|
HC INJ HEPARIN SODIUM PER 1000U
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600140
|
|
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 INJ HEPARIN SODIUM PER 1000U
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| 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 |
$0.19
|
| Rate for Payer: Priority Health Narrow Network |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.93
|
|
|
HC INJ HYDROCORTISONE NA SUCCINATE, UP TO 100MG
|
Facility
|
IP
|
$43.70
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
63600241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna Commercial |
$39.33
|
| Rate for Payer: ASR ASR |
$42.39
|
| Rate for Payer: BCBS Trust/PPO |
$35.89
|
| Rate for Payer: BCN Commercial |
$35.89
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$41.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$42.39
|
| Rate for Payer: Healthscope Whirlpool |
$43.70
|
| Rate for Payer: Mclaren Commercial |
$39.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Nomi Health Commercial |
$35.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.46
|
|
|
HC INJ HYDROCORTISONE NA SUCCINATE, UP TO 100MG
|
Facility
|
OP
|
$43.70
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
63600241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna Commercial |
$39.33
|
| Rate for Payer: Aetna Medicare |
$16.17
|
| Rate for Payer: ASR ASR |
$42.39
|
| Rate for Payer: BCBS Complete |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$36.03
|
| Rate for Payer: BCN Commercial |
$36.03
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$41.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$42.39
|
| Rate for Payer: Healthscope Whirlpool |
$43.70
|
| Rate for Payer: Mclaren Commercial |
$39.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Nomi Health Commercial |
$35.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.89
|
| Rate for Payer: Priority Health Narrow Network |
$18.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.46
|
|
|
HC INJ KNEE ARTHROGRAM CT/MRI
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
36100562
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$239.76 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$583.20
|
| Rate for Payer: Aetna Medicare |
$239.76
|
| Rate for Payer: ASR ASR |
$628.56
|
| Rate for Payer: BCBS Complete |
$259.20
|
| Rate for Payer: BCBS Trust/PPO |
$534.28
|
| Rate for Payer: BCN Commercial |
$534.28
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cofinity Commercial |
$609.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.40
|
| Rate for Payer: Healthscope Commercial |
$628.56
|
| Rate for Payer: Healthscope Whirlpool |
$648.00
|
| Rate for Payer: Mclaren Commercial |
$583.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$518.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.80
|
| Rate for Payer: Nomi Health Commercial |
$531.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$486.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$436.73
|
| Rate for Payer: Priority Health Narrow Network |
$349.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$570.24
|
|
|
HC INJ KNEE ARTHROGRAM CT/MRI
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
36100562
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$486.00 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$583.20
|
| Rate for Payer: ASR ASR |
$628.56
|
| Rate for Payer: BCBS Trust/PPO |
$532.14
|
| Rate for Payer: BCN Commercial |
$532.14
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cofinity Commercial |
$609.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.40
|
| Rate for Payer: Healthscope Commercial |
$628.56
|
| Rate for Payer: Healthscope Whirlpool |
$648.00
|
| Rate for Payer: Mclaren Commercial |
$583.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.80
|
| Rate for Payer: Nomi Health Commercial |
$531.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$486.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$570.24
|
|
|
HC INJ LIDOCAINE HYDROCHLORIDE 1 MG
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
63600262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna Commercial |
$0.92
|
| Rate for Payer: ASR ASR |
$0.99
|
| Rate for Payer: BCBS Trust/PPO |
$0.84
|
| Rate for Payer: BCN Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$0.99
|
| Rate for Payer: Healthscope Whirlpool |
$1.02
|
| Rate for Payer: Mclaren Commercial |
$0.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.87
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.90
|
|
|
HC INJ LIDOCAINE HYDROCHLORIDE 1 MG
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
63600262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna Commercial |
$0.92
|
| Rate for Payer: Aetna Medicare |
$0.38
|
| Rate for Payer: ASR ASR |
$0.99
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS Trust/PPO |
$0.84
|
| Rate for Payer: BCN Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$0.99
|
| Rate for Payer: Healthscope Whirlpool |
$1.02
|
| Rate for Payer: Mclaren Commercial |
$0.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.87
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.77
|
| 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 |
$0.90
|
|
|
HC INJ LUMB W MYELO 2+REG SAME MD
|
Facility
|
OP
|
$2,201.80
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
36100463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$2,201.80 |
| Rate for Payer: Aetna Commercial |
$1,981.62
|
| Rate for Payer: Aetna Medicare |
$781.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: ASR ASR |
$2,135.75
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,815.38
|
| Rate for Payer: BCN Commercial |
$1,815.38
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,761.44
|
| Rate for Payer: Cash Price |
$1,761.44
|
| Rate for Payer: Cofinity Commercial |
$2,069.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,761.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$2,135.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,201.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$781.10
|
| Rate for Payer: Mclaren Commercial |
$1,981.62
|
| Rate for Payer: Mclaren Medicaid |
$781.10
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$428.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,871.53
|
| Rate for Payer: Nomi Health Commercial |
$1,805.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,651.35
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$859.21
|
| Rate for Payer: PHP Medicaid |
$418.67
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,929.22
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,543.46
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,937.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$1,210.70
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP DNSP |
$781.10
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC INJ LUMB W MYELO 2+REG SAME MD
|
Facility
|
IP
|
$2,201.80
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
36100463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,651.35 |
| Max. Negotiated Rate |
$2,201.80 |
| Rate for Payer: Aetna Commercial |
$1,981.62
|
| Rate for Payer: ASR ASR |
$2,135.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,808.12
|
| Rate for Payer: BCN Commercial |
$1,808.12
|
| Rate for Payer: Cash Price |
$1,761.44
|
| Rate for Payer: Cofinity Commercial |
$2,069.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,761.44
|
| Rate for Payer: Healthscope Commercial |
$2,135.75
|
| Rate for Payer: Healthscope Whirlpool |
$2,201.80
|
| Rate for Payer: Mclaren Commercial |
$1,981.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,871.53
|
| Rate for Payer: Nomi Health Commercial |
$1,805.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,651.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,937.58
|
|
|
HC INJ LUMB W MYELO CERV SAME MD
|
Facility
|
IP
|
$2,248.62
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
36100460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,686.46 |
| Max. Negotiated Rate |
$2,248.62 |
| Rate for Payer: Aetna Commercial |
$2,023.76
|
| Rate for Payer: ASR ASR |
$2,181.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,846.57
|
| Rate for Payer: BCN Commercial |
$1,846.57
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cofinity Commercial |
$2,113.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,798.90
|
| Rate for Payer: Healthscope Commercial |
$2,181.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,248.62
|
| Rate for Payer: Mclaren Commercial |
$2,023.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,911.33
|
| Rate for Payer: Nomi Health Commercial |
$1,843.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,686.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,978.79
|
|
|
HC INJ LUMB W MYELO CERV SAME MD
|
Facility
|
OP
|
$2,248.62
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
36100460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$2,248.62 |
| Rate for Payer: Aetna Commercial |
$2,023.76
|
| Rate for Payer: Aetna Medicare |
$781.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: ASR ASR |
$2,181.16
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,853.99
|
| Rate for Payer: BCN Commercial |
$1,853.99
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cofinity Commercial |
$2,113.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,798.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$2,181.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,248.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$781.10
|
| Rate for Payer: Mclaren Commercial |
$2,023.76
|
| Rate for Payer: Mclaren Medicaid |
$781.10
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$428.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,911.33
|
| Rate for Payer: Nomi Health Commercial |
$1,843.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,686.46
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$859.21
|
| Rate for Payer: PHP Medicaid |
$418.67
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,970.24
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,576.28
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,978.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$1,210.70
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP DNSP |
$781.10
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC INJ LUMB W MYELO LS SAME MD
|
Facility
|
IP
|
$2,248.62
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
36100462
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,686.46 |
| Max. Negotiated Rate |
$2,248.62 |
| Rate for Payer: Aetna Commercial |
$2,023.76
|
| Rate for Payer: ASR ASR |
$2,181.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,846.57
|
| Rate for Payer: BCN Commercial |
$1,846.57
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cofinity Commercial |
$2,113.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,798.90
|
| Rate for Payer: Healthscope Commercial |
$2,181.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,248.62
|
| Rate for Payer: Mclaren Commercial |
$2,023.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,911.33
|
| Rate for Payer: Nomi Health Commercial |
$1,843.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,686.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,978.79
|
|
|
HC INJ LUMB W MYELO LS SAME MD
|
Facility
|
OP
|
$2,248.62
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
36100462
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$2,248.62 |
| Rate for Payer: Aetna Commercial |
$2,023.76
|
| Rate for Payer: Aetna Medicare |
$781.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: ASR ASR |
$2,181.16
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,853.99
|
| Rate for Payer: BCN Commercial |
$1,853.99
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cofinity Commercial |
$2,113.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,798.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$2,181.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,248.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$781.10
|
| Rate for Payer: Mclaren Commercial |
$2,023.76
|
| Rate for Payer: Mclaren Medicaid |
$781.10
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$428.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,911.33
|
| Rate for Payer: Nomi Health Commercial |
$1,843.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,686.46
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$859.21
|
| Rate for Payer: PHP Medicaid |
$418.67
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,970.24
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,576.28
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,978.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$1,210.70
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP DNSP |
$781.10
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC INJ LUMB W MYELO THOR SAME MD
|
Facility
|
IP
|
$2,248.62
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
36100461
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,686.46 |
| Max. Negotiated Rate |
$2,248.62 |
| Rate for Payer: Aetna Commercial |
$2,023.76
|
| Rate for Payer: ASR ASR |
$2,181.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,846.57
|
| Rate for Payer: BCN Commercial |
$1,846.57
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cofinity Commercial |
$2,113.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,798.90
|
| Rate for Payer: Healthscope Commercial |
$2,181.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,248.62
|
| Rate for Payer: Mclaren Commercial |
$2,023.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,911.33
|
| Rate for Payer: Nomi Health Commercial |
$1,843.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,686.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,978.79
|
|
|
HC INJ LUMB W MYELO THOR SAME MD
|
Facility
|
OP
|
$2,248.62
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
36100461
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$2,248.62 |
| Rate for Payer: Aetna Commercial |
$2,023.76
|
| Rate for Payer: Aetna Medicare |
$781.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: ASR ASR |
$2,181.16
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,853.99
|
| Rate for Payer: BCN Commercial |
$1,853.99
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cash Price |
$1,798.90
|
| Rate for Payer: Cofinity Commercial |
$2,113.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,798.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$2,181.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,248.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$781.10
|
| Rate for Payer: Mclaren Commercial |
$2,023.76
|
| Rate for Payer: Mclaren Medicaid |
$781.10
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$428.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,911.33
|
| Rate for Payer: Nomi Health Commercial |
$1,843.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,686.46
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$859.21
|
| Rate for Payer: PHP Medicaid |
$418.67
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,970.24
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,576.28
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,978.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$1,210.70
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP DNSP |
$781.10
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC INJ LYMPHANGIOGRAPHY
|
Facility
|
OP
|
$1,331.27
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
36100445
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$492.57 |
| Max. Negotiated Rate |
$1,331.27 |
| Rate for Payer: Aetna Commercial |
$1,198.14
|
| Rate for Payer: Aetna Medicare |
$492.57
|
| Rate for Payer: ASR ASR |
$1,291.33
|
| Rate for Payer: BCBS Complete |
$532.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,097.63
|
| Rate for Payer: BCN Commercial |
$1,097.63
|
| Rate for Payer: Cash Price |
$1,065.02
|
| Rate for Payer: Cofinity Commercial |
$1,251.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,065.02
|
| Rate for Payer: Healthscope Commercial |
$1,291.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,331.27
|
| Rate for Payer: Mclaren Commercial |
$1,198.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,131.58
|
| Rate for Payer: Nomi Health Commercial |
$1,091.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$998.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,166.46
|
| Rate for Payer: Priority Health Narrow Network |
$933.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,171.52
|
|
|
HC INJ LYMPHANGIOGRAPHY
|
Facility
|
IP
|
$1,331.27
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
36100445
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$998.45 |
| Max. Negotiated Rate |
$1,331.27 |
| Rate for Payer: Aetna Commercial |
$1,198.14
|
| Rate for Payer: ASR ASR |
$1,291.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,093.24
|
| Rate for Payer: BCN Commercial |
$1,093.24
|
| Rate for Payer: Cash Price |
$1,065.02
|
| Rate for Payer: Cofinity Commercial |
$1,251.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,065.02
|
| Rate for Payer: Healthscope Commercial |
$1,291.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,331.27
|
| Rate for Payer: Mclaren Commercial |
$1,198.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,131.58
|
| Rate for Payer: Nomi Health Commercial |
$1,091.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$998.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,171.52
|
|
|
HC INJ, METHYLPREDNISOLONE ACETATE, 1 MG
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
63600239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna Commercial |
$0.48
|
| Rate for Payer: Aetna Medicare |
$0.20
|
| Rate for Payer: ASR ASR |
$0.51
|
| Rate for Payer: BCBS Complete |
$0.21
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: BCN Commercial |
$0.44
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cofinity Commercial |
$0.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.42
|
| Rate for Payer: Healthscope Commercial |
$0.51
|
| Rate for Payer: Healthscope Whirlpool |
$0.53
|
| Rate for Payer: Mclaren Commercial |
$0.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.45
|
| Rate for Payer: Nomi Health Commercial |
$0.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.12
|
| Rate for Payer: Priority Health Narrow Network |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.47
|
|
|
HC INJ, METHYLPREDNISOLONE ACETATE, 1 MG
|
Facility
|
IP
|
$0.53
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
63600239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna Commercial |
$0.48
|
| Rate for Payer: ASR ASR |
$0.51
|
| Rate for Payer: BCBS Trust/PPO |
$0.44
|
| Rate for Payer: BCN Commercial |
$0.44
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cofinity Commercial |
$0.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.42
|
| Rate for Payer: Healthscope Commercial |
$0.51
|
| Rate for Payer: Healthscope Whirlpool |
$0.53
|
| Rate for Payer: Mclaren Commercial |
$0.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.45
|
| Rate for Payer: Nomi Health Commercial |
$0.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.47
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, 5 MG
|
Facility
|
OP
|
$2.65
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
63600240
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: Aetna Medicare |
$0.98
|
| Rate for Payer: ASR ASR |
$2.57
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.18
|
| Rate for Payer: BCN Commercial |
$2.18
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$2.57
|
| Rate for Payer: Healthscope Whirlpool |
$2.65
|
| Rate for Payer: Mclaren Commercial |
$2.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.27
|
| Rate for Payer: Priority Health Narrow Network |
$0.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.33
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, 5 MG
|
Facility
|
IP
|
$2.65
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
63600240
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: ASR ASR |
$2.57
|
| Rate for Payer: BCBS Trust/PPO |
$2.18
|
| Rate for Payer: BCN Commercial |
$2.18
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$2.57
|
| Rate for Payer: Healthscope Whirlpool |
$2.65
|
| Rate for Payer: Mclaren Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.33
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 125MG
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
63600102
|
|
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 INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 125MG
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
63600102
|
|
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 INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 40MG
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
63600101
|
|
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
|
|
