|
HC INJECTION HIP ARTHROGRAM BIL
|
Facility
|
OP
|
$1,238.30
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.38 |
| Max. Negotiated Rate |
$1,238.30 |
| Rate for Payer: Aetna Commercial |
$1,114.47
|
| Rate for Payer: Aetna Medicare |
$458.17
|
| Rate for Payer: ASR ASR |
$1,201.15
|
| Rate for Payer: BCBS Complete |
$495.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,020.98
|
| Rate for Payer: BCN Commercial |
$1,020.98
|
| Rate for Payer: Cash Price |
$990.64
|
| Rate for Payer: Cash Price |
$990.64
|
| Rate for Payer: Cofinity Commercial |
$1,164.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.64
|
| Rate for Payer: Healthscope Commercial |
$1,201.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,238.30
|
| Rate for Payer: Mclaren Commercial |
$1,114.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$990.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.56
|
| Rate for Payer: Nomi Health Commercial |
$1,015.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$928.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$311.72
|
| Rate for Payer: Priority Health Narrow Network |
$249.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,089.70
|
|
|
HC INJECTION HIP ARTHROGRAM BIL
|
Facility
|
IP
|
$1,238.30
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$928.73 |
| Max. Negotiated Rate |
$1,238.30 |
| Rate for Payer: Aetna Commercial |
$1,114.47
|
| Rate for Payer: ASR ASR |
$1,201.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,016.89
|
| Rate for Payer: BCN Commercial |
$1,016.89
|
| Rate for Payer: Cash Price |
$990.64
|
| Rate for Payer: Cofinity Commercial |
$1,164.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.64
|
| Rate for Payer: Healthscope Commercial |
$1,201.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,238.30
|
| Rate for Payer: Mclaren Commercial |
$1,114.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.56
|
| Rate for Payer: Nomi Health Commercial |
$1,015.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$928.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,089.70
|
|
|
HC INJECTION INTRALESIONAL UP TO 7 LESIONS
|
Facility
|
IP
|
$150.05
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
76100134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.54 |
| Max. Negotiated Rate |
$150.05 |
| Rate for Payer: Aetna Commercial |
$135.04
|
| Rate for Payer: ASR ASR |
$145.55
|
| Rate for Payer: BCBS Trust/PPO |
$123.22
|
| Rate for Payer: BCN Commercial |
$123.22
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cofinity Commercial |
$141.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.04
|
| Rate for Payer: Healthscope Commercial |
$145.55
|
| Rate for Payer: Healthscope Whirlpool |
$150.05
|
| Rate for Payer: Mclaren Commercial |
$135.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.54
|
| Rate for Payer: Nomi Health Commercial |
$123.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.04
|
|
|
HC INJECTION INTRALESIONAL UP TO 7 LESIONS
|
Facility
|
OP
|
$150.05
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
76100134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$309.86 |
| Rate for Payer: Aetna Commercial |
$135.04
|
| Rate for Payer: Aetna Medicare |
$199.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: ASR ASR |
$145.55
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$123.72
|
| Rate for Payer: BCN Commercial |
$123.72
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cofinity Commercial |
$141.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$145.55
|
| Rate for Payer: Healthscope Whirlpool |
$150.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Mclaren Commercial |
$135.04
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$109.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.54
|
| Rate for Payer: Nomi Health Commercial |
$123.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.54
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$219.90
|
| Rate for Payer: PHP Medicaid |
$107.15
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$131.47
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$105.19
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$309.86
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP DNSP |
$199.91
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC INJECTION, IRON DEXTRAN, 50 MG
|
Facility
|
IP
|
$63.67
|
|
|
Service Code
|
CPT J1750
|
| Hospital Charge Code |
63600097
|
|
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, IRON DEXTRAN, 50 MG
|
Facility
|
OP
|
$63.67
|
|
|
Service Code
|
CPT J1750
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$57.30
|
| Rate for Payer: Aetna Medicare |
$18.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.64
|
| Rate for Payer: ASR ASR |
$61.76
|
| Rate for Payer: BCBS Complete |
$9.95
|
| Rate for Payer: BCBS MAPPO |
$18.11
|
| Rate for Payer: BCBS Trust/PPO |
$52.50
|
| Rate for Payer: BCN Commercial |
$52.50
|
| Rate for Payer: BCN Medicare Advantage |
$18.11
|
| 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: Health Alliance Plan Medicare Advantage |
$18.11
|
| Rate for Payer: Healthscope Commercial |
$61.76
|
| Rate for Payer: Healthscope Whirlpool |
$63.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.11
|
| Rate for Payer: Mclaren Commercial |
$57.30
|
| Rate for Payer: Mclaren Medicaid |
$18.11
|
| Rate for Payer: Mclaren Medicare |
$18.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.02
|
| Rate for Payer: Meridian Medicaid |
$9.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.92
|
| 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: PACE Medicare |
$17.20
|
| Rate for Payer: PACE SWMI |
$18.11
|
| Rate for Payer: PHP Commercial |
$19.92
|
| Rate for Payer: PHP Medicaid |
$9.71
|
| Rate for Payer: PHP Medicare Advantage |
$18.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.76
|
| Rate for Payer: Priority Health Medicare |
$18.11
|
| Rate for Payer: Priority Health Narrow Network |
$15.01
|
| Rate for Payer: Railroad Medicare Medicare |
$18.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.11
|
| Rate for Payer: UHC Exchange |
$28.07
|
| Rate for Payer: UHC Medicaid |
$9.47
|
| Rate for Payer: UHCCP DNSP |
$18.11
|
| Rate for Payer: UHCCP Medicaid |
$9.47
|
| Rate for Payer: VA VA |
$18.11
|
|
|
HC INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
63600098
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.41
|
| Rate for Payer: ASR ASR |
$20.59
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS MAPPO |
$0.33
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: BCN Medicare Advantage |
$0.33
|
| 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: Health Alliance Plan Medicare Advantage |
$0.33
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Healthscope Whirlpool |
$21.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.33
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Mclaren Medicaid |
$0.33
|
| Rate for Payer: Mclaren Medicare |
$0.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.35
|
| Rate for Payer: Meridian Medicaid |
$0.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.36
|
| 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: PACE Medicare |
$0.31
|
| Rate for Payer: PACE SWMI |
$0.33
|
| Rate for Payer: PHP Commercial |
$0.36
|
| Rate for Payer: PHP Medicaid |
$0.18
|
| Rate for Payer: PHP Medicare Advantage |
$0.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.35
|
| Rate for Payer: Priority Health Medicare |
$0.33
|
| Rate for Payer: Priority Health Narrow Network |
$0.28
|
| Rate for Payer: Railroad Medicare Medicare |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.51
|
| Rate for Payer: UHC Medicaid |
$0.17
|
| Rate for Payer: UHCCP DNSP |
$0.33
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: VA VA |
$0.33
|
|
|
HC INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
63600098
|
|
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 INJECTION, LINCOMYCIN HCL, UP TO 300 MG
|
Facility
|
OP
|
$46.70
|
|
|
Service Code
|
CPT J2010
|
| Hospital Charge Code |
63600099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$46.70 |
| Rate for Payer: Aetna Commercial |
$42.03
|
| Rate for Payer: Aetna Medicare |
$17.28
|
| Rate for Payer: ASR ASR |
$45.30
|
| Rate for Payer: BCBS Complete |
$18.68
|
| Rate for Payer: BCBS Trust/PPO |
$38.50
|
| Rate for Payer: BCN Commercial |
$38.50
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cofinity Commercial |
$43.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.36
|
| Rate for Payer: Healthscope Commercial |
$45.30
|
| Rate for Payer: Healthscope Whirlpool |
$46.70
|
| Rate for Payer: Mclaren Commercial |
$42.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.70
|
| Rate for Payer: Nomi Health Commercial |
$38.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.60
|
| Rate for Payer: Priority Health Narrow Network |
$4.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.10
|
|
|
HC INJECTION, LINCOMYCIN HCL, UP TO 300 MG
|
Facility
|
IP
|
$46.70
|
|
|
Service Code
|
CPT J2010
|
| Hospital Charge Code |
63600099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$46.70 |
| Rate for Payer: Aetna Commercial |
$42.03
|
| Rate for Payer: ASR ASR |
$45.30
|
| Rate for Payer: BCBS Trust/PPO |
$38.35
|
| Rate for Payer: BCN Commercial |
$38.35
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cofinity Commercial |
$43.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.36
|
| Rate for Payer: Healthscope Commercial |
$45.30
|
| Rate for Payer: Healthscope Whirlpool |
$46.70
|
| Rate for Payer: Mclaren Commercial |
$42.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.70
|
| Rate for Payer: Nomi Health Commercial |
$38.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.10
|
|
|
HC INJECTION LUMBAR DISKOGRAPHY
|
Facility
|
IP
|
$2,396.52
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
36100282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,797.39 |
| Max. Negotiated Rate |
$2,396.52 |
| Rate for Payer: Aetna Commercial |
$2,156.87
|
| Rate for Payer: ASR ASR |
$2,324.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,968.02
|
| Rate for Payer: BCN Commercial |
$1,968.02
|
| Rate for Payer: Cash Price |
$1,917.22
|
| Rate for Payer: Cofinity Commercial |
$2,252.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,917.22
|
| Rate for Payer: Healthscope Commercial |
$2,324.62
|
| Rate for Payer: Healthscope Whirlpool |
$2,396.52
|
| Rate for Payer: Mclaren Commercial |
$2,156.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,037.04
|
| Rate for Payer: Nomi Health Commercial |
$1,965.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,797.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,108.94
|
|
|
HC INJECTION LUMBAR DISKOGRAPHY
|
Facility
|
OP
|
$2,396.52
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
36100282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$886.71 |
| Max. Negotiated Rate |
$2,396.52 |
| Rate for Payer: Aetna Commercial |
$2,156.87
|
| Rate for Payer: Aetna Medicare |
$886.71
|
| Rate for Payer: ASR ASR |
$2,324.62
|
| Rate for Payer: BCBS Complete |
$958.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,975.93
|
| Rate for Payer: BCN Commercial |
$1,975.93
|
| Rate for Payer: Cash Price |
$1,917.22
|
| Rate for Payer: Cofinity Commercial |
$2,252.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,917.22
|
| Rate for Payer: Healthscope Commercial |
$2,324.62
|
| Rate for Payer: Healthscope Whirlpool |
$2,396.52
|
| Rate for Payer: Mclaren Commercial |
$2,156.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,917.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,037.04
|
| Rate for Payer: Nomi Health Commercial |
$1,965.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,797.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,099.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,679.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,108.94
|
|
|
HC INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
63600096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Aetna Commercial |
$0.95
|
| Rate for Payer: ASR ASR |
$1.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.87
|
| Rate for Payer: BCN Commercial |
$0.87
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Cofinity Commercial |
$1.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.85
|
| Rate for Payer: Healthscope Commercial |
$1.03
|
| Rate for Payer: Healthscope Whirlpool |
$1.06
|
| Rate for Payer: Mclaren Commercial |
$0.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.90
|
| Rate for Payer: Nomi Health Commercial |
$0.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.93
|
|
|
HC INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
63600096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Aetna Commercial |
$0.95
|
| Rate for Payer: Aetna Medicare |
$0.39
|
| Rate for Payer: ASR ASR |
$1.03
|
| Rate for Payer: BCBS Complete |
$0.42
|
| Rate for Payer: BCBS Trust/PPO |
$0.87
|
| Rate for Payer: BCN Commercial |
$0.87
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Cofinity Commercial |
$1.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.85
|
| Rate for Payer: Healthscope Commercial |
$1.03
|
| Rate for Payer: Healthscope Whirlpool |
$1.06
|
| Rate for Payer: Mclaren Commercial |
$0.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.90
|
| Rate for Payer: Nomi Health Commercial |
$0.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.93
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
|
Facility
|
OP
|
$10.61
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Aetna Commercial |
$9.55
|
| Rate for Payer: Aetna Medicare |
$3.93
|
| Rate for Payer: ASR ASR |
$10.29
|
| Rate for Payer: BCBS Complete |
$4.24
|
| Rate for Payer: BCBS Trust/PPO |
$8.75
|
| Rate for Payer: BCN Commercial |
$8.75
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cofinity Commercial |
$9.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$10.29
|
| Rate for Payer: Healthscope Whirlpool |
$10.61
|
| Rate for Payer: Mclaren Commercial |
$9.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.02
|
| Rate for Payer: Nomi Health Commercial |
$8.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.30
|
| Rate for Payer: Priority Health Narrow Network |
$7.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.34
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
|
Facility
|
IP
|
$10.61
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Aetna Commercial |
$9.55
|
| Rate for Payer: ASR ASR |
$10.29
|
| Rate for Payer: BCBS Trust/PPO |
$8.71
|
| Rate for Payer: BCN Commercial |
$8.71
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cofinity Commercial |
$9.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$10.29
|
| Rate for Payer: Healthscope Whirlpool |
$10.61
|
| Rate for Payer: Mclaren Commercial |
$9.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.02
|
| Rate for Payer: Nomi Health Commercial |
$8.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.34
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
63600094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$15.92 |
| Rate for Payer: Aetna Commercial |
$14.33
|
| Rate for Payer: ASR ASR |
$15.44
|
| Rate for Payer: BCBS Trust/PPO |
$13.07
|
| Rate for Payer: BCN Commercial |
$13.07
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$15.44
|
| Rate for Payer: Healthscope Whirlpool |
$15.92
|
| Rate for Payer: Mclaren Commercial |
$14.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Nomi Health Commercial |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.01
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
63600094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$15.92 |
| Rate for Payer: Aetna Commercial |
$14.33
|
| Rate for Payer: Aetna Medicare |
$5.89
|
| Rate for Payer: ASR ASR |
$15.44
|
| Rate for Payer: BCBS Complete |
$6.37
|
| Rate for Payer: BCBS Trust/PPO |
$13.13
|
| Rate for Payer: BCN Commercial |
$13.13
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$15.44
|
| Rate for Payer: Healthscope Whirlpool |
$15.92
|
| Rate for Payer: Mclaren Commercial |
$14.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Nomi Health Commercial |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.95
|
| Rate for Payer: Priority Health Narrow Network |
$11.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.01
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
63600095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$21.87
|
| Rate for Payer: BCN Commercial |
$21.87
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.25
|
| Rate for Payer: Priority Health Narrow Network |
$18.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
63600095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.90 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: ASR ASR |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$21.79
|
| Rate for Payer: BCN Commercial |
$21.79
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$24.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Healthscope Whirlpool |
$26.53
|
| Rate for Payer: Mclaren Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.35
|
|
|
HC INJECTION MYELOGRAM
|
Facility
|
IP
|
$1,088.69
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
36100281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$816.52 |
| Max. Negotiated Rate |
$1,088.69 |
| Rate for Payer: Aetna Commercial |
$979.82
|
| Rate for Payer: ASR ASR |
$1,056.03
|
| Rate for Payer: BCBS Trust/PPO |
$894.03
|
| Rate for Payer: BCN Commercial |
$894.03
|
| Rate for Payer: Cash Price |
$870.95
|
| Rate for Payer: Cofinity Commercial |
$1,023.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$870.95
|
| Rate for Payer: Healthscope Commercial |
$1,056.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,088.69
|
| Rate for Payer: Mclaren Commercial |
$979.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$925.39
|
| Rate for Payer: Nomi Health Commercial |
$892.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$816.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$958.05
|
|
|
HC INJECTION MYELOGRAM
|
Facility
|
OP
|
$1,088.69
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
36100281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$275.53 |
| Max. Negotiated Rate |
$1,088.69 |
| Rate for Payer: Aetna Commercial |
$979.82
|
| Rate for Payer: Aetna Medicare |
$402.82
|
| Rate for Payer: ASR ASR |
$1,056.03
|
| Rate for Payer: BCBS Complete |
$435.48
|
| Rate for Payer: BCBS Trust/PPO |
$897.62
|
| Rate for Payer: BCN Commercial |
$897.62
|
| Rate for Payer: Cash Price |
$870.95
|
| Rate for Payer: Cash Price |
$870.95
|
| Rate for Payer: Cofinity Commercial |
$1,023.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$870.95
|
| Rate for Payer: Healthscope Commercial |
$1,056.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,088.69
|
| Rate for Payer: Mclaren Commercial |
$979.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$870.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$925.39
|
| Rate for Payer: Nomi Health Commercial |
$892.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$816.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$344.41
|
| Rate for Payer: Priority Health Narrow Network |
$275.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$958.05
|
|
|
HC INJECTION PLANTAR DIGIT
|
Facility
|
IP
|
$358.69
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.02 |
| Max. Negotiated Rate |
$358.69 |
| Rate for Payer: Aetna Commercial |
$322.82
|
| Rate for Payer: ASR ASR |
$347.93
|
| Rate for Payer: BCBS Trust/PPO |
$294.56
|
| Rate for Payer: BCN Commercial |
$294.56
|
| Rate for Payer: Cash Price |
$286.95
|
| Rate for Payer: Cofinity Commercial |
$337.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.95
|
| Rate for Payer: Healthscope Commercial |
$347.93
|
| Rate for Payer: Healthscope Whirlpool |
$358.69
|
| Rate for Payer: Mclaren Commercial |
$322.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.89
|
| Rate for Payer: Nomi Health Commercial |
$294.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.65
|
|
|
HC INJECTION PLANTAR DIGIT
|
Facility
|
OP
|
$358.69
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$474.07 |
| Rate for Payer: Aetna Commercial |
$322.82
|
| 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 |
$347.93
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$295.74
|
| Rate for Payer: BCN Commercial |
$295.74
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$286.95
|
| Rate for Payer: Cash Price |
$286.95
|
| Rate for Payer: Cofinity Commercial |
$337.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$347.93
|
| Rate for Payer: Healthscope Whirlpool |
$358.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$322.82
|
| 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 |
$304.89
|
| Rate for Payer: Nomi Health Commercial |
$294.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.02
|
| 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 |
$314.28
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$251.44
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.65
|
| 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 PLANTAR DIGIT BILATERAL
|
Facility
|
OP
|
$538.03
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$538.03 |
| Rate for Payer: Aetna Commercial |
$484.23
|
| 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 |
$521.89
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$443.61
|
| Rate for Payer: BCN Commercial |
$443.61
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$430.42
|
| Rate for Payer: Cash Price |
$430.42
|
| Rate for Payer: Cofinity Commercial |
$505.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$521.89
|
| Rate for Payer: Healthscope Whirlpool |
$538.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$484.23
|
| 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 |
$457.33
|
| Rate for Payer: Nomi Health Commercial |
$441.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$403.52
|
| 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 |
$471.42
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$377.16
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$473.47
|
| 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
|
|
