|
HC INJ ANESTH/STEROID BRACHIAL PLEXUS CONT
|
Facility
|
OP
|
$3,235.56
|
|
|
Service Code
|
CPT 64416
|
| Hospital Charge Code |
37100010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$3,235.56 |
| Rate for Payer: Aetna Commercial |
$2,912.00
|
| Rate for Payer: Aetna Commercial |
$4,368.01
|
| Rate for Payer: Aetna Medicare |
$881.29
|
| Rate for Payer: Aetna Medicare |
$881.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: ASR ASR |
$3,138.49
|
| Rate for Payer: ASR ASR |
$4,707.74
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$4,001.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,667.72
|
| Rate for Payer: BCN Commercial |
$4,001.58
|
| Rate for Payer: BCN Commercial |
$2,667.72
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$2,588.45
|
| Rate for Payer: Cash Price |
$2,588.45
|
| Rate for Payer: Cash Price |
$3,882.67
|
| Rate for Payer: Cash Price |
$3,882.67
|
| Rate for Payer: Cofinity Commercial |
$3,041.43
|
| Rate for Payer: Cofinity Commercial |
$4,562.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,882.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,588.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$3,138.49
|
| Rate for Payer: Healthscope Commercial |
$4,707.74
|
| Rate for Payer: Healthscope Whirlpool |
$3,235.56
|
| Rate for Payer: Healthscope Whirlpool |
$4,853.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$881.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$881.29
|
| Rate for Payer: Mclaren Commercial |
$4,368.01
|
| Rate for Payer: Mclaren Commercial |
$2,912.00
|
| Rate for Payer: Mclaren Medicaid |
$881.29
|
| Rate for Payer: Mclaren Medicaid |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$484.00
|
| Rate for Payer: Meridian Medicaid |
$484.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,750.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,125.34
|
| Rate for Payer: Nomi Health Commercial |
$3,979.74
|
| Rate for Payer: Nomi Health Commercial |
$2,653.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,426.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,640.01
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$969.42
|
| Rate for Payer: PHP Commercial |
$969.42
|
| Rate for Payer: PHP Medicaid |
$472.37
|
| Rate for Payer: PHP Medicaid |
$472.37
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,265.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,265.02
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,012.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,012.02
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,270.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,847.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Exchange |
$1,366.00
|
| Rate for Payer: UHC Exchange |
$1,366.00
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP DNSP |
$881.29
|
| Rate for Payer: UHCCP DNSP |
$881.29
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC INJ ANESTH/STEROID SCIATIC NERVE CONT
|
Facility
|
OP
|
$3,244.17
|
|
|
Service Code
|
CPT 64446
|
| Hospital Charge Code |
37000020
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$3,244.17 |
| Rate for Payer: Aetna Commercial |
$2,919.75
|
| Rate for Payer: Aetna Commercial |
$4,379.63
|
| Rate for Payer: Aetna Medicare |
$881.29
|
| Rate for Payer: Aetna Medicare |
$881.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: ASR ASR |
$3,146.84
|
| Rate for Payer: ASR ASR |
$4,720.27
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$4,012.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,674.82
|
| Rate for Payer: BCN Commercial |
$4,012.23
|
| Rate for Payer: BCN Commercial |
$2,674.82
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$2,595.34
|
| Rate for Payer: Cash Price |
$2,595.34
|
| Rate for Payer: Cash Price |
$3,893.01
|
| Rate for Payer: Cash Price |
$3,893.01
|
| Rate for Payer: Cofinity Commercial |
$3,049.52
|
| Rate for Payer: Cofinity Commercial |
$4,574.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,893.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,595.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$3,146.84
|
| Rate for Payer: Healthscope Commercial |
$4,720.27
|
| Rate for Payer: Healthscope Whirlpool |
$3,244.17
|
| Rate for Payer: Healthscope Whirlpool |
$4,866.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$881.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$881.29
|
| Rate for Payer: Mclaren Commercial |
$4,379.63
|
| Rate for Payer: Mclaren Commercial |
$2,919.75
|
| Rate for Payer: Mclaren Medicaid |
$881.29
|
| Rate for Payer: Mclaren Medicaid |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$484.00
|
| Rate for Payer: Meridian Medicaid |
$484.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,757.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,136.32
|
| Rate for Payer: Nomi Health Commercial |
$3,990.33
|
| Rate for Payer: Nomi Health Commercial |
$2,660.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,433.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,649.70
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$969.42
|
| Rate for Payer: PHP Commercial |
$969.42
|
| Rate for Payer: PHP Medicaid |
$472.37
|
| Rate for Payer: PHP Medicaid |
$472.37
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,297.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,297.64
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,838.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,838.11
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,282.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,854.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Exchange |
$1,366.00
|
| Rate for Payer: UHC Exchange |
$1,366.00
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP DNSP |
$881.29
|
| Rate for Payer: UHCCP DNSP |
$881.29
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC INJ ANESTH/STEROID SCIATIC NERVE CONT
|
Facility
|
IP
|
$3,244.17
|
|
|
Service Code
|
CPT 64446
|
| Hospital Charge Code |
37000020
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2,433.13 |
| Max. Negotiated Rate |
$3,244.17 |
| Rate for Payer: Aetna Commercial |
$2,919.75
|
| Rate for Payer: Aetna Commercial |
$4,379.63
|
| Rate for Payer: ASR ASR |
$3,146.84
|
| Rate for Payer: ASR ASR |
$4,720.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,664.11
|
| Rate for Payer: BCBS Trust/PPO |
$3,996.17
|
| Rate for Payer: BCN Commercial |
$2,664.11
|
| Rate for Payer: BCN Commercial |
$3,996.17
|
| Rate for Payer: Cash Price |
$3,893.01
|
| Rate for Payer: Cash Price |
$2,595.34
|
| Rate for Payer: Cofinity Commercial |
$4,574.28
|
| Rate for Payer: Cofinity Commercial |
$3,049.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,595.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,893.01
|
| Rate for Payer: Healthscope Commercial |
$3,146.84
|
| Rate for Payer: Healthscope Commercial |
$4,720.27
|
| Rate for Payer: Healthscope Whirlpool |
$4,866.26
|
| Rate for Payer: Healthscope Whirlpool |
$3,244.17
|
| Rate for Payer: Mclaren Commercial |
$4,379.63
|
| Rate for Payer: Mclaren Commercial |
$2,919.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,136.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,757.54
|
| Rate for Payer: Nomi Health Commercial |
$3,990.33
|
| Rate for Payer: Nomi Health Commercial |
$2,660.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,433.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,649.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,282.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,854.87
|
|
|
HC INJ ANEST/STEROID ILIOING ILIOHYPOGAST NRV
|
Facility
|
OP
|
$994.97
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
76100270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$1,090.18 |
| Rate for Payer: Aetna Commercial |
$895.47
|
| Rate for Payer: Aetna Medicare |
$703.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: ASR ASR |
$965.12
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$820.35
|
| Rate for Payer: BCN Commercial |
$820.35
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$795.98
|
| Rate for Payer: Cash Price |
$795.98
|
| Rate for Payer: Cofinity Commercial |
$935.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$965.12
|
| Rate for Payer: Healthscope Whirlpool |
$994.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$703.34
|
| Rate for Payer: Mclaren Commercial |
$895.47
|
| Rate for Payer: Mclaren Medicaid |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$386.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.72
|
| Rate for Payer: Nomi Health Commercial |
$815.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$746.23
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$773.67
|
| Rate for Payer: PHP Medicaid |
$376.99
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$871.79
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Narrow Network |
$697.47
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$875.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$1,090.18
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP DNSP |
$703.34
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC INJ ANEST/STEROID ILIOING ILIOHYPOGAST NRV
|
Facility
|
IP
|
$994.97
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
76100270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$746.23 |
| Max. Negotiated Rate |
$994.97 |
| Rate for Payer: Aetna Commercial |
$895.47
|
| Rate for Payer: ASR ASR |
$965.12
|
| Rate for Payer: BCBS Trust/PPO |
$817.07
|
| Rate for Payer: BCN Commercial |
$817.07
|
| Rate for Payer: Cash Price |
$795.98
|
| Rate for Payer: Cofinity Commercial |
$935.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.98
|
| Rate for Payer: Healthscope Commercial |
$965.12
|
| Rate for Payer: Healthscope Whirlpool |
$994.97
|
| Rate for Payer: Mclaren Commercial |
$895.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.72
|
| Rate for Payer: Nomi Health Commercial |
$815.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$746.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$875.57
|
|
|
HC INJ BEBTELOVIMAB
|
Facility
|
IP
|
$494.70
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
77100034
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$371.02 |
| Max. Negotiated Rate |
$494.70 |
| Rate for Payer: Aetna Commercial |
$445.23
|
| Rate for Payer: ASR ASR |
$479.86
|
| Rate for Payer: BCBS Trust/PPO |
$406.25
|
| Rate for Payer: BCN Commercial |
$406.25
|
| Rate for Payer: Cash Price |
$395.76
|
| Rate for Payer: Cofinity Commercial |
$465.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.76
|
| Rate for Payer: Healthscope Commercial |
$479.86
|
| Rate for Payer: Healthscope Whirlpool |
$494.70
|
| Rate for Payer: Mclaren Commercial |
$445.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.50
|
| Rate for Payer: Nomi Health Commercial |
$405.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.34
|
|
|
HC INJ BEBTELOVIMAB
|
Facility
|
OP
|
$494.70
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
77100034
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$183.04 |
| Max. Negotiated Rate |
$494.70 |
| Rate for Payer: Aetna Commercial |
$445.23
|
| Rate for Payer: Aetna Medicare |
$183.04
|
| Rate for Payer: ASR ASR |
$479.86
|
| Rate for Payer: BCBS Complete |
$197.88
|
| Rate for Payer: BCBS Trust/PPO |
$407.88
|
| Rate for Payer: BCN Commercial |
$407.88
|
| Rate for Payer: Cash Price |
$395.76
|
| Rate for Payer: Cofinity Commercial |
$465.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.76
|
| Rate for Payer: Healthscope Commercial |
$479.86
|
| Rate for Payer: Healthscope Whirlpool |
$494.70
|
| Rate for Payer: Mclaren Commercial |
$445.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$395.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.50
|
| Rate for Payer: Nomi Health Commercial |
$405.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$433.46
|
| Rate for Payer: Priority Health Narrow Network |
$346.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.34
|
|
|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: Aetna Medicare |
$7.86
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.17
|
| Rate for Payer: Priority Health Narrow Network |
$5.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
|
|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.43
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
IP
|
$1,125.53
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$844.15 |
| Max. Negotiated Rate |
$1,125.53 |
| Rate for Payer: Aetna Commercial |
$1,012.98
|
| Rate for Payer: ASR ASR |
$1,091.76
|
| Rate for Payer: BCBS Trust/PPO |
$924.29
|
| Rate for Payer: BCN Commercial |
$924.29
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cofinity Commercial |
$1,058.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.42
|
| Rate for Payer: Healthscope Commercial |
$1,091.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,125.53
|
| Rate for Payer: Mclaren Commercial |
$1,012.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.70
|
| Rate for Payer: Nomi Health Commercial |
$922.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$844.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$990.47
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
OP
|
$1,125.53
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$1,366.00 |
| Rate for Payer: Aetna Commercial |
$1,012.98
|
| Rate for Payer: Aetna Medicare |
$881.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: ASR ASR |
$1,091.76
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$928.00
|
| Rate for Payer: BCN Commercial |
$928.00
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cofinity Commercial |
$1,058.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,091.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,125.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$881.29
|
| Rate for Payer: Mclaren Commercial |
$1,012.98
|
| Rate for Payer: Mclaren Medicaid |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$484.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.70
|
| Rate for Payer: Nomi Health Commercial |
$922.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$844.15
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$969.42
|
| Rate for Payer: PHP Medicaid |
$472.37
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$986.19
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Narrow Network |
$789.00
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$990.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Exchange |
$1,366.00
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP DNSP |
$881.29
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
IP
|
$1,125.53
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$844.15 |
| Max. Negotiated Rate |
$1,125.53 |
| Rate for Payer: Aetna Commercial |
$1,012.98
|
| Rate for Payer: ASR ASR |
$1,091.76
|
| Rate for Payer: BCBS Trust/PPO |
$924.29
|
| Rate for Payer: BCN Commercial |
$924.29
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cofinity Commercial |
$1,058.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.42
|
| Rate for Payer: Healthscope Commercial |
$1,091.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,125.53
|
| Rate for Payer: Mclaren Commercial |
$1,012.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.70
|
| Rate for Payer: Nomi Health Commercial |
$922.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$844.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$990.47
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
OP
|
$1,125.53
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$1,366.00 |
| Rate for Payer: Aetna Commercial |
$1,012.98
|
| Rate for Payer: Aetna Medicare |
$881.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: ASR ASR |
$1,091.76
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$928.00
|
| Rate for Payer: BCN Commercial |
$928.00
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cofinity Commercial |
$1,058.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,091.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,125.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$881.29
|
| Rate for Payer: Mclaren Commercial |
$1,012.98
|
| Rate for Payer: Mclaren Medicaid |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$484.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.70
|
| Rate for Payer: Nomi Health Commercial |
$922.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$844.15
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$969.42
|
| Rate for Payer: PHP Medicaid |
$472.37
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$986.19
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Narrow Network |
$789.00
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$990.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Exchange |
$1,366.00
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP DNSP |
$881.29
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
IP
|
$1,125.53
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$844.15 |
| Max. Negotiated Rate |
$1,125.53 |
| Rate for Payer: Aetna Commercial |
$1,012.98
|
| Rate for Payer: ASR ASR |
$1,091.76
|
| Rate for Payer: BCBS Trust/PPO |
$924.29
|
| Rate for Payer: BCN Commercial |
$924.29
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cofinity Commercial |
$1,058.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.42
|
| Rate for Payer: Healthscope Commercial |
$1,091.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,125.53
|
| Rate for Payer: Mclaren Commercial |
$1,012.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.70
|
| Rate for Payer: Nomi Health Commercial |
$922.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$844.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$990.47
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
OP
|
$1,125.53
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$1,366.00 |
| Rate for Payer: Aetna Commercial |
$1,012.98
|
| Rate for Payer: Aetna Medicare |
$881.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: ASR ASR |
$1,091.76
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$928.00
|
| Rate for Payer: BCN Commercial |
$928.00
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cofinity Commercial |
$1,058.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,091.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,125.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$881.29
|
| Rate for Payer: Mclaren Commercial |
$1,012.98
|
| Rate for Payer: Mclaren Medicaid |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$484.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.70
|
| Rate for Payer: Nomi Health Commercial |
$922.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$844.15
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$969.42
|
| Rate for Payer: PHP Medicaid |
$472.37
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$986.19
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Narrow Network |
$789.00
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$990.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Exchange |
$1,366.00
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP DNSP |
$881.29
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$121.44 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: Aetna Medicare |
$78.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.94
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: BCBS Complete |
$43.03
|
| Rate for Payer: BCBS MAPPO |
$78.35
|
| Rate for Payer: BCBS Trust/PPO |
$55.76
|
| Rate for Payer: BCN Commercial |
$55.76
|
| Rate for Payer: BCN Medicare Advantage |
$78.35
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.35
|
| Rate for Payer: Healthscope Commercial |
$65.60
|
| Rate for Payer: Healthscope Whirlpool |
$67.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$78.35
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Mclaren Medicaid |
$78.35
|
| Rate for Payer: Mclaren Medicare |
$78.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.27
|
| Rate for Payer: Meridian Medicaid |
$43.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PACE Medicare |
$74.43
|
| Rate for Payer: PACE SWMI |
$78.35
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: PHP Medicaid |
$42.00
|
| Rate for Payer: PHP Medicare Advantage |
$78.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$83.61
|
| Rate for Payer: Priority Health Medicare |
$78.35
|
| Rate for Payer: Priority Health Narrow Network |
$66.89
|
| Rate for Payer: Railroad Medicare Medicare |
$78.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$78.35
|
| Rate for Payer: UHC Exchange |
$121.44
|
| Rate for Payer: UHC Medicaid |
$40.98
|
| Rate for Payer: UHCCP DNSP |
$78.35
|
| Rate for Payer: UHCCP Medicaid |
$40.98
|
| Rate for Payer: VA VA |
$78.35
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$67.63 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: BCBS Trust/PPO |
$55.54
|
| Rate for Payer: BCN Commercial |
$55.54
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$65.60
|
| Rate for Payer: Healthscope Whirlpool |
$67.63
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
IP
|
$368.24
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.18 |
| Max. Negotiated Rate |
$368.24 |
| Rate for Payer: Aetna Commercial |
$331.42
|
| Rate for Payer: ASR ASR |
$357.19
|
| Rate for Payer: BCBS Trust/PPO |
$302.40
|
| Rate for Payer: BCN Commercial |
$302.40
|
| Rate for Payer: Cash Price |
$294.59
|
| Rate for Payer: Cofinity Commercial |
$346.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.59
|
| Rate for Payer: Healthscope Commercial |
$357.19
|
| Rate for Payer: Healthscope Whirlpool |
$368.24
|
| Rate for Payer: Mclaren Commercial |
$331.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.00
|
| Rate for Payer: Nomi Health Commercial |
$301.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$324.05
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
OP
|
$368.24
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$385.87 |
| Rate for Payer: Aetna Commercial |
$331.42
|
| Rate for Payer: Aetna Medicare |
$248.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: ASR ASR |
$357.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$303.61
|
| Rate for Payer: BCN Commercial |
$303.61
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$294.59
|
| Rate for Payer: Cash Price |
$294.59
|
| Rate for Payer: Cofinity Commercial |
$346.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$357.19
|
| Rate for Payer: Healthscope Whirlpool |
$368.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$248.95
|
| Rate for Payer: Mclaren Commercial |
$331.42
|
| Rate for Payer: Mclaren Medicaid |
$248.95
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$136.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.00
|
| Rate for Payer: Nomi Health Commercial |
$301.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.18
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$273.85
|
| Rate for Payer: PHP Medicaid |
$133.44
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$322.65
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health Narrow Network |
$258.14
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$324.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Exchange |
$385.87
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP DNSP |
$248.95
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
HC INJ DAXIBOTULINUMTOXINA-LANM, 1 UNIT
|
Facility
|
IP
|
$11.22
|
|
|
Service Code
|
HCPCS J0589
|
| Hospital Charge Code |
63600257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Aetna Commercial |
$10.10
|
| Rate for Payer: ASR ASR |
$10.88
|
| Rate for Payer: BCBS Trust/PPO |
$9.21
|
| Rate for Payer: BCN Commercial |
$9.21
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Cofinity Commercial |
$10.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.98
|
| Rate for Payer: Healthscope Commercial |
$10.88
|
| Rate for Payer: Healthscope Whirlpool |
$11.22
|
| Rate for Payer: Mclaren Commercial |
$10.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.54
|
| Rate for Payer: Nomi Health Commercial |
$9.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.87
|
|
|
HC INJ DAXIBOTULINUMTOXINA-LANM, 1 UNIT
|
Facility
|
OP
|
$11.22
|
|
|
Service Code
|
HCPCS J0589
|
| Hospital Charge Code |
63600257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Aetna Commercial |
$10.10
|
| Rate for Payer: Aetna Medicare |
$3.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.86
|
| Rate for Payer: ASR ASR |
$10.88
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: BCBS MAPPO |
$3.09
|
| Rate for Payer: BCBS Trust/PPO |
$9.25
|
| Rate for Payer: BCN Commercial |
$9.25
|
| Rate for Payer: BCN Medicare Advantage |
$3.09
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Cofinity Commercial |
$10.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.09
|
| Rate for Payer: Healthscope Commercial |
$10.88
|
| Rate for Payer: Healthscope Whirlpool |
$11.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.09
|
| Rate for Payer: Mclaren Commercial |
$10.10
|
| Rate for Payer: Mclaren Medicaid |
$3.09
|
| Rate for Payer: Mclaren Medicare |
$3.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.24
|
| Rate for Payer: Meridian Medicaid |
$1.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.54
|
| Rate for Payer: Nomi Health Commercial |
$9.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.41
|
| Rate for Payer: PACE Medicare |
$2.94
|
| Rate for Payer: PACE SWMI |
$3.09
|
| Rate for Payer: PHP Commercial |
$3.40
|
| Rate for Payer: PHP Medicaid |
$1.66
|
| Rate for Payer: PHP Medicare Advantage |
$3.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.23
|
| Rate for Payer: Priority Health Medicare |
$3.09
|
| Rate for Payer: Priority Health Narrow Network |
$2.58
|
| Rate for Payer: Railroad Medicare Medicare |
$3.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.09
|
| Rate for Payer: UHC Exchange |
$4.79
|
| Rate for Payer: UHC Medicaid |
$1.62
|
| Rate for Payer: UHCCP DNSP |
$3.09
|
| Rate for Payer: UHCCP Medicaid |
$1.62
|
| Rate for Payer: VA VA |
$3.09
|
|
|
HC INJ, DENOSUMAB-BMWO, 1 MG
|
Facility
|
IP
|
$24.17
|
|
|
Service Code
|
HCPCS Q5157
|
| Hospital Charge Code |
63600286
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$24.17 |
| Rate for Payer: Aetna Commercial |
$21.75
|
| Rate for Payer: ASR ASR |
$23.44
|
| Rate for Payer: BCBS Trust/PPO |
$19.85
|
| Rate for Payer: BCN Commercial |
$19.85
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cofinity Commercial |
$22.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Healthscope Commercial |
$23.44
|
| Rate for Payer: Healthscope Whirlpool |
$24.17
|
| Rate for Payer: Mclaren Commercial |
$21.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: Nomi Health Commercial |
$19.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.27
|
|
|
HC INJ, DENOSUMAB-BMWO, 1 MG
|
Facility
|
OP
|
$24.17
|
|
|
Service Code
|
HCPCS Q5157
|
| Hospital Charge Code |
63600286
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$40.63 |
| Rate for Payer: Aetna Commercial |
$21.75
|
| Rate for Payer: Aetna Medicare |
$26.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.76
|
| Rate for Payer: ASR ASR |
$23.44
|
| Rate for Payer: BCBS Complete |
$14.39
|
| Rate for Payer: BCBS MAPPO |
$26.21
|
| Rate for Payer: BCBS Trust/PPO |
$19.93
|
| Rate for Payer: BCN Commercial |
$19.93
|
| Rate for Payer: BCN Medicare Advantage |
$26.21
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cofinity Commercial |
$22.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.21
|
| Rate for Payer: Healthscope Commercial |
$23.44
|
| Rate for Payer: Healthscope Whirlpool |
$24.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$26.21
|
| Rate for Payer: Mclaren Commercial |
$21.75
|
| Rate for Payer: Mclaren Medicaid |
$26.21
|
| Rate for Payer: Mclaren Medicare |
$26.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.52
|
| Rate for Payer: Meridian Medicaid |
$14.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: Nomi Health Commercial |
$19.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.13
|
| Rate for Payer: PACE Medicare |
$24.90
|
| Rate for Payer: PACE SWMI |
$26.21
|
| Rate for Payer: PHP Commercial |
$28.83
|
| Rate for Payer: PHP Medicaid |
$14.05
|
| Rate for Payer: PHP Medicare Advantage |
$26.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29.07
|
| Rate for Payer: Priority Health Medicare |
$26.21
|
| Rate for Payer: Priority Health Narrow Network |
$23.26
|
| Rate for Payer: Railroad Medicare Medicare |
$26.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.21
|
| Rate for Payer: UHC Exchange |
$40.63
|
| Rate for Payer: UHC Medicaid |
$13.71
|
| Rate for Payer: UHCCP DNSP |
$26.21
|
| Rate for Payer: UHCCP Medicaid |
$13.71
|
| Rate for Payer: VA VA |
$26.21
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$893.87
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$670.40 |
| Max. Negotiated Rate |
$893.87 |
| Rate for Payer: Aetna Commercial |
$804.48
|
| Rate for Payer: ASR ASR |
$867.05
|
| Rate for Payer: BCBS Trust/PPO |
$734.05
|
| Rate for Payer: BCN Commercial |
$734.05
|
| Rate for Payer: Cash Price |
$715.10
|
| Rate for Payer: Cofinity Commercial |
$840.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.10
|
| Rate for Payer: Healthscope Commercial |
$867.05
|
| Rate for Payer: Healthscope Whirlpool |
$893.87
|
| Rate for Payer: Mclaren Commercial |
$804.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.79
|
| Rate for Payer: Nomi Health Commercial |
$732.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$670.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$786.61
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$893.87
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$1,090.18 |
| Rate for Payer: Aetna Commercial |
$804.48
|
| Rate for Payer: Aetna Medicare |
$703.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: ASR ASR |
$867.05
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$737.00
|
| Rate for Payer: BCN Commercial |
$737.00
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$715.10
|
| Rate for Payer: Cash Price |
$715.10
|
| Rate for Payer: Cofinity Commercial |
$840.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$867.05
|
| Rate for Payer: Healthscope Whirlpool |
$893.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$703.34
|
| Rate for Payer: Mclaren Commercial |
$804.48
|
| Rate for Payer: Mclaren Medicaid |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$386.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.79
|
| Rate for Payer: Nomi Health Commercial |
$732.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$670.40
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$773.67
|
| Rate for Payer: PHP Medicaid |
$376.99
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$783.21
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Narrow Network |
$626.60
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$786.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$1,090.18
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP DNSP |
$703.34
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
