|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL
|
Facility
|
IP
|
$1,487.35
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,115.51 |
| Max. Negotiated Rate |
$1,487.35 |
| Rate for Payer: Aetna Commercial |
$1,338.62
|
| Rate for Payer: ASR ASR |
$1,442.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,221.41
|
| Rate for Payer: BCN Commercial |
$1,221.41
|
| Rate for Payer: Cash Price |
$1,189.88
|
| Rate for Payer: Cofinity Commercial |
$1,398.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,189.88
|
| Rate for Payer: Healthscope Commercial |
$1,442.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,487.35
|
| Rate for Payer: Mclaren Commercial |
$1,338.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.25
|
| Rate for Payer: Nomi Health Commercial |
$1,219.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,115.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,308.87
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR SINGLE LEVEL
|
Facility
|
OP
|
$1,567.72
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$1,567.72 |
| Rate for Payer: Aetna Commercial |
$1,410.95
|
| 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 |
$1,520.69
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,292.59
|
| Rate for Payer: BCN Commercial |
$1,292.59
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$1,254.18
|
| Rate for Payer: Cash Price |
$1,254.18
|
| Rate for Payer: Cofinity Commercial |
$1,473.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,254.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,520.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,567.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$881.29
|
| Rate for Payer: Mclaren Commercial |
$1,410.95
|
| 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 |
$1,332.56
|
| Rate for Payer: Nomi Health Commercial |
$1,285.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,175.79
|
| 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 |
$1,373.64
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,098.97
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,379.59
|
| 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 TRANSFORAMIN LUMB OR SACR SINGLE LEVEL
|
Facility
|
IP
|
$1,567.72
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,175.79 |
| Max. Negotiated Rate |
$1,567.72 |
| Rate for Payer: Aetna Commercial |
$1,410.95
|
| Rate for Payer: ASR ASR |
$1,520.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,287.41
|
| Rate for Payer: BCN Commercial |
$1,287.41
|
| Rate for Payer: Cash Price |
$1,254.18
|
| Rate for Payer: Cofinity Commercial |
$1,473.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,254.18
|
| Rate for Payer: Healthscope Commercial |
$1,520.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,567.72
|
| Rate for Payer: Mclaren Commercial |
$1,410.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,332.56
|
| Rate for Payer: Nomi Health Commercial |
$1,285.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,175.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,379.59
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SAC SINGLE LEVEL BIL
|
Facility
|
OP
|
$1,208.96
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$1,366.00 |
| Rate for Payer: Aetna Commercial |
$1,088.06
|
| 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 |
$1,172.69
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$996.79
|
| Rate for Payer: BCN Commercial |
$996.79
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$967.17
|
| Rate for Payer: Cash Price |
$967.17
|
| Rate for Payer: Cofinity Commercial |
$1,136.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$967.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,172.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,208.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$881.29
|
| Rate for Payer: Mclaren Commercial |
$1,088.06
|
| 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 |
$1,027.62
|
| Rate for Payer: Nomi Health Commercial |
$991.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$906.72
|
| 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 |
$1,059.29
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Narrow Network |
$847.48
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,063.88
|
| 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 TRANSFORAMIN LUMB OR SAC SINGLE LEVEL BIL
|
Facility
|
IP
|
$1,208.96
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$906.72 |
| Max. Negotiated Rate |
$1,208.96 |
| Rate for Payer: Aetna Commercial |
$1,088.06
|
| Rate for Payer: ASR ASR |
$1,172.69
|
| Rate for Payer: BCBS Trust/PPO |
$992.80
|
| Rate for Payer: BCN Commercial |
$992.80
|
| Rate for Payer: Cash Price |
$967.17
|
| Rate for Payer: Cofinity Commercial |
$1,136.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$967.17
|
| Rate for Payer: Healthscope Commercial |
$1,172.69
|
| Rate for Payer: Healthscope Whirlpool |
$1,208.96
|
| Rate for Payer: Mclaren Commercial |
$1,088.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,027.62
|
| Rate for Payer: Nomi Health Commercial |
$991.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$906.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,063.88
|
|
|
HC INJECTION TURBINATE THERAPEUTIC
|
Facility
|
OP
|
$1,404.54
|
|
|
Service Code
|
CPT 30200
|
| Hospital Charge Code |
76100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.05 |
| Max. Negotiated Rate |
$1,404.54 |
| Rate for Payer: Aetna Commercial |
$1,264.09
|
| Rate for Payer: Aetna Medicare |
$537.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.74
|
| Rate for Payer: ASR ASR |
$1,362.40
|
| Rate for Payer: BCBS Complete |
$295.13
|
| Rate for Payer: BCBS MAPPO |
$537.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,158.04
|
| Rate for Payer: BCN Commercial |
$1,158.04
|
| Rate for Payer: BCN Medicare Advantage |
$537.39
|
| Rate for Payer: Cash Price |
$1,123.63
|
| Rate for Payer: Cash Price |
$1,123.63
|
| Rate for Payer: Cofinity Commercial |
$1,320.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.39
|
| Rate for Payer: Healthscope Commercial |
$1,362.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$537.39
|
| Rate for Payer: Mclaren Commercial |
$1,264.09
|
| Rate for Payer: Mclaren Medicaid |
$537.39
|
| Rate for Payer: Mclaren Medicare |
$537.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.26
|
| Rate for Payer: Meridian Medicaid |
$295.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,193.86
|
| Rate for Payer: Nomi Health Commercial |
$1,151.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,053.40
|
| Rate for Payer: PACE Medicare |
$510.52
|
| Rate for Payer: PACE SWMI |
$537.39
|
| Rate for Payer: PHP Commercial |
$591.13
|
| Rate for Payer: PHP Medicaid |
$288.04
|
| Rate for Payer: PHP Medicare Advantage |
$537.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,230.66
|
| Rate for Payer: Priority Health Medicare |
$537.39
|
| Rate for Payer: Priority Health Narrow Network |
$984.58
|
| Rate for Payer: Railroad Medicare Medicare |
$537.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,236.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$537.39
|
| Rate for Payer: UHC Exchange |
$832.95
|
| Rate for Payer: UHC Medicaid |
$281.05
|
| Rate for Payer: UHCCP DNSP |
$537.39
|
| Rate for Payer: UHCCP Medicaid |
$281.05
|
| Rate for Payer: VA VA |
$537.39
|
|
|
HC INJECTION TURBINATE THERAPEUTIC
|
Facility
|
IP
|
$1,404.54
|
|
|
Service Code
|
CPT 30200
|
| Hospital Charge Code |
76100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,053.40 |
| Max. Negotiated Rate |
$1,404.54 |
| Rate for Payer: Aetna Commercial |
$1,264.09
|
| Rate for Payer: ASR ASR |
$1,362.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,153.41
|
| Rate for Payer: BCN Commercial |
$1,153.41
|
| Rate for Payer: Cash Price |
$1,123.63
|
| Rate for Payer: Cofinity Commercial |
$1,320.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.63
|
| Rate for Payer: Healthscope Commercial |
$1,362.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.54
|
| Rate for Payer: Mclaren Commercial |
$1,264.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,193.86
|
| Rate for Payer: Nomi Health Commercial |
$1,151.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,053.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,236.00
|
|
|
HC INJECTION VENOGRAM
|
Facility
|
OP
|
$595.32
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
36100095
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$220.27 |
| Max. Negotiated Rate |
$595.32 |
| Rate for Payer: Aetna Commercial |
$535.79
|
| Rate for Payer: Aetna Medicare |
$220.27
|
| Rate for Payer: ASR ASR |
$577.46
|
| Rate for Payer: BCBS Complete |
$238.13
|
| Rate for Payer: BCBS Trust/PPO |
$490.84
|
| Rate for Payer: BCN Commercial |
$490.84
|
| Rate for Payer: Cash Price |
$476.26
|
| Rate for Payer: Cofinity Commercial |
$559.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.26
|
| Rate for Payer: Healthscope Commercial |
$577.46
|
| Rate for Payer: Healthscope Whirlpool |
$595.32
|
| Rate for Payer: Mclaren Commercial |
$535.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$476.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.02
|
| Rate for Payer: Nomi Health Commercial |
$488.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$521.62
|
| Rate for Payer: Priority Health Narrow Network |
$417.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.88
|
|
|
HC INJECTION VENOGRAM
|
Facility
|
IP
|
$595.32
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
36100095
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$446.49 |
| Max. Negotiated Rate |
$595.32 |
| Rate for Payer: Aetna Commercial |
$535.79
|
| Rate for Payer: ASR ASR |
$577.46
|
| Rate for Payer: BCBS Trust/PPO |
$488.88
|
| Rate for Payer: BCN Commercial |
$488.88
|
| Rate for Payer: Cash Price |
$476.26
|
| Rate for Payer: Cofinity Commercial |
$559.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.26
|
| Rate for Payer: Healthscope Commercial |
$577.46
|
| Rate for Payer: Healthscope Whirlpool |
$595.32
|
| Rate for Payer: Mclaren Commercial |
$535.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.02
|
| Rate for Payer: Nomi Health Commercial |
$488.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.88
|
|
|
HC INJECTION WRIST ARTHROGRAM
|
Facility
|
IP
|
$1,175.24
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
36100039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$881.43 |
| Max. Negotiated Rate |
$1,175.24 |
| Rate for Payer: Aetna Commercial |
$1,057.72
|
| Rate for Payer: ASR ASR |
$1,139.98
|
| Rate for Payer: BCBS Trust/PPO |
$965.11
|
| Rate for Payer: BCN Commercial |
$965.11
|
| Rate for Payer: Cash Price |
$940.19
|
| Rate for Payer: Cofinity Commercial |
$1,104.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.19
|
| Rate for Payer: Healthscope Commercial |
$1,139.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,175.24
|
| Rate for Payer: Mclaren Commercial |
$1,057.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$998.95
|
| Rate for Payer: Nomi Health Commercial |
$963.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$881.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,034.21
|
|
|
HC INJECTION WRIST ARTHROGRAM
|
Facility
|
OP
|
$1,175.24
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
36100039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$434.84 |
| Max. Negotiated Rate |
$1,175.24 |
| Rate for Payer: Aetna Commercial |
$1,057.72
|
| Rate for Payer: Aetna Medicare |
$434.84
|
| Rate for Payer: ASR ASR |
$1,139.98
|
| Rate for Payer: BCBS Complete |
$470.10
|
| Rate for Payer: BCBS Trust/PPO |
$968.99
|
| Rate for Payer: BCN Commercial |
$968.99
|
| Rate for Payer: Cash Price |
$940.19
|
| Rate for Payer: Cofinity Commercial |
$1,104.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.19
|
| Rate for Payer: Healthscope Commercial |
$1,139.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,175.24
|
| Rate for Payer: Mclaren Commercial |
$1,057.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$940.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$998.95
|
| Rate for Payer: Nomi Health Commercial |
$963.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$881.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,029.75
|
| Rate for Payer: Priority Health Narrow Network |
$823.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,034.21
|
|
|
HC INJECT/IRRIGATE CORPORA CAVERNOSA
|
Facility
|
IP
|
$380.84
|
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$285.63 |
| Max. Negotiated Rate |
$380.84 |
| Rate for Payer: Aetna Commercial |
$342.76
|
| Rate for Payer: ASR ASR |
$369.41
|
| Rate for Payer: BCBS Trust/PPO |
$312.75
|
| Rate for Payer: BCN Commercial |
$312.75
|
| Rate for Payer: Cash Price |
$304.67
|
| Rate for Payer: Cofinity Commercial |
$357.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.67
|
| Rate for Payer: Healthscope Commercial |
$369.41
|
| Rate for Payer: Healthscope Whirlpool |
$380.84
|
| Rate for Payer: Mclaren Commercial |
$342.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.71
|
| Rate for Payer: Nomi Health Commercial |
$312.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.14
|
|
|
HC INJECT/IRRIGATE CORPORA CAVERNOSA
|
Facility
|
OP
|
$380.84
|
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.91 |
| Max. Negotiated Rate |
$380.84 |
| Rate for Payer: Aetna Commercial |
$342.76
|
| Rate for Payer: Aetna Medicare |
$140.91
|
| Rate for Payer: ASR ASR |
$369.41
|
| Rate for Payer: BCBS Complete |
$152.34
|
| Rate for Payer: BCBS Trust/PPO |
$314.00
|
| Rate for Payer: BCN Commercial |
$314.00
|
| Rate for Payer: Cash Price |
$304.67
|
| Rate for Payer: Cofinity Commercial |
$357.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.67
|
| Rate for Payer: Healthscope Commercial |
$369.41
|
| Rate for Payer: Healthscope Whirlpool |
$380.84
|
| Rate for Payer: Mclaren Commercial |
$342.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$304.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.71
|
| Rate for Payer: Nomi Health Commercial |
$312.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$333.69
|
| Rate for Payer: Priority Health Narrow Network |
$266.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.14
|
|
|
HC INJECT PORTAL VEIN
|
Facility
|
OP
|
$2,836.51
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
36100543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,049.51 |
| Max. Negotiated Rate |
$2,836.51 |
| Rate for Payer: Aetna Commercial |
$2,552.86
|
| Rate for Payer: Aetna Medicare |
$1,049.51
|
| Rate for Payer: ASR ASR |
$2,751.41
|
| Rate for Payer: BCBS Complete |
$1,134.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,338.70
|
| Rate for Payer: BCN Commercial |
$2,338.70
|
| Rate for Payer: Cash Price |
$2,269.21
|
| Rate for Payer: Cofinity Commercial |
$2,666.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,269.21
|
| Rate for Payer: Healthscope Commercial |
$2,751.41
|
| Rate for Payer: Healthscope Whirlpool |
$2,836.51
|
| Rate for Payer: Mclaren Commercial |
$2,552.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,269.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,411.03
|
| Rate for Payer: Nomi Health Commercial |
$2,325.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,127.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,485.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,988.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,496.13
|
|
|
HC INJECT PORTAL VEIN
|
Facility
|
IP
|
$2,836.51
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
36100543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,127.38 |
| Max. Negotiated Rate |
$2,836.51 |
| Rate for Payer: Aetna Commercial |
$2,552.86
|
| Rate for Payer: ASR ASR |
$2,751.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,329.34
|
| Rate for Payer: BCN Commercial |
$2,329.34
|
| Rate for Payer: Cash Price |
$2,269.21
|
| Rate for Payer: Cofinity Commercial |
$2,666.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,269.21
|
| Rate for Payer: Healthscope Commercial |
$2,751.41
|
| Rate for Payer: Healthscope Whirlpool |
$2,836.51
|
| Rate for Payer: Mclaren Commercial |
$2,552.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,411.03
|
| Rate for Payer: Nomi Health Commercial |
$2,325.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,127.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,496.13
|
|
|
HC INJECT PROC PENILE PLAQUE
|
Facility
|
IP
|
$368.37
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.28 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$331.53
|
| Rate for Payer: ASR ASR |
$357.32
|
| Rate for Payer: BCBS Trust/PPO |
$302.51
|
| Rate for Payer: BCN Commercial |
$302.51
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cofinity Commercial |
$346.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.70
|
| Rate for Payer: Healthscope Commercial |
$357.32
|
| Rate for Payer: Healthscope Whirlpool |
$368.37
|
| Rate for Payer: Mclaren Commercial |
$331.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.11
|
| Rate for Payer: Nomi Health Commercial |
$302.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$324.17
|
|
|
HC INJECT PROC PENILE PLAQUE
|
Facility
|
OP
|
$368.37
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$385.87 |
| Rate for Payer: Aetna Commercial |
$331.53
|
| Rate for Payer: Aetna Medicare |
$248.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: ASR ASR |
$357.32
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$303.72
|
| Rate for Payer: BCN Commercial |
$303.72
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cofinity Commercial |
$346.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$357.32
|
| Rate for Payer: Healthscope Whirlpool |
$368.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$248.95
|
| Rate for Payer: Mclaren Commercial |
$331.53
|
| Rate for Payer: Mclaren Medicaid |
$248.95
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$136.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.11
|
| Rate for Payer: Nomi Health Commercial |
$302.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.28
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$273.85
|
| Rate for Payer: PHP Medicaid |
$133.44
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$322.77
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health Narrow Network |
$258.23
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$324.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Exchange |
$385.87
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP DNSP |
$248.95
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 1 OR 2 MUSCLES
|
Facility
|
OP
|
$381.62
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
36100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$474.07 |
| Rate for Payer: Aetna Commercial |
$343.46
|
| 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 |
$370.17
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$314.65
|
| Rate for Payer: BCN Commercial |
$314.65
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$305.30
|
| Rate for Payer: Cash Price |
$305.30
|
| Rate for Payer: Cofinity Commercial |
$358.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$370.17
|
| Rate for Payer: Healthscope Whirlpool |
$381.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$343.46
|
| 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 |
$324.38
|
| Rate for Payer: Nomi Health Commercial |
$312.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$286.21
|
| 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 |
$445.48
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$356.39
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.83
|
| 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 INJECT SING OR MULTI TRIGGER PTS 1 OR 2 MUSCLES
|
Facility
|
IP
|
$381.62
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
36100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.21 |
| Max. Negotiated Rate |
$381.62 |
| Rate for Payer: Aetna Commercial |
$343.46
|
| Rate for Payer: ASR ASR |
$370.17
|
| Rate for Payer: BCBS Trust/PPO |
$313.39
|
| Rate for Payer: BCN Commercial |
$313.39
|
| Rate for Payer: Cash Price |
$305.30
|
| Rate for Payer: Cofinity Commercial |
$358.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.30
|
| Rate for Payer: Healthscope Commercial |
$370.17
|
| Rate for Payer: Healthscope Whirlpool |
$381.62
|
| Rate for Payer: Mclaren Commercial |
$343.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.38
|
| Rate for Payer: Nomi Health Commercial |
$312.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$286.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.83
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 3 OR MORE MUSCLES
|
Facility
|
IP
|
$497.42
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
36100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$373.06 |
| Max. Negotiated Rate |
$497.42 |
| Rate for Payer: Aetna Commercial |
$447.68
|
| Rate for Payer: ASR ASR |
$482.50
|
| Rate for Payer: BCBS Trust/PPO |
$408.48
|
| Rate for Payer: BCN Commercial |
$408.48
|
| Rate for Payer: Cash Price |
$397.94
|
| Rate for Payer: Cofinity Commercial |
$467.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.94
|
| Rate for Payer: Healthscope Commercial |
$482.50
|
| Rate for Payer: Healthscope Whirlpool |
$497.42
|
| Rate for Payer: Mclaren Commercial |
$447.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$422.81
|
| Rate for Payer: Nomi Health Commercial |
$407.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$437.73
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 3 OR MORE MUSCLES
|
Facility
|
OP
|
$497.42
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
36100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$497.42 |
| Rate for Payer: Aetna Commercial |
$447.68
|
| 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 |
$482.50
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$410.12
|
| Rate for Payer: BCN Commercial |
$410.12
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$397.94
|
| Rate for Payer: Cash Price |
$397.94
|
| Rate for Payer: Cofinity Commercial |
$467.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$482.50
|
| Rate for Payer: Healthscope Whirlpool |
$497.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$447.68
|
| 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 |
$422.81
|
| Rate for Payer: Nomi Health Commercial |
$407.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.06
|
| 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 |
$435.84
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$348.69
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$437.73
|
| 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 INJ ENOXAPARIN SODIUM PER 10 MG
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63600151
|
|
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 INJ ENOXAPARIN SODIUM PER 10 MG
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63600151
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| 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 |
$0.55
|
| Rate for Payer: Priority Health Narrow Network |
$0.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.01
|
|
|
HC INJ ENZYME PALMAR FASCIAL CORD
|
Facility
|
OP
|
$346.44
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$474.07 |
| Rate for Payer: Aetna Commercial |
$311.80
|
| 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 |
$336.05
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$285.64
|
| Rate for Payer: BCN Commercial |
$285.64
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$277.15
|
| Rate for Payer: Cash Price |
$277.15
|
| Rate for Payer: Cofinity Commercial |
$325.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$336.05
|
| Rate for Payer: Healthscope Whirlpool |
$346.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$311.80
|
| 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 |
$294.47
|
| Rate for Payer: Nomi Health Commercial |
$284.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.83
|
| 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 |
$303.55
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$242.85
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.87
|
| 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 INJ ENZYME PALMAR FASCIAL CORD
|
Facility
|
IP
|
$346.44
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.83 |
| Max. Negotiated Rate |
$346.44 |
| Rate for Payer: Aetna Commercial |
$311.80
|
| Rate for Payer: ASR ASR |
$336.05
|
| Rate for Payer: BCBS Trust/PPO |
$284.50
|
| Rate for Payer: BCN Commercial |
$284.50
|
| Rate for Payer: Cash Price |
$277.15
|
| Rate for Payer: Cofinity Commercial |
$325.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.15
|
| Rate for Payer: Healthscope Commercial |
$336.05
|
| Rate for Payer: Healthscope Whirlpool |
$346.44
|
| Rate for Payer: Mclaren Commercial |
$311.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.47
|
| Rate for Payer: Nomi Health Commercial |
$284.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.87
|
|
