|
HC INJECTION WRIST ARTHROGRAM
|
Facility
|
IP
|
$1,152.20
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
36100039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$725.89 |
| Max. Negotiated Rate |
$1,036.98 |
| Rate for Payer: Aetna Commercial |
$979.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$748.93
|
| Rate for Payer: Cash Price |
$921.76
|
| Rate for Payer: Cofinity Commercial |
$806.54
|
| Rate for Payer: Cofinity Commercial |
$990.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$806.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$921.76
|
| Rate for Payer: Healthscope Commercial |
$1,036.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$979.37
|
| Rate for Payer: PHP Commercial |
$979.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$748.93
|
| Rate for Payer: Priority Health SBD |
$725.89
|
|
|
HC INJECT/IRRIGATE CORPORA CAVERNOSA
|
Facility
|
OP
|
$373.37
|
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.35 |
| Max. Negotiated Rate |
$336.03 |
| Rate for Payer: Aetna Commercial |
$317.36
|
| Rate for Payer: Aetna Medicare |
$186.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.69
|
| Rate for Payer: BCBS Complete |
$149.35
|
| Rate for Payer: Cash Price |
$298.70
|
| Rate for Payer: Cofinity Commercial |
$261.36
|
| Rate for Payer: Cofinity Commercial |
$321.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$261.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.70
|
| Rate for Payer: Healthscope Commercial |
$336.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.36
|
| Rate for Payer: PHP Commercial |
$317.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.69
|
| Rate for Payer: Priority Health SBD |
$235.22
|
|
|
HC INJECT/IRRIGATE CORPORA CAVERNOSA
|
Facility
|
IP
|
$373.37
|
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.22 |
| Max. Negotiated Rate |
$336.03 |
| Rate for Payer: Aetna Commercial |
$317.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.69
|
| Rate for Payer: Cash Price |
$298.70
|
| Rate for Payer: Cofinity Commercial |
$261.36
|
| Rate for Payer: Cofinity Commercial |
$321.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$261.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.70
|
| Rate for Payer: Healthscope Commercial |
$336.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.36
|
| Rate for Payer: PHP Commercial |
$317.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.69
|
| Rate for Payer: Priority Health SBD |
$235.22
|
|
|
HC INJECT PORTAL VEIN
|
Facility
|
IP
|
$2,780.89
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
36100543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,751.96 |
| Max. Negotiated Rate |
$2,502.80 |
| Rate for Payer: Aetna Commercial |
$2,363.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,807.58
|
| Rate for Payer: Cash Price |
$2,224.71
|
| Rate for Payer: Cofinity Commercial |
$1,946.62
|
| Rate for Payer: Cofinity Commercial |
$2,391.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,946.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,224.71
|
| Rate for Payer: Healthscope Commercial |
$2,502.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.76
|
| Rate for Payer: PHP Commercial |
$2,363.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.58
|
| Rate for Payer: Priority Health SBD |
$1,751.96
|
|
|
HC INJECT PORTAL VEIN
|
Facility
|
OP
|
$2,780.89
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
36100543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$339.30 |
| Max. Negotiated Rate |
$4,032.40 |
| Rate for Payer: Aetna Commercial |
$2,363.76
|
| Rate for Payer: Aetna Medicare |
$1,390.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,807.58
|
| Rate for Payer: BCBS Complete |
$1,112.36
|
| Rate for Payer: BCBS Trust/PPO |
$4,032.40
|
| Rate for Payer: BCN Commercial |
$4,032.40
|
| Rate for Payer: Cash Price |
$2,224.71
|
| Rate for Payer: Cash Price |
$2,224.71
|
| Rate for Payer: Cash Price |
$2,224.71
|
| Rate for Payer: Cofinity Commercial |
$1,946.62
|
| Rate for Payer: Cofinity Commercial |
$2,391.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,946.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,224.71
|
| Rate for Payer: Healthscope Commercial |
$2,502.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.76
|
| Rate for Payer: PHP Commercial |
$2,363.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.58
|
| Rate for Payer: Priority Health SBD |
$1,751.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.30
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECT PROC PENILE PLAQUE
|
Facility
|
IP
|
$361.15
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.52 |
| Max. Negotiated Rate |
$325.04 |
| Rate for Payer: Aetna Commercial |
$306.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.75
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Cofinity Commercial |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.92
|
| Rate for Payer: Healthscope Commercial |
$325.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.98
|
| Rate for Payer: PHP Commercial |
$306.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.75
|
| Rate for Payer: Priority Health SBD |
$227.52
|
|
|
HC INJECT PROC PENILE PLAQUE
|
Facility
|
OP
|
$361.15
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.51 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$306.98
|
| Rate for Payer: Aetna Medicare |
$247.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: BCBS Complete |
$134.11
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$138.31
|
| Rate for Payer: BCN Commercial |
$138.31
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Cofinity Commercial |
$252.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Healthscope Commercial |
$325.04
|
| Rate for Payer: Mclaren Medicaid |
$127.72
|
| Rate for Payer: Mclaren Medicare |
$238.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: Meridian Medicaid |
$134.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.98
|
| Rate for Payer: Nomi Health Commercial |
$500.41
|
| Rate for Payer: PACE Medicare |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Commercial |
$306.98
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.94
|
| Rate for Payer: Priority Health Medicare |
$238.29
|
| Rate for Payer: Priority Health Narrow Network |
$599.15
|
| Rate for Payer: Priority Health SBD |
$227.52
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.51
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: UHCCP Medicaid |
$134.16
|
| Rate for Payer: VA VA |
$238.29
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 1 OR 2 MUSCLES
|
Facility
|
IP
|
$374.14
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
36100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.71 |
| Max. Negotiated Rate |
$336.73 |
| Rate for Payer: Aetna Commercial |
$318.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.19
|
| Rate for Payer: Cash Price |
$299.31
|
| Rate for Payer: Cofinity Commercial |
$261.90
|
| Rate for Payer: Cofinity Commercial |
$321.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$261.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.31
|
| Rate for Payer: Healthscope Commercial |
$336.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.02
|
| Rate for Payer: PHP Commercial |
$318.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.19
|
| Rate for Payer: Priority Health SBD |
$235.71
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 1 OR 2 MUSCLES
|
Facility
|
OP
|
$374.14
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
36100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.96 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Commercial |
$318.02
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.19
|
| 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 |
$299.31
|
| Rate for Payer: Cash Price |
$299.31
|
| Rate for Payer: Cash Price |
$299.31
|
| Rate for Payer: Cofinity Commercial |
$321.76
|
| Rate for Payer: Cofinity Commercial |
$261.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$261.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$336.73
|
| 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 |
$318.02
|
| 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 |
$318.02
|
| 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 |
$243.19
|
| 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 |
$235.71
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.96
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$162.83
|
| Rate for Payer: VA VA |
$289.22
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 3 OR MORE MUSCLES
|
Facility
|
OP
|
$487.67
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
36100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.28 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Commercial |
$414.52
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.99
|
| 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 |
$390.14
|
| Rate for Payer: Cash Price |
$390.14
|
| Rate for Payer: Cash Price |
$390.14
|
| Rate for Payer: Cofinity Commercial |
$419.40
|
| Rate for Payer: Cofinity Commercial |
$341.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$341.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$438.90
|
| 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 |
$414.52
|
| 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 |
$414.52
|
| 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 |
$316.99
|
| 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 |
$307.23
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.28
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$162.83
|
| Rate for Payer: VA VA |
$289.22
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 3 OR MORE MUSCLES
|
Facility
|
IP
|
$487.67
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
36100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$307.23 |
| Max. Negotiated Rate |
$438.90 |
| Rate for Payer: Aetna Commercial |
$414.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.99
|
| Rate for Payer: Cash Price |
$390.14
|
| Rate for Payer: Cofinity Commercial |
$341.37
|
| Rate for Payer: Cofinity Commercial |
$419.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$341.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.14
|
| Rate for Payer: Healthscope Commercial |
$438.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.52
|
| Rate for Payer: PHP Commercial |
$414.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.99
|
| Rate for Payer: Priority Health SBD |
$307.23
|
|
|
HC INJ ENOXAPARIN SODIUM PER 10 MG
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63600151
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| 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 |
$1.61
|
| Rate for Payer: BCN Commercial |
$1.61
|
| 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 INJ ENOXAPARIN SODIUM PER 10 MG
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63600151
|
|
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 INJ ENZYME PALMAR FASCIAL CORD
|
Facility
|
OP
|
$339.65
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Commercial |
$288.70
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.77
|
| 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 |
$33.25
|
| Rate for Payer: BCN Commercial |
$33.25
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$271.72
|
| Rate for Payer: Cash Price |
$271.72
|
| Rate for Payer: Cash Price |
$271.72
|
| Rate for Payer: Cofinity Commercial |
$292.10
|
| Rate for Payer: Cofinity Commercial |
$237.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$305.68
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.70
|
| 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 |
$288.70
|
| 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 |
$220.77
|
| 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 |
$213.98
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.64
|
| 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 INJ ENZYME PALMAR FASCIAL CORD
|
Facility
|
IP
|
$339.65
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.98 |
| Max. Negotiated Rate |
$305.68 |
| Rate for Payer: Aetna Commercial |
$288.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.77
|
| Rate for Payer: Cash Price |
$271.72
|
| Rate for Payer: Cofinity Commercial |
$237.76
|
| Rate for Payer: Cofinity Commercial |
$292.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.72
|
| Rate for Payer: Healthscope Commercial |
$305.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.70
|
| Rate for Payer: PHP Commercial |
$288.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.77
|
| Rate for Payer: Priority Health SBD |
$213.98
|
|
|
HC INJ HEPARIN SODIUM PER 1000U
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| 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 |
$0.61
|
| Rate for Payer: BCN Commercial |
$0.61
|
| 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 INJ HEPARIN SODIUM PER 1000U
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600140
|
|
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 INJ HYDROCORTISONE NA SUCCINATE, UP TO 100MG
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
63600241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health SBD |
$26.99
|
|
|
HC INJ HYDROCORTISONE NA SUCCINATE, UP TO 100MG
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
63600241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$54.78 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$54.78
|
| Rate for Payer: BCN Commercial |
$54.78
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health SBD |
$26.99
|
|
|
HC INJ KNEE ARTHROGRAM CT/MRI
|
Facility
|
OP
|
$617.14
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
36100562
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$42.36 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$524.57
|
| Rate for Payer: Aetna Medicare |
$308.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.14
|
| Rate for Payer: BCBS Complete |
$246.86
|
| Rate for Payer: BCBS Trust/PPO |
$333.98
|
| Rate for Payer: BCN Commercial |
$333.98
|
| Rate for Payer: Cash Price |
$493.71
|
| Rate for Payer: Cash Price |
$493.71
|
| Rate for Payer: Cash Price |
$493.71
|
| Rate for Payer: Cofinity Commercial |
$432.00
|
| Rate for Payer: Cofinity Commercial |
$530.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.71
|
| Rate for Payer: Healthscope Commercial |
$555.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.57
|
| Rate for Payer: PHP Commercial |
$524.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.14
|
| Rate for Payer: Priority Health SBD |
$388.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.36
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJ KNEE ARTHROGRAM CT/MRI
|
Facility
|
IP
|
$617.14
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
36100562
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$388.80 |
| Max. Negotiated Rate |
$555.43 |
| Rate for Payer: Aetna Commercial |
$524.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.14
|
| Rate for Payer: Cash Price |
$493.71
|
| Rate for Payer: Cofinity Commercial |
$432.00
|
| Rate for Payer: Cofinity Commercial |
$530.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.71
|
| Rate for Payer: Healthscope Commercial |
$555.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.57
|
| Rate for Payer: PHP Commercial |
$524.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.14
|
| Rate for Payer: Priority Health SBD |
$388.80
|
|
|
HC INJ LIDOCAINE HYDROCHLORIDE 1 MG
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
63600262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna Commercial |
$0.85
|
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.65
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.70
|
| Rate for Payer: Cofinity Commercial |
$0.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.80
|
| Rate for Payer: Healthscope Commercial |
$0.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.85
|
| Rate for Payer: PHP Commercial |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health SBD |
$0.63
|
|
|
HC INJ LIDOCAINE HYDROCHLORIDE 1 MG
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
63600262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna Commercial |
$0.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.65
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.70
|
| Rate for Payer: Cofinity Commercial |
$0.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.80
|
| Rate for Payer: Healthscope Commercial |
$0.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.85
|
| Rate for Payer: PHP Commercial |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health SBD |
$0.63
|
|
|
HC INJ LUMB W MYELO 2+REG SAME MD
|
Facility
|
IP
|
$2,096.95
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
36100463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,321.08 |
| Max. Negotiated Rate |
$1,887.26 |
| Rate for Payer: Aetna Commercial |
$1,782.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,363.02
|
| Rate for Payer: Cash Price |
$1,677.56
|
| Rate for Payer: Cofinity Commercial |
$1,467.86
|
| Rate for Payer: Cofinity Commercial |
$1,803.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,467.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,677.56
|
| Rate for Payer: Healthscope Commercial |
$1,887.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,782.41
|
| Rate for Payer: PHP Commercial |
$1,782.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,363.02
|
| Rate for Payer: Priority Health SBD |
$1,321.08
|
|
|
HC INJ LUMB W MYELO 2+REG SAME MD
|
Facility
|
OP
|
$2,096.95
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
36100463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.73 |
| Max. Negotiated Rate |
$2,432.92 |
| Rate for Payer: Aetna Commercial |
$1,782.41
|
| Rate for Payer: Aetna Medicare |
$805.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,363.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$967.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$967.60
|
| Rate for Payer: BCBS Complete |
$435.65
|
| Rate for Payer: BCBS MAPPO |
$774.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,042.35
|
| Rate for Payer: BCN Commercial |
$1,042.35
|
| Rate for Payer: BCN Medicare Advantage |
$774.08
|
| Rate for Payer: Cash Price |
$1,677.56
|
| Rate for Payer: Cash Price |
$1,677.56
|
| Rate for Payer: Cash Price |
$1,677.56
|
| Rate for Payer: Cofinity Commercial |
$1,803.38
|
| Rate for Payer: Cofinity Commercial |
$1,467.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,467.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,677.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.08
|
| Rate for Payer: Healthscope Commercial |
$1,887.26
|
| Rate for Payer: Mclaren Medicaid |
$414.91
|
| Rate for Payer: Mclaren Medicare |
$774.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.78
|
| Rate for Payer: Meridian Medicaid |
$435.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$890.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,782.41
|
| Rate for Payer: Nomi Health Commercial |
$2,322.24
|
| Rate for Payer: PACE Medicare |
$735.38
|
| Rate for Payer: PACE SWMI |
$774.08
|
| Rate for Payer: PHP Commercial |
$1,782.41
|
| Rate for Payer: PHP Medicare Advantage |
$774.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,363.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,432.92
|
| Rate for Payer: Priority Health Medicare |
$774.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,946.34
|
| Rate for Payer: Priority Health SBD |
$1,321.08
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.73
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.08
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$774.08
|
| Rate for Payer: UHCCP Medicaid |
$435.81
|
| Rate for Payer: VA VA |
$774.08
|
|
