|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: BCBS Complete |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.56
|
| Rate for Payer: Priority Health Narrow Network |
$14.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
|
|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: ASR ASR |
$19.79
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$20.40
|
| Rate for Payer: Healthscope Whirlpool |
$19.79
|
| Rate for Payer: Mclaren Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.95
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
OP
|
$1,081.82
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$443.17 |
| Max. Negotiated Rate |
$1,081.82 |
| Rate for Payer: Aetna Commercial |
$973.64
|
| Rate for Payer: Aetna Medicare |
$810.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,012.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,012.74
|
| Rate for Payer: ASR ASR |
$1,049.37
|
| Rate for Payer: BCBS Complete |
$465.37
|
| Rate for Payer: BCBS MAPPO |
$810.19
|
| Rate for Payer: BCBS Trust/PPO |
$838.74
|
| Rate for Payer: BCN Commercial |
$838.74
|
| Rate for Payer: BCN Medicare Advantage |
$810.19
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cofinity Commercial |
$1,016.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$865.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.19
|
| Rate for Payer: Healthscope Commercial |
$1,081.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,049.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$810.19
|
| Rate for Payer: Mclaren Commercial |
$973.64
|
| Rate for Payer: Mclaren Medicaid |
$443.17
|
| Rate for Payer: Mclaren Medicare |
$810.19
|
| Rate for Payer: Meridian Medicaid |
$465.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$850.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$931.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.55
|
| Rate for Payer: PACE Medicare |
$769.68
|
| Rate for Payer: PACE SWMI |
$810.19
|
| Rate for Payer: PHP Commercial |
$891.21
|
| Rate for Payer: PHP Medicaid |
$443.17
|
| Rate for Payer: PHP Medicare Advantage |
$810.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$984.46
|
| Rate for Payer: Priority Health Medicare |
$810.19
|
| Rate for Payer: Priority Health Narrow Network |
$768.09
|
| Rate for Payer: Railroad Medicare Medicare |
$810.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$952.00
|
| Rate for Payer: UHC Medicare Advantage |
$834.50
|
| Rate for Payer: VA VA |
$810.19
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
IP
|
$1,081.82
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$757.27 |
| Max. Negotiated Rate |
$1,081.82 |
| Rate for Payer: Aetna Commercial |
$973.64
|
| Rate for Payer: ASR ASR |
$1,049.37
|
| Rate for Payer: BCBS Trust/PPO |
$838.74
|
| Rate for Payer: BCN Commercial |
$838.74
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cofinity Commercial |
$1,016.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$865.46
|
| Rate for Payer: Healthscope Commercial |
$1,081.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,049.37
|
| Rate for Payer: Mclaren Commercial |
$973.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$952.00
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
IP
|
$1,081.82
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$757.27 |
| Max. Negotiated Rate |
$1,081.82 |
| Rate for Payer: Aetna Commercial |
$973.64
|
| Rate for Payer: ASR ASR |
$1,049.37
|
| Rate for Payer: BCBS Trust/PPO |
$838.74
|
| Rate for Payer: BCN Commercial |
$838.74
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cofinity Commercial |
$1,016.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$865.46
|
| Rate for Payer: Healthscope Commercial |
$1,081.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,049.37
|
| Rate for Payer: Mclaren Commercial |
$973.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$952.00
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
OP
|
$1,081.82
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$443.17 |
| Max. Negotiated Rate |
$1,081.82 |
| Rate for Payer: Aetna Commercial |
$973.64
|
| Rate for Payer: Aetna Medicare |
$810.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,012.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,012.74
|
| Rate for Payer: ASR ASR |
$1,049.37
|
| Rate for Payer: BCBS Complete |
$465.37
|
| Rate for Payer: BCBS MAPPO |
$810.19
|
| Rate for Payer: BCBS Trust/PPO |
$838.74
|
| Rate for Payer: BCN Commercial |
$838.74
|
| Rate for Payer: BCN Medicare Advantage |
$810.19
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cofinity Commercial |
$1,016.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$865.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.19
|
| Rate for Payer: Healthscope Commercial |
$1,081.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,049.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$810.19
|
| Rate for Payer: Mclaren Commercial |
$973.64
|
| Rate for Payer: Mclaren Medicaid |
$443.17
|
| Rate for Payer: Mclaren Medicare |
$810.19
|
| Rate for Payer: Meridian Medicaid |
$465.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$850.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$931.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.55
|
| Rate for Payer: PACE Medicare |
$769.68
|
| Rate for Payer: PACE SWMI |
$810.19
|
| Rate for Payer: PHP Commercial |
$891.21
|
| Rate for Payer: PHP Medicaid |
$443.17
|
| Rate for Payer: PHP Medicare Advantage |
$810.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$984.46
|
| Rate for Payer: Priority Health Medicare |
$810.19
|
| Rate for Payer: Priority Health Narrow Network |
$768.09
|
| Rate for Payer: Railroad Medicare Medicare |
$810.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$952.00
|
| Rate for Payer: UHC Medicare Advantage |
$834.50
|
| Rate for Payer: VA VA |
$810.19
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
OP
|
$1,081.82
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$443.17 |
| Max. Negotiated Rate |
$1,081.82 |
| Rate for Payer: Aetna Commercial |
$973.64
|
| Rate for Payer: Aetna Medicare |
$810.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,012.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,012.74
|
| Rate for Payer: ASR ASR |
$1,049.37
|
| Rate for Payer: BCBS Complete |
$465.37
|
| Rate for Payer: BCBS MAPPO |
$810.19
|
| Rate for Payer: BCBS Trust/PPO |
$838.74
|
| Rate for Payer: BCN Commercial |
$838.74
|
| Rate for Payer: BCN Medicare Advantage |
$810.19
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cofinity Commercial |
$1,016.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$865.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.19
|
| Rate for Payer: Healthscope Commercial |
$1,081.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,049.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$810.19
|
| Rate for Payer: Mclaren Commercial |
$973.64
|
| Rate for Payer: Mclaren Medicaid |
$443.17
|
| Rate for Payer: Mclaren Medicare |
$810.19
|
| Rate for Payer: Meridian Medicaid |
$465.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$850.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$931.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.55
|
| Rate for Payer: PACE Medicare |
$769.68
|
| Rate for Payer: PACE SWMI |
$810.19
|
| Rate for Payer: PHP Commercial |
$891.21
|
| Rate for Payer: PHP Medicaid |
$443.17
|
| Rate for Payer: PHP Medicare Advantage |
$810.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$984.46
|
| Rate for Payer: Priority Health Medicare |
$810.19
|
| Rate for Payer: Priority Health Narrow Network |
$768.09
|
| Rate for Payer: Railroad Medicare Medicare |
$810.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$952.00
|
| Rate for Payer: UHC Medicare Advantage |
$834.50
|
| Rate for Payer: VA VA |
$810.19
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
IP
|
$1,081.82
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$757.27 |
| Max. Negotiated Rate |
$1,081.82 |
| Rate for Payer: Aetna Commercial |
$973.64
|
| Rate for Payer: ASR ASR |
$1,049.37
|
| Rate for Payer: BCBS Trust/PPO |
$838.74
|
| Rate for Payer: BCN Commercial |
$838.74
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cofinity Commercial |
$1,016.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$865.46
|
| Rate for Payer: Healthscope Commercial |
$1,081.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,049.37
|
| Rate for Payer: Mclaren Commercial |
$973.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$952.00
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial |
$58.50
|
| Rate for Payer: ASR ASR |
$63.05
|
| Rate for Payer: BCBS Trust/PPO |
$50.39
|
| Rate for Payer: BCN Commercial |
$50.39
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$61.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$65.00
|
| Rate for Payer: Healthscope Whirlpool |
$63.05
|
| Rate for Payer: Mclaren Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.20
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.25 |
| Max. Negotiated Rate |
$82.84 |
| Rate for Payer: Aetna Commercial |
$58.50
|
| Rate for Payer: Aetna Medicare |
$66.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.84
|
| Rate for Payer: ASR ASR |
$63.05
|
| Rate for Payer: BCBS Complete |
$38.06
|
| Rate for Payer: BCBS MAPPO |
$66.27
|
| Rate for Payer: BCBS Trust/PPO |
$50.39
|
| Rate for Payer: BCN Commercial |
$50.39
|
| Rate for Payer: BCN Medicare Advantage |
$66.27
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$61.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.27
|
| Rate for Payer: Healthscope Commercial |
$65.00
|
| Rate for Payer: Healthscope Whirlpool |
$63.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$66.27
|
| Rate for Payer: Mclaren Commercial |
$58.50
|
| Rate for Payer: Mclaren Medicaid |
$36.25
|
| Rate for Payer: Mclaren Medicare |
$66.27
|
| Rate for Payer: Meridian Medicaid |
$38.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$69.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PACE Medicare |
$62.96
|
| Rate for Payer: PACE SWMI |
$66.27
|
| Rate for Payer: PHP Commercial |
$72.90
|
| Rate for Payer: PHP Medicaid |
$36.25
|
| Rate for Payer: PHP Medicare Advantage |
$66.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.15
|
| Rate for Payer: Priority Health Medicare |
$66.27
|
| Rate for Payer: Priority Health Narrow Network |
$46.15
|
| Rate for Payer: Railroad Medicare Medicare |
$66.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.20
|
| Rate for Payer: UHC Medicare Advantage |
$68.26
|
| Rate for Payer: VA VA |
$66.27
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
IP
|
$353.94
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.76 |
| Max. Negotiated Rate |
$353.94 |
| Rate for Payer: Aetna Commercial |
$318.55
|
| Rate for Payer: ASR ASR |
$343.32
|
| Rate for Payer: BCBS Trust/PPO |
$274.41
|
| Rate for Payer: BCN Commercial |
$274.41
|
| Rate for Payer: Cash Price |
$283.15
|
| Rate for Payer: Cofinity Commercial |
$332.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.15
|
| Rate for Payer: Healthscope Commercial |
$353.94
|
| Rate for Payer: Healthscope Whirlpool |
$343.32
|
| Rate for Payer: Mclaren Commercial |
$318.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$311.47
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
OP
|
$353.94
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.16 |
| Max. Negotiated Rate |
$353.94 |
| Rate for Payer: Aetna Commercial |
$318.55
|
| Rate for Payer: Aetna Medicare |
$219.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.60
|
| Rate for Payer: ASR ASR |
$343.32
|
| Rate for Payer: BCBS Complete |
$126.18
|
| Rate for Payer: BCBS MAPPO |
$219.68
|
| Rate for Payer: BCBS Trust/PPO |
$274.41
|
| Rate for Payer: BCN Commercial |
$274.41
|
| Rate for Payer: BCN Medicare Advantage |
$219.68
|
| Rate for Payer: Cash Price |
$283.15
|
| Rate for Payer: Cash Price |
$283.15
|
| Rate for Payer: Cofinity Commercial |
$332.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.68
|
| Rate for Payer: Healthscope Commercial |
$353.94
|
| Rate for Payer: Healthscope Whirlpool |
$343.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$219.68
|
| Rate for Payer: Mclaren Commercial |
$318.55
|
| Rate for Payer: Mclaren Medicaid |
$120.16
|
| Rate for Payer: Mclaren Medicare |
$219.68
|
| Rate for Payer: Meridian Medicaid |
$126.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.85
|
| Rate for Payer: PACE Medicare |
$208.70
|
| Rate for Payer: PACE SWMI |
$219.68
|
| Rate for Payer: PHP Commercial |
$241.65
|
| Rate for Payer: PHP Medicaid |
$120.16
|
| Rate for Payer: PHP Medicare Advantage |
$219.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$322.09
|
| Rate for Payer: Priority Health Medicare |
$219.68
|
| Rate for Payer: Priority Health Narrow Network |
$251.30
|
| Rate for Payer: Railroad Medicare Medicare |
$219.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$311.47
|
| Rate for Payer: UHC Medicare Advantage |
$226.27
|
| Rate for Payer: VA VA |
$219.68
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$859.16
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$336.24 |
| Max. Negotiated Rate |
$859.16 |
| Rate for Payer: Aetna Commercial |
$773.24
|
| Rate for Payer: Aetna Medicare |
$614.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.38
|
| Rate for Payer: ASR ASR |
$833.39
|
| Rate for Payer: BCBS Complete |
$353.08
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCBS Trust/PPO |
$666.11
|
| Rate for Payer: BCN Commercial |
$666.11
|
| Rate for Payer: BCN Medicare Advantage |
$614.70
|
| Rate for Payer: Cash Price |
$687.33
|
| Rate for Payer: Cash Price |
$687.33
|
| Rate for Payer: Cofinity Commercial |
$807.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.70
|
| Rate for Payer: Healthscope Commercial |
$859.16
|
| Rate for Payer: Healthscope Whirlpool |
$833.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$614.70
|
| Rate for Payer: Mclaren Commercial |
$773.24
|
| Rate for Payer: Mclaren Medicaid |
$336.24
|
| Rate for Payer: Mclaren Medicare |
$614.70
|
| Rate for Payer: Meridian Medicaid |
$353.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$645.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$706.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.29
|
| Rate for Payer: PACE Medicare |
$583.96
|
| Rate for Payer: PACE SWMI |
$614.70
|
| Rate for Payer: PHP Commercial |
$676.17
|
| Rate for Payer: PHP Medicaid |
$336.24
|
| Rate for Payer: PHP Medicare Advantage |
$614.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$781.84
|
| Rate for Payer: Priority Health Medicare |
$614.70
|
| Rate for Payer: Priority Health Narrow Network |
$610.00
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$756.06
|
| Rate for Payer: UHC Medicare Advantage |
$633.14
|
| Rate for Payer: VA VA |
$614.70
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$859.16
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$601.41 |
| Max. Negotiated Rate |
$859.16 |
| Rate for Payer: Aetna Commercial |
$773.24
|
| Rate for Payer: ASR ASR |
$833.39
|
| Rate for Payer: BCBS Trust/PPO |
$666.11
|
| Rate for Payer: BCN Commercial |
$666.11
|
| Rate for Payer: Cash Price |
$687.33
|
| Rate for Payer: Cofinity Commercial |
$807.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.33
|
| Rate for Payer: Healthscope Commercial |
$859.16
|
| Rate for Payer: Healthscope Whirlpool |
$833.39
|
| Rate for Payer: Mclaren Commercial |
$773.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$756.06
|
|
|
HC INJ DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$902.12
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$631.48 |
| Max. Negotiated Rate |
$902.12 |
| Rate for Payer: Aetna Commercial |
$811.91
|
| Rate for Payer: ASR ASR |
$875.06
|
| Rate for Payer: BCBS Trust/PPO |
$699.41
|
| Rate for Payer: BCN Commercial |
$699.41
|
| Rate for Payer: Cash Price |
$721.70
|
| Rate for Payer: Cofinity Commercial |
$847.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.70
|
| Rate for Payer: Healthscope Commercial |
$902.12
|
| Rate for Payer: Healthscope Whirlpool |
$875.06
|
| Rate for Payer: Mclaren Commercial |
$811.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$766.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$793.87
|
|
|
HC INJ DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$902.12
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$336.24 |
| Max. Negotiated Rate |
$902.12 |
| Rate for Payer: Aetna Commercial |
$811.91
|
| Rate for Payer: Aetna Medicare |
$614.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.38
|
| Rate for Payer: ASR ASR |
$875.06
|
| Rate for Payer: BCBS Complete |
$353.08
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCBS Trust/PPO |
$699.41
|
| Rate for Payer: BCN Commercial |
$699.41
|
| Rate for Payer: BCN Medicare Advantage |
$614.70
|
| Rate for Payer: Cash Price |
$721.70
|
| Rate for Payer: Cash Price |
$721.70
|
| Rate for Payer: Cofinity Commercial |
$847.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.70
|
| Rate for Payer: Healthscope Commercial |
$902.12
|
| Rate for Payer: Healthscope Whirlpool |
$875.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$614.70
|
| Rate for Payer: Mclaren Commercial |
$811.91
|
| Rate for Payer: Mclaren Medicaid |
$336.24
|
| Rate for Payer: Mclaren Medicare |
$614.70
|
| Rate for Payer: Meridian Medicaid |
$353.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$645.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$706.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$766.80
|
| Rate for Payer: PACE Medicare |
$583.96
|
| Rate for Payer: PACE SWMI |
$614.70
|
| Rate for Payer: PHP Commercial |
$676.17
|
| Rate for Payer: PHP Medicaid |
$336.24
|
| Rate for Payer: PHP Medicare Advantage |
$614.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$820.93
|
| Rate for Payer: Priority Health Medicare |
$614.70
|
| Rate for Payer: Priority Health Narrow Network |
$640.51
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$793.87
|
| Rate for Payer: UHC Medicare Advantage |
$633.14
|
| Rate for Payer: VA VA |
$614.70
|
|
|
HC INJECT CARPAL TUNNEL
|
Facility
|
OP
|
$378.64
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$378.64 |
| Rate for Payer: Aetna Commercial |
$340.78
|
| Rate for Payer: Aetna Medicare |
$263.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: ASR ASR |
$367.28
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$293.56
|
| Rate for Payer: BCN Commercial |
$293.56
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cofinity Commercial |
$355.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$378.64
|
| Rate for Payer: Healthscope Whirlpool |
$367.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$263.27
|
| Rate for Payer: Mclaren Commercial |
$340.78
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.84
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Commercial |
$289.60
|
| Rate for Payer: PHP Medicaid |
$144.01
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$344.56
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$268.83
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$333.20
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
HC INJECT CARPAL TUNNEL
|
Facility
|
IP
|
$378.64
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.05 |
| Max. Negotiated Rate |
$378.64 |
| Rate for Payer: Aetna Commercial |
$340.78
|
| Rate for Payer: ASR ASR |
$367.28
|
| Rate for Payer: BCBS Trust/PPO |
$293.56
|
| Rate for Payer: BCN Commercial |
$293.56
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cofinity Commercial |
$355.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.91
|
| Rate for Payer: Healthscope Commercial |
$378.64
|
| Rate for Payer: Healthscope Whirlpool |
$367.28
|
| Rate for Payer: Mclaren Commercial |
$340.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$333.20
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$532.00 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: ASR ASR |
$737.20
|
| Rate for Payer: BCBS Trust/PPO |
$589.23
|
| Rate for Payer: BCN Commercial |
$589.23
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cofinity Commercial |
$714.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.00
|
| Rate for Payer: Healthscope Commercial |
$760.00
|
| Rate for Payer: Healthscope Whirlpool |
$737.20
|
| Rate for Payer: Mclaren Commercial |
$684.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$646.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$668.80
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Aetna Medicare |
$263.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: ASR ASR |
$737.20
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$589.23
|
| Rate for Payer: BCN Commercial |
$589.23
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cofinity Commercial |
$714.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$760.00
|
| Rate for Payer: Healthscope Whirlpool |
$737.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$263.27
|
| Rate for Payer: Mclaren Commercial |
$684.00
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$646.00
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Commercial |
$289.60
|
| Rate for Payer: PHP Medicaid |
$144.01
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$691.60
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$539.60
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$668.80
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.61 |
| Max. Negotiated Rate |
$3,060.00 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Medicare |
$43.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.95
|
| Rate for Payer: ASR ASR |
$2,968.20
|
| Rate for Payer: BCBS Complete |
$24.79
|
| Rate for Payer: BCBS MAPPO |
$43.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,372.42
|
| Rate for Payer: BCN Commercial |
$2,372.42
|
| Rate for Payer: BCN Medicare Advantage |
$43.16
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cofinity Commercial |
$2,876.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,448.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.16
|
| Rate for Payer: Healthscope Commercial |
$3,060.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,968.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$43.16
|
| Rate for Payer: Mclaren Commercial |
$2,754.00
|
| Rate for Payer: Mclaren Medicaid |
$23.61
|
| Rate for Payer: Mclaren Medicare |
$43.16
|
| Rate for Payer: Meridian Medicaid |
$24.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,601.00
|
| Rate for Payer: PACE Medicare |
$41.00
|
| Rate for Payer: PACE SWMI |
$43.16
|
| Rate for Payer: PHP Commercial |
$47.48
|
| Rate for Payer: PHP Medicaid |
$23.61
|
| Rate for Payer: PHP Medicare Advantage |
$43.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,142.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,784.60
|
| Rate for Payer: Priority Health Medicare |
$43.16
|
| Rate for Payer: Priority Health Narrow Network |
$2,172.60
|
| Rate for Payer: Railroad Medicare Medicare |
$43.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,692.80
|
| Rate for Payer: UHC Medicare Advantage |
$44.46
|
| Rate for Payer: VA VA |
$43.16
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,142.00 |
| Max. Negotiated Rate |
$3,060.00 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: ASR ASR |
$2,968.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,372.42
|
| Rate for Payer: BCN Commercial |
$2,372.42
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cofinity Commercial |
$2,876.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,448.00
|
| Rate for Payer: Healthscope Commercial |
$3,060.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,968.20
|
| Rate for Payer: Mclaren Commercial |
$2,754.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,601.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,142.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,692.80
|
|
|
HC INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.48 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: BCBS Trust/PPO |
$47.45
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.69
|
| Rate for Payer: Priority Health Narrow Network |
$43.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
|
HC INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: ASR ASR |
$59.36
|
| Rate for Payer: BCBS Trust/PPO |
$47.45
|
| Rate for Payer: BCN Commercial |
$47.45
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$57.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Healthscope Whirlpool |
$59.36
|
| Rate for Payer: Mclaren Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.86
|
|
|
HC INJECTION, CERTOLIZUMAB PEGOL, 1 MG
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: ASR ASR |
$9.70
|
| Rate for Payer: BCBS Trust/PPO |
$7.75
|
| Rate for Payer: BCN Commercial |
$7.75
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$9.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Healthscope Commercial |
$10.00
|
| Rate for Payer: Healthscope Whirlpool |
$9.70
|
| Rate for Payer: Mclaren Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.80
|
|
