|
HC INJ LUMB W MYELO CERV SAME MD
|
Facility
|
IP
|
$2,204.53
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
36100460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,388.85 |
| Max. Negotiated Rate |
$1,984.08 |
| Rate for Payer: Aetna Commercial |
$1,873.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,432.94
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cofinity Commercial |
$1,543.17
|
| Rate for Payer: Cofinity Commercial |
$1,895.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,543.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.62
|
| Rate for Payer: Healthscope Commercial |
$1,984.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.85
|
| Rate for Payer: PHP Commercial |
$1,873.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.94
|
| Rate for Payer: Priority Health SBD |
$1,388.85
|
|
|
HC INJ LUMB W MYELO CERV SAME MD
|
Facility
|
OP
|
$2,204.53
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
36100460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.59 |
| Max. Negotiated Rate |
$2,432.92 |
| Rate for Payer: Aetna Commercial |
$1,873.85
|
| Rate for Payer: Aetna Medicare |
$805.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,432.94
|
| 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 |
$828.67
|
| Rate for Payer: BCN Commercial |
$828.67
|
| Rate for Payer: BCN Medicare Advantage |
$774.08
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cofinity Commercial |
$1,895.90
|
| Rate for Payer: Cofinity Commercial |
$1,543.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,543.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.08
|
| Rate for Payer: Healthscope Commercial |
$1,984.08
|
| 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 |
$1,873.85
|
| 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 |
$1,873.85
|
| 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 |
$1,432.94
|
| 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 |
$1,388.85
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.59
|
| 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
|
|
|
HC INJ LUMB W MYELO LS SAME MD
|
Facility
|
IP
|
$2,204.53
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
36100462
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,388.85 |
| Max. Negotiated Rate |
$1,984.08 |
| Rate for Payer: Aetna Commercial |
$1,873.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,432.94
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cofinity Commercial |
$1,543.17
|
| Rate for Payer: Cofinity Commercial |
$1,895.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,543.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.62
|
| Rate for Payer: Healthscope Commercial |
$1,984.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.85
|
| Rate for Payer: PHP Commercial |
$1,873.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.94
|
| Rate for Payer: Priority Health SBD |
$1,388.85
|
|
|
HC INJ LUMB W MYELO LS SAME MD
|
Facility
|
OP
|
$2,204.53
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
36100462
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$123.14 |
| Max. Negotiated Rate |
$2,432.92 |
| Rate for Payer: Aetna Commercial |
$1,873.85
|
| Rate for Payer: Aetna Medicare |
$805.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,432.94
|
| 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 |
$847.90
|
| Rate for Payer: BCN Commercial |
$847.90
|
| Rate for Payer: BCN Medicare Advantage |
$774.08
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cofinity Commercial |
$1,895.90
|
| Rate for Payer: Cofinity Commercial |
$1,543.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,543.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.08
|
| Rate for Payer: Healthscope Commercial |
$1,984.08
|
| 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 |
$1,873.85
|
| 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 |
$1,873.85
|
| 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 |
$1,432.94
|
| 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 |
$1,388.85
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.14
|
| 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
|
|
|
HC INJ LUMB W MYELO THOR SAME MD
|
Facility
|
OP
|
$2,204.53
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
36100461
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.50 |
| Max. Negotiated Rate |
$2,432.92 |
| Rate for Payer: Aetna Commercial |
$1,873.85
|
| Rate for Payer: Aetna Medicare |
$805.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,432.94
|
| 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 |
$441.98
|
| Rate for Payer: BCN Commercial |
$441.98
|
| Rate for Payer: BCN Medicare Advantage |
$774.08
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cofinity Commercial |
$1,895.90
|
| Rate for Payer: Cofinity Commercial |
$1,543.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,543.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.08
|
| Rate for Payer: Healthscope Commercial |
$1,984.08
|
| 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 |
$1,873.85
|
| 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 |
$1,873.85
|
| 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 |
$1,432.94
|
| 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 |
$1,388.85
|
| Rate for Payer: Railroad Medicare Medicare |
$774.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.50
|
| 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
|
|
|
HC INJ LUMB W MYELO THOR SAME MD
|
Facility
|
IP
|
$2,204.53
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
36100461
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,388.85 |
| Max. Negotiated Rate |
$1,984.08 |
| Rate for Payer: Aetna Commercial |
$1,873.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,432.94
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cofinity Commercial |
$1,543.17
|
| Rate for Payer: Cofinity Commercial |
$1,895.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,543.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.62
|
| Rate for Payer: Healthscope Commercial |
$1,984.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.85
|
| Rate for Payer: PHP Commercial |
$1,873.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.94
|
| Rate for Payer: Priority Health SBD |
$1,388.85
|
|
|
HC INJ LYMPHANGIOGRAPHY
|
Facility
|
IP
|
$1,305.17
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
36100445
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$822.26 |
| Max. Negotiated Rate |
$1,174.65 |
| Rate for Payer: Aetna Commercial |
$1,109.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$848.36
|
| Rate for Payer: Cash Price |
$1,044.14
|
| Rate for Payer: Cofinity Commercial |
$1,122.45
|
| Rate for Payer: Cofinity Commercial |
$913.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$913.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,044.14
|
| Rate for Payer: Healthscope Commercial |
$1,174.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,109.39
|
| Rate for Payer: PHP Commercial |
$1,109.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.36
|
| Rate for Payer: Priority Health SBD |
$822.26
|
|
|
HC INJ LYMPHANGIOGRAPHY
|
Facility
|
OP
|
$1,305.17
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
36100445
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.09 |
| Max. Negotiated Rate |
$1,174.65 |
| Rate for Payer: Aetna Commercial |
$1,109.39
|
| Rate for Payer: Aetna Medicare |
$652.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$848.36
|
| Rate for Payer: BCBS Complete |
$522.07
|
| Rate for Payer: BCBS Trust/PPO |
$174.02
|
| Rate for Payer: BCN Commercial |
$174.02
|
| Rate for Payer: Cash Price |
$1,044.14
|
| Rate for Payer: Cash Price |
$1,044.14
|
| Rate for Payer: Cash Price |
$1,044.14
|
| Rate for Payer: Cofinity Commercial |
$1,122.45
|
| Rate for Payer: Cofinity Commercial |
$913.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$913.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,044.14
|
| Rate for Payer: Healthscope Commercial |
$1,174.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,109.39
|
| Rate for Payer: PHP Commercial |
$1,109.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.36
|
| Rate for Payer: Priority Health SBD |
$822.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.09
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJ, METHYLPREDNISOLONE ACETATE, 1 MG
|
Facility
|
IP
|
$0.52
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
63600239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Aetna Commercial |
$0.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.34
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cofinity Commercial |
$0.36
|
| Rate for Payer: Cofinity Commercial |
$0.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.42
|
| Rate for Payer: Healthscope Commercial |
$0.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.44
|
| Rate for Payer: PHP Commercial |
$0.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.34
|
| Rate for Payer: Priority Health SBD |
$0.33
|
|
|
HC INJ, METHYLPREDNISOLONE ACETATE, 1 MG
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
63600239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Aetna Commercial |
$0.44
|
| Rate for Payer: Aetna Medicare |
$0.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.15
|
| Rate for Payer: BCBS Complete |
$0.07
|
| Rate for Payer: BCBS MAPPO |
$0.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.33
|
| Rate for Payer: BCN Commercial |
$0.33
|
| Rate for Payer: BCN Medicare Advantage |
$0.12
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cofinity Commercial |
$0.45
|
| Rate for Payer: Cofinity Commercial |
$0.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.12
|
| Rate for Payer: Healthscope Commercial |
$0.47
|
| Rate for Payer: Mclaren Medicaid |
$0.06
|
| Rate for Payer: Mclaren Medicare |
$0.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.13
|
| Rate for Payer: Meridian Medicaid |
$0.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.44
|
| Rate for Payer: Nomi Health Commercial |
$0.36
|
| Rate for Payer: PACE Medicare |
$0.11
|
| Rate for Payer: PACE SWMI |
$0.12
|
| Rate for Payer: PHP Commercial |
$0.44
|
| Rate for Payer: PHP Medicare Advantage |
$0.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.33
|
| Rate for Payer: Priority Health Medicare |
$0.12
|
| Rate for Payer: Priority Health Narrow Network |
$0.26
|
| Rate for Payer: Priority Health SBD |
$0.33
|
| Rate for Payer: Railroad Medicare Medicare |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.12
|
| Rate for Payer: UHC Medicare Advantage |
$0.12
|
| Rate for Payer: UHCCP Medicaid |
$0.07
|
| Rate for Payer: VA VA |
$0.12
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, 5 MG
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
63600240
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna Medicare |
$0.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.34
|
| Rate for Payer: BCBS Complete |
$0.15
|
| Rate for Payer: BCBS MAPPO |
$0.27
|
| Rate for Payer: BCBS Trust/PPO |
$0.83
|
| Rate for Payer: BCN Commercial |
$0.83
|
| Rate for Payer: BCN Medicare Advantage |
$0.27
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.27
|
| Rate for Payer: Healthscope Commercial |
$2.34
|
| Rate for Payer: Mclaren Medicaid |
$0.14
|
| Rate for Payer: Mclaren Medicare |
$0.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.28
|
| Rate for Payer: Meridian Medicaid |
$0.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: Nomi Health Commercial |
$0.81
|
| Rate for Payer: PACE Medicare |
$0.26
|
| Rate for Payer: PACE SWMI |
$0.27
|
| Rate for Payer: PHP Commercial |
$2.21
|
| Rate for Payer: PHP Medicare Advantage |
$0.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.87
|
| Rate for Payer: Priority Health Medicare |
$0.27
|
| Rate for Payer: Priority Health Narrow Network |
$0.70
|
| Rate for Payer: Priority Health SBD |
$1.64
|
| Rate for Payer: Railroad Medicare Medicare |
$0.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.27
|
| Rate for Payer: UHC Medicare Advantage |
$0.27
|
| Rate for Payer: UHCCP Medicaid |
$0.15
|
| Rate for Payer: VA VA |
$0.27
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, 5 MG
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
63600240
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.69
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: PHP Commercial |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: Priority Health SBD |
$1.64
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 125MG
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
63600102
|
|
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 INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 125MG
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
63600102
|
|
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 INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 40MG
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
63600101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 40MG
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
63600101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
|
|
HC INJ NERV BLOCK GREAT OCCIPTL
|
Facility
|
OP
|
$264.38
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
36100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.94 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Commercial |
$224.72
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.85
|
| 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 |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cofinity Commercial |
$227.37
|
| Rate for Payer: Cofinity Commercial |
$185.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$237.94
|
| 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 |
$224.72
|
| 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 |
$224.72
|
| 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 |
$171.85
|
| 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 |
$166.56
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.94
|
| 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 NERV BLOCK GREAT OCCIPTL
|
Facility
|
IP
|
$264.38
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
36100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.56 |
| Max. Negotiated Rate |
$237.94 |
| Rate for Payer: Aetna Commercial |
$224.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.85
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cofinity Commercial |
$185.07
|
| Rate for Payer: Cofinity Commercial |
$227.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.50
|
| Rate for Payer: Healthscope Commercial |
$237.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.72
|
| Rate for Payer: PHP Commercial |
$224.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.85
|
| Rate for Payer: Priority Health SBD |
$166.56
|
|
|
HC INJ ONABOTULINUMTOXINA PER 1 UNIT
|
Facility
|
OP
|
$8.16
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$19.41 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$18.19
|
| Rate for Payer: BCN Commercial |
$18.19
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cofinity Commercial |
$7.02
|
| Rate for Payer: Cofinity Commercial |
$5.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$7.34
|
| Rate for Payer: Mclaren Medicaid |
$3.47
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: Meridian Medicaid |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.94
|
| Rate for Payer: Nomi Health Commercial |
$19.41
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$6.94
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.43
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health Narrow Network |
$14.74
|
| Rate for Payer: Priority Health SBD |
$5.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$3.64
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC INJ ONABOTULINUMTOXINA PER 1 UNIT
|
Facility
|
IP
|
$8.16
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.30
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cofinity Commercial |
$5.71
|
| Rate for Payer: Cofinity Commercial |
$7.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.53
|
| Rate for Payer: Healthscope Commercial |
$7.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.94
|
| Rate for Payer: PHP Commercial |
$6.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.30
|
| Rate for Payer: Priority Health SBD |
$5.14
|
|
|
HC INJ, PENICILLIN G BENZATHINE, 100,000 UNITS
|
Facility
|
IP
|
$17.18
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$15.46 |
| Rate for Payer: Aetna Commercial |
$14.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.17
|
| Rate for Payer: Cash Price |
$13.74
|
| Rate for Payer: Cofinity Commercial |
$12.03
|
| Rate for Payer: Cofinity Commercial |
$14.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.74
|
| Rate for Payer: Healthscope Commercial |
$15.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.60
|
| Rate for Payer: PHP Commercial |
$14.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.17
|
| Rate for Payer: Priority Health SBD |
$10.82
|
|
|
HC INJ, PENICILLIN G BENZATHINE, 100,000 UNITS
|
Facility
|
OP
|
$17.18
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$80.46 |
| Rate for Payer: Aetna Commercial |
$14.60
|
| Rate for Payer: Aetna Medicare |
$27.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.52
|
| Rate for Payer: BCBS Complete |
$15.09
|
| Rate for Payer: BCBS MAPPO |
$26.82
|
| Rate for Payer: BCBS Trust/PPO |
$71.64
|
| Rate for Payer: BCN Commercial |
$71.64
|
| Rate for Payer: BCN Medicare Advantage |
$26.82
|
| Rate for Payer: Cash Price |
$13.74
|
| Rate for Payer: Cash Price |
$13.74
|
| Rate for Payer: Cofinity Commercial |
$14.77
|
| Rate for Payer: Cofinity Commercial |
$12.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.82
|
| Rate for Payer: Healthscope Commercial |
$15.46
|
| Rate for Payer: Mclaren Medicaid |
$14.38
|
| Rate for Payer: Mclaren Medicare |
$26.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.16
|
| Rate for Payer: Meridian Medicaid |
$15.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.60
|
| Rate for Payer: Nomi Health Commercial |
$80.46
|
| Rate for Payer: PACE Medicare |
$25.48
|
| Rate for Payer: PACE SWMI |
$26.82
|
| Rate for Payer: PHP Commercial |
$14.60
|
| Rate for Payer: PHP Medicare Advantage |
$26.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.14
|
| Rate for Payer: Priority Health Medicare |
$26.82
|
| Rate for Payer: Priority Health Narrow Network |
$56.11
|
| Rate for Payer: Priority Health SBD |
$10.82
|
| Rate for Payer: Railroad Medicare Medicare |
$26.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.82
|
| Rate for Payer: UHC Medicare Advantage |
$26.82
|
| Rate for Payer: UHCCP Medicaid |
$15.10
|
| Rate for Payer: VA VA |
$26.82
|
|
|
HC INJ SELECT R VENT/ATRIAL ANGIO HRT CATH
|
Facility
|
OP
|
$683.54
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
36000110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$25.09 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$581.01
|
| Rate for Payer: Aetna Medicare |
$341.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.30
|
| Rate for Payer: BCBS Complete |
$273.42
|
| Rate for Payer: BCBS Trust/PPO |
$25.09
|
| Rate for Payer: BCN Commercial |
$25.09
|
| Rate for Payer: Cash Price |
$546.83
|
| Rate for Payer: Cash Price |
$546.83
|
| Rate for Payer: Cash Price |
$546.83
|
| Rate for Payer: Cofinity Commercial |
$478.48
|
| Rate for Payer: Cofinity Commercial |
$587.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$478.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$546.83
|
| Rate for Payer: Healthscope Commercial |
$615.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.01
|
| Rate for Payer: PHP Commercial |
$581.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.30
|
| Rate for Payer: Priority Health SBD |
$430.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.39
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJ SELECT R VENT/ATRIAL ANGIO HRT CATH
|
Facility
|
IP
|
$683.54
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
36000110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$430.63 |
| Max. Negotiated Rate |
$615.19 |
| Rate for Payer: Aetna Commercial |
$581.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.30
|
| Rate for Payer: Cash Price |
$546.83
|
| Rate for Payer: Cofinity Commercial |
$478.48
|
| Rate for Payer: Cofinity Commercial |
$587.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$478.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$546.83
|
| Rate for Payer: Healthscope Commercial |
$615.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.01
|
| Rate for Payer: PHP Commercial |
$581.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.30
|
| Rate for Payer: Priority Health SBD |
$430.63
|
|
|
HC INJ TIXAGEVIMAB AND CILGAVIMAB
|
Facility
|
IP
|
$208.08
|
|
|
Service Code
|
HCPCS M0220
|
| Hospital Charge Code |
77100033
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$131.09 |
| Max. Negotiated Rate |
$187.27 |
| Rate for Payer: Aetna Commercial |
$176.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.25
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$145.66
|
| Rate for Payer: Cofinity Commercial |
$178.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$145.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Healthscope Commercial |
$187.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.87
|
| Rate for Payer: PHP Commercial |
$176.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.25
|
| Rate for Payer: Priority Health SBD |
$131.09
|
|
