|
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
|
|
|
HC INJECTION, PROMETHAZINE HCL, UP TO 50 MG
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT J2550
|
| Hospital Charge Code |
63600100
|
|
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: BCBS Trust/PPO |
$9.34
|
| Rate for Payer: BCN Commercial |
$9.34
|
| Rate for Payer: Cash Price |
$12.49
|
| 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, PROMETHAZINE HCL, UP TO 50 MG
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT J2550
|
| Hospital Charge Code |
63600100
|
|
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 PUDENDAL NERVE
|
Facility
|
IP
|
$1,193.61
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
36100570
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$751.97 |
| Max. Negotiated Rate |
$1,074.25 |
| Rate for Payer: Aetna Commercial |
$1,014.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$775.85
|
| Rate for Payer: Cash Price |
$954.89
|
| Rate for Payer: Cofinity Commercial |
$1,026.50
|
| Rate for Payer: Cofinity Commercial |
$835.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$835.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$954.89
|
| Rate for Payer: Healthscope Commercial |
$1,074.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,014.57
|
| Rate for Payer: PHP Commercial |
$1,014.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$775.85
|
| Rate for Payer: Priority Health SBD |
$751.97
|
|
|
HC INJECTION PUDENDAL NERVE
|
Facility
|
OP
|
$1,193.61
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
36100570
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.83 |
| Max. Negotiated Rate |
$2,741.59 |
| Rate for Payer: Aetna Commercial |
$1,014.57
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$775.85
|
| 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 |
$506.74
|
| Rate for Payer: BCN Commercial |
$506.74
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$954.89
|
| Rate for Payer: Cash Price |
$954.89
|
| Rate for Payer: Cash Price |
$954.89
|
| Rate for Payer: Cofinity Commercial |
$1,026.50
|
| Rate for Payer: Cofinity Commercial |
$835.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$835.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$954.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,074.25
|
| 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 |
$1,014.57
|
| 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 |
$1,014.57
|
| 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 |
$775.85
|
| 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 |
$751.97
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.83
|
| 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 INJECTION SCLEROSING SOL MULTIPLE
|
Facility
|
IP
|
$329.29
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.45 |
| Max. Negotiated Rate |
$296.36 |
| Rate for Payer: Aetna Commercial |
$279.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.04
|
| Rate for Payer: Cash Price |
$263.43
|
| Rate for Payer: Cofinity Commercial |
$230.50
|
| Rate for Payer: Cofinity Commercial |
$283.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.43
|
| Rate for Payer: Healthscope Commercial |
$296.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.90
|
| Rate for Payer: PHP Commercial |
$279.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.04
|
| Rate for Payer: Priority Health SBD |
$207.45
|
|
|
HC INJECTION SCLEROSING SOL MULTIPLE
|
Facility
|
OP
|
$329.29
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.82 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Commercial |
$279.90
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$177.48
|
| Rate for Payer: BCN Commercial |
$177.48
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$263.43
|
| Rate for Payer: Cash Price |
$263.43
|
| Rate for Payer: Cash Price |
$263.43
|
| Rate for Payer: Cofinity Commercial |
$283.19
|
| Rate for Payer: Cofinity Commercial |
$230.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$296.36
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.90
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$279.90
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$207.45
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.82
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$220.39
|
| Rate for Payer: VA VA |
$391.45
|
|
|
HC INJECTION SCLEROSING SOL SINGLE
|
Facility
|
OP
|
$252.82
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
36100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Commercial |
$214.90
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$78.75
|
| Rate for Payer: BCN Commercial |
$78.75
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$202.26
|
| Rate for Payer: Cash Price |
$202.26
|
| Rate for Payer: Cash Price |
$202.26
|
| Rate for Payer: Cofinity Commercial |
$217.43
|
| Rate for Payer: Cofinity Commercial |
$176.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$227.54
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.90
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$214.90
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$159.28
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.57
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$220.39
|
| Rate for Payer: VA VA |
$391.45
|
|
|
HC INJECTION SCLEROSING SOL SINGLE
|
Facility
|
IP
|
$252.82
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
36100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.28 |
| Max. Negotiated Rate |
$227.54 |
| Rate for Payer: Aetna Commercial |
$214.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.33
|
| Rate for Payer: Cash Price |
$202.26
|
| Rate for Payer: Cofinity Commercial |
$176.97
|
| Rate for Payer: Cofinity Commercial |
$217.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.26
|
| Rate for Payer: Healthscope Commercial |
$227.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.90
|
| Rate for Payer: PHP Commercial |
$214.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.33
|
| Rate for Payer: Priority Health SBD |
$159.28
|
|
|
HC INJECTION SHOULDER ARTHROGRAM
|
Facility
|
IP
|
$863.45
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
36100037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$543.97 |
| Max. Negotiated Rate |
$777.10 |
| Rate for Payer: Aetna Commercial |
$733.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$561.24
|
| Rate for Payer: Cash Price |
$690.76
|
| Rate for Payer: Cofinity Commercial |
$604.42
|
| Rate for Payer: Cofinity Commercial |
$742.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$604.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.76
|
| Rate for Payer: Healthscope Commercial |
$777.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.93
|
| Rate for Payer: PHP Commercial |
$733.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.24
|
| Rate for Payer: Priority Health SBD |
$543.97
|
|
|
HC INJECTION SHOULDER ARTHROGRAM
|
Facility
|
OP
|
$863.45
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
36100037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$52.38 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$733.93
|
| Rate for Payer: Aetna Medicare |
$431.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$561.24
|
| Rate for Payer: BCBS Complete |
$345.38
|
| Rate for Payer: BCBS Trust/PPO |
$182.12
|
| Rate for Payer: BCN Commercial |
$182.12
|
| Rate for Payer: Cash Price |
$690.76
|
| Rate for Payer: Cash Price |
$690.76
|
| Rate for Payer: Cash Price |
$690.76
|
| Rate for Payer: Cofinity Commercial |
$604.42
|
| Rate for Payer: Cofinity Commercial |
$742.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$604.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.76
|
| Rate for Payer: Healthscope Commercial |
$777.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.93
|
| Rate for Payer: PHP Commercial |
$733.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.24
|
| Rate for Payer: Priority Health SBD |
$543.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.38
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION SHUNTOGRAM
|
Facility
|
OP
|
$388.71
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
36100224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$41.29 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: Aetna Medicare |
$194.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.66
|
| Rate for Payer: BCBS Complete |
$155.48
|
| Rate for Payer: BCBS Trust/PPO |
$96.43
|
| Rate for Payer: BCN Commercial |
$96.43
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$272.10
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health SBD |
$244.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.29
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION SHUNTOGRAM
|
Facility
|
IP
|
$388.71
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
36100224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$244.89 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.66
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$272.10
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health SBD |
$244.89
|
|
|
HC INJECTION SIALOGRAM
|
Facility
|
OP
|
$291.84
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
36100190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.11 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: Aetna Medicare |
$145.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.70
|
| Rate for Payer: BCBS Complete |
$116.74
|
| Rate for Payer: BCBS Trust/PPO |
$280.63
|
| Rate for Payer: BCN Commercial |
$280.63
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$204.29
|
| Rate for Payer: Cofinity Commercial |
$250.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Healthscope Commercial |
$262.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.70
|
| Rate for Payer: Priority Health SBD |
$183.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.11
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION SIALOGRAM
|
Facility
|
IP
|
$291.84
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
36100190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$183.86 |
| Max. Negotiated Rate |
$262.66 |
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.70
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$204.29
|
| Rate for Payer: Cofinity Commercial |
$250.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Healthscope Commercial |
$262.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.70
|
| Rate for Payer: Priority Health SBD |
$183.86
|
|
|
HC INJECTION SI JOINT ANESTHESIA/STEROID
|
Facility
|
OP
|
$1,011.25
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$87.11 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$859.56
|
| Rate for Payer: Aetna Medicare |
$505.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.31
|
| Rate for Payer: BCBS Complete |
$404.50
|
| Rate for Payer: BCBS Trust/PPO |
$441.70
|
| Rate for Payer: BCN Commercial |
$441.70
|
| Rate for Payer: Cash Price |
$809.00
|
| Rate for Payer: Cash Price |
$809.00
|
| Rate for Payer: Cash Price |
$809.00
|
| Rate for Payer: Cofinity Commercial |
$707.88
|
| Rate for Payer: Cofinity Commercial |
$869.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$707.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.00
|
| Rate for Payer: Healthscope Commercial |
$910.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.56
|
| Rate for Payer: PHP Commercial |
$859.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$323.52
|
| Rate for Payer: Priority Health Narrow Network |
$258.82
|
| Rate for Payer: Priority Health SBD |
$637.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.11
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION SI JOINT ANESTHESIA/STEROID
|
Facility
|
IP
|
$1,011.25
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$637.09 |
| Max. Negotiated Rate |
$910.12 |
| Rate for Payer: Aetna Commercial |
$859.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.31
|
| Rate for Payer: Cash Price |
$809.00
|
| Rate for Payer: Cofinity Commercial |
$869.68
|
| Rate for Payer: Cofinity Commercial |
$707.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$707.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.00
|
| Rate for Payer: Healthscope Commercial |
$910.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.56
|
| Rate for Payer: PHP Commercial |
$859.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.31
|
| Rate for Payer: Priority Health SBD |
$637.09
|
|
|
HC INJECTION SI JOINT BIL ANESTHESIA/STEROID
|
Facility
|
OP
|
$1,047.85
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$87.11 |
| Max. Negotiated Rate |
$943.06 |
| Rate for Payer: Aetna Commercial |
$890.67
|
| Rate for Payer: Aetna Medicare |
$523.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.10
|
| Rate for Payer: BCBS Complete |
$419.14
|
| Rate for Payer: BCBS Trust/PPO |
$441.70
|
| Rate for Payer: BCN Commercial |
$441.70
|
| Rate for Payer: Cash Price |
$838.28
|
| Rate for Payer: Cash Price |
$838.28
|
| Rate for Payer: Cash Price |
$838.28
|
| Rate for Payer: Cofinity Commercial |
$733.50
|
| Rate for Payer: Cofinity Commercial |
$901.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$733.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.28
|
| Rate for Payer: Healthscope Commercial |
$943.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.67
|
| Rate for Payer: PHP Commercial |
$890.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$681.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$323.52
|
| Rate for Payer: Priority Health Narrow Network |
$258.82
|
| Rate for Payer: Priority Health SBD |
$660.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.11
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION SI JOINT BIL ANESTHESIA/STEROID
|
Facility
|
IP
|
$1,047.85
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$660.15 |
| Max. Negotiated Rate |
$943.06 |
| Rate for Payer: Aetna Commercial |
$890.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.10
|
| Rate for Payer: Cash Price |
$838.28
|
| Rate for Payer: Cofinity Commercial |
$901.15
|
| Rate for Payer: Cofinity Commercial |
$733.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$733.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.28
|
| Rate for Payer: Healthscope Commercial |
$943.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.67
|
| Rate for Payer: PHP Commercial |
$890.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$681.10
|
| Rate for Payer: Priority Health SBD |
$660.15
|
|
|
HC INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$279.36
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
36100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.99 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Commercial |
$237.46
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.58
|
| 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 |
$223.49
|
| Rate for Payer: Cash Price |
$223.49
|
| Rate for Payer: Cash Price |
$223.49
|
| Rate for Payer: Cofinity Commercial |
$240.25
|
| Rate for Payer: Cofinity Commercial |
$195.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$251.42
|
| 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 |
$237.46
|
| 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 |
$237.46
|
| 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 |
$181.58
|
| 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 |
$176.00
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.99
|
| 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 SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$279.36
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
36100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.00 |
| Max. Negotiated Rate |
$251.42 |
| Rate for Payer: Aetna Commercial |
$237.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.58
|
| Rate for Payer: Cash Price |
$223.49
|
| Rate for Payer: Cofinity Commercial |
$195.55
|
| Rate for Payer: Cofinity Commercial |
$240.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.49
|
| Rate for Payer: Healthscope Commercial |
$251.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.46
|
| Rate for Payer: PHP Commercial |
$237.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.58
|
| Rate for Payer: Priority Health SBD |
$176.00
|
|
|
HC INJECTION SPLENOPOTOGRAM SPLENOPORTOG
|
Facility
|
OP
|
$437.63
|
|
|
Service Code
|
CPT 38200
|
| Hospital Charge Code |
36100183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.07 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$371.99
|
| Rate for Payer: Aetna Medicare |
$218.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.46
|
| Rate for Payer: BCBS Complete |
$175.05
|
| Rate for Payer: BCBS Trust/PPO |
$284.25
|
| Rate for Payer: BCN Commercial |
$284.25
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$306.34
|
| Rate for Payer: Cofinity Commercial |
$376.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$306.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Healthscope Commercial |
$393.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: PHP Commercial |
$371.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: Priority Health SBD |
$275.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.07
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION SPLENOPOTOGRAM SPLENOPORTOG
|
Facility
|
IP
|
$437.63
|
|
|
Service Code
|
CPT 38200
|
| Hospital Charge Code |
36100183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$275.71 |
| Max. Negotiated Rate |
$393.87 |
| Rate for Payer: Aetna Commercial |
$371.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.46
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$306.34
|
| Rate for Payer: Cofinity Commercial |
$376.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$306.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Healthscope Commercial |
$393.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: PHP Commercial |
$371.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: Priority Health SBD |
$275.71
|
|
|
HC INJECTIONS SCLEROSANT FOR SPIDER VEINS /TRNK
|
Facility
|
IP
|
$1,085.28
|
|
|
Service Code
|
CPT 36468
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$683.73 |
| Max. Negotiated Rate |
$976.75 |
| Rate for Payer: Aetna Commercial |
$922.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$705.43
|
| Rate for Payer: Cash Price |
$868.22
|
| Rate for Payer: Cofinity Commercial |
$759.70
|
| Rate for Payer: Cofinity Commercial |
$933.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$759.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$868.22
|
| Rate for Payer: Healthscope Commercial |
$976.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$922.49
|
| Rate for Payer: PHP Commercial |
$922.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.43
|
| Rate for Payer: Priority Health SBD |
$683.73
|
|
|
HC INJECTIONS SCLEROSANT FOR SPIDER VEINS /TRNK
|
Facility
|
OP
|
$1,085.28
|
|
|
Service Code
|
CPT 36468
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.08 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Commercial |
$922.49
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$705.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$82.08
|
| Rate for Payer: BCN Commercial |
$82.08
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$868.22
|
| Rate for Payer: Cash Price |
$868.22
|
| Rate for Payer: Cash Price |
$868.22
|
| Rate for Payer: Cofinity Commercial |
$759.70
|
| Rate for Payer: Cofinity Commercial |
$933.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$759.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$868.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$976.75
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$922.49
|
| Rate for Payer: Nomi Health Commercial |
$1,174.35
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$922.49
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$683.73
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,101.89
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$220.39
|
| Rate for Payer: VA VA |
$391.45
|
|
