|
HC INJECTION, PROMETHAZINE HCL, UP TO 50 MG
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT J2550
|
| Hospital Charge Code |
63600100
|
|
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, PROMETHAZINE HCL, UP TO 50 MG
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT J2550
|
| Hospital Charge Code |
63600100
|
|
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 PUDENDAL NERVE
|
Facility
|
IP
|
$1,170.21
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
36100570
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$819.15 |
| Max. Negotiated Rate |
$1,170.21 |
| Rate for Payer: Aetna Commercial |
$1,053.19
|
| Rate for Payer: ASR ASR |
$1,135.10
|
| Rate for Payer: BCBS Trust/PPO |
$907.26
|
| Rate for Payer: BCN Commercial |
$907.26
|
| Rate for Payer: Cash Price |
$936.17
|
| Rate for Payer: Cofinity Commercial |
$1,100.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$936.17
|
| Rate for Payer: Healthscope Commercial |
$1,170.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,135.10
|
| Rate for Payer: Mclaren Commercial |
$1,053.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$994.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,029.78
|
|
|
HC INJECTION PUDENDAL NERVE
|
Facility
|
OP
|
$1,170.21
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
36100570
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$443.17 |
| Max. Negotiated Rate |
$1,170.21 |
| Rate for Payer: Aetna Commercial |
$1,053.19
|
| 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 |
$1,135.10
|
| Rate for Payer: BCBS Complete |
$465.37
|
| Rate for Payer: BCBS MAPPO |
$810.19
|
| Rate for Payer: BCBS Trust/PPO |
$907.26
|
| Rate for Payer: BCN Commercial |
$907.26
|
| Rate for Payer: BCN Medicare Advantage |
$810.19
|
| Rate for Payer: Cash Price |
$936.17
|
| Rate for Payer: Cash Price |
$936.17
|
| Rate for Payer: Cofinity Commercial |
$1,100.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$936.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.19
|
| Rate for Payer: Healthscope Commercial |
$1,170.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,135.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$810.19
|
| Rate for Payer: Mclaren Commercial |
$1,053.19
|
| 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 |
$994.68
|
| 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 |
$819.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,064.89
|
| Rate for Payer: Priority Health Medicare |
$810.19
|
| Rate for Payer: Priority Health Narrow Network |
$830.85
|
| Rate for Payer: Railroad Medicare Medicare |
$810.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,029.78
|
| Rate for Payer: UHC Medicare Advantage |
$834.50
|
| Rate for Payer: VA VA |
$810.19
|
|
|
HC INJECTION SCLEROSING SOL MULTIPLE
|
Facility
|
OP
|
$322.83
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$443.04 |
| Rate for Payer: Aetna Commercial |
$290.55
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$313.15
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$250.29
|
| Rate for Payer: BCN Commercial |
$250.29
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$258.26
|
| Rate for Payer: Cash Price |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$303.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$322.83
|
| Rate for Payer: Healthscope Whirlpool |
$313.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$290.55
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.41
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$293.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$229.21
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$284.09
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC INJECTION SCLEROSING SOL MULTIPLE
|
Facility
|
IP
|
$322.83
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.98 |
| Max. Negotiated Rate |
$322.83 |
| Rate for Payer: Aetna Commercial |
$290.55
|
| Rate for Payer: ASR ASR |
$313.15
|
| Rate for Payer: BCBS Trust/PPO |
$250.29
|
| Rate for Payer: BCN Commercial |
$250.29
|
| Rate for Payer: Cash Price |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$303.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.26
|
| Rate for Payer: Healthscope Commercial |
$322.83
|
| Rate for Payer: Healthscope Whirlpool |
$313.15
|
| Rate for Payer: Mclaren Commercial |
$290.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$284.09
|
|
|
HC INJECTION SCLEROSING SOL SINGLE
|
Facility
|
IP
|
$245.28
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
36100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.70 |
| Max. Negotiated Rate |
$245.28 |
| Rate for Payer: Aetna Commercial |
$220.75
|
| Rate for Payer: ASR ASR |
$237.92
|
| Rate for Payer: BCBS Trust/PPO |
$190.17
|
| Rate for Payer: BCN Commercial |
$190.17
|
| Rate for Payer: Cash Price |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$230.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.22
|
| Rate for Payer: Healthscope Commercial |
$245.28
|
| Rate for Payer: Healthscope Whirlpool |
$237.92
|
| Rate for Payer: Mclaren Commercial |
$220.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.85
|
|
|
HC INJECTION SCLEROSING SOL SINGLE
|
Facility
|
OP
|
$245.28
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
36100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.70 |
| Max. Negotiated Rate |
$443.04 |
| Rate for Payer: Aetna Commercial |
$220.75
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$237.92
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$190.17
|
| Rate for Payer: BCN Commercial |
$190.17
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$196.22
|
| Rate for Payer: Cash Price |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$230.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$245.28
|
| Rate for Payer: Healthscope Whirlpool |
$237.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$220.75
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.49
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.20
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$174.15
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.85
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC INJECTION SHOULDER ARTHROGRAM
|
Facility
|
OP
|
$846.52
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
36100037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$211.39 |
| Max. Negotiated Rate |
$846.52 |
| Rate for Payer: Aetna Commercial |
$761.87
|
| Rate for Payer: ASR ASR |
$821.12
|
| Rate for Payer: BCBS Complete |
$338.61
|
| Rate for Payer: BCBS Trust/PPO |
$656.31
|
| Rate for Payer: BCN Commercial |
$656.31
|
| Rate for Payer: Cash Price |
$677.22
|
| Rate for Payer: Cash Price |
$677.22
|
| Rate for Payer: Cofinity Commercial |
$795.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$677.22
|
| Rate for Payer: Healthscope Commercial |
$846.52
|
| Rate for Payer: Healthscope Whirlpool |
$821.12
|
| Rate for Payer: Mclaren Commercial |
$761.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$719.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$264.24
|
| Rate for Payer: Priority Health Narrow Network |
$211.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$744.94
|
|
|
HC INJECTION SHOULDER ARTHROGRAM
|
Facility
|
IP
|
$846.52
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
36100037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$592.56 |
| Max. Negotiated Rate |
$846.52 |
| Rate for Payer: Aetna Commercial |
$761.87
|
| Rate for Payer: ASR ASR |
$821.12
|
| Rate for Payer: BCBS Trust/PPO |
$656.31
|
| Rate for Payer: BCN Commercial |
$656.31
|
| Rate for Payer: Cash Price |
$677.22
|
| Rate for Payer: Cofinity Commercial |
$795.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$677.22
|
| Rate for Payer: Healthscope Commercial |
$846.52
|
| Rate for Payer: Healthscope Whirlpool |
$821.12
|
| Rate for Payer: Mclaren Commercial |
$761.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$719.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$744.94
|
|
|
HC INJECTION SHUNTOGRAM
|
Facility
|
IP
|
$381.09
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
36100224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.76 |
| Max. Negotiated Rate |
$381.09 |
| Rate for Payer: Aetna Commercial |
$342.98
|
| Rate for Payer: ASR ASR |
$369.66
|
| Rate for Payer: BCBS Trust/PPO |
$295.46
|
| Rate for Payer: BCN Commercial |
$295.46
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$358.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Healthscope Commercial |
$381.09
|
| Rate for Payer: Healthscope Whirlpool |
$369.66
|
| Rate for Payer: Mclaren Commercial |
$342.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.36
|
|
|
HC INJECTION SHUNTOGRAM
|
Facility
|
OP
|
$381.09
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
36100224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.44 |
| Max. Negotiated Rate |
$381.09 |
| Rate for Payer: Aetna Commercial |
$342.98
|
| Rate for Payer: ASR ASR |
$369.66
|
| Rate for Payer: BCBS Complete |
$152.44
|
| Rate for Payer: BCBS Trust/PPO |
$295.46
|
| Rate for Payer: BCN Commercial |
$295.46
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$358.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Healthscope Commercial |
$381.09
|
| Rate for Payer: Healthscope Whirlpool |
$369.66
|
| Rate for Payer: Mclaren Commercial |
$342.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$346.79
|
| Rate for Payer: Priority Health Narrow Network |
$270.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.36
|
|
|
HC INJECTION SIALOGRAM
|
Facility
|
OP
|
$286.12
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
36100190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.44 |
| Max. Negotiated Rate |
$286.12 |
| Rate for Payer: Aetna Commercial |
$257.51
|
| Rate for Payer: ASR ASR |
$277.54
|
| Rate for Payer: BCBS Complete |
$114.45
|
| Rate for Payer: BCBS Trust/PPO |
$221.83
|
| Rate for Payer: BCN Commercial |
$221.83
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$268.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.90
|
| Rate for Payer: Healthscope Commercial |
$286.12
|
| Rate for Payer: Healthscope Whirlpool |
$277.54
|
| Rate for Payer: Mclaren Commercial |
$257.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.30
|
| Rate for Payer: Priority Health Narrow Network |
$103.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.79
|
|
|
HC INJECTION SIALOGRAM
|
Facility
|
IP
|
$286.12
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
36100190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$200.28 |
| Max. Negotiated Rate |
$286.12 |
| Rate for Payer: Aetna Commercial |
$257.51
|
| Rate for Payer: ASR ASR |
$277.54
|
| Rate for Payer: BCBS Trust/PPO |
$221.83
|
| Rate for Payer: BCN Commercial |
$221.83
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$268.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.90
|
| Rate for Payer: Healthscope Commercial |
$286.12
|
| Rate for Payer: Healthscope Whirlpool |
$277.54
|
| Rate for Payer: Mclaren Commercial |
$257.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.79
|
|
|
HC INJECTION SI JOINT ANESTHESIA/STEROID
|
Facility
|
OP
|
$991.42
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$396.57 |
| Max. Negotiated Rate |
$1,072.35 |
| Rate for Payer: Aetna Commercial |
$892.28
|
| Rate for Payer: ASR ASR |
$961.68
|
| Rate for Payer: BCBS Complete |
$396.57
|
| Rate for Payer: BCBS Trust/PPO |
$768.65
|
| Rate for Payer: BCN Commercial |
$768.65
|
| Rate for Payer: Cash Price |
$793.14
|
| Rate for Payer: Cash Price |
$793.14
|
| Rate for Payer: Cofinity Commercial |
$931.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.14
|
| Rate for Payer: Healthscope Commercial |
$991.42
|
| Rate for Payer: Healthscope Whirlpool |
$961.68
|
| Rate for Payer: Mclaren Commercial |
$892.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$842.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,072.35
|
| Rate for Payer: Priority Health Narrow Network |
$857.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.45
|
|
|
HC INJECTION SI JOINT ANESTHESIA/STEROID
|
Facility
|
IP
|
$991.42
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$693.99 |
| Max. Negotiated Rate |
$991.42 |
| Rate for Payer: Aetna Commercial |
$892.28
|
| Rate for Payer: ASR ASR |
$961.68
|
| Rate for Payer: BCBS Trust/PPO |
$768.65
|
| Rate for Payer: BCN Commercial |
$768.65
|
| Rate for Payer: Cash Price |
$793.14
|
| Rate for Payer: Cofinity Commercial |
$931.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.14
|
| Rate for Payer: Healthscope Commercial |
$991.42
|
| Rate for Payer: Healthscope Whirlpool |
$961.68
|
| Rate for Payer: Mclaren Commercial |
$892.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$842.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.45
|
|
|
HC INJECTION SI JOINT BIL ANESTHESIA/STEROID
|
Facility
|
OP
|
$1,027.30
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$410.92 |
| Max. Negotiated Rate |
$1,072.35 |
| Rate for Payer: Aetna Commercial |
$924.57
|
| Rate for Payer: ASR ASR |
$996.48
|
| Rate for Payer: BCBS Complete |
$410.92
|
| Rate for Payer: BCBS Trust/PPO |
$796.47
|
| Rate for Payer: BCN Commercial |
$796.47
|
| Rate for Payer: Cash Price |
$821.84
|
| Rate for Payer: Cash Price |
$821.84
|
| Rate for Payer: Cofinity Commercial |
$965.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$821.84
|
| Rate for Payer: Healthscope Commercial |
$1,027.30
|
| Rate for Payer: Healthscope Whirlpool |
$996.48
|
| Rate for Payer: Mclaren Commercial |
$924.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$873.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,072.35
|
| Rate for Payer: Priority Health Narrow Network |
$857.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$904.02
|
|
|
HC INJECTION SI JOINT BIL ANESTHESIA/STEROID
|
Facility
|
IP
|
$1,027.30
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$719.11 |
| Max. Negotiated Rate |
$1,027.30 |
| Rate for Payer: Aetna Commercial |
$924.57
|
| Rate for Payer: ASR ASR |
$996.48
|
| Rate for Payer: BCBS Trust/PPO |
$796.47
|
| Rate for Payer: BCN Commercial |
$796.47
|
| Rate for Payer: Cash Price |
$821.84
|
| Rate for Payer: Cofinity Commercial |
$965.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$821.84
|
| Rate for Payer: Healthscope Commercial |
$1,027.30
|
| Rate for Payer: Healthscope Whirlpool |
$996.48
|
| Rate for Payer: Mclaren Commercial |
$924.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$873.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$904.02
|
|
|
HC INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$273.88
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
36100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$329.09 |
| Rate for Payer: Aetna Commercial |
$246.49
|
| 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 |
$265.66
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$212.34
|
| Rate for Payer: BCN Commercial |
$212.34
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$219.10
|
| Rate for Payer: Cash Price |
$219.10
|
| Rate for Payer: Cofinity Commercial |
$257.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$273.88
|
| Rate for Payer: Healthscope Whirlpool |
$265.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$263.27
|
| Rate for Payer: Mclaren Commercial |
$246.49
|
| 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 |
$232.80
|
| 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 |
$191.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$249.23
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$194.45
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.01
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
HC INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$273.88
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
36100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.72 |
| Max. Negotiated Rate |
$273.88 |
| Rate for Payer: Aetna Commercial |
$246.49
|
| Rate for Payer: ASR ASR |
$265.66
|
| Rate for Payer: BCBS Trust/PPO |
$212.34
|
| Rate for Payer: BCN Commercial |
$212.34
|
| Rate for Payer: Cash Price |
$219.10
|
| Rate for Payer: Cofinity Commercial |
$257.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.10
|
| Rate for Payer: Healthscope Commercial |
$273.88
|
| Rate for Payer: Healthscope Whirlpool |
$265.66
|
| Rate for Payer: Mclaren Commercial |
$246.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.01
|
|
|
HC INJECTION SPLENOPOTOGRAM SPLENOPORTOG
|
Facility
|
IP
|
$429.05
|
|
|
Service Code
|
CPT 38200
|
| Hospital Charge Code |
36100183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$300.34 |
| Max. Negotiated Rate |
$429.05 |
| Rate for Payer: Aetna Commercial |
$386.14
|
| Rate for Payer: ASR ASR |
$416.18
|
| Rate for Payer: BCBS Trust/PPO |
$332.64
|
| Rate for Payer: BCN Commercial |
$332.64
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cofinity Commercial |
$403.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.24
|
| Rate for Payer: Healthscope Commercial |
$429.05
|
| Rate for Payer: Healthscope Whirlpool |
$416.18
|
| Rate for Payer: Mclaren Commercial |
$386.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.56
|
|
|
HC INJECTION SPLENOPOTOGRAM SPLENOPORTOG
|
Facility
|
OP
|
$429.05
|
|
|
Service Code
|
CPT 38200
|
| Hospital Charge Code |
36100183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$171.62 |
| Max. Negotiated Rate |
$429.05 |
| Rate for Payer: Aetna Commercial |
$386.14
|
| Rate for Payer: ASR ASR |
$416.18
|
| Rate for Payer: BCBS Complete |
$171.62
|
| Rate for Payer: BCBS Trust/PPO |
$332.64
|
| Rate for Payer: BCN Commercial |
$332.64
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cofinity Commercial |
$403.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.24
|
| Rate for Payer: Healthscope Commercial |
$429.05
|
| Rate for Payer: Healthscope Whirlpool |
$416.18
|
| Rate for Payer: Mclaren Commercial |
$386.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.44
|
| Rate for Payer: Priority Health Narrow Network |
$304.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.56
|
|
|
HC INJECTIONS SCLEROSANT FOR SPIDER VEINS /TRNK
|
Facility
|
OP
|
$1,064.00
|
|
|
Service Code
|
CPT 36468
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$1,064.00 |
| Rate for Payer: Aetna Commercial |
$957.60
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$1,032.08
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$824.92
|
| Rate for Payer: BCN Commercial |
$824.92
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$851.20
|
| Rate for Payer: Cash Price |
$851.20
|
| Rate for Payer: Cofinity Commercial |
$1,000.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$851.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$1,064.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,032.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$957.60
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$904.40
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$968.24
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$755.44
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$936.32
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC INJECTIONS SCLEROSANT FOR SPIDER VEINS /TRNK
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT 36468
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$744.80 |
| Max. Negotiated Rate |
$1,064.00 |
| Rate for Payer: Aetna Commercial |
$957.60
|
| Rate for Payer: ASR ASR |
$1,032.08
|
| Rate for Payer: BCBS Trust/PPO |
$824.92
|
| Rate for Payer: BCN Commercial |
$824.92
|
| Rate for Payer: Cash Price |
$851.20
|
| Rate for Payer: Cofinity Commercial |
$1,000.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$851.20
|
| Rate for Payer: Healthscope Commercial |
$1,064.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,032.08
|
| Rate for Payer: Mclaren Commercial |
$957.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$904.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$936.32
|
|
|
HC INJECTION, TESTOSTERONE CYPIONATE, 1 MG
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
CPT J1071
|
| Hospital Charge Code |
63600109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: ASR ASR |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cofinity Commercial |
$0.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.13
|
| Rate for Payer: Healthscope Commercial |
$0.16
|
| Rate for Payer: Healthscope Whirlpool |
$0.16
|
| Rate for Payer: Mclaren Commercial |
$0.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.14
|
|
