|
HC INJ DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$966.17
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$1,090.18 |
| Rate for Payer: Aetna Commercial |
$869.55
|
| 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 |
$937.18
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$796.61
|
| Rate for Payer: BCN Commercial |
$796.61
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$772.94
|
| Rate for Payer: Cash Price |
$772.94
|
| Rate for Payer: Cofinity Commercial |
$908.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$937.18
|
| Rate for Payer: Healthscope Whirlpool |
$966.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$703.34
|
| Rate for Payer: Mclaren Commercial |
$869.55
|
| 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 |
$821.24
|
| Rate for Payer: Nomi Health Commercial |
$792.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$724.63
|
| 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 |
$846.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Narrow Network |
$677.29
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$850.23
|
| 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 DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$966.17
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$724.63 |
| Max. Negotiated Rate |
$966.17 |
| Rate for Payer: Aetna Commercial |
$869.55
|
| Rate for Payer: ASR ASR |
$937.18
|
| Rate for Payer: BCBS Trust/PPO |
$793.42
|
| Rate for Payer: BCN Commercial |
$793.42
|
| Rate for Payer: Cash Price |
$772.94
|
| Rate for Payer: Cofinity Commercial |
$908.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.94
|
| Rate for Payer: Healthscope Commercial |
$937.18
|
| Rate for Payer: Healthscope Whirlpool |
$966.17
|
| Rate for Payer: Mclaren Commercial |
$869.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$821.24
|
| Rate for Payer: Nomi Health Commercial |
$792.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$724.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$850.23
|
|
|
HC INJECT CARPAL TUNNEL
|
Facility
|
IP
|
$393.93
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.45 |
| Max. Negotiated Rate |
$393.93 |
| Rate for Payer: Aetna Commercial |
$354.54
|
| Rate for Payer: ASR ASR |
$382.11
|
| Rate for Payer: BCBS Trust/PPO |
$323.50
|
| Rate for Payer: BCN Commercial |
$323.50
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cofinity Commercial |
$370.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.14
|
| Rate for Payer: Healthscope Commercial |
$382.11
|
| Rate for Payer: Healthscope Whirlpool |
$393.93
|
| Rate for Payer: Mclaren Commercial |
$354.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.84
|
| Rate for Payer: Nomi Health Commercial |
$323.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$346.66
|
|
|
HC INJECT CARPAL TUNNEL
|
Facility
|
OP
|
$393.93
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$474.07 |
| Rate for Payer: Aetna Commercial |
$354.54
|
| Rate for Payer: Aetna Medicare |
$305.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: ASR ASR |
$382.11
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$324.80
|
| Rate for Payer: BCN Commercial |
$324.80
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cofinity Commercial |
$370.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$382.11
|
| Rate for Payer: Healthscope Whirlpool |
$393.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$354.54
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$167.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.84
|
| Rate for Payer: Nomi Health Commercial |
$323.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.45
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$336.44
|
| Rate for Payer: PHP Medicaid |
$163.94
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$345.16
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$276.14
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$346.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$474.07
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP DNSP |
$305.85
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
OP
|
$1,186.06
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$1,186.06 |
| Rate for Payer: Aetna Commercial |
$1,067.45
|
| Rate for Payer: Aetna Commercial |
$711.63
|
| Rate for Payer: Aetna Medicare |
$305.85
|
| Rate for Payer: Aetna Medicare |
$305.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: ASR ASR |
$766.98
|
| Rate for Payer: ASR ASR |
$1,150.48
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$651.93
|
| Rate for Payer: BCBS Trust/PPO |
$977.91
|
| Rate for Payer: BCN Commercial |
$977.91
|
| Rate for Payer: BCN Commercial |
$651.93
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$948.85
|
| Rate for Payer: Cash Price |
$948.85
|
| Rate for Payer: Cash Price |
$632.56
|
| Rate for Payer: Cash Price |
$632.56
|
| Rate for Payer: Cofinity Commercial |
$1,114.90
|
| Rate for Payer: Cofinity Commercial |
$743.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$1,150.48
|
| Rate for Payer: Healthscope Commercial |
$766.98
|
| Rate for Payer: Healthscope Whirlpool |
$790.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,186.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$711.63
|
| Rate for Payer: Mclaren Commercial |
$1,067.45
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$167.97
|
| Rate for Payer: Meridian Medicaid |
$167.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,008.15
|
| Rate for Payer: Nomi Health Commercial |
$972.57
|
| Rate for Payer: Nomi Health Commercial |
$648.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$889.54
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$336.44
|
| Rate for Payer: PHP Commercial |
$336.44
|
| Rate for Payer: PHP Medicaid |
$163.94
|
| Rate for Payer: PHP Medicaid |
$163.94
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,039.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$692.81
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$831.43
|
| Rate for Payer: Priority Health Narrow Network |
$554.28
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,043.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$695.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$474.07
|
| Rate for Payer: UHC Exchange |
$474.07
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP DNSP |
$305.85
|
| Rate for Payer: UHCCP DNSP |
$305.85
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
IP
|
$1,186.06
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$889.54 |
| Max. Negotiated Rate |
$1,186.06 |
| Rate for Payer: Aetna Commercial |
$1,067.45
|
| Rate for Payer: Aetna Commercial |
$711.63
|
| Rate for Payer: ASR ASR |
$1,150.48
|
| Rate for Payer: ASR ASR |
$766.98
|
| Rate for Payer: BCBS Trust/PPO |
$973.99
|
| Rate for Payer: BCBS Trust/PPO |
$649.32
|
| Rate for Payer: BCN Commercial |
$973.99
|
| Rate for Payer: BCN Commercial |
$649.32
|
| Rate for Payer: Cash Price |
$632.56
|
| Rate for Payer: Cash Price |
$948.85
|
| Rate for Payer: Cofinity Commercial |
$743.26
|
| Rate for Payer: Cofinity Commercial |
$1,114.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.56
|
| Rate for Payer: Healthscope Commercial |
$1,150.48
|
| Rate for Payer: Healthscope Commercial |
$766.98
|
| Rate for Payer: Healthscope Whirlpool |
$790.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,186.06
|
| Rate for Payer: Mclaren Commercial |
$711.63
|
| Rate for Payer: Mclaren Commercial |
$1,067.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,008.15
|
| Rate for Payer: Nomi Health Commercial |
$648.37
|
| Rate for Payer: Nomi Health Commercial |
$972.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$889.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$695.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,043.73
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
OP
|
$3,183.62
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.39 |
| Max. Negotiated Rate |
$3,183.62 |
| Rate for Payer: Aetna Commercial |
$2,865.26
|
| Rate for Payer: Aetna Medicare |
$44.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.90
|
| Rate for Payer: ASR ASR |
$3,088.11
|
| Rate for Payer: BCBS Complete |
$24.56
|
| Rate for Payer: BCBS MAPPO |
$44.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,624.89
|
| Rate for Payer: BCN Commercial |
$2,624.89
|
| Rate for Payer: BCN Medicare Advantage |
$44.72
|
| Rate for Payer: Cash Price |
$2,546.90
|
| Rate for Payer: Cash Price |
$2,546.90
|
| Rate for Payer: Cofinity Commercial |
$2,992.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,546.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.72
|
| Rate for Payer: Healthscope Commercial |
$3,088.11
|
| Rate for Payer: Healthscope Whirlpool |
$3,183.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$44.72
|
| Rate for Payer: Mclaren Commercial |
$2,865.26
|
| Rate for Payer: Mclaren Medicaid |
$44.72
|
| Rate for Payer: Mclaren Medicare |
$44.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.96
|
| Rate for Payer: Meridian Medicaid |
$24.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,706.08
|
| Rate for Payer: Nomi Health Commercial |
$2,610.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,387.72
|
| Rate for Payer: PACE Medicare |
$42.48
|
| Rate for Payer: PACE SWMI |
$44.72
|
| Rate for Payer: PHP Commercial |
$49.19
|
| Rate for Payer: PHP Medicaid |
$23.97
|
| Rate for Payer: PHP Medicare Advantage |
$44.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.46
|
| Rate for Payer: Priority Health Medicare |
$44.72
|
| Rate for Payer: Priority Health Narrow Network |
$37.17
|
| Rate for Payer: Railroad Medicare Medicare |
$44.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,801.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44.72
|
| Rate for Payer: UHC Exchange |
$69.32
|
| Rate for Payer: UHC Medicaid |
$23.39
|
| Rate for Payer: UHCCP DNSP |
$44.72
|
| Rate for Payer: UHCCP Medicaid |
$23.39
|
| Rate for Payer: VA VA |
$44.72
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
IP
|
$3,183.62
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,387.72 |
| Max. Negotiated Rate |
$3,183.62 |
| Rate for Payer: Aetna Commercial |
$2,865.26
|
| Rate for Payer: ASR ASR |
$3,088.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,614.39
|
| Rate for Payer: BCN Commercial |
$2,614.39
|
| Rate for Payer: Cash Price |
$2,546.90
|
| Rate for Payer: Cofinity Commercial |
$2,992.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,546.90
|
| Rate for Payer: Healthscope Commercial |
$3,088.11
|
| Rate for Payer: Healthscope Whirlpool |
$3,183.62
|
| Rate for Payer: Mclaren Commercial |
$2,865.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,706.08
|
| Rate for Payer: Nomi Health Commercial |
$2,610.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,387.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,801.59
|
|
|
HC INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
IP
|
$63.67
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.75 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$57.30
|
| Rate for Payer: ASR ASR |
$61.76
|
| Rate for Payer: BCBS Trust/PPO |
$52.29
|
| Rate for Payer: BCN Commercial |
$52.29
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$59.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$61.76
|
| Rate for Payer: Healthscope Whirlpool |
$63.67
|
| Rate for Payer: Mclaren Commercial |
$57.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.03
|
|
|
HC INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
OP
|
$63.67
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$57.30
|
| Rate for Payer: Aetna Medicare |
$23.56
|
| Rate for Payer: ASR ASR |
$61.76
|
| Rate for Payer: BCBS Complete |
$25.47
|
| Rate for Payer: BCBS Trust/PPO |
$52.50
|
| Rate for Payer: BCN Commercial |
$52.50
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$59.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$61.76
|
| Rate for Payer: Healthscope Whirlpool |
$63.67
|
| Rate for Payer: Mclaren Commercial |
$57.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.48
|
| Rate for Payer: Priority Health Narrow Network |
$0.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.03
|
|
|
HC INJECTION, CERTOLIZUMAB PEGOL, 1 MG
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: ASR ASR |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$8.54
|
| Rate for Payer: BCN Commercial |
$8.54
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$9.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$10.09
|
| Rate for Payer: Healthscope Whirlpool |
$10.40
|
| Rate for Payer: Mclaren Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.15
|
|
|
HC INJECTION, CERTOLIZUMAB PEGOL, 1 MG
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Medicare |
$3.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.74
|
| Rate for Payer: ASR ASR |
$10.09
|
| Rate for Payer: BCBS Complete |
$2.08
|
| Rate for Payer: BCBS MAPPO |
$3.79
|
| Rate for Payer: BCBS Trust/PPO |
$8.57
|
| Rate for Payer: BCN Commercial |
$8.57
|
| Rate for Payer: BCN Medicare Advantage |
$3.79
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$9.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.79
|
| Rate for Payer: Healthscope Commercial |
$10.09
|
| Rate for Payer: Healthscope Whirlpool |
$10.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.79
|
| Rate for Payer: Mclaren Commercial |
$9.36
|
| Rate for Payer: Mclaren Medicaid |
$3.79
|
| Rate for Payer: Mclaren Medicare |
$3.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.98
|
| Rate for Payer: Meridian Medicaid |
$2.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.80
|
| Rate for Payer: PACE Medicare |
$3.60
|
| Rate for Payer: PACE SWMI |
$3.79
|
| Rate for Payer: PHP Commercial |
$4.17
|
| Rate for Payer: PHP Medicaid |
$2.03
|
| Rate for Payer: PHP Medicare Advantage |
$3.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.01
|
| Rate for Payer: Priority Health Medicare |
$3.79
|
| Rate for Payer: Priority Health Narrow Network |
$3.21
|
| Rate for Payer: Railroad Medicare Medicare |
$3.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.79
|
| Rate for Payer: UHC Exchange |
$5.87
|
| Rate for Payer: UHC Medicaid |
$1.98
|
| Rate for Payer: UHCCP DNSP |
$3.79
|
| Rate for Payer: UHCCP Medicaid |
$1.98
|
| Rate for Payer: VA VA |
$3.79
|
|
|
HC INJECTION CERVICAL OR THORACIC
|
Facility
|
OP
|
$1,031.17
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
36100283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$381.53 |
| Max. Negotiated Rate |
$1,031.17 |
| Rate for Payer: Aetna Commercial |
$928.05
|
| Rate for Payer: Aetna Medicare |
$381.53
|
| Rate for Payer: ASR ASR |
$1,000.23
|
| Rate for Payer: BCBS Complete |
$412.47
|
| Rate for Payer: BCBS Trust/PPO |
$850.20
|
| Rate for Payer: BCN Commercial |
$850.20
|
| Rate for Payer: Cash Price |
$824.94
|
| Rate for Payer: Cofinity Commercial |
$969.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$824.94
|
| Rate for Payer: Healthscope Commercial |
$1,000.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,031.17
|
| Rate for Payer: Mclaren Commercial |
$928.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$824.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.49
|
| Rate for Payer: Nomi Health Commercial |
$845.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$773.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$903.51
|
| Rate for Payer: Priority Health Narrow Network |
$722.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$907.43
|
|
|
HC INJECTION CERVICAL OR THORACIC
|
Facility
|
IP
|
$1,031.17
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
36100283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$773.38 |
| Max. Negotiated Rate |
$1,031.17 |
| Rate for Payer: Aetna Commercial |
$928.05
|
| Rate for Payer: ASR ASR |
$1,000.23
|
| Rate for Payer: BCBS Trust/PPO |
$846.80
|
| Rate for Payer: BCN Commercial |
$846.80
|
| Rate for Payer: Cash Price |
$824.94
|
| Rate for Payer: Cofinity Commercial |
$969.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$824.94
|
| Rate for Payer: Healthscope Commercial |
$1,000.23
|
| Rate for Payer: Healthscope Whirlpool |
$1,031.17
|
| Rate for Payer: Mclaren Commercial |
$928.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.49
|
| Rate for Payer: Nomi Health Commercial |
$845.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$773.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$907.43
|
|
|
HC INJECTION CONTRAST FOR TUBE ASSESSMENT
|
Facility
|
OP
|
$1,039.24
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
36100223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$384.52 |
| Max. Negotiated Rate |
$1,039.24 |
| Rate for Payer: Aetna Commercial |
$935.32
|
| Rate for Payer: Aetna Medicare |
$384.52
|
| Rate for Payer: ASR ASR |
$1,008.06
|
| Rate for Payer: BCBS Complete |
$415.70
|
| Rate for Payer: BCBS Trust/PPO |
$856.85
|
| Rate for Payer: BCN Commercial |
$856.85
|
| Rate for Payer: Cash Price |
$831.39
|
| Rate for Payer: Cofinity Commercial |
$976.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$831.39
|
| Rate for Payer: Healthscope Commercial |
$1,008.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,039.24
|
| Rate for Payer: Mclaren Commercial |
$935.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$831.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$883.35
|
| Rate for Payer: Nomi Health Commercial |
$852.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$779.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$910.58
|
| Rate for Payer: Priority Health Narrow Network |
$728.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$914.53
|
|
|
HC INJECTION CONTRAST FOR TUBE ASSESSMENT
|
Facility
|
IP
|
$1,039.24
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
36100223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$779.43 |
| Max. Negotiated Rate |
$1,039.24 |
| Rate for Payer: Aetna Commercial |
$935.32
|
| Rate for Payer: ASR ASR |
$1,008.06
|
| Rate for Payer: BCBS Trust/PPO |
$853.42
|
| Rate for Payer: BCN Commercial |
$853.42
|
| Rate for Payer: Cash Price |
$831.39
|
| Rate for Payer: Cofinity Commercial |
$976.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$831.39
|
| Rate for Payer: Healthscope Commercial |
$1,008.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,039.24
|
| Rate for Payer: Mclaren Commercial |
$935.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$883.35
|
| Rate for Payer: Nomi Health Commercial |
$852.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$779.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$914.53
|
|
|
HC INJECTION, DENOSUMAB, 1MG
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$45.74 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$29.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.89
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: BCBS Complete |
$16.21
|
| Rate for Payer: BCBS MAPPO |
$29.51
|
| Rate for Payer: BCBS Trust/PPO |
$21.45
|
| Rate for Payer: BCN Commercial |
$21.45
|
| Rate for Payer: BCN Medicare Advantage |
$29.51
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.51
|
| Rate for Payer: Healthscope Commercial |
$25.23
|
| Rate for Payer: Healthscope Whirlpool |
$26.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$29.51
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$29.51
|
| Rate for Payer: Mclaren Medicare |
$29.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.99
|
| Rate for Payer: Meridian Medicaid |
$16.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.51
|
| Rate for Payer: PACE Medicare |
$28.03
|
| Rate for Payer: PACE SWMI |
$29.51
|
| Rate for Payer: PHP Commercial |
$32.46
|
| Rate for Payer: PHP Medicaid |
$15.82
|
| Rate for Payer: PHP Medicare Advantage |
$29.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30.57
|
| Rate for Payer: Priority Health Medicare |
$29.51
|
| Rate for Payer: Priority Health Narrow Network |
$24.46
|
| Rate for Payer: Railroad Medicare Medicare |
$29.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.51
|
| Rate for Payer: UHC Exchange |
$45.74
|
| Rate for Payer: UHC Medicaid |
$15.43
|
| Rate for Payer: UHCCP DNSP |
$29.51
|
| Rate for Payer: UHCCP Medicaid |
$15.43
|
| Rate for Payer: VA VA |
$29.51
|
|
|
HC INJECTION, DENOSUMAB, 1MG
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.36
|
| Rate for Payer: BCN Commercial |
$21.36
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$25.23
|
| Rate for Payer: Healthscope Whirlpool |
$26.01
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
|
HC INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
|
Facility
|
OP
|
$14.86
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$53.77 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: ASR ASR |
$14.41
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: BCBS Trust/PPO |
$12.25
|
| Rate for Payer: BCN Commercial |
$12.25
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$14.41
|
| Rate for Payer: Healthscope Whirlpool |
$14.86
|
| Rate for Payer: Mclaren Commercial |
$13.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$53.77
|
| Rate for Payer: Priority Health Narrow Network |
$43.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
|
|
HC INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
|
Facility
|
IP
|
$14.86
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$14.86 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: ASR ASR |
$14.41
|
| Rate for Payer: BCBS Trust/PPO |
$12.20
|
| Rate for Payer: BCN Commercial |
$12.20
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$14.41
|
| Rate for Payer: Healthscope Whirlpool |
$14.86
|
| Rate for Payer: Mclaren Commercial |
$13.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
|
|
HC INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
|
Facility
|
OP
|
$2.12
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
63600167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$1.91
|
| Rate for Payer: Aetna Medicare |
$0.78
|
| Rate for Payer: ASR ASR |
$2.06
|
| Rate for Payer: BCBS Complete |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$1.75
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$1.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.70
|
| Rate for Payer: Healthscope Commercial |
$2.06
|
| Rate for Payer: Healthscope Whirlpool |
$2.12
|
| Rate for Payer: Mclaren Commercial |
$1.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.80
|
| Rate for Payer: Nomi Health Commercial |
$1.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.74
|
| Rate for Payer: Priority Health Narrow Network |
$0.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.87
|
|
|
HC INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
|
Facility
|
IP
|
$2.12
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
63600167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$1.91
|
| Rate for Payer: ASR ASR |
$2.06
|
| Rate for Payer: BCBS Trust/PPO |
$1.74
|
| Rate for Payer: BCN Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$1.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.70
|
| Rate for Payer: Healthscope Commercial |
$2.06
|
| Rate for Payer: Healthscope Whirlpool |
$2.12
|
| Rate for Payer: Mclaren Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.80
|
| Rate for Payer: Nomi Health Commercial |
$1.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.87
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
IP
|
$1,154.72
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$866.04 |
| Max. Negotiated Rate |
$1,154.72 |
| Rate for Payer: Aetna Commercial |
$1,039.25
|
| Rate for Payer: ASR ASR |
$1,120.08
|
| Rate for Payer: BCBS Trust/PPO |
$948.26
|
| Rate for Payer: BCN Commercial |
$948.26
|
| Rate for Payer: Cash Price |
$923.78
|
| Rate for Payer: Cofinity Commercial |
$1,085.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$923.78
|
| Rate for Payer: Healthscope Commercial |
$1,120.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,154.72
|
| Rate for Payer: Mclaren Commercial |
$1,039.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$981.51
|
| Rate for Payer: Nomi Health Commercial |
$946.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$866.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,016.15
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
OP
|
$1,154.72
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$427.25 |
| Max. Negotiated Rate |
$1,154.72 |
| Rate for Payer: Aetna Commercial |
$1,039.25
|
| Rate for Payer: Aetna Medicare |
$427.25
|
| Rate for Payer: ASR ASR |
$1,120.08
|
| Rate for Payer: BCBS Complete |
$461.89
|
| Rate for Payer: BCBS Trust/PPO |
$952.07
|
| Rate for Payer: BCN Commercial |
$952.07
|
| Rate for Payer: Cash Price |
$923.78
|
| Rate for Payer: Cofinity Commercial |
$1,085.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$923.78
|
| Rate for Payer: Healthscope Commercial |
$1,120.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,154.72
|
| Rate for Payer: Mclaren Commercial |
$1,039.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$923.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$981.51
|
| Rate for Payer: Nomi Health Commercial |
$946.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$866.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,011.77
|
| Rate for Payer: Priority Health Narrow Network |
$809.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,016.15
|
|
|
HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL
|
Facility
|
OP
|
$1,939.68
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$1,939.68 |
| Rate for Payer: Aetna Commercial |
$1,745.71
|
| 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 |
$1,881.49
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,599.27
|
| Rate for Payer: BCN Commercial |
$1,599.27
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$1,551.74
|
| Rate for Payer: Cash Price |
$1,551.74
|
| Rate for Payer: Cofinity Commercial |
$1,823.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,551.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,881.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,939.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$881.29
|
| Rate for Payer: Mclaren Commercial |
$1,745.71
|
| 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 |
$1,648.73
|
| Rate for Payer: Nomi Health Commercial |
$1,590.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,454.76
|
| 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 |
$1,699.55
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,359.72
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,706.92
|
| 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
|
|
