|
HC INJECTION FACET JOINT L OR S 2ND LEVEL
|
Facility
|
OP
|
$411.81
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$164.72 |
| Max. Negotiated Rate |
$411.81 |
| Rate for Payer: Aetna Commercial |
$370.63
|
| Rate for Payer: Aetna Medicare |
$205.91
|
| Rate for Payer: ASR ASR |
$399.46
|
| Rate for Payer: ASR Commercial |
$399.46
|
| Rate for Payer: BCBS Complete |
$164.72
|
| Rate for Payer: BCBS Trust/PPO |
$337.23
|
| Rate for Payer: BCN Commercial |
$319.28
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cofinity Commercial |
$387.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.45
|
| Rate for Payer: Healthscope Commercial |
$411.81
|
| Rate for Payer: Healthscope Whirlpool |
$399.46
|
| Rate for Payer: Mclaren Commercial |
$370.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.04
|
| Rate for Payer: Nomi Health Commercial |
$337.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$360.83
|
| Rate for Payer: Priority Health Narrow Network |
$288.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$362.39
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL
|
Facility
|
OP
|
$617.71
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$247.08 |
| Max. Negotiated Rate |
$617.71 |
| Rate for Payer: Aetna Commercial |
$555.94
|
| Rate for Payer: Aetna Medicare |
$308.86
|
| Rate for Payer: ASR ASR |
$599.18
|
| Rate for Payer: ASR Commercial |
$599.18
|
| Rate for Payer: BCBS Complete |
$247.08
|
| Rate for Payer: BCBS Trust/PPO |
$505.84
|
| Rate for Payer: BCN Commercial |
$478.91
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$580.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.17
|
| Rate for Payer: Healthscope Commercial |
$617.71
|
| Rate for Payer: Healthscope Whirlpool |
$599.18
|
| Rate for Payer: Mclaren Commercial |
$555.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.05
|
| Rate for Payer: Nomi Health Commercial |
$506.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.24
|
| Rate for Payer: Priority Health Narrow Network |
$433.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$543.58
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL
|
Facility
|
IP
|
$617.71
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$401.51 |
| Max. Negotiated Rate |
$617.71 |
| Rate for Payer: Aetna Commercial |
$555.94
|
| Rate for Payer: ASR ASR |
$599.18
|
| Rate for Payer: ASR Commercial |
$599.18
|
| Rate for Payer: BCBS Trust/PPO |
$503.37
|
| Rate for Payer: BCN Commercial |
$478.91
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$580.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.17
|
| Rate for Payer: Healthscope Commercial |
$617.71
|
| Rate for Payer: Healthscope Whirlpool |
$599.18
|
| Rate for Payer: Mclaren Commercial |
$555.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.05
|
| Rate for Payer: Nomi Health Commercial |
$506.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$543.58
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LE
|
Facility
|
IP
|
$411.81
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100295
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$267.68 |
| Max. Negotiated Rate |
$411.81 |
| Rate for Payer: Aetna Commercial |
$370.63
|
| Rate for Payer: ASR ASR |
$399.46
|
| Rate for Payer: ASR Commercial |
$399.46
|
| Rate for Payer: BCBS Trust/PPO |
$335.58
|
| Rate for Payer: BCN Commercial |
$319.28
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cofinity Commercial |
$387.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.45
|
| Rate for Payer: Healthscope Commercial |
$411.81
|
| Rate for Payer: Healthscope Whirlpool |
$399.46
|
| Rate for Payer: Mclaren Commercial |
$370.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.04
|
| Rate for Payer: Nomi Health Commercial |
$337.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$362.39
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LE
|
Facility
|
OP
|
$411.81
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100295
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$164.72 |
| Max. Negotiated Rate |
$411.81 |
| Rate for Payer: Aetna Commercial |
$370.63
|
| Rate for Payer: Aetna Medicare |
$205.91
|
| Rate for Payer: ASR ASR |
$399.46
|
| Rate for Payer: ASR Commercial |
$399.46
|
| Rate for Payer: BCBS Complete |
$164.72
|
| Rate for Payer: BCBS Trust/PPO |
$337.23
|
| Rate for Payer: BCN Commercial |
$319.28
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cofinity Commercial |
$387.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.45
|
| Rate for Payer: Healthscope Commercial |
$411.81
|
| Rate for Payer: Healthscope Whirlpool |
$399.46
|
| Rate for Payer: Mclaren Commercial |
$370.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.04
|
| Rate for Payer: Nomi Health Commercial |
$337.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$360.83
|
| Rate for Payer: Priority Health Narrow Network |
$288.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$362.39
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL
|
Facility
|
OP
|
$617.71
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$247.08 |
| Max. Negotiated Rate |
$617.71 |
| Rate for Payer: Aetna Commercial |
$555.94
|
| Rate for Payer: Aetna Medicare |
$308.86
|
| Rate for Payer: ASR ASR |
$599.18
|
| Rate for Payer: ASR Commercial |
$599.18
|
| Rate for Payer: BCBS Complete |
$247.08
|
| Rate for Payer: BCBS Trust/PPO |
$505.84
|
| Rate for Payer: BCN Commercial |
$478.91
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$580.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.17
|
| Rate for Payer: Healthscope Commercial |
$617.71
|
| Rate for Payer: Healthscope Whirlpool |
$599.18
|
| Rate for Payer: Mclaren Commercial |
$555.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.05
|
| Rate for Payer: Nomi Health Commercial |
$506.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.24
|
| Rate for Payer: Priority Health Narrow Network |
$433.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$543.58
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL
|
Facility
|
IP
|
$617.71
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$401.51 |
| Max. Negotiated Rate |
$617.71 |
| Rate for Payer: Aetna Commercial |
$555.94
|
| Rate for Payer: ASR ASR |
$599.18
|
| Rate for Payer: ASR Commercial |
$599.18
|
| Rate for Payer: BCBS Trust/PPO |
$503.37
|
| Rate for Payer: BCN Commercial |
$478.91
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$580.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.17
|
| Rate for Payer: Healthscope Commercial |
$617.71
|
| Rate for Payer: Healthscope Whirlpool |
$599.18
|
| Rate for Payer: Mclaren Commercial |
$555.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.05
|
| Rate for Payer: Nomi Health Commercial |
$506.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$543.58
|
|
|
HC INJECTION FOR CEREBRAL SHUNT
|
Facility
|
IP
|
$826.35
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36100270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$537.13 |
| Max. Negotiated Rate |
$826.35 |
| Rate for Payer: Aetna Commercial |
$743.72
|
| Rate for Payer: ASR ASR |
$801.56
|
| Rate for Payer: ASR Commercial |
$801.56
|
| Rate for Payer: BCBS Trust/PPO |
$673.39
|
| Rate for Payer: BCN Commercial |
$640.67
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cofinity Commercial |
$776.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.08
|
| Rate for Payer: Healthscope Commercial |
$826.35
|
| Rate for Payer: Healthscope Whirlpool |
$801.56
|
| Rate for Payer: Mclaren Commercial |
$743.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$702.40
|
| Rate for Payer: Nomi Health Commercial |
$677.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$727.19
|
|
|
HC INJECTION FOR CEREBRAL SHUNT
|
Facility
|
OP
|
$826.35
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36100270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$362.01 |
| Max. Negotiated Rate |
$1,046.87 |
| Rate for Payer: Aetna Commercial |
$743.72
|
| Rate for Payer: Aetna Medicare |
$675.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: ASR ASR |
$801.56
|
| Rate for Payer: ASR Commercial |
$801.56
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCBS Trust/PPO |
$676.70
|
| Rate for Payer: BCN Commercial |
$640.67
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cofinity Commercial |
$776.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$826.35
|
| Rate for Payer: Healthscope Whirlpool |
$801.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$675.40
|
| Rate for Payer: Mclaren Commercial |
$743.72
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$702.40
|
| Rate for Payer: Nomi Health Commercial |
$677.61
|
| Rate for Payer: PACE Medicare |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$742.94
|
| Rate for Payer: PHP Medicaid |
$362.01
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$724.05
|
| Rate for Payer: Priority Health Medicare |
$675.40
|
| Rate for Payer: Priority Health Narrow Network |
$579.27
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$727.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Exchange |
$1,046.87
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP DNSP |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$362.01
|
| Rate for Payer: VA VA |
$675.40
|
|
|
HC INJECTION FOR HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$656.49
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
36100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$426.72 |
| Max. Negotiated Rate |
$656.49 |
| Rate for Payer: Aetna Commercial |
$590.84
|
| Rate for Payer: ASR ASR |
$636.80
|
| Rate for Payer: ASR Commercial |
$636.80
|
| Rate for Payer: BCBS Trust/PPO |
$534.97
|
| Rate for Payer: BCN Commercial |
$508.98
|
| Rate for Payer: Cash Price |
$525.19
|
| Rate for Payer: Cofinity Commercial |
$617.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.19
|
| Rate for Payer: Healthscope Commercial |
$656.49
|
| Rate for Payer: Healthscope Whirlpool |
$636.80
|
| Rate for Payer: Mclaren Commercial |
$590.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.02
|
| Rate for Payer: Nomi Health Commercial |
$538.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$577.71
|
|
|
HC INJECTION FOR HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$656.49
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
36100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.60 |
| Max. Negotiated Rate |
$656.49 |
| Rate for Payer: Aetna Commercial |
$590.84
|
| Rate for Payer: Aetna Medicare |
$328.25
|
| Rate for Payer: ASR ASR |
$636.80
|
| Rate for Payer: ASR Commercial |
$636.80
|
| Rate for Payer: BCBS Complete |
$262.60
|
| Rate for Payer: BCBS Trust/PPO |
$537.60
|
| Rate for Payer: BCN Commercial |
$508.98
|
| Rate for Payer: Cash Price |
$525.19
|
| Rate for Payer: Cofinity Commercial |
$617.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.19
|
| Rate for Payer: Healthscope Commercial |
$656.49
|
| Rate for Payer: Healthscope Whirlpool |
$636.80
|
| Rate for Payer: Mclaren Commercial |
$590.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.02
|
| Rate for Payer: Nomi Health Commercial |
$538.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$575.22
|
| Rate for Payer: Priority Health Narrow Network |
$460.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$577.71
|
|
|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
IP
|
$1,309.24
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$851.01 |
| Max. Negotiated Rate |
$1,309.24 |
| Rate for Payer: Aetna Commercial |
$1,178.32
|
| Rate for Payer: ASR ASR |
$1,269.96
|
| Rate for Payer: ASR Commercial |
$1,269.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.90
|
| Rate for Payer: BCN Commercial |
$1,015.05
|
| Rate for Payer: Cash Price |
$1,047.39
|
| Rate for Payer: Cofinity Commercial |
$1,230.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,047.39
|
| Rate for Payer: Healthscope Commercial |
$1,309.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,269.96
|
| Rate for Payer: Mclaren Commercial |
$1,178.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,112.85
|
| Rate for Payer: Nomi Health Commercial |
$1,073.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,152.13
|
|
|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
OP
|
$1,309.24
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$523.70 |
| Max. Negotiated Rate |
$1,309.24 |
| Rate for Payer: Aetna Commercial |
$1,178.32
|
| Rate for Payer: Aetna Medicare |
$654.62
|
| Rate for Payer: ASR ASR |
$1,269.96
|
| Rate for Payer: ASR Commercial |
$1,269.96
|
| Rate for Payer: BCBS Complete |
$523.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,072.14
|
| Rate for Payer: BCN Commercial |
$1,015.05
|
| Rate for Payer: Cash Price |
$1,047.39
|
| Rate for Payer: Cofinity Commercial |
$1,230.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,047.39
|
| Rate for Payer: Healthscope Commercial |
$1,309.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,269.96
|
| Rate for Payer: Mclaren Commercial |
$1,178.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,112.85
|
| Rate for Payer: Nomi Health Commercial |
$1,073.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,147.16
|
| Rate for Payer: Priority Health Narrow Network |
$917.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,152.13
|
|
|
HC INJECTION HIP ARTHROGRAM BIL
|
Facility
|
OP
|
$1,214.02
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$485.61 |
| Max. Negotiated Rate |
$1,214.02 |
| Rate for Payer: Aetna Commercial |
$1,092.62
|
| Rate for Payer: Aetna Medicare |
$607.01
|
| Rate for Payer: ASR ASR |
$1,177.60
|
| Rate for Payer: ASR Commercial |
$1,177.60
|
| Rate for Payer: BCBS Complete |
$485.61
|
| Rate for Payer: BCBS Trust/PPO |
$994.16
|
| Rate for Payer: BCN Commercial |
$941.23
|
| Rate for Payer: Cash Price |
$971.22
|
| Rate for Payer: Cofinity Commercial |
$1,141.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$971.22
|
| Rate for Payer: Healthscope Commercial |
$1,214.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,177.60
|
| Rate for Payer: Mclaren Commercial |
$1,092.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,031.92
|
| Rate for Payer: Nomi Health Commercial |
$995.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,063.72
|
| Rate for Payer: Priority Health Narrow Network |
$851.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,068.34
|
|
|
HC INJECTION HIP ARTHROGRAM BIL
|
Facility
|
IP
|
$1,214.02
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$789.11 |
| Max. Negotiated Rate |
$1,214.02 |
| Rate for Payer: Aetna Commercial |
$1,092.62
|
| Rate for Payer: ASR ASR |
$1,177.60
|
| Rate for Payer: ASR Commercial |
$1,177.60
|
| Rate for Payer: BCBS Trust/PPO |
$989.30
|
| Rate for Payer: BCN Commercial |
$941.23
|
| Rate for Payer: Cash Price |
$971.22
|
| Rate for Payer: Cofinity Commercial |
$1,141.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$971.22
|
| Rate for Payer: Healthscope Commercial |
$1,214.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,177.60
|
| Rate for Payer: Mclaren Commercial |
$1,092.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,031.92
|
| Rate for Payer: Nomi Health Commercial |
$995.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,068.34
|
|
|
HC INJECTION INTRALESIONAL UP TO 7 LESIONS
|
Facility
|
OP
|
$147.11
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
76100134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.62 |
| Max. Negotiated Rate |
$300.37 |
| Rate for Payer: Aetna Commercial |
$132.40
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: ASR ASR |
$142.70
|
| Rate for Payer: ASR Commercial |
$142.70
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCBS Trust/PPO |
$120.47
|
| Rate for Payer: BCN Commercial |
$114.05
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$138.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$147.11
|
| Rate for Payer: Healthscope Whirlpool |
$142.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Commercial |
$132.40
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: Nomi Health Commercial |
$120.63
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$213.17
|
| Rate for Payer: PHP Medicaid |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.90
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health Narrow Network |
$103.12
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$300.37
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP DNSP |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC INJECTION INTRALESIONAL UP TO 7 LESIONS
|
Facility
|
IP
|
$147.11
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
76100134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.62 |
| Max. Negotiated Rate |
$147.11 |
| Rate for Payer: Aetna Commercial |
$132.40
|
| Rate for Payer: ASR ASR |
$142.70
|
| Rate for Payer: ASR Commercial |
$142.70
|
| Rate for Payer: BCBS Trust/PPO |
$119.88
|
| Rate for Payer: BCN Commercial |
$114.05
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$138.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Healthscope Commercial |
$147.11
|
| Rate for Payer: Healthscope Whirlpool |
$142.70
|
| Rate for Payer: Mclaren Commercial |
$132.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: Nomi Health Commercial |
$120.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.46
|
|
|
HC INJECTION, IRON DEXTRAN, 50 MG
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT J1750
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: ASR Commercial |
$60.55
|
| Rate for Payer: BCBS Trust/PPO |
$50.87
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$60.55
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
|
|
HC INJECTION, IRON DEXTRAN, 50 MG
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT J1750
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna Medicare |
$18.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.64
|
| Rate for Payer: ASR ASR |
$60.55
|
| Rate for Payer: ASR Commercial |
$60.55
|
| Rate for Payer: BCBS Complete |
$10.19
|
| Rate for Payer: BCBS MAPPO |
$18.11
|
| Rate for Payer: BCBS Trust/PPO |
$51.12
|
| Rate for Payer: BCN Commercial |
$48.39
|
| Rate for Payer: BCN Medicare Advantage |
$18.11
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$58.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.11
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Healthscope Whirlpool |
$60.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.11
|
| Rate for Payer: Mclaren Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$9.71
|
| Rate for Payer: Mclaren Medicare |
$18.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.02
|
| Rate for Payer: Meridian Medicaid |
$10.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PACE Medicare |
$17.20
|
| Rate for Payer: PACE SWMI |
$18.11
|
| Rate for Payer: PHP Commercial |
$19.92
|
| Rate for Payer: PHP Medicaid |
$9.71
|
| Rate for Payer: PHP Medicare Advantage |
$18.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.69
|
| Rate for Payer: Priority Health Medicare |
$18.11
|
| Rate for Payer: Priority Health Narrow Network |
$43.76
|
| Rate for Payer: Railroad Medicare Medicare |
$18.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.11
|
| Rate for Payer: UHC Exchange |
$28.07
|
| Rate for Payer: UHC Medicare Advantage |
$18.11
|
| Rate for Payer: UHCCP DNSP |
$18.11
|
| Rate for Payer: UHCCP Medicaid |
$9.71
|
| Rate for Payer: VA VA |
$18.11
|
|
|
HC INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
63600098
|
|
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 INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
63600098
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| 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: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.30
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PHP Commercial |
$0.33
|
| Rate for Payer: PHP Medicaid |
$0.16
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Narrow Network |
$14.59
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Exchange |
$0.47
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHCCP DNSP |
$0.30
|
| Rate for Payer: UHCCP Medicaid |
$0.16
|
| Rate for Payer: VA VA |
$0.30
|
|
|
HC INJECTION, LINCOMYCIN HCL, UP TO 300 MG
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT J2010
|
| Hospital Charge Code |
63600099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$45.78 |
| Rate for Payer: Aetna Commercial |
$41.20
|
| Rate for Payer: Aetna Medicare |
$22.89
|
| Rate for Payer: ASR ASR |
$44.41
|
| Rate for Payer: ASR Commercial |
$44.41
|
| Rate for Payer: BCBS Complete |
$18.31
|
| Rate for Payer: BCBS Trust/PPO |
$37.49
|
| Rate for Payer: BCN Commercial |
$35.49
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$43.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$45.78
|
| Rate for Payer: Healthscope Whirlpool |
$44.41
|
| Rate for Payer: Mclaren Commercial |
$41.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.11
|
| Rate for Payer: Priority Health Narrow Network |
$32.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.29
|
|
|
HC INJECTION, LINCOMYCIN HCL, UP TO 300 MG
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT J2010
|
| Hospital Charge Code |
63600099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$45.78 |
| Rate for Payer: Aetna Commercial |
$41.20
|
| Rate for Payer: ASR ASR |
$44.41
|
| Rate for Payer: ASR Commercial |
$44.41
|
| Rate for Payer: BCBS Trust/PPO |
$37.31
|
| Rate for Payer: BCN Commercial |
$35.49
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$43.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$45.78
|
| Rate for Payer: Healthscope Whirlpool |
$44.41
|
| Rate for Payer: Mclaren Commercial |
$41.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.29
|
|
|
HC INJECTION LUMBAR DISKOGRAPHY
|
Facility
|
IP
|
$2,349.53
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
36100282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,527.19 |
| Max. Negotiated Rate |
$2,349.53 |
| Rate for Payer: Aetna Commercial |
$2,114.58
|
| Rate for Payer: ASR ASR |
$2,279.04
|
| Rate for Payer: ASR Commercial |
$2,279.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,914.63
|
| Rate for Payer: BCN Commercial |
$1,821.59
|
| Rate for Payer: Cash Price |
$1,879.62
|
| Rate for Payer: Cofinity Commercial |
$2,208.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,879.62
|
| Rate for Payer: Healthscope Commercial |
$2,349.53
|
| Rate for Payer: Healthscope Whirlpool |
$2,279.04
|
| Rate for Payer: Mclaren Commercial |
$2,114.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,997.10
|
| Rate for Payer: Nomi Health Commercial |
$1,926.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,527.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,067.59
|
|
|
HC INJECTION LUMBAR DISKOGRAPHY
|
Facility
|
OP
|
$2,349.53
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
36100282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$939.81 |
| Max. Negotiated Rate |
$2,349.53 |
| Rate for Payer: Aetna Commercial |
$2,114.58
|
| Rate for Payer: Aetna Medicare |
$1,174.77
|
| Rate for Payer: ASR ASR |
$2,279.04
|
| Rate for Payer: ASR Commercial |
$2,279.04
|
| Rate for Payer: BCBS Complete |
$939.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,924.03
|
| Rate for Payer: BCN Commercial |
$1,821.59
|
| Rate for Payer: Cash Price |
$1,879.62
|
| Rate for Payer: Cofinity Commercial |
$2,208.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,879.62
|
| Rate for Payer: Healthscope Commercial |
$2,349.53
|
| Rate for Payer: Healthscope Whirlpool |
$2,279.04
|
| Rate for Payer: Mclaren Commercial |
$2,114.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,997.10
|
| Rate for Payer: Nomi Health Commercial |
$1,926.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,527.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,058.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,647.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,067.59
|
|
