|
HC INJECTION PLATELET PLASMA W/IMG HARVEST/PREP
|
Facility
|
OP
|
$805.80
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
76100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.56 |
| Max. Negotiated Rate |
$805.80 |
| Rate for Payer: Aetna Commercial |
$725.22
|
| Rate for Payer: Aetna Medicare |
$390.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$488.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$488.71
|
| Rate for Payer: ASR ASR |
$781.63
|
| Rate for Payer: ASR Commercial |
$781.63
|
| Rate for Payer: BCBS Complete |
$220.04
|
| Rate for Payer: BCBS MAPPO |
$390.97
|
| Rate for Payer: BCBS Trust/PPO |
$659.87
|
| Rate for Payer: BCN Commercial |
$624.74
|
| Rate for Payer: BCN Medicare Advantage |
$390.97
|
| Rate for Payer: Cash Price |
$644.64
|
| Rate for Payer: Cash Price |
$644.64
|
| Rate for Payer: Cofinity Commercial |
$757.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$644.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.97
|
| Rate for Payer: Healthscope Commercial |
$805.80
|
| Rate for Payer: Healthscope Whirlpool |
$781.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$390.97
|
| Rate for Payer: Mclaren Commercial |
$725.22
|
| Rate for Payer: Mclaren Medicaid |
$209.56
|
| Rate for Payer: Mclaren Medicare |
$390.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.52
|
| Rate for Payer: Meridian Medicaid |
$220.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$684.93
|
| Rate for Payer: Nomi Health Commercial |
$660.76
|
| Rate for Payer: PACE Medicare |
$371.42
|
| Rate for Payer: PACE SWMI |
$390.97
|
| Rate for Payer: PHP Commercial |
$430.07
|
| Rate for Payer: PHP Medicaid |
$209.56
|
| Rate for Payer: PHP Medicare Advantage |
$390.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$706.04
|
| Rate for Payer: Priority Health Medicare |
$390.97
|
| Rate for Payer: Priority Health Narrow Network |
$564.87
|
| Rate for Payer: Railroad Medicare Medicare |
$390.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$709.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.97
|
| Rate for Payer: UHC Exchange |
$606.00
|
| Rate for Payer: UHC Medicare Advantage |
$390.97
|
| Rate for Payer: UHCCP DNSP |
$390.97
|
| Rate for Payer: UHCCP Medicaid |
$209.56
|
| Rate for Payer: VA VA |
$390.97
|
|
|
HC INJECTION PROC CYSTOGRAPHY VOIDING
|
Facility
|
OP
|
$1,310.34
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
36100251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.79 |
| Max. Negotiated Rate |
$1,310.34 |
| Rate for Payer: Aetna Commercial |
$1,179.31
|
| Rate for Payer: Aetna Medicare |
$655.17
|
| Rate for Payer: ASR ASR |
$1,271.03
|
| Rate for Payer: ASR Commercial |
$1,271.03
|
| Rate for Payer: BCBS Complete |
$524.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,073.04
|
| Rate for Payer: BCN Commercial |
$1,015.91
|
| Rate for Payer: Cash Price |
$1,048.27
|
| Rate for Payer: Cash Price |
$1,048.27
|
| Rate for Payer: Cofinity Commercial |
$1,231.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,048.27
|
| Rate for Payer: Healthscope Commercial |
$1,310.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,271.03
|
| Rate for Payer: Mclaren Commercial |
$1,179.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,113.79
|
| Rate for Payer: Nomi Health Commercial |
$1,074.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.49
|
| Rate for Payer: Priority Health Narrow Network |
$138.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,153.10
|
|
|
HC INJECTION PROC CYSTOGRAPHY VOIDING
|
Facility
|
IP
|
$1,310.34
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
36100251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$851.72 |
| Max. Negotiated Rate |
$1,310.34 |
| Rate for Payer: Aetna Commercial |
$1,179.31
|
| Rate for Payer: ASR ASR |
$1,271.03
|
| Rate for Payer: ASR Commercial |
$1,271.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,067.80
|
| Rate for Payer: BCN Commercial |
$1,015.91
|
| Rate for Payer: Cash Price |
$1,048.27
|
| Rate for Payer: Cofinity Commercial |
$1,231.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,048.27
|
| Rate for Payer: Healthscope Commercial |
$1,310.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,271.03
|
| Rate for Payer: Mclaren Commercial |
$1,179.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,113.79
|
| Rate for Payer: Nomi Health Commercial |
$1,074.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,153.10
|
|
|
HC INJECTION PROCEDURE
|
Facility
|
OP
|
$603.48
|
|
| Hospital Charge Code |
36000085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$241.39 |
| Max. Negotiated Rate |
$603.48 |
| Rate for Payer: Aetna Commercial |
$543.13
|
| Rate for Payer: Aetna Medicare |
$301.74
|
| Rate for Payer: ASR ASR |
$585.38
|
| Rate for Payer: ASR Commercial |
$585.38
|
| Rate for Payer: BCBS Complete |
$241.39
|
| Rate for Payer: BCBS Trust/PPO |
$494.19
|
| Rate for Payer: BCN Commercial |
$467.88
|
| Rate for Payer: Cash Price |
$482.78
|
| Rate for Payer: Cofinity Commercial |
$567.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$482.78
|
| Rate for Payer: Healthscope Commercial |
$603.48
|
| Rate for Payer: Healthscope Whirlpool |
$585.38
|
| Rate for Payer: Mclaren Commercial |
$543.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.96
|
| Rate for Payer: Nomi Health Commercial |
$494.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$528.77
|
| Rate for Payer: Priority Health Narrow Network |
$423.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$531.06
|
|
|
HC INJECTION PROCEDURE
|
Facility
|
IP
|
$603.48
|
|
| Hospital Charge Code |
36000085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$392.26 |
| Max. Negotiated Rate |
$603.48 |
| Rate for Payer: Aetna Commercial |
$543.13
|
| Rate for Payer: ASR ASR |
$585.38
|
| Rate for Payer: ASR Commercial |
$585.38
|
| Rate for Payer: BCBS Trust/PPO |
$491.78
|
| Rate for Payer: BCN Commercial |
$467.88
|
| Rate for Payer: Cash Price |
$482.78
|
| Rate for Payer: Cofinity Commercial |
$567.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$482.78
|
| Rate for Payer: Healthscope Commercial |
$603.48
|
| Rate for Payer: Healthscope Whirlpool |
$585.38
|
| Rate for Payer: Mclaren Commercial |
$543.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.96
|
| Rate for Payer: Nomi Health Commercial |
$494.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$531.06
|
|
|
HC INJECTION PROCEDURE ILEAL CONDUIT
|
Facility
|
OP
|
$643.53
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
36100249
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$257.41 |
| Max. Negotiated Rate |
$643.53 |
| Rate for Payer: Aetna Commercial |
$579.18
|
| Rate for Payer: Aetna Medicare |
$321.76
|
| Rate for Payer: ASR ASR |
$624.22
|
| Rate for Payer: ASR Commercial |
$624.22
|
| Rate for Payer: BCBS Complete |
$257.41
|
| Rate for Payer: BCBS Trust/PPO |
$526.99
|
| Rate for Payer: BCN Commercial |
$498.93
|
| Rate for Payer: Cash Price |
$514.82
|
| Rate for Payer: Cash Price |
$514.82
|
| Rate for Payer: Cofinity Commercial |
$604.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.82
|
| Rate for Payer: Healthscope Commercial |
$643.53
|
| Rate for Payer: Healthscope Whirlpool |
$624.22
|
| Rate for Payer: Mclaren Commercial |
$579.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$547.00
|
| Rate for Payer: Nomi Health Commercial |
$527.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$418.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.11
|
| Rate for Payer: Priority Health Narrow Network |
$260.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$566.31
|
|
|
HC INJECTION PROCEDURE ILEAL CONDUIT
|
Facility
|
IP
|
$643.53
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
36100249
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$418.29 |
| Max. Negotiated Rate |
$643.53 |
| Rate for Payer: Aetna Commercial |
$579.18
|
| Rate for Payer: ASR ASR |
$624.22
|
| Rate for Payer: ASR Commercial |
$624.22
|
| Rate for Payer: BCBS Trust/PPO |
$524.41
|
| Rate for Payer: BCN Commercial |
$498.93
|
| Rate for Payer: Cash Price |
$514.82
|
| Rate for Payer: Cofinity Commercial |
$604.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.82
|
| Rate for Payer: Healthscope Commercial |
$643.53
|
| Rate for Payer: Healthscope Whirlpool |
$624.22
|
| Rate for Payer: Mclaren Commercial |
$579.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$547.00
|
| Rate for Payer: Nomi Health Commercial |
$527.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$418.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$566.31
|
|
|
HC INJECTION PROC RETROGRAD CYSTOGRAPHY
|
Facility
|
IP
|
$832.48
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
36100252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$541.11 |
| Max. Negotiated Rate |
$832.48 |
| Rate for Payer: Aetna Commercial |
$749.23
|
| Rate for Payer: ASR ASR |
$807.51
|
| Rate for Payer: ASR Commercial |
$807.51
|
| Rate for Payer: BCBS Trust/PPO |
$678.39
|
| Rate for Payer: BCN Commercial |
$645.42
|
| Rate for Payer: Cash Price |
$665.98
|
| Rate for Payer: Cofinity Commercial |
$782.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$665.98
|
| Rate for Payer: Healthscope Commercial |
$832.48
|
| Rate for Payer: Healthscope Whirlpool |
$807.51
|
| Rate for Payer: Mclaren Commercial |
$749.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$707.61
|
| Rate for Payer: Nomi Health Commercial |
$682.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$732.58
|
|
|
HC INJECTION PROC RETROGRAD CYSTOGRAPHY
|
Facility
|
OP
|
$832.48
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
36100252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$332.99 |
| Max. Negotiated Rate |
$832.48 |
| Rate for Payer: Aetna Commercial |
$749.23
|
| Rate for Payer: Aetna Medicare |
$416.24
|
| Rate for Payer: ASR ASR |
$807.51
|
| Rate for Payer: ASR Commercial |
$807.51
|
| Rate for Payer: BCBS Complete |
$332.99
|
| Rate for Payer: BCBS Trust/PPO |
$681.72
|
| Rate for Payer: BCN Commercial |
$645.42
|
| Rate for Payer: Cash Price |
$665.98
|
| Rate for Payer: Cofinity Commercial |
$782.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$665.98
|
| Rate for Payer: Healthscope Commercial |
$832.48
|
| Rate for Payer: Healthscope Whirlpool |
$807.51
|
| Rate for Payer: Mclaren Commercial |
$749.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$707.61
|
| Rate for Payer: Nomi Health Commercial |
$682.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$729.42
|
| Rate for Payer: Priority Health Narrow Network |
$583.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$732.58
|
|
|
HC INJECTION, PROMETHAZINE HCL, UP TO 50 MG
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT J2550
|
| Hospital Charge Code |
63600100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: ASR ASR |
$15.14
|
| Rate for Payer: ASR Commercial |
$15.14
|
| Rate for Payer: BCBS Trust/PPO |
$12.72
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$15.61
|
| Rate for Payer: Healthscope Whirlpool |
$15.14
|
| Rate for Payer: Mclaren Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
|
|
HC INJECTION, PROMETHAZINE HCL, UP TO 50 MG
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT J2550
|
| Hospital Charge Code |
63600100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: Aetna Commercial |
$14.05
|
| Rate for Payer: Aetna Medicare |
$7.80
|
| Rate for Payer: ASR ASR |
$15.14
|
| Rate for Payer: ASR Commercial |
$15.14
|
| Rate for Payer: BCBS Complete |
$6.24
|
| Rate for Payer: BCBS Trust/PPO |
$12.78
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$15.61
|
| Rate for Payer: Healthscope Whirlpool |
$15.14
|
| Rate for Payer: Mclaren Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.44
|
| Rate for Payer: Priority Health Narrow Network |
$2.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
|
|
HC INJECTION PUDENDAL NERVE
|
Facility
|
IP
|
$1,193.61
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
36100570
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$775.85 |
| Max. Negotiated Rate |
$1,193.61 |
| Rate for Payer: Aetna Commercial |
$1,074.25
|
| Rate for Payer: ASR ASR |
$1,157.80
|
| Rate for Payer: ASR Commercial |
$1,157.80
|
| Rate for Payer: BCBS Trust/PPO |
$972.67
|
| Rate for Payer: BCN Commercial |
$925.41
|
| Rate for Payer: Cash Price |
$954.89
|
| Rate for Payer: Cofinity Commercial |
$1,121.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$954.89
|
| Rate for Payer: Healthscope Commercial |
$1,193.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,157.80
|
| Rate for Payer: Mclaren Commercial |
$1,074.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,014.57
|
| Rate for Payer: Nomi Health Commercial |
$978.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$775.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,050.38
|
|
|
HC INJECTION PUDENDAL NERVE
|
Facility
|
OP
|
$1,193.61
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
36100570
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$467.55 |
| Max. Negotiated Rate |
$1,352.05 |
| Rate for Payer: Aetna Commercial |
$1,074.25
|
| 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 |
$1,157.80
|
| Rate for Payer: ASR Commercial |
$1,157.80
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$977.45
|
| Rate for Payer: BCN Commercial |
$925.41
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$954.89
|
| Rate for Payer: Cash Price |
$954.89
|
| Rate for Payer: Cofinity Commercial |
$1,121.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$954.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,193.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,157.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$872.29
|
| Rate for Payer: Mclaren Commercial |
$1,074.25
|
| 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 |
$1,014.57
|
| Rate for Payer: Nomi Health Commercial |
$978.76
|
| 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 |
$775.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,045.84
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$836.72
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,050.38
|
| 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 INJECTION SCLEROSING SOL MULTIPLE
|
Facility
|
IP
|
$329.29
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.04 |
| Max. Negotiated Rate |
$329.29 |
| Rate for Payer: Aetna Commercial |
$296.36
|
| Rate for Payer: ASR ASR |
$319.41
|
| Rate for Payer: ASR Commercial |
$319.41
|
| Rate for Payer: BCBS Trust/PPO |
$268.34
|
| Rate for Payer: BCN Commercial |
$255.30
|
| Rate for Payer: Cash Price |
$263.43
|
| Rate for Payer: Cofinity Commercial |
$309.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.43
|
| Rate for Payer: Healthscope Commercial |
$329.29
|
| Rate for Payer: Healthscope Whirlpool |
$319.41
|
| Rate for Payer: Mclaren Commercial |
$296.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.90
|
| Rate for Payer: Nomi Health Commercial |
$270.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.78
|
|
|
HC INJECTION SCLEROSING SOL MULTIPLE
|
Facility
|
OP
|
$329.29
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$296.36
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$319.41
|
| Rate for Payer: ASR Commercial |
$319.41
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$269.66
|
| Rate for Payer: BCN Commercial |
$255.30
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$263.43
|
| Rate for Payer: Cash Price |
$263.43
|
| Rate for Payer: Cofinity Commercial |
$309.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$329.29
|
| Rate for Payer: Healthscope Whirlpool |
$319.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$296.36
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.90
|
| Rate for Payer: Nomi Health Commercial |
$270.02
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.52
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$230.83
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
HC INJECTION SCLEROSING SOL SINGLE
|
Facility
|
IP
|
$252.82
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
36100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.33 |
| Max. Negotiated Rate |
$252.82 |
| Rate for Payer: Aetna Commercial |
$227.54
|
| Rate for Payer: ASR ASR |
$245.24
|
| Rate for Payer: ASR Commercial |
$245.24
|
| Rate for Payer: BCBS Trust/PPO |
$206.02
|
| Rate for Payer: BCN Commercial |
$196.01
|
| Rate for Payer: Cash Price |
$202.26
|
| Rate for Payer: Cofinity Commercial |
$237.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.26
|
| Rate for Payer: Healthscope Commercial |
$252.82
|
| Rate for Payer: Healthscope Whirlpool |
$245.24
|
| Rate for Payer: Mclaren Commercial |
$227.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.90
|
| Rate for Payer: Nomi Health Commercial |
$207.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.48
|
|
|
HC INJECTION SCLEROSING SOL SINGLE
|
Facility
|
OP
|
$252.82
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
36100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.33 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$227.54
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$245.24
|
| Rate for Payer: ASR Commercial |
$245.24
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$207.03
|
| Rate for Payer: BCN Commercial |
$196.01
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$202.26
|
| Rate for Payer: Cash Price |
$202.26
|
| Rate for Payer: Cofinity Commercial |
$237.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$252.82
|
| Rate for Payer: Healthscope Whirlpool |
$245.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$227.54
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.90
|
| Rate for Payer: Nomi Health Commercial |
$207.31
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$221.52
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$177.23
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
HC INJECTION SHOULDER ARTHROGRAM
|
Facility
|
OP
|
$863.45
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
36100037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$863.45 |
| Rate for Payer: Aetna Commercial |
$777.10
|
| Rate for Payer: Aetna Medicare |
$431.72
|
| Rate for Payer: ASR ASR |
$837.55
|
| Rate for Payer: ASR Commercial |
$837.55
|
| Rate for Payer: BCBS Complete |
$345.38
|
| Rate for Payer: BCBS Trust/PPO |
$707.08
|
| Rate for Payer: BCN Commercial |
$669.43
|
| Rate for Payer: Cash Price |
$690.76
|
| Rate for Payer: Cash Price |
$690.76
|
| Rate for Payer: Cofinity Commercial |
$811.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.76
|
| Rate for Payer: Healthscope Commercial |
$863.45
|
| Rate for Payer: Healthscope Whirlpool |
$837.55
|
| Rate for Payer: Mclaren Commercial |
$777.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.93
|
| Rate for Payer: Nomi Health Commercial |
$708.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.74
|
| Rate for Payer: Priority Health Narrow Network |
$226.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$759.84
|
|
|
HC INJECTION SHOULDER ARTHROGRAM
|
Facility
|
IP
|
$863.45
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
36100037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$561.24 |
| Max. Negotiated Rate |
$863.45 |
| Rate for Payer: Aetna Commercial |
$777.10
|
| Rate for Payer: ASR ASR |
$837.55
|
| Rate for Payer: ASR Commercial |
$837.55
|
| Rate for Payer: BCBS Trust/PPO |
$703.63
|
| Rate for Payer: BCN Commercial |
$669.43
|
| Rate for Payer: Cash Price |
$690.76
|
| Rate for Payer: Cofinity Commercial |
$811.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.76
|
| Rate for Payer: Healthscope Commercial |
$863.45
|
| Rate for Payer: Healthscope Whirlpool |
$837.55
|
| Rate for Payer: Mclaren Commercial |
$777.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.93
|
| Rate for Payer: Nomi Health Commercial |
$708.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$759.84
|
|
|
HC INJECTION SHUNTOGRAM
|
Facility
|
OP
|
$388.71
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
36100224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.48 |
| Max. Negotiated Rate |
$388.71 |
| Rate for Payer: Aetna Commercial |
$349.84
|
| Rate for Payer: Aetna Medicare |
$194.36
|
| Rate for Payer: ASR ASR |
$377.05
|
| Rate for Payer: ASR Commercial |
$377.05
|
| Rate for Payer: BCBS Complete |
$155.48
|
| Rate for Payer: BCBS Trust/PPO |
$318.31
|
| Rate for Payer: BCN Commercial |
$301.37
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$365.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$388.71
|
| Rate for Payer: Healthscope Whirlpool |
$377.05
|
| Rate for Payer: Mclaren Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$340.59
|
| Rate for Payer: Priority Health Narrow Network |
$272.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.06
|
|
|
HC INJECTION SHUNTOGRAM
|
Facility
|
IP
|
$388.71
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
36100224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.66 |
| Max. Negotiated Rate |
$388.71 |
| Rate for Payer: Aetna Commercial |
$349.84
|
| Rate for Payer: ASR ASR |
$377.05
|
| Rate for Payer: ASR Commercial |
$377.05
|
| Rate for Payer: BCBS Trust/PPO |
$316.76
|
| Rate for Payer: BCN Commercial |
$301.37
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$365.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$388.71
|
| Rate for Payer: Healthscope Whirlpool |
$377.05
|
| Rate for Payer: Mclaren Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.06
|
|
|
HC INJECTION SIALOGRAM
|
Facility
|
OP
|
$291.84
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
36100190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.68 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$262.66
|
| Rate for Payer: Aetna Medicare |
$145.92
|
| Rate for Payer: ASR ASR |
$283.08
|
| Rate for Payer: ASR Commercial |
$283.08
|
| Rate for Payer: BCBS Complete |
$116.74
|
| Rate for Payer: BCBS Trust/PPO |
$238.99
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$274.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Healthscope Commercial |
$291.84
|
| Rate for Payer: Healthscope Whirlpool |
$283.08
|
| Rate for Payer: Mclaren Commercial |
$262.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$239.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.35
|
| Rate for Payer: Priority Health Narrow Network |
$110.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.82
|
|
|
HC INJECTION SIALOGRAM
|
Facility
|
IP
|
$291.84
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
36100190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$189.70 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$262.66
|
| Rate for Payer: ASR ASR |
$283.08
|
| Rate for Payer: ASR Commercial |
$283.08
|
| Rate for Payer: BCBS Trust/PPO |
$237.82
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$274.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Healthscope Commercial |
$291.84
|
| Rate for Payer: Healthscope Whirlpool |
$283.08
|
| Rate for Payer: Mclaren Commercial |
$262.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$239.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.82
|
|
|
HC INJECTION SI JOINT ANESTHESIA/STEROID
|
Facility
|
OP
|
$1,011.25
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$404.50 |
| Max. Negotiated Rate |
$1,147.41 |
| Rate for Payer: Aetna Commercial |
$910.12
|
| Rate for Payer: Aetna Medicare |
$505.62
|
| Rate for Payer: ASR ASR |
$980.91
|
| Rate for Payer: ASR Commercial |
$980.91
|
| Rate for Payer: BCBS Complete |
$404.50
|
| Rate for Payer: BCBS Trust/PPO |
$828.11
|
| Rate for Payer: BCN Commercial |
$784.02
|
| Rate for Payer: Cash Price |
$809.00
|
| Rate for Payer: Cash Price |
$809.00
|
| Rate for Payer: Cofinity Commercial |
$950.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.00
|
| Rate for Payer: Healthscope Commercial |
$1,011.25
|
| Rate for Payer: Healthscope Whirlpool |
$980.91
|
| Rate for Payer: Mclaren Commercial |
$910.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.56
|
| Rate for Payer: Nomi Health Commercial |
$829.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,147.41
|
| Rate for Payer: Priority Health Narrow Network |
$917.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$889.90
|
|
|
HC INJECTION SI JOINT ANESTHESIA/STEROID
|
Facility
|
IP
|
$1,011.25
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$657.31 |
| Max. Negotiated Rate |
$1,011.25 |
| Rate for Payer: Aetna Commercial |
$910.12
|
| Rate for Payer: ASR ASR |
$980.91
|
| Rate for Payer: ASR Commercial |
$980.91
|
| Rate for Payer: BCBS Trust/PPO |
$824.07
|
| Rate for Payer: BCN Commercial |
$784.02
|
| Rate for Payer: Cash Price |
$809.00
|
| Rate for Payer: Cofinity Commercial |
$950.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.00
|
| Rate for Payer: Healthscope Commercial |
$1,011.25
|
| Rate for Payer: Healthscope Whirlpool |
$980.91
|
| Rate for Payer: Mclaren Commercial |
$910.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.56
|
| Rate for Payer: Nomi Health Commercial |
$829.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$889.90
|
|
