|
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
|
|
|
HC INJ NERV BLOCK GREAT OCCIPTL
|
Facility
|
IP
|
$269.67
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
36100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.25 |
| Max. Negotiated Rate |
$269.67 |
| Rate for Payer: Aetna Commercial |
$242.70
|
| Rate for Payer: Aetna Commercial |
$364.05
|
| Rate for Payer: ASR ASR |
$261.58
|
| Rate for Payer: ASR ASR |
$392.37
|
| Rate for Payer: BCBS Trust/PPO |
$221.45
|
| Rate for Payer: BCBS Trust/PPO |
$332.18
|
| Rate for Payer: BCN Commercial |
$221.45
|
| Rate for Payer: BCN Commercial |
$332.18
|
| Rate for Payer: Cash Price |
$323.60
|
| Rate for Payer: Cash Price |
$215.74
|
| Rate for Payer: Cofinity Commercial |
$380.23
|
| Rate for Payer: Cofinity Commercial |
$253.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.60
|
| Rate for Payer: Healthscope Commercial |
$261.58
|
| Rate for Payer: Healthscope Commercial |
$392.37
|
| Rate for Payer: Healthscope Whirlpool |
$404.50
|
| Rate for Payer: Healthscope Whirlpool |
$269.67
|
| Rate for Payer: Mclaren Commercial |
$364.05
|
| Rate for Payer: Mclaren Commercial |
$242.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.22
|
| Rate for Payer: Nomi Health Commercial |
$331.69
|
| Rate for Payer: Nomi Health Commercial |
$221.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.31
|
|
|
HC INJ NERV BLOCK GREAT OCCIPTL
|
Facility
|
OP
|
$269.67
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
36100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$474.07 |
| Rate for Payer: Aetna Commercial |
$242.70
|
| Rate for Payer: Aetna Commercial |
$364.05
|
| Rate for Payer: Aetna Medicare |
$305.85
|
| Rate for Payer: Aetna Medicare |
$305.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: ASR ASR |
$392.37
|
| Rate for Payer: ASR ASR |
$261.58
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$333.51
|
| Rate for Payer: BCBS Trust/PPO |
$222.34
|
| Rate for Payer: BCN Commercial |
$222.34
|
| Rate for Payer: BCN Commercial |
$333.51
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$215.74
|
| Rate for Payer: Cash Price |
$215.74
|
| Rate for Payer: Cash Price |
$323.60
|
| Rate for Payer: Cash Price |
$323.60
|
| Rate for Payer: Cofinity Commercial |
$253.49
|
| Rate for Payer: Cofinity Commercial |
$380.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$261.58
|
| Rate for Payer: Healthscope Commercial |
$392.37
|
| Rate for Payer: Healthscope Whirlpool |
$404.50
|
| Rate for Payer: Healthscope Whirlpool |
$269.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$364.05
|
| Rate for Payer: Mclaren Commercial |
$242.70
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$167.97
|
| Rate for Payer: Meridian Medicaid |
$167.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.22
|
| Rate for Payer: Nomi Health Commercial |
$221.13
|
| Rate for Payer: Nomi Health Commercial |
$331.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.25
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$336.44
|
| Rate for Payer: PHP Commercial |
$336.44
|
| Rate for Payer: PHP Medicaid |
$163.94
|
| Rate for Payer: PHP Medicaid |
$163.94
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$236.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$354.42
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$189.04
|
| Rate for Payer: Priority Health Narrow Network |
$283.55
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$474.07
|
| Rate for Payer: UHC Exchange |
$474.07
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP DNSP |
$305.85
|
| Rate for Payer: UHCCP DNSP |
$305.85
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC INJ ONABOTULINUMTOXINA PER 1 UNIT
|
Facility
|
OP
|
$8.32
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$10.09 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Medicare |
$6.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.14
|
| Rate for Payer: ASR ASR |
$8.07
|
| Rate for Payer: BCBS Complete |
$3.58
|
| Rate for Payer: BCBS MAPPO |
$6.51
|
| Rate for Payer: BCBS Trust/PPO |
$6.86
|
| Rate for Payer: BCN Commercial |
$6.86
|
| Rate for Payer: BCN Medicare Advantage |
$6.51
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$7.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.51
|
| Rate for Payer: Healthscope Commercial |
$8.07
|
| Rate for Payer: Healthscope Whirlpool |
$8.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.51
|
| Rate for Payer: Mclaren Commercial |
$7.49
|
| Rate for Payer: Mclaren Medicaid |
$6.51
|
| Rate for Payer: Mclaren Medicare |
$6.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.84
|
| Rate for Payer: Meridian Medicaid |
$3.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.07
|
| Rate for Payer: Nomi Health Commercial |
$6.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.24
|
| Rate for Payer: PACE Medicare |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.51
|
| Rate for Payer: PHP Commercial |
$7.16
|
| Rate for Payer: PHP Medicaid |
$3.49
|
| Rate for Payer: PHP Medicare Advantage |
$6.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.76
|
| Rate for Payer: Priority Health Medicare |
$6.51
|
| Rate for Payer: Priority Health Narrow Network |
$5.41
|
| Rate for Payer: Railroad Medicare Medicare |
$6.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.51
|
| Rate for Payer: UHC Exchange |
$10.09
|
| Rate for Payer: UHC Medicaid |
$3.40
|
| Rate for Payer: UHCCP DNSP |
$6.51
|
| Rate for Payer: UHCCP Medicaid |
$3.40
|
| Rate for Payer: VA VA |
$6.51
|
|
|
HC INJ ONABOTULINUMTOXINA PER 1 UNIT
|
Facility
|
IP
|
$8.32
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: ASR ASR |
$8.07
|
| Rate for Payer: BCBS Trust/PPO |
$6.83
|
| Rate for Payer: BCN Commercial |
$6.83
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$7.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Healthscope Commercial |
$8.07
|
| Rate for Payer: Healthscope Whirlpool |
$8.32
|
| Rate for Payer: Mclaren Commercial |
$7.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.07
|
| Rate for Payer: Nomi Health Commercial |
$6.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.32
|
|
|
HC INJ PEN G BENZATHINE/PROCAINE 100,000 UNITS
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
63600271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Medicare |
$19.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.40
|
| Rate for Payer: ASR ASR |
$58.20
|
| Rate for Payer: BCBS Complete |
$10.72
|
| Rate for Payer: BCBS MAPPO |
$19.52
|
| Rate for Payer: BCBS Trust/PPO |
$49.47
|
| Rate for Payer: BCN Commercial |
$49.47
|
| Rate for Payer: BCN Medicare Advantage |
$19.52
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$56.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.52
|
| Rate for Payer: Healthscope Commercial |
$58.20
|
| Rate for Payer: Healthscope Whirlpool |
$60.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.52
|
| Rate for Payer: Mclaren Commercial |
$54.00
|
| Rate for Payer: Mclaren Medicaid |
$19.52
|
| Rate for Payer: Mclaren Medicare |
$19.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.50
|
| Rate for Payer: Meridian Medicaid |
$10.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.00
|
| Rate for Payer: Nomi Health Commercial |
$49.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.00
|
| Rate for Payer: PACE Medicare |
$18.54
|
| Rate for Payer: PACE SWMI |
$19.52
|
| Rate for Payer: PHP Commercial |
$21.47
|
| Rate for Payer: PHP Medicaid |
$10.46
|
| Rate for Payer: PHP Medicare Advantage |
$19.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.26
|
| Rate for Payer: Priority Health Medicare |
$19.52
|
| Rate for Payer: Priority Health Narrow Network |
$16.21
|
| Rate for Payer: Railroad Medicare Medicare |
$19.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19.52
|
| Rate for Payer: UHC Exchange |
$30.26
|
| Rate for Payer: UHC Medicaid |
$10.21
|
| Rate for Payer: UHCCP DNSP |
$19.52
|
| Rate for Payer: UHCCP Medicaid |
$10.21
|
| Rate for Payer: VA VA |
$19.52
|
|
|
HC INJ PEN G BENZATHINE/PROCAINE 100,000 UNITS
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
63600271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: ASR ASR |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$49.27
|
| Rate for Payer: BCN Commercial |
$49.27
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$56.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$58.20
|
| Rate for Payer: Healthscope Whirlpool |
$60.00
|
| Rate for Payer: Mclaren Commercial |
$54.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.00
|
| Rate for Payer: Nomi Health Commercial |
$49.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.80
|
|
|
HC INJ, PENICILLIN G BENZATHINE, 100,000 UNITS
|
Facility
|
OP
|
$17.52
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.14 |
| Max. Negotiated Rate |
$48.78 |
| Rate for Payer: Aetna Commercial |
$15.77
|
| Rate for Payer: Aetna Medicare |
$31.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.34
|
| Rate for Payer: ASR ASR |
$16.99
|
| Rate for Payer: BCBS Complete |
$17.28
|
| Rate for Payer: BCBS MAPPO |
$31.47
|
| Rate for Payer: BCBS Trust/PPO |
$14.45
|
| Rate for Payer: BCN Commercial |
$14.45
|
| Rate for Payer: BCN Medicare Advantage |
$31.47
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$16.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$16.99
|
| Rate for Payer: Healthscope Whirlpool |
$17.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$31.47
|
| Rate for Payer: Mclaren Commercial |
$15.77
|
| Rate for Payer: Mclaren Medicaid |
$31.47
|
| Rate for Payer: Mclaren Medicare |
$31.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.04
|
| Rate for Payer: Meridian Medicaid |
$17.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.89
|
| Rate for Payer: Nomi Health Commercial |
$14.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.14
|
| Rate for Payer: PACE Medicare |
$29.90
|
| Rate for Payer: PACE SWMI |
$31.47
|
| Rate for Payer: PHP Commercial |
$34.62
|
| Rate for Payer: PHP Medicaid |
$16.87
|
| Rate for Payer: PHP Medicare Advantage |
$31.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$33.17
|
| Rate for Payer: Priority Health Medicare |
$31.47
|
| Rate for Payer: Priority Health Narrow Network |
$26.54
|
| Rate for Payer: Railroad Medicare Medicare |
$31.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.47
|
| Rate for Payer: UHC Exchange |
$48.78
|
| Rate for Payer: UHC Medicaid |
$16.46
|
| Rate for Payer: UHCCP DNSP |
$31.47
|
| Rate for Payer: UHCCP Medicaid |
$16.46
|
| Rate for Payer: VA VA |
$31.47
|
|
|
HC INJ, PENICILLIN G BENZATHINE, 100,000 UNITS
|
Facility
|
IP
|
$17.52
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.14 |
| Max. Negotiated Rate |
$17.52 |
| Rate for Payer: Aetna Commercial |
$15.77
|
| Rate for Payer: ASR ASR |
$16.99
|
| Rate for Payer: BCBS Trust/PPO |
$14.39
|
| Rate for Payer: BCN Commercial |
$14.39
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$16.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.02
|
| Rate for Payer: Healthscope Commercial |
$16.99
|
| Rate for Payer: Healthscope Whirlpool |
$17.52
|
| Rate for Payer: Mclaren Commercial |
$15.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.89
|
| Rate for Payer: Nomi Health Commercial |
$14.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.42
|
|
|
HC INJ PROCHLORPERAZINE UP TO 10 MG
|
Facility
|
OP
|
$79.78
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
63600246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$79.78 |
| Rate for Payer: Aetna Commercial |
$71.80
|
| Rate for Payer: Aetna Medicare |
$29.52
|
| Rate for Payer: ASR ASR |
$77.39
|
| Rate for Payer: BCBS Complete |
$31.91
|
| Rate for Payer: BCBS Trust/PPO |
$65.78
|
| Rate for Payer: BCN Commercial |
$65.78
|
| Rate for Payer: Cash Price |
$63.82
|
| Rate for Payer: Cash Price |
$63.82
|
| Rate for Payer: Cofinity Commercial |
$74.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.82
|
| Rate for Payer: Healthscope Commercial |
$77.39
|
| Rate for Payer: Healthscope Whirlpool |
$79.78
|
| Rate for Payer: Mclaren Commercial |
$71.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.81
|
| Rate for Payer: Nomi Health Commercial |
$65.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.62
|
| Rate for Payer: Priority Health Narrow Network |
$2.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.21
|
|
|
HC INJ PROCHLORPERAZINE UP TO 10 MG
|
Facility
|
IP
|
$79.78
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
63600246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.84 |
| Max. Negotiated Rate |
$79.78 |
| Rate for Payer: Aetna Commercial |
$71.80
|
| Rate for Payer: ASR ASR |
$77.39
|
| Rate for Payer: BCBS Trust/PPO |
$65.52
|
| Rate for Payer: BCN Commercial |
$65.52
|
| Rate for Payer: Cash Price |
$63.82
|
| Rate for Payer: Cofinity Commercial |
$74.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.82
|
| Rate for Payer: Healthscope Commercial |
$77.39
|
| Rate for Payer: Healthscope Whirlpool |
$79.78
|
| Rate for Payer: Mclaren Commercial |
$71.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.81
|
| Rate for Payer: Nomi Health Commercial |
$65.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.21
|
|
|
HC INJ SELECT R VENT/ATRIAL ANGIO HRT CATH
|
Facility
|
IP
|
$697.21
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
36000110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$522.91 |
| Max. Negotiated Rate |
$697.21 |
| Rate for Payer: Aetna Commercial |
$627.49
|
| Rate for Payer: ASR ASR |
$676.29
|
| Rate for Payer: BCBS Trust/PPO |
$572.55
|
| Rate for Payer: BCN Commercial |
$572.55
|
| Rate for Payer: Cash Price |
$557.77
|
| Rate for Payer: Cofinity Commercial |
$655.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.77
|
| Rate for Payer: Healthscope Commercial |
$676.29
|
| Rate for Payer: Healthscope Whirlpool |
$697.21
|
| Rate for Payer: Mclaren Commercial |
$627.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.63
|
| Rate for Payer: Nomi Health Commercial |
$571.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$522.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$613.54
|
|
|
HC INJ SELECT R VENT/ATRIAL ANGIO HRT CATH
|
Facility
|
OP
|
$697.21
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
36000110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$257.97 |
| Max. Negotiated Rate |
$697.21 |
| Rate for Payer: Aetna Commercial |
$627.49
|
| Rate for Payer: Aetna Medicare |
$257.97
|
| Rate for Payer: ASR ASR |
$676.29
|
| Rate for Payer: BCBS Complete |
$278.88
|
| Rate for Payer: BCBS Trust/PPO |
$574.85
|
| Rate for Payer: BCN Commercial |
$574.85
|
| Rate for Payer: Cash Price |
$557.77
|
| Rate for Payer: Cofinity Commercial |
$655.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.77
|
| Rate for Payer: Healthscope Commercial |
$676.29
|
| Rate for Payer: Healthscope Whirlpool |
$697.21
|
| Rate for Payer: Mclaren Commercial |
$627.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$557.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.63
|
| Rate for Payer: Nomi Health Commercial |
$571.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$522.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$610.90
|
| Rate for Payer: Priority Health Narrow Network |
$488.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$613.54
|
|
|
HC INJ TIXAGEVIMAB AND CILGAVIMAB
|
Facility
|
IP
|
$212.24
|
|
|
Service Code
|
HCPCS M0220
|
| Hospital Charge Code |
77100033
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$159.18 |
| Max. Negotiated Rate |
$212.24 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: ASR ASR |
$205.87
|
| Rate for Payer: BCBS Trust/PPO |
$174.29
|
| Rate for Payer: BCN Commercial |
$174.29
|
| Rate for Payer: Cash Price |
$169.79
|
| Rate for Payer: Cofinity Commercial |
$199.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.79
|
| Rate for Payer: Healthscope Commercial |
$205.87
|
| Rate for Payer: Healthscope Whirlpool |
$212.24
|
| Rate for Payer: Mclaren Commercial |
$191.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.40
|
| Rate for Payer: Nomi Health Commercial |
$174.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.77
|
|
|
HC INJ TIXAGEVIMAB AND CILGAVIMAB
|
Facility
|
OP
|
$212.24
|
|
|
Service Code
|
HCPCS M0220
|
| Hospital Charge Code |
77100033
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$78.53 |
| Max. Negotiated Rate |
$212.24 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: Aetna Medicare |
$78.53
|
| Rate for Payer: ASR ASR |
$205.87
|
| Rate for Payer: BCBS Complete |
$84.90
|
| Rate for Payer: BCBS Trust/PPO |
$174.99
|
| Rate for Payer: BCN Commercial |
$174.99
|
| Rate for Payer: Cash Price |
$169.79
|
| Rate for Payer: Cofinity Commercial |
$199.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.79
|
| Rate for Payer: Healthscope Commercial |
$205.87
|
| Rate for Payer: Healthscope Whirlpool |
$212.24
|
| Rate for Payer: Mclaren Commercial |
$191.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.40
|
| Rate for Payer: Nomi Health Commercial |
$174.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$185.96
|
| Rate for Payer: Priority Health Narrow Network |
$148.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.77
|
|
|
HC INJ, TRIAMCINOLONE ACETONIDE, NOT SPECIFIED, 10 MG
|
Facility
|
OP
|
$10.61
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
63600103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Aetna Commercial |
$9.55
|
| Rate for Payer: Aetna Medicare |
$3.93
|
| Rate for Payer: ASR ASR |
$10.29
|
| Rate for Payer: BCBS Complete |
$4.24
|
| Rate for Payer: BCBS Trust/PPO |
$8.75
|
| Rate for Payer: BCN Commercial |
$8.75
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cofinity Commercial |
$9.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$10.29
|
| Rate for Payer: Healthscope Whirlpool |
$10.61
|
| Rate for Payer: Mclaren Commercial |
$9.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.02
|
| Rate for Payer: Nomi Health Commercial |
$8.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.77
|
| Rate for Payer: Priority Health Narrow Network |
$0.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.34
|
|
|
HC INJ, TRIAMCINOLONE ACETONIDE, NOT SPECIFIED, 10 MG
|
Facility
|
IP
|
$10.61
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
63600103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Aetna Commercial |
$9.55
|
| Rate for Payer: ASR ASR |
$10.29
|
| Rate for Payer: BCBS Trust/PPO |
$8.71
|
| Rate for Payer: BCN Commercial |
$8.71
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cofinity Commercial |
$9.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$10.29
|
| Rate for Payer: Healthscope Whirlpool |
$10.61
|
| Rate for Payer: Mclaren Commercial |
$9.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.02
|
| Rate for Payer: Nomi Health Commercial |
$8.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.34
|
|
|
HC INJ, VIT B12 CYANCOBALAMIN, UP TO 1000MCG
|
Facility
|
OP
|
$5.30
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
63600104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: Aetna Commercial |
$4.77
|
| Rate for Payer: Aetna Medicare |
$1.96
|
| Rate for Payer: ASR ASR |
$5.14
|
| Rate for Payer: BCBS Complete |
$2.12
|
| Rate for Payer: BCBS Trust/PPO |
$4.37
|
| Rate for Payer: BCN Commercial |
$4.37
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Cofinity Commercial |
$4.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.24
|
| Rate for Payer: Healthscope Commercial |
$5.14
|
| Rate for Payer: Healthscope Whirlpool |
$5.30
|
| Rate for Payer: Mclaren Commercial |
$4.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.50
|
| Rate for Payer: Nomi Health Commercial |
$4.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.66
|
| Rate for Payer: Priority Health Narrow Network |
$0.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.66
|
|
|
HC INJ, VIT B12 CYANCOBALAMIN, UP TO 1000MCG
|
Facility
|
IP
|
$5.30
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
63600104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: Aetna Commercial |
$4.77
|
| Rate for Payer: ASR ASR |
$5.14
|
| Rate for Payer: BCBS Trust/PPO |
$4.35
|
| Rate for Payer: BCN Commercial |
$4.35
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Cofinity Commercial |
$4.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.24
|
| Rate for Payer: Healthscope Commercial |
$5.14
|
| Rate for Payer: Healthscope Whirlpool |
$5.30
|
| Rate for Payer: Mclaren Commercial |
$4.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.50
|
| Rate for Payer: Nomi Health Commercial |
$4.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.66
|
|
|
HC INSECT VENOM ALLERGY PANEL
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC INSECT VENOM ALLERGY PANEL
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC INSERT CATH COMPLICATED
|
Facility
|
IP
|
$510.33
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
45000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.75 |
| Max. Negotiated Rate |
$510.33 |
| Rate for Payer: Aetna Commercial |
$459.30
|
| Rate for Payer: ASR ASR |
$495.02
|
| Rate for Payer: BCBS Trust/PPO |
$419.08
|
| Rate for Payer: BCN Commercial |
$419.08
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cofinity Commercial |
$479.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.26
|
| Rate for Payer: Healthscope Commercial |
$495.02
|
| Rate for Payer: Healthscope Whirlpool |
$510.33
|
| Rate for Payer: Mclaren Commercial |
$459.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.78
|
| Rate for Payer: Nomi Health Commercial |
$418.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.09
|
|
|
HC INSERT CATH COMPLICATED
|
Facility
|
OP
|
$510.33
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
45000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$510.33 |
| Rate for Payer: Aetna Commercial |
$459.30
|
| Rate for Payer: Aetna Medicare |
$128.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: ASR ASR |
$495.02
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$420.77
|
| Rate for Payer: BCN Commercial |
$420.77
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cofinity Commercial |
$479.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$495.02
|
| Rate for Payer: Healthscope Whirlpool |
$510.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$128.21
|
| Rate for Payer: Mclaren Commercial |
$459.30
|
| Rate for Payer: Mclaren Medicaid |
$128.21
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$70.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.78
|
| Rate for Payer: Nomi Health Commercial |
$418.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.75
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$141.03
|
| Rate for Payer: PHP Medicaid |
$68.72
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$447.15
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health Narrow Network |
$357.74
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$198.73
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP DNSP |
$128.21
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: VA VA |
$128.21
|
|
|
HC INSERT CERVICAL DILATOR
|
Facility
|
IP
|
$431.70
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
36100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.77 |
| Max. Negotiated Rate |
$431.70 |
| Rate for Payer: Aetna Commercial |
$388.53
|
| Rate for Payer: ASR ASR |
$418.75
|
| Rate for Payer: BCBS Trust/PPO |
$354.51
|
| Rate for Payer: BCN Commercial |
$354.51
|
| Rate for Payer: Cash Price |
$345.36
|
| Rate for Payer: Cofinity Commercial |
$405.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.36
|
| Rate for Payer: Healthscope Commercial |
$418.75
|
| Rate for Payer: Healthscope Whirlpool |
$431.70
|
| Rate for Payer: Mclaren Commercial |
$388.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.94
|
| Rate for Payer: Nomi Health Commercial |
$353.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$379.90
|
|
|
HC INSERT CERVICAL DILATOR
|
Facility
|
OP
|
$431.70
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
36100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$470.63 |
| Rate for Payer: Aetna Commercial |
$388.53
|
| Rate for Payer: Aetna Medicare |
$303.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.54
|
| Rate for Payer: ASR ASR |
$418.75
|
| Rate for Payer: BCBS Complete |
$166.75
|
| Rate for Payer: BCBS MAPPO |
$303.63
|
| Rate for Payer: BCBS Trust/PPO |
$355.94
|
| Rate for Payer: BCN Commercial |
$355.94
|
| Rate for Payer: BCN Medicare Advantage |
$303.63
|
| Rate for Payer: Cash Price |
$345.36
|
| Rate for Payer: Cash Price |
$345.36
|
| Rate for Payer: Cofinity Commercial |
$405.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.63
|
| Rate for Payer: Healthscope Commercial |
$418.75
|
| Rate for Payer: Healthscope Whirlpool |
$431.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$303.63
|
| Rate for Payer: Mclaren Commercial |
$388.53
|
| Rate for Payer: Mclaren Medicaid |
$303.63
|
| Rate for Payer: Mclaren Medicare |
$303.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.81
|
| Rate for Payer: Meridian Medicaid |
$166.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.94
|
| Rate for Payer: Nomi Health Commercial |
$353.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.77
|
| Rate for Payer: PACE Medicare |
$288.45
|
| Rate for Payer: PACE SWMI |
$303.63
|
| Rate for Payer: PHP Commercial |
$333.99
|
| Rate for Payer: PHP Medicaid |
$162.75
|
| Rate for Payer: PHP Medicare Advantage |
$303.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$272.38
|
| Rate for Payer: Priority Health Medicare |
$303.63
|
| Rate for Payer: Priority Health Narrow Network |
$217.90
|
| Rate for Payer: Railroad Medicare Medicare |
$303.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$379.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.63
|
| Rate for Payer: UHC Exchange |
$470.63
|
| Rate for Payer: UHC Medicaid |
$158.80
|
| Rate for Payer: UHCCP DNSP |
$303.63
|
| Rate for Payer: UHCCP Medicaid |
$158.80
|
| Rate for Payer: VA VA |
$303.63
|
|
