|
HC INJECT/IRRIGATE CORPORA CAVERNOSA
|
Facility
|
IP
|
$366.05
|
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$256.24 |
| Max. Negotiated Rate |
$366.05 |
| Rate for Payer: Aetna Commercial |
$329.44
|
| Rate for Payer: ASR ASR |
$355.07
|
| Rate for Payer: BCBS Trust/PPO |
$283.80
|
| Rate for Payer: BCN Commercial |
$283.80
|
| Rate for Payer: Cash Price |
$292.84
|
| Rate for Payer: Cofinity Commercial |
$344.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.84
|
| Rate for Payer: Healthscope Commercial |
$366.05
|
| Rate for Payer: Healthscope Whirlpool |
$355.07
|
| Rate for Payer: Mclaren Commercial |
$329.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.12
|
|
|
HC INJECT/IRRIGATE CORPORA CAVERNOSA
|
Facility
|
OP
|
$366.05
|
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.42 |
| Max. Negotiated Rate |
$366.05 |
| Rate for Payer: Aetna Commercial |
$329.44
|
| Rate for Payer: ASR ASR |
$355.07
|
| Rate for Payer: BCBS Complete |
$146.42
|
| Rate for Payer: BCBS Trust/PPO |
$283.80
|
| Rate for Payer: BCN Commercial |
$283.80
|
| Rate for Payer: Cash Price |
$292.84
|
| Rate for Payer: Cofinity Commercial |
$344.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.84
|
| Rate for Payer: Healthscope Commercial |
$366.05
|
| Rate for Payer: Healthscope Whirlpool |
$355.07
|
| Rate for Payer: Mclaren Commercial |
$329.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$333.11
|
| Rate for Payer: Priority Health Narrow Network |
$259.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.12
|
|
|
HC INJECT PORTAL VEIN
|
Facility
|
IP
|
$2,726.36
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
36100543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,908.45 |
| Max. Negotiated Rate |
$2,726.36 |
| Rate for Payer: Aetna Commercial |
$2,453.72
|
| Rate for Payer: ASR ASR |
$2,644.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,113.75
|
| Rate for Payer: BCN Commercial |
$2,113.75
|
| Rate for Payer: Cash Price |
$2,181.09
|
| Rate for Payer: Cofinity Commercial |
$2,562.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,181.09
|
| Rate for Payer: Healthscope Commercial |
$2,726.36
|
| Rate for Payer: Healthscope Whirlpool |
$2,644.57
|
| Rate for Payer: Mclaren Commercial |
$2,453.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,317.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,399.20
|
|
|
HC INJECT PORTAL VEIN
|
Facility
|
OP
|
$2,726.36
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
36100543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,090.54 |
| Max. Negotiated Rate |
$2,726.36 |
| Rate for Payer: Aetna Commercial |
$2,453.72
|
| Rate for Payer: ASR ASR |
$2,644.57
|
| Rate for Payer: BCBS Complete |
$1,090.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,113.75
|
| Rate for Payer: BCN Commercial |
$2,113.75
|
| Rate for Payer: Cash Price |
$2,181.09
|
| Rate for Payer: Cofinity Commercial |
$2,562.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,181.09
|
| Rate for Payer: Healthscope Commercial |
$2,726.36
|
| Rate for Payer: Healthscope Whirlpool |
$2,644.57
|
| Rate for Payer: Mclaren Commercial |
$2,453.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,317.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,480.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,935.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,399.20
|
|
|
HC INJECT PROC PENILE PLAQUE
|
Facility
|
OP
|
$354.07
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.16 |
| Max. Negotiated Rate |
$354.07 |
| Rate for Payer: Aetna Commercial |
$318.66
|
| 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 |
$343.45
|
| Rate for Payer: BCBS Complete |
$126.18
|
| Rate for Payer: BCBS MAPPO |
$219.68
|
| Rate for Payer: BCBS Trust/PPO |
$274.51
|
| Rate for Payer: BCN Commercial |
$274.51
|
| Rate for Payer: BCN Medicare Advantage |
$219.68
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cofinity Commercial |
$332.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.68
|
| Rate for Payer: Healthscope Commercial |
$354.07
|
| Rate for Payer: Healthscope Whirlpool |
$343.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$219.68
|
| Rate for Payer: Mclaren Commercial |
$318.66
|
| 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 |
$300.96
|
| 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 |
$247.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$322.20
|
| Rate for Payer: Priority Health Medicare |
$219.68
|
| Rate for Payer: Priority Health Narrow Network |
$251.39
|
| Rate for Payer: Railroad Medicare Medicare |
$219.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$311.58
|
| Rate for Payer: UHC Medicare Advantage |
$226.27
|
| Rate for Payer: VA VA |
$219.68
|
|
|
HC INJECT PROC PENILE PLAQUE
|
Facility
|
IP
|
$354.07
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.85 |
| Max. Negotiated Rate |
$354.07 |
| Rate for Payer: Aetna Commercial |
$318.66
|
| Rate for Payer: ASR ASR |
$343.45
|
| Rate for Payer: BCBS Trust/PPO |
$274.51
|
| Rate for Payer: BCN Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cofinity Commercial |
$332.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.26
|
| Rate for Payer: Healthscope Commercial |
$354.07
|
| Rate for Payer: Healthscope Whirlpool |
$343.45
|
| Rate for Payer: Mclaren Commercial |
$318.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$311.58
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 1 OR 2 MUSCLES
|
Facility
|
IP
|
$366.80
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
36100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$256.76 |
| Max. Negotiated Rate |
$366.80 |
| Rate for Payer: Aetna Commercial |
$330.12
|
| Rate for Payer: ASR ASR |
$355.80
|
| Rate for Payer: BCBS Trust/PPO |
$284.38
|
| Rate for Payer: BCN Commercial |
$284.38
|
| Rate for Payer: Cash Price |
$293.44
|
| Rate for Payer: Cofinity Commercial |
$344.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.44
|
| Rate for Payer: Healthscope Commercial |
$366.80
|
| Rate for Payer: Healthscope Whirlpool |
$355.80
|
| Rate for Payer: Mclaren Commercial |
$330.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.78
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 1 OR 2 MUSCLES
|
Facility
|
OP
|
$366.80
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
36100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$377.64 |
| Rate for Payer: Aetna Commercial |
$330.12
|
| 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 |
$355.80
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$284.38
|
| Rate for Payer: BCN Commercial |
$284.38
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$293.44
|
| Rate for Payer: Cash Price |
$293.44
|
| Rate for Payer: Cofinity Commercial |
$344.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$366.80
|
| Rate for Payer: Healthscope Whirlpool |
$355.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$263.27
|
| Rate for Payer: Mclaren Commercial |
$330.12
|
| 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 |
$311.78
|
| 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 |
$256.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$377.64
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$302.11
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.78
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 3 OR MORE MUSCLES
|
Facility
|
IP
|
$478.11
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
36100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.68 |
| Max. Negotiated Rate |
$478.11 |
| Rate for Payer: Aetna Commercial |
$430.30
|
| Rate for Payer: ASR ASR |
$463.77
|
| Rate for Payer: BCBS Trust/PPO |
$370.68
|
| Rate for Payer: BCN Commercial |
$370.68
|
| Rate for Payer: Cash Price |
$382.49
|
| Rate for Payer: Cofinity Commercial |
$449.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$382.49
|
| Rate for Payer: Healthscope Commercial |
$478.11
|
| Rate for Payer: Healthscope Whirlpool |
$463.77
|
| Rate for Payer: Mclaren Commercial |
$430.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$406.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$420.74
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 3 OR MORE MUSCLES
|
Facility
|
OP
|
$478.11
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
36100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$478.11 |
| Rate for Payer: Aetna Commercial |
$430.30
|
| 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 |
$463.77
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$370.68
|
| Rate for Payer: BCN Commercial |
$370.68
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$382.49
|
| Rate for Payer: Cash Price |
$382.49
|
| Rate for Payer: Cofinity Commercial |
$449.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$382.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$478.11
|
| Rate for Payer: Healthscope Whirlpool |
$463.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$263.27
|
| Rate for Payer: Mclaren Commercial |
$430.30
|
| 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 |
$406.39
|
| 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 |
$334.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.08
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$339.46
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$420.74
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
HC INJ ENOXAPARIN SODIUM PER 10 MG
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63600151
|
|
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 INJ ENOXAPARIN SODIUM PER 10 MG
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63600151
|
|
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 INJ ENZYME PALMAR FASCIAL CORD
|
Facility
|
OP
|
$332.99
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$332.99 |
| Rate for Payer: Aetna Commercial |
$299.69
|
| 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 |
$323.00
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$258.17
|
| Rate for Payer: BCN Commercial |
$258.17
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$266.39
|
| Rate for Payer: Cash Price |
$266.39
|
| Rate for Payer: Cofinity Commercial |
$313.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$332.99
|
| Rate for Payer: Healthscope Whirlpool |
$323.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$263.27
|
| Rate for Payer: Mclaren Commercial |
$299.69
|
| 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 |
$283.04
|
| 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 |
$233.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.02
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$236.42
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.03
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
HC INJ ENZYME PALMAR FASCIAL CORD
|
Facility
|
IP
|
$332.99
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$233.09 |
| Max. Negotiated Rate |
$332.99 |
| Rate for Payer: Aetna Commercial |
$299.69
|
| Rate for Payer: ASR ASR |
$323.00
|
| Rate for Payer: BCBS Trust/PPO |
$258.17
|
| Rate for Payer: BCN Commercial |
$258.17
|
| Rate for Payer: Cash Price |
$266.39
|
| Rate for Payer: Cofinity Commercial |
$313.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.39
|
| Rate for Payer: Healthscope Commercial |
$332.99
|
| Rate for Payer: Healthscope Whirlpool |
$323.00
|
| Rate for Payer: Mclaren Commercial |
$299.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.03
|
|
|
HC INJ HEPARIN SODIUM PER 1000U
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| 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: 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 |
$0.93
|
| Rate for Payer: Priority Health Narrow Network |
$0.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.90
|
|
|
HC INJ HEPARIN SODIUM PER 1000U
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600140
|
|
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 INJ KNEE ARTHROGRAM CT/MRI
|
Facility
|
IP
|
$542.10
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
36100562
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$379.47 |
| Max. Negotiated Rate |
$542.10 |
| Rate for Payer: Aetna Commercial |
$487.89
|
| Rate for Payer: ASR ASR |
$525.84
|
| Rate for Payer: BCBS Trust/PPO |
$420.29
|
| Rate for Payer: BCN Commercial |
$420.29
|
| Rate for Payer: Cash Price |
$433.68
|
| Rate for Payer: Cofinity Commercial |
$509.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.68
|
| Rate for Payer: Healthscope Commercial |
$542.10
|
| Rate for Payer: Healthscope Whirlpool |
$525.84
|
| Rate for Payer: Mclaren Commercial |
$487.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$477.05
|
|
|
HC INJ KNEE ARTHROGRAM CT/MRI
|
Facility
|
OP
|
$542.10
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
36100562
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$216.84 |
| Max. Negotiated Rate |
$542.10 |
| Rate for Payer: Aetna Commercial |
$487.89
|
| Rate for Payer: ASR ASR |
$525.84
|
| Rate for Payer: BCBS Complete |
$216.84
|
| Rate for Payer: BCBS Trust/PPO |
$420.29
|
| Rate for Payer: BCN Commercial |
$420.29
|
| Rate for Payer: Cash Price |
$433.68
|
| Rate for Payer: Cash Price |
$433.68
|
| Rate for Payer: Cofinity Commercial |
$509.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.68
|
| Rate for Payer: Healthscope Commercial |
$542.10
|
| Rate for Payer: Healthscope Whirlpool |
$525.84
|
| Rate for Payer: Mclaren Commercial |
$487.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$370.21
|
| Rate for Payer: Priority Health Narrow Network |
$296.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$477.05
|
|
|
HC INJ LUMB W MYELO 2+REG SAME MD
|
Facility
|
OP
|
$2,055.83
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
36100463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$389.31 |
| Max. Negotiated Rate |
$2,055.83 |
| Rate for Payer: Aetna Commercial |
$1,850.25
|
| Rate for Payer: Aetna Medicare |
$711.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$889.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$889.64
|
| Rate for Payer: ASR ASR |
$1,994.16
|
| Rate for Payer: BCBS Complete |
$408.81
|
| Rate for Payer: BCBS MAPPO |
$711.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,593.88
|
| Rate for Payer: BCN Commercial |
$1,593.88
|
| Rate for Payer: BCN Medicare Advantage |
$711.71
|
| Rate for Payer: Cash Price |
$1,644.66
|
| Rate for Payer: Cash Price |
$1,644.66
|
| Rate for Payer: Cofinity Commercial |
$1,932.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,644.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.71
|
| Rate for Payer: Healthscope Commercial |
$2,055.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,994.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$711.71
|
| Rate for Payer: Mclaren Commercial |
$1,850.25
|
| Rate for Payer: Mclaren Medicaid |
$389.31
|
| Rate for Payer: Mclaren Medicare |
$711.71
|
| Rate for Payer: Meridian Medicaid |
$408.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$747.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$818.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,747.46
|
| Rate for Payer: PACE Medicare |
$676.12
|
| Rate for Payer: PACE SWMI |
$711.71
|
| Rate for Payer: PHP Commercial |
$782.88
|
| Rate for Payer: PHP Medicaid |
$389.31
|
| Rate for Payer: PHP Medicare Advantage |
$711.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,439.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,870.81
|
| Rate for Payer: Priority Health Medicare |
$711.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,459.64
|
| Rate for Payer: Railroad Medicare Medicare |
$711.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,809.13
|
| Rate for Payer: UHC Medicare Advantage |
$733.06
|
| Rate for Payer: VA VA |
$711.71
|
|
|
HC INJ LUMB W MYELO 2+REG SAME MD
|
Facility
|
IP
|
$2,055.83
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
36100463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,439.08 |
| Max. Negotiated Rate |
$2,055.83 |
| Rate for Payer: Aetna Commercial |
$1,850.25
|
| Rate for Payer: ASR ASR |
$1,994.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,593.88
|
| Rate for Payer: BCN Commercial |
$1,593.88
|
| Rate for Payer: Cash Price |
$1,644.66
|
| Rate for Payer: Cofinity Commercial |
$1,932.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,644.66
|
| Rate for Payer: Healthscope Commercial |
$2,055.83
|
| Rate for Payer: Healthscope Whirlpool |
$1,994.16
|
| Rate for Payer: Mclaren Commercial |
$1,850.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,747.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,439.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,809.13
|
|
|
HC INJ LUMB W MYELO CERV SAME MD
|
Facility
|
OP
|
$2,161.30
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
36100460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$389.31 |
| Max. Negotiated Rate |
$2,161.30 |
| Rate for Payer: Aetna Commercial |
$1,945.17
|
| Rate for Payer: Aetna Medicare |
$711.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$889.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$889.64
|
| Rate for Payer: ASR ASR |
$2,096.46
|
| Rate for Payer: BCBS Complete |
$408.81
|
| Rate for Payer: BCBS MAPPO |
$711.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,675.66
|
| Rate for Payer: BCN Commercial |
$1,675.66
|
| Rate for Payer: BCN Medicare Advantage |
$711.71
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cofinity Commercial |
$2,031.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.71
|
| Rate for Payer: Healthscope Commercial |
$2,161.30
|
| Rate for Payer: Healthscope Whirlpool |
$2,096.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$711.71
|
| Rate for Payer: Mclaren Commercial |
$1,945.17
|
| Rate for Payer: Mclaren Medicaid |
$389.31
|
| Rate for Payer: Mclaren Medicare |
$711.71
|
| Rate for Payer: Meridian Medicaid |
$408.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$747.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$818.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,837.10
|
| Rate for Payer: PACE Medicare |
$676.12
|
| Rate for Payer: PACE SWMI |
$711.71
|
| Rate for Payer: PHP Commercial |
$782.88
|
| Rate for Payer: PHP Medicaid |
$389.31
|
| Rate for Payer: PHP Medicare Advantage |
$711.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,966.78
|
| Rate for Payer: Priority Health Medicare |
$711.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,534.52
|
| Rate for Payer: Railroad Medicare Medicare |
$711.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,901.94
|
| Rate for Payer: UHC Medicare Advantage |
$733.06
|
| Rate for Payer: VA VA |
$711.71
|
|
|
HC INJ LUMB W MYELO CERV SAME MD
|
Facility
|
IP
|
$2,161.30
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
36100460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,512.91 |
| Max. Negotiated Rate |
$2,161.30 |
| Rate for Payer: Aetna Commercial |
$1,945.17
|
| Rate for Payer: ASR ASR |
$2,096.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,675.66
|
| Rate for Payer: BCN Commercial |
$1,675.66
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cofinity Commercial |
$2,031.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.04
|
| Rate for Payer: Healthscope Commercial |
$2,161.30
|
| Rate for Payer: Healthscope Whirlpool |
$2,096.46
|
| Rate for Payer: Mclaren Commercial |
$1,945.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,837.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,901.94
|
|
|
HC INJ LUMB W MYELO LS SAME MD
|
Facility
|
IP
|
$2,161.30
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
36100462
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,512.91 |
| Max. Negotiated Rate |
$2,161.30 |
| Rate for Payer: Aetna Commercial |
$1,945.17
|
| Rate for Payer: ASR ASR |
$2,096.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,675.66
|
| Rate for Payer: BCN Commercial |
$1,675.66
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cofinity Commercial |
$2,031.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.04
|
| Rate for Payer: Healthscope Commercial |
$2,161.30
|
| Rate for Payer: Healthscope Whirlpool |
$2,096.46
|
| Rate for Payer: Mclaren Commercial |
$1,945.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,837.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,901.94
|
|
|
HC INJ LUMB W MYELO LS SAME MD
|
Facility
|
OP
|
$2,161.30
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
36100462
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$389.31 |
| Max. Negotiated Rate |
$2,161.30 |
| Rate for Payer: Aetna Commercial |
$1,945.17
|
| Rate for Payer: Aetna Medicare |
$711.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$889.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$889.64
|
| Rate for Payer: ASR ASR |
$2,096.46
|
| Rate for Payer: BCBS Complete |
$408.81
|
| Rate for Payer: BCBS MAPPO |
$711.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,675.66
|
| Rate for Payer: BCN Commercial |
$1,675.66
|
| Rate for Payer: BCN Medicare Advantage |
$711.71
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cofinity Commercial |
$2,031.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.71
|
| Rate for Payer: Healthscope Commercial |
$2,161.30
|
| Rate for Payer: Healthscope Whirlpool |
$2,096.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$711.71
|
| Rate for Payer: Mclaren Commercial |
$1,945.17
|
| Rate for Payer: Mclaren Medicaid |
$389.31
|
| Rate for Payer: Mclaren Medicare |
$711.71
|
| Rate for Payer: Meridian Medicaid |
$408.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$747.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$818.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,837.10
|
| Rate for Payer: PACE Medicare |
$676.12
|
| Rate for Payer: PACE SWMI |
$711.71
|
| Rate for Payer: PHP Commercial |
$782.88
|
| Rate for Payer: PHP Medicaid |
$389.31
|
| Rate for Payer: PHP Medicare Advantage |
$711.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,966.78
|
| Rate for Payer: Priority Health Medicare |
$711.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,534.52
|
| Rate for Payer: Railroad Medicare Medicare |
$711.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,901.94
|
| Rate for Payer: UHC Medicare Advantage |
$733.06
|
| Rate for Payer: VA VA |
$711.71
|
|
|
HC INJ LUMB W MYELO THOR SAME MD
|
Facility
|
OP
|
$2,161.30
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
36100461
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$389.31 |
| Max. Negotiated Rate |
$2,161.30 |
| Rate for Payer: Aetna Commercial |
$1,945.17
|
| Rate for Payer: Aetna Medicare |
$711.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$889.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$889.64
|
| Rate for Payer: ASR ASR |
$2,096.46
|
| Rate for Payer: BCBS Complete |
$408.81
|
| Rate for Payer: BCBS MAPPO |
$711.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,675.66
|
| Rate for Payer: BCN Commercial |
$1,675.66
|
| Rate for Payer: BCN Medicare Advantage |
$711.71
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cofinity Commercial |
$2,031.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.71
|
| Rate for Payer: Healthscope Commercial |
$2,161.30
|
| Rate for Payer: Healthscope Whirlpool |
$2,096.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$711.71
|
| Rate for Payer: Mclaren Commercial |
$1,945.17
|
| Rate for Payer: Mclaren Medicaid |
$389.31
|
| Rate for Payer: Mclaren Medicare |
$711.71
|
| Rate for Payer: Meridian Medicaid |
$408.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$747.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$818.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,837.10
|
| Rate for Payer: PACE Medicare |
$676.12
|
| Rate for Payer: PACE SWMI |
$711.71
|
| Rate for Payer: PHP Commercial |
$782.88
|
| Rate for Payer: PHP Medicaid |
$389.31
|
| Rate for Payer: PHP Medicare Advantage |
$711.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,966.78
|
| Rate for Payer: Priority Health Medicare |
$711.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,534.52
|
| Rate for Payer: Railroad Medicare Medicare |
$711.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,901.94
|
| Rate for Payer: UHC Medicare Advantage |
$733.06
|
| Rate for Payer: VA VA |
$711.71
|
|
