|
HC INJECTION LUMBAR DISKOGRAPHY
|
Facility
|
IP
|
$2,349.53
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
36100282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,480.20 |
| Max. Negotiated Rate |
$2,114.58 |
| Rate for Payer: Aetna Commercial |
$1,997.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,527.19
|
| Rate for Payer: Cash Price |
$1,879.62
|
| Rate for Payer: Cofinity Commercial |
$1,644.67
|
| Rate for Payer: Cofinity Commercial |
$2,020.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,644.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,879.62
|
| Rate for Payer: Healthscope Commercial |
$2,114.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,997.10
|
| Rate for Payer: PHP Commercial |
$1,997.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,527.19
|
| Rate for Payer: Priority Health SBD |
$1,480.20
|
|
|
HC INJECTION LUMBAR DISKOGRAPHY
|
Facility
|
OP
|
$2,349.53
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
36100282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$164.09 |
| Max. Negotiated Rate |
$2,114.58 |
| Rate for Payer: Aetna Commercial |
$1,997.10
|
| Rate for Payer: Aetna Medicare |
$1,174.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,527.19
|
| Rate for Payer: BCBS Complete |
$939.81
|
| Rate for Payer: BCBS Trust/PPO |
$678.71
|
| Rate for Payer: BCN Commercial |
$678.71
|
| Rate for Payer: Cash Price |
$1,879.62
|
| Rate for Payer: Cash Price |
$1,879.62
|
| Rate for Payer: Cash Price |
$1,879.62
|
| Rate for Payer: Cofinity Commercial |
$1,644.67
|
| Rate for Payer: Cofinity Commercial |
$2,020.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,644.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,879.62
|
| Rate for Payer: Healthscope Commercial |
$2,114.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,997.10
|
| Rate for Payer: PHP Commercial |
$1,997.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,527.19
|
| Rate for Payer: Priority Health SBD |
$1,480.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.09
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
63600096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.68
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Commercial |
$0.73
|
| Rate for Payer: Cofinity Commercial |
$0.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: PHP Commercial |
$0.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.68
|
| Rate for Payer: Priority Health SBD |
$0.66
|
|
|
HC INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
63600096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: Aetna Medicare |
$0.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.68
|
| Rate for Payer: BCBS Complete |
$0.42
|
| Rate for Payer: BCBS Trust/PPO |
$0.39
|
| Rate for Payer: BCN Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Commercial |
$0.73
|
| Rate for Payer: Cofinity Commercial |
$0.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: PHP Commercial |
$0.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.68
|
| Rate for Payer: Priority Health SBD |
$0.66
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.76
|
| Rate for Payer: BCBS Complete |
$4.16
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health SBD |
$6.55
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.76
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health SBD |
$6.55
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
63600094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.15
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$10.93
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health SBD |
$9.83
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
63600094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna Medicare |
$7.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.15
|
| Rate for Payer: BCBS Complete |
$6.24
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$10.93
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health SBD |
$9.83
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
63600095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
63600095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
|
|
HC INJECTION MYELOGRAM
|
Facility
|
OP
|
$1,067.34
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
36100281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$87.26 |
| Max. Negotiated Rate |
$960.61 |
| Rate for Payer: Aetna Commercial |
$907.24
|
| Rate for Payer: Aetna Medicare |
$533.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.77
|
| Rate for Payer: BCBS Complete |
$426.94
|
| Rate for Payer: BCBS Trust/PPO |
$441.24
|
| Rate for Payer: BCN Commercial |
$441.24
|
| Rate for Payer: Cash Price |
$853.87
|
| Rate for Payer: Cash Price |
$853.87
|
| Rate for Payer: Cash Price |
$853.87
|
| Rate for Payer: Cofinity Commercial |
$747.14
|
| Rate for Payer: Cofinity Commercial |
$917.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$747.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.87
|
| Rate for Payer: Healthscope Commercial |
$960.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$907.24
|
| Rate for Payer: PHP Commercial |
$907.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.77
|
| Rate for Payer: Priority Health SBD |
$672.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.26
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION MYELOGRAM
|
Facility
|
IP
|
$1,067.34
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
36100281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$672.42 |
| Max. Negotiated Rate |
$960.61 |
| Rate for Payer: Aetna Commercial |
$907.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.77
|
| Rate for Payer: Cash Price |
$853.87
|
| Rate for Payer: Cofinity Commercial |
$747.14
|
| Rate for Payer: Cofinity Commercial |
$917.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$747.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.87
|
| Rate for Payer: Healthscope Commercial |
$960.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$907.24
|
| Rate for Payer: PHP Commercial |
$907.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.77
|
| Rate for Payer: Priority Health SBD |
$672.42
|
|
|
HC INJECTION PLANTAR DIGIT
|
Facility
|
OP
|
$351.66
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.45 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Commercial |
$298.91
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.58
|
| 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 |
$281.33
|
| Rate for Payer: Cash Price |
$281.33
|
| Rate for Payer: Cash Price |
$281.33
|
| Rate for Payer: Cofinity Commercial |
$302.43
|
| Rate for Payer: Cofinity Commercial |
$246.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$316.49
|
| 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 |
$298.91
|
| 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 |
$298.91
|
| 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 |
$228.58
|
| 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 |
$221.55
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.45
|
| 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 PLANTAR DIGIT
|
Facility
|
IP
|
$351.66
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.55 |
| Max. Negotiated Rate |
$316.49 |
| Rate for Payer: Aetna Commercial |
$298.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.58
|
| Rate for Payer: Cash Price |
$281.33
|
| Rate for Payer: Cofinity Commercial |
$246.16
|
| Rate for Payer: Cofinity Commercial |
$302.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.33
|
| Rate for Payer: Healthscope Commercial |
$316.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.91
|
| Rate for Payer: PHP Commercial |
$298.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.58
|
| Rate for Payer: Priority Health SBD |
$221.55
|
|
|
HC INJECTION PLANTAR DIGIT BILATERAL
|
Facility
|
IP
|
$527.48
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.31 |
| Max. Negotiated Rate |
$474.73 |
| Rate for Payer: Aetna Commercial |
$448.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.86
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cofinity Commercial |
$369.24
|
| Rate for Payer: Cofinity Commercial |
$453.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$369.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.98
|
| Rate for Payer: Healthscope Commercial |
$474.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.36
|
| Rate for Payer: PHP Commercial |
$448.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.86
|
| Rate for Payer: Priority Health SBD |
$332.31
|
|
|
HC INJECTION PLANTAR DIGIT BILATERAL
|
Facility
|
OP
|
$527.48
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.45 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Commercial |
$448.36
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.86
|
| 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 |
$421.98
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cofinity Commercial |
$453.63
|
| Rate for Payer: Cofinity Commercial |
$369.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$369.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$474.73
|
| 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 |
$448.36
|
| 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 |
$448.36
|
| 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 |
$342.86
|
| 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 |
$332.31
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.45
|
| 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 PLATELET PLASMA W/IMG HARVEST/PREP
|
Facility
|
OP
|
$805.80
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
76100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.56 |
| Max. Negotiated Rate |
$1,228.82 |
| Rate for Payer: Aetna Commercial |
$684.93
|
| Rate for Payer: Aetna Medicare |
$406.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$488.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$488.71
|
| Rate for Payer: BCBS Complete |
$220.04
|
| Rate for Payer: BCBS MAPPO |
$390.97
|
| Rate for Payer: BCN Medicare Advantage |
$390.97
|
| Rate for Payer: Cash Price |
$644.64
|
| Rate for Payer: Cash Price |
$644.64
|
| Rate for Payer: Cash Price |
$644.64
|
| Rate for Payer: Cofinity Commercial |
$692.99
|
| Rate for Payer: Cofinity Commercial |
$564.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$564.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$644.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.97
|
| Rate for Payer: Healthscope Commercial |
$725.22
|
| Rate for Payer: Mclaren Medicaid |
$209.56
|
| Rate for Payer: Mclaren Medicare |
$390.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.52
|
| Rate for Payer: Meridian Medicaid |
$220.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$684.93
|
| Rate for Payer: Nomi Health Commercial |
$1,172.91
|
| Rate for Payer: PACE Medicare |
$371.42
|
| Rate for Payer: PACE SWMI |
$390.97
|
| Rate for Payer: PHP Commercial |
$684.93
|
| Rate for Payer: PHP Medicare Advantage |
$390.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,228.82
|
| Rate for Payer: Priority Health Medicare |
$390.97
|
| Rate for Payer: Priority Health Narrow Network |
$983.06
|
| Rate for Payer: Priority Health SBD |
$507.65
|
| Rate for Payer: Railroad Medicare Medicare |
$390.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,100.54
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.97
|
| Rate for Payer: UHC Medicare Advantage |
$390.97
|
| Rate for Payer: UHCCP Medicaid |
$220.12
|
| Rate for Payer: VA VA |
$390.97
|
|
|
HC INJECTION PLATELET PLASMA W/IMG HARVEST/PREP
|
Facility
|
IP
|
$805.80
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
76100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$507.65 |
| Max. Negotiated Rate |
$725.22 |
| Rate for Payer: Aetna Commercial |
$684.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.77
|
| Rate for Payer: Cash Price |
$644.64
|
| Rate for Payer: Cofinity Commercial |
$564.06
|
| Rate for Payer: Cofinity Commercial |
$692.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$564.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$644.64
|
| Rate for Payer: Healthscope Commercial |
$725.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$684.93
|
| Rate for Payer: PHP Commercial |
$684.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.77
|
| Rate for Payer: Priority Health SBD |
$507.65
|
|
|
HC INJECTION PROC CYSTOGRAPHY VOIDING
|
Facility
|
OP
|
$1,310.34
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
36100251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$45.67 |
| Max. Negotiated Rate |
$1,179.31 |
| Rate for Payer: Aetna Commercial |
$1,113.79
|
| Rate for Payer: Aetna Medicare |
$655.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.72
|
| Rate for Payer: BCBS Complete |
$524.14
|
| Rate for Payer: BCBS Trust/PPO |
$314.59
|
| Rate for Payer: BCN Commercial |
$314.59
|
| Rate for Payer: Cash Price |
$1,048.27
|
| Rate for Payer: Cash Price |
$1,048.27
|
| Rate for Payer: Cash Price |
$1,048.27
|
| Rate for Payer: Cofinity Commercial |
$1,126.89
|
| Rate for Payer: Cofinity Commercial |
$917.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$917.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,048.27
|
| Rate for Payer: Healthscope Commercial |
$1,179.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,113.79
|
| Rate for Payer: PHP Commercial |
$1,113.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.72
|
| Rate for Payer: Priority Health SBD |
$825.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.67
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION PROC CYSTOGRAPHY VOIDING
|
Facility
|
IP
|
$1,310.34
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
36100251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$825.51 |
| Max. Negotiated Rate |
$1,179.31 |
| Rate for Payer: Aetna Commercial |
$1,113.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.72
|
| Rate for Payer: Cash Price |
$1,048.27
|
| Rate for Payer: Cofinity Commercial |
$1,126.89
|
| Rate for Payer: Cofinity Commercial |
$917.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$917.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,048.27
|
| Rate for Payer: Healthscope Commercial |
$1,179.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,113.79
|
| Rate for Payer: PHP Commercial |
$1,113.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.72
|
| Rate for Payer: Priority Health SBD |
$825.51
|
|
|
HC INJECTION PROCEDURE
|
Facility
|
IP
|
$603.48
|
|
| Hospital Charge Code |
36000085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$380.19 |
| Max. Negotiated Rate |
$543.13 |
| Rate for Payer: Aetna Commercial |
$512.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.26
|
| Rate for Payer: Cash Price |
$482.78
|
| Rate for Payer: Cofinity Commercial |
$422.44
|
| Rate for Payer: Cofinity Commercial |
$518.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$422.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$482.78
|
| Rate for Payer: Healthscope Commercial |
$543.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.96
|
| Rate for Payer: PHP Commercial |
$512.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.26
|
| Rate for Payer: Priority Health SBD |
$380.19
|
|
|
HC INJECTION PROCEDURE
|
Facility
|
OP
|
$603.48
|
|
| Hospital Charge Code |
36000085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$241.39 |
| Max. Negotiated Rate |
$543.13 |
| Rate for Payer: Aetna Commercial |
$512.96
|
| Rate for Payer: Aetna Medicare |
$301.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.26
|
| Rate for Payer: BCBS Complete |
$241.39
|
| Rate for Payer: Cash Price |
$482.78
|
| Rate for Payer: Cofinity Commercial |
$422.44
|
| Rate for Payer: Cofinity Commercial |
$518.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$422.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$482.78
|
| Rate for Payer: Healthscope Commercial |
$543.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.96
|
| Rate for Payer: PHP Commercial |
$512.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.26
|
| Rate for Payer: Priority Health SBD |
$380.19
|
|
|
HC INJECTION PROCEDURE ILEAL CONDUIT
|
Facility
|
IP
|
$643.53
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
36100249
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$405.42 |
| Max. Negotiated Rate |
$579.18 |
| Rate for Payer: Aetna Commercial |
$547.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.29
|
| Rate for Payer: Cash Price |
$514.82
|
| Rate for Payer: Cofinity Commercial |
$450.47
|
| Rate for Payer: Cofinity Commercial |
$553.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$450.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.82
|
| Rate for Payer: Healthscope Commercial |
$579.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$547.00
|
| Rate for Payer: PHP Commercial |
$547.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$418.29
|
| Rate for Payer: Priority Health SBD |
$405.42
|
|
|
HC INJECTION PROCEDURE ILEAL CONDUIT
|
Facility
|
OP
|
$643.53
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
36100249
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.78 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$547.00
|
| Rate for Payer: Aetna Medicare |
$321.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.29
|
| Rate for Payer: BCBS Complete |
$257.41
|
| Rate for Payer: BCBS Trust/PPO |
$204.48
|
| Rate for Payer: BCN Commercial |
$204.48
|
| Rate for Payer: Cash Price |
$514.82
|
| Rate for Payer: Cash Price |
$514.82
|
| Rate for Payer: Cash Price |
$514.82
|
| Rate for Payer: Cofinity Commercial |
$450.47
|
| Rate for Payer: Cofinity Commercial |
$553.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$450.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.82
|
| Rate for Payer: Healthscope Commercial |
$579.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$547.00
|
| Rate for Payer: PHP Commercial |
$547.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$418.29
|
| Rate for Payer: Priority Health SBD |
$405.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.78
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION PROC RETROGRAD CYSTOGRAPHY
|
Facility
|
OP
|
$832.48
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
36100252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$67.17 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$707.61
|
| Rate for Payer: Aetna Medicare |
$416.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$541.11
|
| Rate for Payer: BCBS Complete |
$332.99
|
| Rate for Payer: BCBS Trust/PPO |
$284.90
|
| Rate for Payer: BCN Commercial |
$284.90
|
| Rate for Payer: Cash Price |
$665.98
|
| Rate for Payer: Cash Price |
$665.98
|
| Rate for Payer: Cash Price |
$665.98
|
| Rate for Payer: Cofinity Commercial |
$582.74
|
| Rate for Payer: Cofinity Commercial |
$715.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$582.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$665.98
|
| Rate for Payer: Healthscope Commercial |
$749.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$707.61
|
| Rate for Payer: PHP Commercial |
$707.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.11
|
| Rate for Payer: Priority Health SBD |
$524.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.17
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
