|
HC INJECTION LUMBAR DISKOGRAPHY
|
Facility
|
IP
|
$2,303.46
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
36100282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,612.42 |
| Max. Negotiated Rate |
$2,303.46 |
| Rate for Payer: Aetna Commercial |
$2,073.11
|
| Rate for Payer: ASR ASR |
$2,234.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,785.87
|
| Rate for Payer: BCN Commercial |
$1,785.87
|
| Rate for Payer: Cash Price |
$1,842.77
|
| Rate for Payer: Cofinity Commercial |
$2,165.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,842.77
|
| Rate for Payer: Healthscope Commercial |
$2,303.46
|
| Rate for Payer: Healthscope Whirlpool |
$2,234.36
|
| Rate for Payer: Mclaren Commercial |
$2,073.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,957.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,612.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,027.04
|
|
|
HC INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
63600096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna Commercial |
$0.92
|
| Rate for Payer: ASR ASR |
$0.99
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$1.02
|
| Rate for Payer: Healthscope Whirlpool |
$0.99
|
| Rate for Payer: Mclaren Commercial |
$0.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.90
|
|
|
HC INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
63600096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna Commercial |
$0.92
|
| Rate for Payer: ASR ASR |
$0.99
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$1.02
|
| Rate for Payer: Healthscope Whirlpool |
$0.99
|
| Rate for Payer: Mclaren Commercial |
$0.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.90
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: ASR ASR |
$9.89
|
| Rate for Payer: BCBS Complete |
$4.08
|
| Rate for Payer: BCBS Trust/PPO |
$7.91
|
| Rate for Payer: BCN Commercial |
$7.91
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$9.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$10.20
|
| Rate for Payer: Healthscope Whirlpool |
$9.89
|
| Rate for Payer: Mclaren Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.28
|
| Rate for Payer: Priority Health Narrow Network |
$7.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.98
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: ASR ASR |
$9.89
|
| Rate for Payer: BCBS Trust/PPO |
$7.91
|
| Rate for Payer: BCN Commercial |
$7.91
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$9.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$10.20
|
| Rate for Payer: Healthscope Whirlpool |
$9.89
|
| Rate for Payer: Mclaren Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.98
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
63600094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: ASR ASR |
$14.84
|
| Rate for Payer: BCBS Trust/PPO |
$11.86
|
| Rate for Payer: BCN Commercial |
$11.86
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Healthscope Whirlpool |
$14.84
|
| Rate for Payer: Mclaren Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.46
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
63600094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: ASR ASR |
$14.84
|
| Rate for Payer: BCBS Complete |
$6.12
|
| Rate for Payer: BCBS Trust/PPO |
$11.86
|
| Rate for Payer: BCN Commercial |
$11.86
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$15.30
|
| Rate for Payer: Healthscope Whirlpool |
$14.84
|
| Rate for Payer: Mclaren Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.92
|
| Rate for Payer: Priority Health Narrow Network |
$10.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.46
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
63600095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.20
|
| Rate for Payer: Priority Health Narrow Network |
$18.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
63600095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
HC INJECTION MYELOGRAM
|
Facility
|
OP
|
$1,046.41
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
36100281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$233.56 |
| Max. Negotiated Rate |
$1,046.41 |
| Rate for Payer: Aetna Commercial |
$941.77
|
| Rate for Payer: ASR ASR |
$1,015.02
|
| Rate for Payer: BCBS Complete |
$418.56
|
| Rate for Payer: BCBS Trust/PPO |
$811.28
|
| Rate for Payer: BCN Commercial |
$811.28
|
| Rate for Payer: Cash Price |
$837.13
|
| Rate for Payer: Cash Price |
$837.13
|
| Rate for Payer: Cofinity Commercial |
$983.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$837.13
|
| Rate for Payer: Healthscope Commercial |
$1,046.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,015.02
|
| Rate for Payer: Mclaren Commercial |
$941.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$889.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$732.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$291.95
|
| Rate for Payer: Priority Health Narrow Network |
$233.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$920.84
|
|
|
HC INJECTION MYELOGRAM
|
Facility
|
IP
|
$1,046.41
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
36100281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$732.49 |
| Max. Negotiated Rate |
$1,046.41 |
| Rate for Payer: Aetna Commercial |
$941.77
|
| Rate for Payer: ASR ASR |
$1,015.02
|
| Rate for Payer: BCBS Trust/PPO |
$811.28
|
| Rate for Payer: BCN Commercial |
$811.28
|
| Rate for Payer: Cash Price |
$837.13
|
| Rate for Payer: Cofinity Commercial |
$983.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$837.13
|
| Rate for Payer: Healthscope Commercial |
$1,046.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,015.02
|
| Rate for Payer: Mclaren Commercial |
$941.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$889.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$732.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$920.84
|
|
|
HC INJECTION PLANTAR DIGIT
|
Facility
|
OP
|
$344.76
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$344.76 |
| Rate for Payer: Aetna Commercial |
$310.28
|
| 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 |
$334.42
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$267.29
|
| Rate for Payer: BCN Commercial |
$267.29
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$275.81
|
| Rate for Payer: Cash Price |
$275.81
|
| Rate for Payer: Cofinity Commercial |
$324.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$344.76
|
| Rate for Payer: Healthscope Whirlpool |
$334.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$263.27
|
| Rate for Payer: Mclaren Commercial |
$310.28
|
| 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 |
$293.05
|
| 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 |
$241.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.73
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$244.78
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.39
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
HC INJECTION PLANTAR DIGIT
|
Facility
|
IP
|
$344.76
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.33 |
| Max. Negotiated Rate |
$344.76 |
| Rate for Payer: Aetna Commercial |
$310.28
|
| Rate for Payer: ASR ASR |
$334.42
|
| Rate for Payer: BCBS Trust/PPO |
$267.29
|
| Rate for Payer: BCN Commercial |
$267.29
|
| Rate for Payer: Cash Price |
$275.81
|
| Rate for Payer: Cofinity Commercial |
$324.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.81
|
| Rate for Payer: Healthscope Commercial |
$344.76
|
| Rate for Payer: Healthscope Whirlpool |
$334.42
|
| Rate for Payer: Mclaren Commercial |
$310.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$293.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$303.39
|
|
|
HC INJECTION PLANTAR DIGIT BILATERAL
|
Facility
|
IP
|
$517.14
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.00 |
| Max. Negotiated Rate |
$517.14 |
| Rate for Payer: Aetna Commercial |
$465.43
|
| Rate for Payer: ASR ASR |
$501.63
|
| Rate for Payer: BCBS Trust/PPO |
$400.94
|
| Rate for Payer: BCN Commercial |
$400.94
|
| Rate for Payer: Cash Price |
$413.71
|
| Rate for Payer: Cofinity Commercial |
$486.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.71
|
| Rate for Payer: Healthscope Commercial |
$517.14
|
| Rate for Payer: Healthscope Whirlpool |
$501.63
|
| Rate for Payer: Mclaren Commercial |
$465.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$439.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$455.08
|
|
|
HC INJECTION PLANTAR DIGIT BILATERAL
|
Facility
|
OP
|
$517.14
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$517.14 |
| Rate for Payer: Aetna Commercial |
$465.43
|
| 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 |
$501.63
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$400.94
|
| Rate for Payer: BCN Commercial |
$400.94
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$413.71
|
| Rate for Payer: Cash Price |
$413.71
|
| Rate for Payer: Cofinity Commercial |
$486.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$517.14
|
| Rate for Payer: Healthscope Whirlpool |
$501.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$263.27
|
| Rate for Payer: Mclaren Commercial |
$465.43
|
| 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 |
$439.57
|
| 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 |
$362.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$470.60
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$367.17
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$455.08
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
HC INJECTION PLATELET PLASMA W/IMG HARVEST/PREP
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
76100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$553.00 |
| Max. Negotiated Rate |
$790.00 |
| Rate for Payer: Aetna Commercial |
$711.00
|
| Rate for Payer: ASR ASR |
$766.30
|
| Rate for Payer: BCBS Trust/PPO |
$612.49
|
| Rate for Payer: BCN Commercial |
$612.49
|
| Rate for Payer: Cash Price |
$632.00
|
| Rate for Payer: Cofinity Commercial |
$742.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.00
|
| Rate for Payer: Healthscope Commercial |
$790.00
|
| Rate for Payer: Healthscope Whirlpool |
$766.30
|
| Rate for Payer: Mclaren Commercial |
$711.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$671.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$695.20
|
|
|
HC INJECTION PLATELET PLASMA W/IMG HARVEST/PREP
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
76100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.73 |
| Max. Negotiated Rate |
$790.00 |
| Rate for Payer: Aetna Commercial |
$711.00
|
| Rate for Payer: Aetna Medicare |
$354.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$442.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$442.70
|
| Rate for Payer: ASR ASR |
$766.30
|
| Rate for Payer: BCBS Complete |
$203.43
|
| Rate for Payer: BCBS MAPPO |
$354.16
|
| Rate for Payer: BCBS Trust/PPO |
$612.49
|
| Rate for Payer: BCN Commercial |
$612.49
|
| Rate for Payer: BCN Medicare Advantage |
$354.16
|
| Rate for Payer: Cash Price |
$632.00
|
| Rate for Payer: Cash Price |
$632.00
|
| Rate for Payer: Cofinity Commercial |
$742.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$790.00
|
| Rate for Payer: Healthscope Whirlpool |
$766.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.16
|
| Rate for Payer: Mclaren Commercial |
$711.00
|
| Rate for Payer: Mclaren Medicaid |
$193.73
|
| Rate for Payer: Mclaren Medicare |
$354.16
|
| Rate for Payer: Meridian Medicaid |
$203.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$371.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$671.50
|
| Rate for Payer: PACE Medicare |
$336.45
|
| Rate for Payer: PACE SWMI |
$354.16
|
| Rate for Payer: PHP Commercial |
$389.58
|
| Rate for Payer: PHP Medicaid |
$193.73
|
| Rate for Payer: PHP Medicare Advantage |
$354.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$718.90
|
| Rate for Payer: Priority Health Medicare |
$354.16
|
| Rate for Payer: Priority Health Narrow Network |
$560.90
|
| Rate for Payer: Railroad Medicare Medicare |
$354.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$695.20
|
| Rate for Payer: UHC Medicare Advantage |
$364.78
|
| Rate for Payer: VA VA |
$354.16
|
|
|
HC INJECTION PROC CYSTOGRAPHY VOIDING
|
Facility
|
OP
|
$1,284.65
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
36100251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$129.71 |
| Max. Negotiated Rate |
$1,284.65 |
| Rate for Payer: Aetna Commercial |
$1,156.18
|
| Rate for Payer: ASR ASR |
$1,246.11
|
| Rate for Payer: BCBS Complete |
$513.86
|
| Rate for Payer: BCBS Trust/PPO |
$995.99
|
| Rate for Payer: BCN Commercial |
$995.99
|
| Rate for Payer: Cash Price |
$1,027.72
|
| Rate for Payer: Cash Price |
$1,027.72
|
| Rate for Payer: Cofinity Commercial |
$1,207.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,027.72
|
| Rate for Payer: Healthscope Commercial |
$1,284.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,246.11
|
| Rate for Payer: Mclaren Commercial |
$1,156.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,091.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.14
|
| Rate for Payer: Priority Health Narrow Network |
$129.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,130.49
|
|
|
HC INJECTION PROC CYSTOGRAPHY VOIDING
|
Facility
|
IP
|
$1,284.65
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
36100251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$899.26 |
| Max. Negotiated Rate |
$1,284.65 |
| Rate for Payer: Aetna Commercial |
$1,156.18
|
| Rate for Payer: ASR ASR |
$1,246.11
|
| Rate for Payer: BCBS Trust/PPO |
$995.99
|
| Rate for Payer: BCN Commercial |
$995.99
|
| Rate for Payer: Cash Price |
$1,027.72
|
| Rate for Payer: Cofinity Commercial |
$1,207.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,027.72
|
| Rate for Payer: Healthscope Commercial |
$1,284.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,246.11
|
| Rate for Payer: Mclaren Commercial |
$1,156.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,091.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,130.49
|
|
|
HC INJECTION PROCEDURE
|
Facility
|
IP
|
$591.65
|
|
| Hospital Charge Code |
36000085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$414.16 |
| Max. Negotiated Rate |
$591.65 |
| Rate for Payer: Aetna Commercial |
$532.48
|
| Rate for Payer: ASR ASR |
$573.90
|
| Rate for Payer: BCBS Trust/PPO |
$458.71
|
| Rate for Payer: BCN Commercial |
$458.71
|
| Rate for Payer: Cash Price |
$473.32
|
| Rate for Payer: Cofinity Commercial |
$556.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.32
|
| Rate for Payer: Healthscope Commercial |
$591.65
|
| Rate for Payer: Healthscope Whirlpool |
$573.90
|
| Rate for Payer: Mclaren Commercial |
$532.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$502.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$520.65
|
|
|
HC INJECTION PROCEDURE
|
Facility
|
OP
|
$591.65
|
|
| Hospital Charge Code |
36000085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$236.66 |
| Max. Negotiated Rate |
$591.65 |
| Rate for Payer: Aetna Commercial |
$532.48
|
| Rate for Payer: ASR ASR |
$573.90
|
| Rate for Payer: BCBS Complete |
$236.66
|
| Rate for Payer: BCBS Trust/PPO |
$458.71
|
| Rate for Payer: BCN Commercial |
$458.71
|
| Rate for Payer: Cash Price |
$473.32
|
| Rate for Payer: Cofinity Commercial |
$556.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.32
|
| Rate for Payer: Healthscope Commercial |
$591.65
|
| Rate for Payer: Healthscope Whirlpool |
$573.90
|
| Rate for Payer: Mclaren Commercial |
$532.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$502.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$538.40
|
| Rate for Payer: Priority Health Narrow Network |
$420.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$520.65
|
|
|
HC INJECTION PROCEDURE ILEAL CONDUIT
|
Facility
|
IP
|
$630.91
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
36100249
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$441.64 |
| Max. Negotiated Rate |
$630.91 |
| Rate for Payer: Aetna Commercial |
$567.82
|
| Rate for Payer: ASR ASR |
$611.98
|
| Rate for Payer: BCBS Trust/PPO |
$489.14
|
| Rate for Payer: BCN Commercial |
$489.14
|
| Rate for Payer: Cash Price |
$504.73
|
| Rate for Payer: Cofinity Commercial |
$593.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.73
|
| Rate for Payer: Healthscope Commercial |
$630.91
|
| Rate for Payer: Healthscope Whirlpool |
$611.98
|
| Rate for Payer: Mclaren Commercial |
$567.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$536.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$555.20
|
|
|
HC INJECTION PROCEDURE ILEAL CONDUIT
|
Facility
|
OP
|
$630.91
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
36100249
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$243.82 |
| Max. Negotiated Rate |
$630.91 |
| Rate for Payer: Aetna Commercial |
$567.82
|
| Rate for Payer: ASR ASR |
$611.98
|
| Rate for Payer: BCBS Complete |
$252.36
|
| Rate for Payer: BCBS Trust/PPO |
$489.14
|
| Rate for Payer: BCN Commercial |
$489.14
|
| Rate for Payer: Cash Price |
$504.73
|
| Rate for Payer: Cash Price |
$504.73
|
| Rate for Payer: Cofinity Commercial |
$593.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.73
|
| Rate for Payer: Healthscope Commercial |
$630.91
|
| Rate for Payer: Healthscope Whirlpool |
$611.98
|
| Rate for Payer: Mclaren Commercial |
$567.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$536.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.78
|
| Rate for Payer: Priority Health Narrow Network |
$243.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$555.20
|
|
|
HC INJECTION PROC RETROGRAD CYSTOGRAPHY
|
Facility
|
IP
|
$816.16
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
36100252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$571.31 |
| Max. Negotiated Rate |
$816.16 |
| Rate for Payer: Aetna Commercial |
$734.54
|
| Rate for Payer: ASR ASR |
$791.68
|
| Rate for Payer: BCBS Trust/PPO |
$632.77
|
| Rate for Payer: BCN Commercial |
$632.77
|
| Rate for Payer: Cash Price |
$652.93
|
| Rate for Payer: Cofinity Commercial |
$767.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$652.93
|
| Rate for Payer: Healthscope Commercial |
$816.16
|
| Rate for Payer: Healthscope Whirlpool |
$791.68
|
| Rate for Payer: Mclaren Commercial |
$734.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$693.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$718.22
|
|
|
HC INJECTION PROC RETROGRAD CYSTOGRAPHY
|
Facility
|
OP
|
$816.16
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
36100252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.46 |
| Max. Negotiated Rate |
$816.16 |
| Rate for Payer: Aetna Commercial |
$734.54
|
| Rate for Payer: ASR ASR |
$791.68
|
| Rate for Payer: BCBS Complete |
$326.46
|
| Rate for Payer: BCBS Trust/PPO |
$632.77
|
| Rate for Payer: BCN Commercial |
$632.77
|
| Rate for Payer: Cash Price |
$652.93
|
| Rate for Payer: Cofinity Commercial |
$767.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$652.93
|
| Rate for Payer: Healthscope Commercial |
$816.16
|
| Rate for Payer: Healthscope Whirlpool |
$791.68
|
| Rate for Payer: Mclaren Commercial |
$734.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$693.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$742.71
|
| Rate for Payer: Priority Health Narrow Network |
$579.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$718.22
|
|
