|
HC INJ ANESTH/STEROID BRACHIAL PLEXUS CONT
|
Facility
|
IP
|
$3,172.12
|
|
|
Service Code
|
CPT 64416
|
| Hospital Charge Code |
37100010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2,061.88 |
| Max. Negotiated Rate |
$3,172.12 |
| Rate for Payer: Aetna Commercial |
$2,854.91
|
| Rate for Payer: ASR ASR |
$3,076.96
|
| Rate for Payer: ASR Commercial |
$3,076.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,584.96
|
| Rate for Payer: BCN Commercial |
$2,459.34
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cofinity Commercial |
$2,981.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,537.70
|
| Rate for Payer: Healthscope Commercial |
$3,172.12
|
| Rate for Payer: Healthscope Whirlpool |
$3,076.96
|
| Rate for Payer: Mclaren Commercial |
$2,854.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,696.30
|
| Rate for Payer: Nomi Health Commercial |
$2,601.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,791.47
|
|
|
HC INJ ANESTH/STEROID SCIATIC NERVE CONT
|
Facility
|
IP
|
$3,180.56
|
|
|
Service Code
|
CPT 64446
|
| Hospital Charge Code |
37000020
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2,067.36 |
| Max. Negotiated Rate |
$3,180.56 |
| Rate for Payer: Aetna Commercial |
$2,862.50
|
| Rate for Payer: ASR ASR |
$3,085.14
|
| Rate for Payer: ASR Commercial |
$3,085.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,591.84
|
| Rate for Payer: BCN Commercial |
$2,465.89
|
| Rate for Payer: Cash Price |
$2,544.45
|
| Rate for Payer: Cofinity Commercial |
$2,989.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,544.45
|
| Rate for Payer: Healthscope Commercial |
$3,180.56
|
| Rate for Payer: Healthscope Whirlpool |
$3,085.14
|
| Rate for Payer: Mclaren Commercial |
$2,862.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,703.48
|
| Rate for Payer: Nomi Health Commercial |
$2,608.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,067.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,798.89
|
|
|
HC INJ ANESTH/STEROID SCIATIC NERVE CONT
|
Facility
|
OP
|
$3,180.56
|
|
|
Service Code
|
CPT 64446
|
| Hospital Charge Code |
37000020
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$467.55 |
| Max. Negotiated Rate |
$3,180.56 |
| Rate for Payer: Aetna Commercial |
$2,862.50
|
| Rate for Payer: Aetna Medicare |
$872.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: ASR ASR |
$3,085.14
|
| Rate for Payer: ASR Commercial |
$3,085.14
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,604.56
|
| Rate for Payer: BCN Commercial |
$2,465.89
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$2,544.45
|
| Rate for Payer: Cash Price |
$2,544.45
|
| Rate for Payer: Cofinity Commercial |
$2,989.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,544.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$3,180.56
|
| Rate for Payer: Healthscope Whirlpool |
$3,085.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$872.29
|
| Rate for Payer: Mclaren Commercial |
$2,862.50
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,703.48
|
| Rate for Payer: Nomi Health Commercial |
$2,608.06
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$959.52
|
| Rate for Payer: PHP Medicaid |
$467.55
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,067.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,084.03
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,667.22
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,798.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,352.05
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP DNSP |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$467.55
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJ ANEST/STEROID ILIOING ILIOHYPOGAST NRV
|
Facility
|
IP
|
$975.46
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
76100270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$634.05 |
| Max. Negotiated Rate |
$975.46 |
| Rate for Payer: Aetna Commercial |
$877.91
|
| Rate for Payer: ASR ASR |
$946.20
|
| Rate for Payer: ASR Commercial |
$946.20
|
| Rate for Payer: BCBS Trust/PPO |
$794.90
|
| Rate for Payer: BCN Commercial |
$756.27
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cofinity Commercial |
$916.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.37
|
| Rate for Payer: Healthscope Commercial |
$975.46
|
| Rate for Payer: Healthscope Whirlpool |
$946.20
|
| Rate for Payer: Mclaren Commercial |
$877.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.14
|
| Rate for Payer: Nomi Health Commercial |
$799.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$858.40
|
|
|
HC INJ ANEST/STEROID ILIOING ILIOHYPOGAST NRV
|
Facility
|
OP
|
$975.46
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
76100270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.69 |
| Max. Negotiated Rate |
$1,051.71 |
| Rate for Payer: Aetna Commercial |
$877.91
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$946.20
|
| Rate for Payer: ASR Commercial |
$946.20
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$798.80
|
| Rate for Payer: BCN Commercial |
$756.27
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cofinity Commercial |
$916.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$975.46
|
| Rate for Payer: Healthscope Whirlpool |
$946.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Commercial |
$877.91
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.14
|
| Rate for Payer: Nomi Health Commercial |
$799.88
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$854.70
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$683.80
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$858.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC INJ BEBTELOVIMAB
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
77100034
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$184.07 |
| Max. Negotiated Rate |
$532.29 |
| Rate for Payer: Aetna Commercial |
$436.50
|
| Rate for Payer: Aetna Medicare |
$343.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$429.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$429.26
|
| Rate for Payer: ASR ASR |
$470.45
|
| Rate for Payer: ASR Commercial |
$470.45
|
| Rate for Payer: BCBS Complete |
$193.27
|
| Rate for Payer: BCBS MAPPO |
$343.41
|
| Rate for Payer: BCBS Trust/PPO |
$397.17
|
| Rate for Payer: BCN Commercial |
$376.02
|
| Rate for Payer: BCN Medicare Advantage |
$343.41
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$455.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$343.41
|
| Rate for Payer: Healthscope Commercial |
$485.00
|
| Rate for Payer: Healthscope Whirlpool |
$470.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$343.41
|
| Rate for Payer: Mclaren Commercial |
$436.50
|
| Rate for Payer: Mclaren Medicaid |
$184.07
|
| Rate for Payer: Mclaren Medicare |
$343.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$360.58
|
| Rate for Payer: Meridian Medicaid |
$193.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$394.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.25
|
| Rate for Payer: Nomi Health Commercial |
$397.70
|
| Rate for Payer: PACE Medicare |
$326.24
|
| Rate for Payer: PACE SWMI |
$343.41
|
| Rate for Payer: PHP Commercial |
$377.75
|
| Rate for Payer: PHP Medicaid |
$184.07
|
| Rate for Payer: PHP Medicare Advantage |
$343.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$184.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$424.96
|
| Rate for Payer: Priority Health Medicare |
$343.41
|
| Rate for Payer: Priority Health Narrow Network |
$339.98
|
| Rate for Payer: Railroad Medicare Medicare |
$343.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$343.41
|
| Rate for Payer: UHC Exchange |
$532.29
|
| Rate for Payer: UHC Medicare Advantage |
$343.41
|
| Rate for Payer: UHCCP DNSP |
$343.41
|
| Rate for Payer: UHCCP Medicaid |
$184.07
|
| Rate for Payer: VA VA |
$343.41
|
|
|
HC INJ BEBTELOVIMAB
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
77100034
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$315.25 |
| Max. Negotiated Rate |
$485.00 |
| Rate for Payer: Aetna Commercial |
$436.50
|
| Rate for Payer: ASR ASR |
$470.45
|
| Rate for Payer: ASR Commercial |
$470.45
|
| Rate for Payer: BCBS Trust/PPO |
$395.23
|
| Rate for Payer: BCN Commercial |
$376.02
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$455.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.00
|
| Rate for Payer: Healthscope Commercial |
$485.00
|
| Rate for Payer: Healthscope Whirlpool |
$470.45
|
| Rate for Payer: Mclaren Commercial |
$436.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.25
|
| Rate for Payer: Nomi Health Commercial |
$397.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.80
|
|
|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.11
|
| Rate for Payer: Priority Health Narrow Network |
$5.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
IP
|
$1,103.46
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$717.25 |
| Max. Negotiated Rate |
$1,103.46 |
| Rate for Payer: Aetna Commercial |
$993.11
|
| Rate for Payer: ASR ASR |
$1,070.36
|
| Rate for Payer: ASR Commercial |
$1,070.36
|
| Rate for Payer: BCBS Trust/PPO |
$899.21
|
| Rate for Payer: BCN Commercial |
$855.51
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$1,037.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Healthscope Commercial |
$1,103.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,070.36
|
| Rate for Payer: Mclaren Commercial |
$993.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$904.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$971.04
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
OP
|
$1,103.46
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$467.55 |
| Max. Negotiated Rate |
$1,352.05 |
| Rate for Payer: Aetna Commercial |
$993.11
|
| Rate for Payer: Aetna Medicare |
$872.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: ASR ASR |
$1,070.36
|
| Rate for Payer: ASR Commercial |
$1,070.36
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$903.62
|
| Rate for Payer: BCN Commercial |
$855.51
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$1,037.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,103.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,070.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$872.29
|
| Rate for Payer: Mclaren Commercial |
$993.11
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$904.84
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$959.52
|
| Rate for Payer: PHP Medicaid |
$467.55
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$966.85
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$773.53
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$971.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,352.05
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP DNSP |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$467.55
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
IP
|
$1,103.46
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$717.25 |
| Max. Negotiated Rate |
$1,103.46 |
| Rate for Payer: Aetna Commercial |
$993.11
|
| Rate for Payer: ASR ASR |
$1,070.36
|
| Rate for Payer: ASR Commercial |
$1,070.36
|
| Rate for Payer: BCBS Trust/PPO |
$899.21
|
| Rate for Payer: BCN Commercial |
$855.51
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$1,037.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Healthscope Commercial |
$1,103.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,070.36
|
| Rate for Payer: Mclaren Commercial |
$993.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$904.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$971.04
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
OP
|
$1,103.46
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$467.55 |
| Max. Negotiated Rate |
$1,352.05 |
| Rate for Payer: Aetna Commercial |
$993.11
|
| Rate for Payer: Aetna Medicare |
$872.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: ASR ASR |
$1,070.36
|
| Rate for Payer: ASR Commercial |
$1,070.36
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$903.62
|
| Rate for Payer: BCN Commercial |
$855.51
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$1,037.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,103.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,070.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$872.29
|
| Rate for Payer: Mclaren Commercial |
$993.11
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$904.84
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$959.52
|
| Rate for Payer: PHP Medicaid |
$467.55
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$966.85
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$773.53
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$971.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,352.05
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP DNSP |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$467.55
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
OP
|
$1,103.46
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$467.55 |
| Max. Negotiated Rate |
$1,352.05 |
| Rate for Payer: Aetna Commercial |
$993.11
|
| Rate for Payer: Aetna Medicare |
$872.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: ASR ASR |
$1,070.36
|
| Rate for Payer: ASR Commercial |
$1,070.36
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$903.62
|
| Rate for Payer: BCN Commercial |
$855.51
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$1,037.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,103.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,070.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$872.29
|
| Rate for Payer: Mclaren Commercial |
$993.11
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$904.84
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$959.52
|
| Rate for Payer: PHP Medicaid |
$467.55
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$966.85
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$773.53
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$971.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,352.05
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP DNSP |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$467.55
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
IP
|
$1,103.46
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$717.25 |
| Max. Negotiated Rate |
$1,103.46 |
| Rate for Payer: Aetna Commercial |
$993.11
|
| Rate for Payer: ASR ASR |
$1,070.36
|
| Rate for Payer: ASR Commercial |
$1,070.36
|
| Rate for Payer: BCBS Trust/PPO |
$899.21
|
| Rate for Payer: BCN Commercial |
$855.51
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$1,037.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Healthscope Commercial |
$1,103.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,070.36
|
| Rate for Payer: Mclaren Commercial |
$993.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$904.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$971.04
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$109.88 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: Aetna Medicare |
$70.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.61
|
| Rate for Payer: ASR ASR |
$64.31
|
| Rate for Payer: ASR Commercial |
$64.31
|
| Rate for Payer: BCBS Complete |
$39.90
|
| Rate for Payer: BCBS MAPPO |
$70.89
|
| Rate for Payer: BCBS Trust/PPO |
$54.29
|
| Rate for Payer: BCN Commercial |
$51.40
|
| Rate for Payer: BCN Medicare Advantage |
$70.89
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.89
|
| Rate for Payer: Healthscope Commercial |
$66.30
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$70.89
|
| Rate for Payer: Mclaren Commercial |
$59.67
|
| Rate for Payer: Mclaren Medicaid |
$38.00
|
| Rate for Payer: Mclaren Medicare |
$70.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.43
|
| Rate for Payer: Meridian Medicaid |
$39.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: PACE Medicare |
$67.35
|
| Rate for Payer: PACE SWMI |
$70.89
|
| Rate for Payer: PHP Commercial |
$77.98
|
| Rate for Payer: PHP Medicaid |
$38.00
|
| Rate for Payer: PHP Medicare Advantage |
$70.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.99
|
| Rate for Payer: Priority Health Medicare |
$70.89
|
| Rate for Payer: Priority Health Narrow Network |
$64.79
|
| Rate for Payer: Railroad Medicare Medicare |
$70.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.89
|
| Rate for Payer: UHC Exchange |
$109.88
|
| Rate for Payer: UHC Medicare Advantage |
$70.89
|
| Rate for Payer: UHCCP DNSP |
$70.89
|
| Rate for Payer: UHCCP Medicaid |
$38.00
|
| Rate for Payer: VA VA |
$70.89
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: ASR ASR |
$64.31
|
| Rate for Payer: ASR Commercial |
$64.31
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| Rate for Payer: BCN Commercial |
$51.40
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$66.30
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| Rate for Payer: Mclaren Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.34
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
IP
|
$361.02
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.66 |
| Max. Negotiated Rate |
$361.02 |
| Rate for Payer: Aetna Commercial |
$324.92
|
| Rate for Payer: ASR ASR |
$350.19
|
| Rate for Payer: ASR Commercial |
$350.19
|
| Rate for Payer: BCBS Trust/PPO |
$294.20
|
| Rate for Payer: BCN Commercial |
$279.90
|
| Rate for Payer: Cash Price |
$288.82
|
| Rate for Payer: Cofinity Commercial |
$339.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.82
|
| Rate for Payer: Healthscope Commercial |
$361.02
|
| Rate for Payer: Healthscope Whirlpool |
$350.19
|
| Rate for Payer: Mclaren Commercial |
$324.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.87
|
| Rate for Payer: Nomi Health Commercial |
$296.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$317.70
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
OP
|
$361.02
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.72 |
| Max. Negotiated Rate |
$369.35 |
| Rate for Payer: Aetna Commercial |
$324.92
|
| Rate for Payer: Aetna Medicare |
$238.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: ASR ASR |
$350.19
|
| Rate for Payer: ASR Commercial |
$350.19
|
| Rate for Payer: BCBS Complete |
$134.11
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$295.64
|
| Rate for Payer: BCN Commercial |
$279.90
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Cash Price |
$288.82
|
| Rate for Payer: Cash Price |
$288.82
|
| Rate for Payer: Cofinity Commercial |
$339.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Healthscope Commercial |
$361.02
|
| Rate for Payer: Healthscope Whirlpool |
$350.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$238.29
|
| Rate for Payer: Mclaren Commercial |
$324.92
|
| Rate for Payer: Mclaren Medicaid |
$127.72
|
| Rate for Payer: Mclaren Medicare |
$238.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: Meridian Medicaid |
$134.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.87
|
| Rate for Payer: Nomi Health Commercial |
$296.04
|
| Rate for Payer: PACE Medicare |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Commercial |
$262.12
|
| Rate for Payer: PHP Medicaid |
$127.72
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$316.33
|
| Rate for Payer: Priority Health Medicare |
$238.29
|
| Rate for Payer: Priority Health Narrow Network |
$253.08
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$317.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Exchange |
$369.35
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: UHCCP DNSP |
$238.29
|
| Rate for Payer: UHCCP Medicaid |
$127.72
|
| Rate for Payer: VA VA |
$238.29
|
|
|
HC INJ DAXIBOTULINUMTOXINA-LANM, 1 UNIT
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
HCPCS J0589
|
| Hospital Charge Code |
63600257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: ASR ASR |
$10.67
|
| Rate for Payer: ASR Commercial |
$10.67
|
| Rate for Payer: BCBS Trust/PPO |
$8.96
|
| Rate for Payer: BCN Commercial |
$8.53
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$10.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.80
|
| Rate for Payer: Healthscope Commercial |
$11.00
|
| Rate for Payer: Healthscope Whirlpool |
$10.67
|
| Rate for Payer: Mclaren Commercial |
$9.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.35
|
| Rate for Payer: Nomi Health Commercial |
$9.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.68
|
|
|
HC INJ DAXIBOTULINUMTOXINA-LANM, 1 UNIT
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
HCPCS J0589
|
| Hospital Charge Code |
63600257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Medicare |
$3.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.91
|
| Rate for Payer: ASR ASR |
$10.67
|
| Rate for Payer: ASR Commercial |
$10.67
|
| Rate for Payer: BCBS Complete |
$1.76
|
| Rate for Payer: BCBS MAPPO |
$3.13
|
| Rate for Payer: BCBS Trust/PPO |
$9.01
|
| Rate for Payer: BCN Commercial |
$8.53
|
| Rate for Payer: BCN Medicare Advantage |
$3.13
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$10.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.13
|
| Rate for Payer: Healthscope Commercial |
$11.00
|
| Rate for Payer: Healthscope Whirlpool |
$10.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.13
|
| Rate for Payer: Mclaren Commercial |
$9.90
|
| Rate for Payer: Mclaren Medicaid |
$1.68
|
| Rate for Payer: Mclaren Medicare |
$3.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.29
|
| Rate for Payer: Meridian Medicaid |
$1.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.35
|
| Rate for Payer: Nomi Health Commercial |
$9.02
|
| Rate for Payer: PACE Medicare |
$2.97
|
| Rate for Payer: PACE SWMI |
$3.13
|
| Rate for Payer: PHP Commercial |
$3.44
|
| Rate for Payer: PHP Medicaid |
$1.68
|
| Rate for Payer: PHP Medicare Advantage |
$3.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.10
|
| Rate for Payer: Priority Health Medicare |
$3.13
|
| Rate for Payer: Priority Health Narrow Network |
$2.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.13
|
| Rate for Payer: UHC Exchange |
$4.85
|
| Rate for Payer: UHC Medicare Advantage |
$3.13
|
| Rate for Payer: UHCCP DNSP |
$3.13
|
| Rate for Payer: UHCCP Medicaid |
$1.68
|
| Rate for Payer: VA VA |
$3.13
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$876.34
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$569.62 |
| Max. Negotiated Rate |
$876.34 |
| Rate for Payer: Aetna Commercial |
$788.71
|
| Rate for Payer: ASR ASR |
$850.05
|
| Rate for Payer: ASR Commercial |
$850.05
|
| Rate for Payer: BCBS Trust/PPO |
$714.13
|
| Rate for Payer: BCN Commercial |
$679.43
|
| Rate for Payer: Cash Price |
$701.07
|
| Rate for Payer: Cofinity Commercial |
$823.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.07
|
| Rate for Payer: Healthscope Commercial |
$876.34
|
| Rate for Payer: Healthscope Whirlpool |
$850.05
|
| Rate for Payer: Mclaren Commercial |
$788.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$744.89
|
| Rate for Payer: Nomi Health Commercial |
$718.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$771.18
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$876.34
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$363.69 |
| Max. Negotiated Rate |
$1,051.71 |
| Rate for Payer: Aetna Commercial |
$788.71
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$850.05
|
| Rate for Payer: ASR Commercial |
$850.05
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$717.63
|
| Rate for Payer: BCN Commercial |
$679.43
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$701.07
|
| Rate for Payer: Cash Price |
$701.07
|
| Rate for Payer: Cofinity Commercial |
$823.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$876.34
|
| Rate for Payer: Healthscope Whirlpool |
$850.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Commercial |
$788.71
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$744.89
|
| Rate for Payer: Nomi Health Commercial |
$718.60
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$767.85
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$614.31
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$771.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC INJ DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$920.16
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$363.69 |
| Max. Negotiated Rate |
$1,051.71 |
| Rate for Payer: Aetna Commercial |
$828.14
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$892.56
|
| Rate for Payer: ASR Commercial |
$892.56
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$753.52
|
| Rate for Payer: BCN Commercial |
$713.40
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$736.13
|
| Rate for Payer: Cash Price |
$736.13
|
| Rate for Payer: Cofinity Commercial |
$864.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$920.16
|
| Rate for Payer: Healthscope Whirlpool |
$892.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Commercial |
$828.14
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.14
|
| Rate for Payer: Nomi Health Commercial |
$754.53
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$806.24
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$645.03
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$809.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC INJ DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$920.16
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$598.10 |
| Max. Negotiated Rate |
$920.16 |
| Rate for Payer: Aetna Commercial |
$828.14
|
| Rate for Payer: ASR ASR |
$892.56
|
| Rate for Payer: ASR Commercial |
$892.56
|
| Rate for Payer: BCBS Trust/PPO |
$749.84
|
| Rate for Payer: BCN Commercial |
$713.40
|
| Rate for Payer: Cash Price |
$736.13
|
| Rate for Payer: Cofinity Commercial |
$864.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.13
|
| Rate for Payer: Healthscope Commercial |
$920.16
|
| Rate for Payer: Healthscope Whirlpool |
$892.56
|
| Rate for Payer: Mclaren Commercial |
$828.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.14
|
| Rate for Payer: Nomi Health Commercial |
$754.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$809.74
|
|
