|
HC INJECTION PLANTAR DIGIT BILATERAL
|
Facility
|
IP
|
$538.03
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.52 |
| Max. Negotiated Rate |
$538.03 |
| Rate for Payer: Aetna Commercial |
$484.23
|
| Rate for Payer: ASR ASR |
$521.89
|
| Rate for Payer: BCBS Trust/PPO |
$441.83
|
| Rate for Payer: BCN Commercial |
$441.83
|
| 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: Healthscope Commercial |
$521.89
|
| Rate for Payer: Healthscope Whirlpool |
$538.03
|
| Rate for Payer: Mclaren Commercial |
$484.23
|
| 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: UHC All Payor (Choice/PPO) + Core |
$473.47
|
|
|
HC INJECTION PLATELET PLASMA W/IMG HARVEST/PREP
|
Facility
|
OP
|
$821.92
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
76100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.80 |
| Max. Negotiated Rate |
$821.92 |
| Rate for Payer: Aetna Commercial |
$739.73
|
| Rate for Payer: Aetna Medicare |
$445.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$556.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$556.40
|
| Rate for Payer: ASR ASR |
$797.26
|
| Rate for Payer: BCBS Complete |
$244.46
|
| Rate for Payer: BCBS MAPPO |
$445.12
|
| Rate for Payer: BCBS Trust/PPO |
$677.67
|
| Rate for Payer: BCN Commercial |
$677.67
|
| Rate for Payer: BCN Medicare Advantage |
$445.12
|
| Rate for Payer: Cash Price |
$657.54
|
| Rate for Payer: Cash Price |
$657.54
|
| Rate for Payer: Cofinity Commercial |
$772.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.12
|
| Rate for Payer: Healthscope Commercial |
$797.26
|
| Rate for Payer: Healthscope Whirlpool |
$821.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$445.12
|
| Rate for Payer: Mclaren Commercial |
$739.73
|
| Rate for Payer: Mclaren Medicaid |
$445.12
|
| Rate for Payer: Mclaren Medicare |
$445.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.38
|
| Rate for Payer: Meridian Medicaid |
$244.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$511.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$489.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$698.63
|
| Rate for Payer: Nomi Health Commercial |
$673.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$616.44
|
| Rate for Payer: PACE Medicare |
$422.86
|
| Rate for Payer: PACE SWMI |
$445.12
|
| Rate for Payer: PHP Commercial |
$489.63
|
| Rate for Payer: PHP Medicaid |
$238.58
|
| Rate for Payer: PHP Medicare Advantage |
$445.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$720.17
|
| Rate for Payer: Priority Health Medicare |
$445.12
|
| Rate for Payer: Priority Health Narrow Network |
$576.17
|
| Rate for Payer: Railroad Medicare Medicare |
$445.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$723.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$445.12
|
| Rate for Payer: UHC Exchange |
$689.94
|
| Rate for Payer: UHC Medicaid |
$232.80
|
| Rate for Payer: UHCCP DNSP |
$445.12
|
| Rate for Payer: UHCCP Medicaid |
$232.80
|
| Rate for Payer: VA VA |
$445.12
|
|
|
HC INJECTION PLATELET PLASMA W/IMG HARVEST/PREP
|
Facility
|
IP
|
$821.92
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
76100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.44 |
| Max. Negotiated Rate |
$821.92 |
| Rate for Payer: Aetna Commercial |
$739.73
|
| Rate for Payer: ASR ASR |
$797.26
|
| Rate for Payer: BCBS Trust/PPO |
$674.96
|
| Rate for Payer: BCN Commercial |
$674.96
|
| Rate for Payer: Cash Price |
$657.54
|
| Rate for Payer: Cofinity Commercial |
$772.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.54
|
| Rate for Payer: Healthscope Commercial |
$797.26
|
| Rate for Payer: Healthscope Whirlpool |
$821.92
|
| Rate for Payer: Mclaren Commercial |
$739.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$698.63
|
| Rate for Payer: Nomi Health Commercial |
$673.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$616.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$723.29
|
|
|
HC INJECTION PROC CYSTOGRAPHY VOIDING
|
Facility
|
IP
|
$1,336.55
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
36100251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,002.41 |
| Max. Negotiated Rate |
$1,336.55 |
| Rate for Payer: Aetna Commercial |
$1,202.89
|
| Rate for Payer: ASR ASR |
$1,296.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,097.57
|
| Rate for Payer: BCN Commercial |
$1,097.57
|
| Rate for Payer: Cash Price |
$1,069.24
|
| Rate for Payer: Cofinity Commercial |
$1,256.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,069.24
|
| Rate for Payer: Healthscope Commercial |
$1,296.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,336.55
|
| Rate for Payer: Mclaren Commercial |
$1,202.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,136.07
|
| Rate for Payer: Nomi Health Commercial |
$1,095.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,002.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,176.16
|
|
|
HC INJECTION PROC CYSTOGRAPHY VOIDING
|
Facility
|
OP
|
$1,336.55
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
36100251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.01 |
| Max. Negotiated Rate |
$1,336.55 |
| Rate for Payer: Aetna Commercial |
$1,202.89
|
| Rate for Payer: Aetna Medicare |
$494.52
|
| Rate for Payer: ASR ASR |
$1,296.45
|
| Rate for Payer: BCBS Complete |
$534.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,101.99
|
| Rate for Payer: BCN Commercial |
$1,101.99
|
| Rate for Payer: Cash Price |
$1,069.24
|
| Rate for Payer: Cash Price |
$1,069.24
|
| Rate for Payer: Cofinity Commercial |
$1,256.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,069.24
|
| Rate for Payer: Healthscope Commercial |
$1,296.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,336.55
|
| Rate for Payer: Mclaren Commercial |
$1,202.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,069.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,136.07
|
| Rate for Payer: Nomi Health Commercial |
$1,095.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,002.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$191.27
|
| Rate for Payer: Priority Health Narrow Network |
$153.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,176.16
|
|
|
HC INJECTION PROCEDURE
|
Facility
|
IP
|
$615.55
|
|
| Hospital Charge Code |
36000085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$461.66 |
| Max. Negotiated Rate |
$615.55 |
| Rate for Payer: Aetna Commercial |
$554.00
|
| Rate for Payer: ASR ASR |
$597.08
|
| Rate for Payer: BCBS Trust/PPO |
$505.49
|
| Rate for Payer: BCN Commercial |
$505.49
|
| Rate for Payer: Cash Price |
$492.44
|
| Rate for Payer: Cofinity Commercial |
$578.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.44
|
| Rate for Payer: Healthscope Commercial |
$597.08
|
| Rate for Payer: Healthscope Whirlpool |
$615.55
|
| Rate for Payer: Mclaren Commercial |
$554.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.22
|
| Rate for Payer: Nomi Health Commercial |
$504.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$461.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$541.68
|
|
|
HC INJECTION PROCEDURE
|
Facility
|
OP
|
$615.55
|
|
| Hospital Charge Code |
36000085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$227.75 |
| Max. Negotiated Rate |
$615.55 |
| Rate for Payer: Aetna Commercial |
$554.00
|
| Rate for Payer: Aetna Medicare |
$227.75
|
| Rate for Payer: ASR ASR |
$597.08
|
| Rate for Payer: BCBS Complete |
$246.22
|
| Rate for Payer: BCBS Trust/PPO |
$507.52
|
| Rate for Payer: BCN Commercial |
$507.52
|
| Rate for Payer: Cash Price |
$492.44
|
| Rate for Payer: Cofinity Commercial |
$578.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.44
|
| Rate for Payer: Healthscope Commercial |
$597.08
|
| Rate for Payer: Healthscope Whirlpool |
$615.55
|
| Rate for Payer: Mclaren Commercial |
$554.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$492.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.22
|
| Rate for Payer: Nomi Health Commercial |
$504.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$461.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$539.34
|
| Rate for Payer: Priority Health Narrow Network |
$431.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$541.68
|
|
|
HC INJECTION PROCEDURE ILEAL CONDUIT
|
Facility
|
IP
|
$656.40
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
36100249
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$492.30 |
| Max. Negotiated Rate |
$656.40 |
| Rate for Payer: Aetna Commercial |
$590.76
|
| Rate for Payer: ASR ASR |
$636.71
|
| Rate for Payer: BCBS Trust/PPO |
$539.04
|
| Rate for Payer: BCN Commercial |
$539.04
|
| Rate for Payer: Cash Price |
$525.12
|
| Rate for Payer: Cofinity Commercial |
$617.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.12
|
| Rate for Payer: Healthscope Commercial |
$636.71
|
| Rate for Payer: Healthscope Whirlpool |
$656.40
|
| Rate for Payer: Mclaren Commercial |
$590.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$557.94
|
| Rate for Payer: Nomi Health Commercial |
$538.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$492.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$577.63
|
|
|
HC INJECTION PROCEDURE ILEAL CONDUIT
|
Facility
|
OP
|
$656.40
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
36100249
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$242.87 |
| Max. Negotiated Rate |
$656.40 |
| Rate for Payer: Aetna Commercial |
$590.76
|
| Rate for Payer: Aetna Medicare |
$242.87
|
| Rate for Payer: ASR ASR |
$636.71
|
| Rate for Payer: BCBS Complete |
$262.56
|
| Rate for Payer: BCBS Trust/PPO |
$541.20
|
| Rate for Payer: BCN Commercial |
$541.20
|
| Rate for Payer: Cash Price |
$525.12
|
| Rate for Payer: Cash Price |
$525.12
|
| Rate for Payer: Cofinity Commercial |
$617.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.12
|
| Rate for Payer: Healthscope Commercial |
$636.71
|
| Rate for Payer: Healthscope Whirlpool |
$656.40
|
| Rate for Payer: Mclaren Commercial |
$590.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$525.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$557.94
|
| Rate for Payer: Nomi Health Commercial |
$538.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$492.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$359.54
|
| Rate for Payer: Priority Health Narrow Network |
$287.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$577.63
|
|
|
HC INJECTION PROC RETROGRAD CYSTOGRAPHY
|
Facility
|
OP
|
$874.10
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
36100252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$323.42 |
| Max. Negotiated Rate |
$874.10 |
| Rate for Payer: Aetna Commercial |
$786.69
|
| Rate for Payer: Aetna Medicare |
$323.42
|
| Rate for Payer: ASR ASR |
$847.88
|
| Rate for Payer: BCBS Complete |
$349.64
|
| Rate for Payer: BCBS Trust/PPO |
$720.70
|
| Rate for Payer: BCN Commercial |
$720.70
|
| Rate for Payer: Cash Price |
$699.28
|
| Rate for Payer: Cofinity Commercial |
$821.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.28
|
| Rate for Payer: Healthscope Commercial |
$847.88
|
| Rate for Payer: Healthscope Whirlpool |
$874.10
|
| Rate for Payer: Mclaren Commercial |
$786.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$699.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$742.99
|
| Rate for Payer: Nomi Health Commercial |
$716.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$655.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$765.89
|
| Rate for Payer: Priority Health Narrow Network |
$612.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.21
|
|
|
HC INJECTION PROC RETROGRAD CYSTOGRAPHY
|
Facility
|
IP
|
$874.10
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
36100252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$655.58 |
| Max. Negotiated Rate |
$874.10 |
| Rate for Payer: Aetna Commercial |
$786.69
|
| Rate for Payer: ASR ASR |
$847.88
|
| Rate for Payer: BCBS Trust/PPO |
$717.81
|
| Rate for Payer: BCN Commercial |
$717.81
|
| Rate for Payer: Cash Price |
$699.28
|
| Rate for Payer: Cofinity Commercial |
$821.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.28
|
| Rate for Payer: Healthscope Commercial |
$847.88
|
| Rate for Payer: Healthscope Whirlpool |
$874.10
|
| Rate for Payer: Mclaren Commercial |
$786.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$742.99
|
| Rate for Payer: Nomi Health Commercial |
$716.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$655.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.21
|
|
|
HC INJECTION, PROMETHAZINE HCL, UP TO 50 MG
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
CPT J2550
|
| Hospital Charge Code |
63600100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.30 |
| 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: 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 |
$4.12
|
| Rate for Payer: Priority Health Narrow Network |
$3.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.01
|
|
|
HC INJECTION, PROMETHAZINE HCL, UP TO 50 MG
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
CPT J2550
|
| Hospital Charge Code |
63600100
|
|
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 PUDENDAL NERVE
|
Facility
|
IP
|
$1,217.48
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
36100570
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$913.11 |
| Max. Negotiated Rate |
$1,217.48 |
| Rate for Payer: Aetna Commercial |
$1,095.73
|
| Rate for Payer: ASR ASR |
$1,180.96
|
| Rate for Payer: BCBS Trust/PPO |
$999.79
|
| Rate for Payer: BCN Commercial |
$999.79
|
| Rate for Payer: Cash Price |
$973.98
|
| Rate for Payer: Cofinity Commercial |
$1,144.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$973.98
|
| Rate for Payer: Healthscope Commercial |
$1,180.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,217.48
|
| Rate for Payer: Mclaren Commercial |
$1,095.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,034.86
|
| Rate for Payer: Nomi Health Commercial |
$998.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$913.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,071.38
|
|
|
HC INJECTION PUDENDAL NERVE
|
Facility
|
OP
|
$1,217.48
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
36100570
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$1,366.00 |
| Rate for Payer: Aetna Commercial |
$1,095.73
|
| 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 |
$1,180.96
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,003.81
|
| Rate for Payer: BCN Commercial |
$1,003.81
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$973.98
|
| Rate for Payer: Cash Price |
$973.98
|
| Rate for Payer: Cofinity Commercial |
$1,144.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$973.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,180.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,217.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$881.29
|
| Rate for Payer: Mclaren Commercial |
$1,095.73
|
| 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 |
$1,034.86
|
| Rate for Payer: Nomi Health Commercial |
$998.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$913.11
|
| 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 |
$1,066.76
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Narrow Network |
$853.45
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,071.38
|
| 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 INJECTION SCLEROSING SOL MULTIPLE
|
Facility
|
OP
|
$335.88
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$627.83 |
| Rate for Payer: Aetna Commercial |
$302.29
|
| Rate for Payer: Aetna Medicare |
$405.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: ASR ASR |
$325.80
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$276.93
|
| Rate for Payer: BCN Commercial |
$276.93
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$268.70
|
| Rate for Payer: Cash Price |
$268.70
|
| Rate for Payer: Cofinity Commercial |
$315.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$325.80
|
| Rate for Payer: Healthscope Whirlpool |
$335.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$405.05
|
| Rate for Payer: Mclaren Commercial |
$302.29
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$222.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.50
|
| Rate for Payer: Nomi Health Commercial |
$275.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.91
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$445.56
|
| Rate for Payer: PHP Medicaid |
$217.11
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$294.30
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Narrow Network |
$235.45
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$627.83
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP DNSP |
$405.05
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC INJECTION SCLEROSING SOL MULTIPLE
|
Facility
|
IP
|
$335.88
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.91 |
| Max. Negotiated Rate |
$335.88 |
| Rate for Payer: Aetna Commercial |
$302.29
|
| Rate for Payer: ASR ASR |
$325.80
|
| Rate for Payer: BCBS Trust/PPO |
$275.82
|
| Rate for Payer: BCN Commercial |
$275.82
|
| Rate for Payer: Cash Price |
$268.70
|
| Rate for Payer: Cofinity Commercial |
$315.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.70
|
| Rate for Payer: Healthscope Commercial |
$325.80
|
| Rate for Payer: Healthscope Whirlpool |
$335.88
|
| Rate for Payer: Mclaren Commercial |
$302.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.50
|
| Rate for Payer: Nomi Health Commercial |
$275.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.57
|
|
|
HC INJECTION SCLEROSING SOL SINGLE
|
Facility
|
OP
|
$257.88
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
36100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.77 |
| Max. Negotiated Rate |
$627.83 |
| Rate for Payer: Aetna Commercial |
$232.09
|
| Rate for Payer: Aetna Medicare |
$405.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: ASR ASR |
$250.14
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$212.62
|
| Rate for Payer: BCN Commercial |
$212.62
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$206.30
|
| Rate for Payer: Cash Price |
$206.30
|
| Rate for Payer: Cofinity Commercial |
$242.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$250.14
|
| Rate for Payer: Healthscope Whirlpool |
$257.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$405.05
|
| Rate for Payer: Mclaren Commercial |
$232.09
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$222.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.20
|
| Rate for Payer: Nomi Health Commercial |
$211.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.41
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$445.56
|
| Rate for Payer: PHP Medicaid |
$217.11
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$225.95
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Narrow Network |
$180.77
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$627.83
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP DNSP |
$405.05
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC INJECTION SCLEROSING SOL SINGLE
|
Facility
|
IP
|
$257.88
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
36100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.41 |
| Max. Negotiated Rate |
$257.88 |
| Rate for Payer: Aetna Commercial |
$232.09
|
| Rate for Payer: ASR ASR |
$250.14
|
| Rate for Payer: BCBS Trust/PPO |
$211.77
|
| Rate for Payer: BCN Commercial |
$211.77
|
| Rate for Payer: Cash Price |
$206.30
|
| Rate for Payer: Cofinity Commercial |
$242.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.30
|
| Rate for Payer: Healthscope Commercial |
$250.14
|
| Rate for Payer: Healthscope Whirlpool |
$257.88
|
| Rate for Payer: Mclaren Commercial |
$232.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.20
|
| Rate for Payer: Nomi Health Commercial |
$211.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.93
|
|
|
HC INJECTION SHOULDER ARTHROGRAM
|
Facility
|
OP
|
$880.72
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
36100037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.38 |
| Max. Negotiated Rate |
$880.72 |
| Rate for Payer: Aetna Commercial |
$792.65
|
| Rate for Payer: Aetna Medicare |
$325.87
|
| Rate for Payer: ASR ASR |
$854.30
|
| Rate for Payer: BCBS Complete |
$352.29
|
| Rate for Payer: BCBS Trust/PPO |
$726.15
|
| Rate for Payer: BCN Commercial |
$726.15
|
| Rate for Payer: Cash Price |
$704.58
|
| Rate for Payer: Cash Price |
$704.58
|
| Rate for Payer: Cofinity Commercial |
$827.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$704.58
|
| Rate for Payer: Healthscope Commercial |
$854.30
|
| Rate for Payer: Healthscope Whirlpool |
$880.72
|
| Rate for Payer: Mclaren Commercial |
$792.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$704.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$748.61
|
| Rate for Payer: Nomi Health Commercial |
$722.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$660.54
|
| 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 |
$775.03
|
|
|
HC INJECTION SHOULDER ARTHROGRAM
|
Facility
|
IP
|
$880.72
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
36100037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$660.54 |
| Max. Negotiated Rate |
$880.72 |
| Rate for Payer: Aetna Commercial |
$792.65
|
| Rate for Payer: ASR ASR |
$854.30
|
| Rate for Payer: BCBS Trust/PPO |
$723.25
|
| Rate for Payer: BCN Commercial |
$723.25
|
| Rate for Payer: Cash Price |
$704.58
|
| Rate for Payer: Cofinity Commercial |
$827.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$704.58
|
| Rate for Payer: Healthscope Commercial |
$854.30
|
| Rate for Payer: Healthscope Whirlpool |
$880.72
|
| Rate for Payer: Mclaren Commercial |
$792.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$748.61
|
| Rate for Payer: Nomi Health Commercial |
$722.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$660.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$775.03
|
|
|
HC INJECTION SHUNTOGRAM
|
Facility
|
OP
|
$396.48
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
36100224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$146.70 |
| Max. Negotiated Rate |
$396.48 |
| Rate for Payer: Aetna Commercial |
$356.83
|
| Rate for Payer: Aetna Medicare |
$146.70
|
| Rate for Payer: ASR ASR |
$384.59
|
| Rate for Payer: BCBS Complete |
$158.59
|
| Rate for Payer: BCBS Trust/PPO |
$326.90
|
| Rate for Payer: BCN Commercial |
$326.90
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Commercial |
$372.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$384.59
|
| Rate for Payer: Healthscope Whirlpool |
$396.48
|
| Rate for Payer: Mclaren Commercial |
$356.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Nomi Health Commercial |
$325.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$347.40
|
| Rate for Payer: Priority Health Narrow Network |
$277.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.90
|
|
|
HC INJECTION SHUNTOGRAM
|
Facility
|
IP
|
$396.48
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
36100224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$297.36 |
| Max. Negotiated Rate |
$396.48 |
| Rate for Payer: Aetna Commercial |
$356.83
|
| Rate for Payer: ASR ASR |
$384.59
|
| Rate for Payer: BCBS Trust/PPO |
$325.59
|
| Rate for Payer: BCN Commercial |
$325.59
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Commercial |
$372.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$384.59
|
| Rate for Payer: Healthscope Whirlpool |
$396.48
|
| Rate for Payer: Mclaren Commercial |
$356.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Nomi Health Commercial |
$325.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.90
|
|
|
HC INJECTION SIALOGRAM
|
Facility
|
IP
|
$297.68
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
36100190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$223.26 |
| Max. Negotiated Rate |
$297.68 |
| Rate for Payer: Aetna Commercial |
$267.91
|
| Rate for Payer: ASR ASR |
$288.75
|
| Rate for Payer: BCBS Trust/PPO |
$244.45
|
| Rate for Payer: BCN Commercial |
$244.45
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cofinity Commercial |
$279.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.14
|
| Rate for Payer: Healthscope Commercial |
$288.75
|
| Rate for Payer: Healthscope Whirlpool |
$297.68
|
| Rate for Payer: Mclaren Commercial |
$267.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.03
|
| Rate for Payer: Nomi Health Commercial |
$244.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.96
|
|
|
HC INJECTION SIALOGRAM
|
Facility
|
OP
|
$297.68
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
36100190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.14 |
| Max. Negotiated Rate |
$297.68 |
| Rate for Payer: Aetna Commercial |
$267.91
|
| Rate for Payer: Aetna Medicare |
$110.14
|
| Rate for Payer: ASR ASR |
$288.75
|
| Rate for Payer: BCBS Complete |
$119.07
|
| Rate for Payer: BCBS Trust/PPO |
$245.44
|
| Rate for Payer: BCN Commercial |
$245.44
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cash Price |
$238.14
|
| Rate for Payer: Cofinity Commercial |
$279.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.14
|
| Rate for Payer: Healthscope Commercial |
$288.75
|
| Rate for Payer: Healthscope Whirlpool |
$297.68
|
| Rate for Payer: Mclaren Commercial |
$267.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$238.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.03
|
| Rate for Payer: Nomi Health Commercial |
$244.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$152.53
|
| Rate for Payer: Priority Health Narrow Network |
$122.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.96
|
|
