCBS Complete |
$2.20
|
| Rate for Payer: BCBS MAPPO |
$3.91
|
| Rate for Payer: BCN Medicare Advantage |
$3.91
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.91
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Mclaren Medicaid |
$2.10
|
| Rate for Payer: Mclaren Medicare |
$3.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.11
|
| Rate for Payer: Meridian Medicaid |
$2.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.67
|
| Rate for Payer: PACE Medicare |
$3.71
|
| Rate for Payer: PACE SWMI |
$3.91
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: PHP Medicare Advantage |
$3.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.63
|
| Rate for Payer: Priority Health Medicare |
$3.91
|
| Rate for Payer: Priority Health SBD |
$6.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.91
|
| Rate for Payer: UHC Medicare Advantage |
$3.91
|
| Rate for Payer: UHCCP Medicaid |
$2.20
|
| Rate for Payer: VA VA |
$3.91
|
|
|
HC INJECTION, CERTOLIZUMAB PEGOL, 1 MG
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.63
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.67
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.63
|
| Rate for Payer: Priority Health SBD |
$6.43
|
|
|
HC INJECTION CERVICAL OR THORACIC
|
Facility
|
IP
|
$1,010.95
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
36100283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$636.90 |
| Max. Negotiated Rate |
$909.86 |
| Rate for Payer: Aetna Commercial |
$859.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.12
|
| Rate for Payer: Cash Price |
$808.76
|
| Rate for Payer: Cofinity Commercial |
$707.66
|
| Rate for Payer: Cofinity Commercial |
$869.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$707.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.76
|
| Rate for Payer: Healthscope Commercial |
$909.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.31
|
| Rate for Payer: PHP Commercial |
$859.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.12
|
| Rate for Payer: Priority Health SBD |
$636.90
|
|
|
HC INJECTION CERVICAL OR THORACIC
|
Facility
|
OP
|
$1,010.95
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
36100283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$404.38 |
| Max. Negotiated Rate |
$909.86 |
| Rate for Payer: Aetna Commercial |
$859.31
|
| Rate for Payer: Aetna Medicare |
$505.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.12
|
| Rate for Payer: BCBS Complete |
$404.38
|
| Rate for Payer: Cash Price |
$808.76
|
| Rate for Payer: Cofinity Commercial |
$707.66
|
| Rate for Payer: Cofinity Commercial |
$869.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$707.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.76
|
| Rate for Payer: Healthscope Commercial |
$909.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.31
|
| Rate for Payer: PHP Commercial |
$859.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.12
|
| Rate for Payer: Priority Health SBD |
$636.90
|
|
|
HC INJECTION CONTRAST FOR TUBE ASSESSMENT
|
Facility
|
IP
|
$1,018.86
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
36100223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$641.88 |
| Max. Negotiated Rate |
$916.97 |
| Rate for Payer: Aetna Commercial |
$866.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$662.26
|
| Rate for Payer: Cash Price |
$815.09
|
| Rate for Payer: Cofinity Commercial |
$713.20
|
| Rate for Payer: Cofinity Commercial |
$876.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$713.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$815.09
|
| Rate for Payer: Healthscope Commercial |
$916.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$866.03
|
| Rate for Payer: PHP Commercial |
$866.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$662.26
|
| Rate for Payer: Priority Health SBD |
$641.88
|
|
|
HC INJECTION CONTRAST FOR TUBE ASSESSMENT
|
Facility
|
OP
|
$1,018.86
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
36100223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$407.54 |
| Max. Negotiated Rate |
$916.97 |
| Rate for Payer: Aetna Commercial |
$866.03
|
| Rate for Payer: Aetna Medicare |
$509.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$662.26
|
| Rate for Payer: BCBS Complete |
$407.54
|
| Rate for Payer: Cash Price |
$815.09
|
| Rate for Payer: Cofinity Commercial |
$713.20
|
| Rate for Payer: Cofinity Commercial |
$876.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$713.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$815.09
|
| Rate for Payer: Healthscope Commercial |
$916.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$866.03
|
| Rate for Payer: PHP Commercial |
$866.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$662.26
|
| Rate for Payer: Priority Health SBD |
$641.88
|
|
|
HC INJECTION, DENOSUMAB, 1MG
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$82.70 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$30.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.73
|
| Rate for Payer: BCBS Complete |
$16.54
|
| Rate for Payer: BCBS MAPPO |
$29.38
|
| Rate for Payer: BCN Medicare Advantage |
$29.38
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$15.75
|
| Rate for Payer: Mclaren Medicare |
$29.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.85
|
| Rate for Payer: Meridian Medicaid |
$16.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: PACE Medicare |
$27.91
|
| Rate for Payer: PACE SWMI |
$29.38
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$29.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health Medicare |
$29.38
|
| Rate for Payer: Priority Health SBD |
$16.07
|
| Rate for Payer: Railroad Medicare Medicare |
$29.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.38
|
| Rate for Payer: UHC Medicare Advantage |
$29.38
|
| Rate for Payer: UHCCP Medicaid |
$16.54
|
| Rate for Payer: VA VA |
$29.38
|
|
|
HC INJECTION, DENOSUMAB, 1MG
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health SBD |
$16.07
|
|
|
HC INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
|
Facility
|
OP
|
$14.57
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna Medicare |
$7.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.47
|
| Rate for Payer: BCBS Complete |
$5.83
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health SBD |
$9.18
|
|
|
HC INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
|
Facility
|
IP
|
$14.57
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.47
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health SBD |
$9.18
|
|
|
HC INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
|
Facility
|
OP
|
$2.08
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
63600167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna Medicare |
$1.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health SBD |
$1.31
|
|
|
HC INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
|
Facility
|
IP
|
$2.08
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
63600167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health SBD |
$1.31
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
IP
|
$1,132.08
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$713.21 |
| Max. Negotiated Rate |
$1,018.87 |
| Rate for Payer: Aetna Commercial |
$962.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.85
|
| Rate for Payer: Cash Price |
$905.66
|
| Rate for Payer: Cofinity Commercial |
$792.46
|
| Rate for Payer: Cofinity Commercial |
$973.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$792.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$905.66
|
| Rate for Payer: Healthscope Commercial |
$1,018.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$962.27
|
| Rate for Payer: PHP Commercial |
$962.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$735.85
|
| Rate for Payer: Priority Health SBD |
$713.21
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
OP
|
$1,132.08
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$452.83 |
| Max. Negotiated Rate |
$1,018.87 |
| Rate for Payer: Aetna Commercial |
$962.27
|
| Rate for Payer: Aetna Medicare |
$566.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.85
|
| Rate for Payer: BCBS Complete |
$452.83
|
| Rate for Payer: Cash Price |
$905.66
|
| Rate for Payer: Cofinity Commercial |
$792.46
|
| Rate for Payer: Cofinity Commercial |
$973.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$792.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$905.66
|
| Rate for Payer: Healthscope Commercial |
$1,018.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$962.27
|
| Rate for Payer: PHP Commercial |
$962.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$735.85
|
| Rate for Payer: Priority Health SBD |
$713.21
|
|
|
HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL
|
Facility
|
IP
|
$1,901.65
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,198.04 |
| Max. Negotiated Rate |
$1,711.48 |
| Rate for Payer: Aetna Commercial |
$1,616.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,236.07
|
| Rate for Payer: Cash Price |
$1,521.32
|
| Rate for Payer: Cofinity Commercial |
$1,331.15
|
| Rate for Payer: Cofinity Commercial |
$1,635.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,331.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,521.32
|
| Rate for Payer: Healthscope Commercial |
$1,711.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,616.40
|
| Rate for Payer: PHP Commercial |
$1,616.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.07
|
| Rate for Payer: Priority Health SBD |
$1,198.04
|
|
|
HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL
|
Facility
|
OP
|
$1,901.65
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$2,444.12 |
| Rate for Payer: Aetna Commercial |
$1,616.40
|
| Rate for Payer: Aetna Medicare |
$903.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,236.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$1,521.32
|
| Rate for Payer: Cash Price |
$1,521.32
|
| Rate for Payer: Cofinity Commercial |
$1,635.42
|
| Rate for Payer: Cofinity Commercial |
$1,331.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,331.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,521.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$1,711.48
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,616.40
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$1,616.40
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.07
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health SBD |
$1,198.04
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,444.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$488.84
|
| Rate for Payer: VA VA |
$868.28
|
|
