|
HC INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
63600096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: ASR ASR |
$1.01
|
| Rate for Payer: ASR Commercial |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.81
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Commercial |
$0.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$1.04
|
| Rate for Payer: Healthscope Whirlpool |
$1.01
|
| Rate for Payer: Mclaren Commercial |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: Nomi Health Commercial |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.92
|
|
|
HC INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
63600096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Medicare |
$0.52
|
| Rate for Payer: ASR ASR |
$1.01
|
| Rate for Payer: ASR Commercial |
$1.01
|
| Rate for Payer: BCBS Complete |
$0.42
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.81
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Commercial |
$0.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$1.04
|
| Rate for Payer: Healthscope Whirlpool |
$1.01
|
| Rate for Payer: Mclaren Commercial |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: Nomi Health Commercial |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.91
|
| Rate for Payer: Priority Health Narrow Network |
$0.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.92
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: ASR ASR |
$10.09
|
| Rate for Payer: ASR Commercial |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$8.47
|
| Rate for Payer: BCN Commercial |
$8.06
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$9.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$10.40
|
| Rate for Payer: Healthscope Whirlpool |
$10.09
|
| Rate for Payer: Mclaren Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.15
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: ASR ASR |
$10.09
|
| Rate for Payer: ASR Commercial |
$10.09
|
| Rate for Payer: BCBS Complete |
$4.16
|
| Rate for Payer: BCBS Trust/PPO |
$8.52
|
| Rate for Payer: BCN Commercial |
$8.06
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$9.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$10.40
|
| Rate for Payer: Healthscope Whirlpool |
$10.09
|
| Rate for Payer: Mclaren Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.11
|
| Rate for Payer: Priority Health Narrow Network |
$7.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.15
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
63600094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.24 |
| 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: 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 |
$13.68
|
| Rate for Payer: Priority Health Narrow Network |
$10.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
63600094
|
|
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, METHYLPREDNISOLONE ACETATE, 80 MG
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
63600095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$13.01
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.79
|
| Rate for Payer: Priority Health Narrow Network |
$18.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
63600095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
|
HC INJECTION MYELOGRAM
|
Facility
|
IP
|
$1,067.34
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
36100281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$693.77 |
| Max. Negotiated Rate |
$1,067.34 |
| Rate for Payer: Aetna Commercial |
$960.61
|
| Rate for Payer: ASR ASR |
$1,035.32
|
| Rate for Payer: ASR Commercial |
$1,035.32
|
| Rate for Payer: BCBS Trust/PPO |
$869.78
|
| Rate for Payer: BCN Commercial |
$827.51
|
| Rate for Payer: Cash Price |
$853.87
|
| Rate for Payer: Cofinity Commercial |
$1,003.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.87
|
| Rate for Payer: Healthscope Commercial |
$1,067.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,035.32
|
| Rate for Payer: Mclaren Commercial |
$960.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$907.24
|
| Rate for Payer: Nomi Health Commercial |
$875.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$939.26
|
|
|
HC INJECTION MYELOGRAM
|
Facility
|
OP
|
$1,067.34
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
36100281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$426.94 |
| Max. Negotiated Rate |
$1,067.34 |
| Rate for Payer: Aetna Commercial |
$960.61
|
| Rate for Payer: Aetna Medicare |
$533.67
|
| Rate for Payer: ASR ASR |
$1,035.32
|
| Rate for Payer: ASR Commercial |
$1,035.32
|
| Rate for Payer: BCBS Complete |
$426.94
|
| Rate for Payer: BCBS Trust/PPO |
$874.04
|
| Rate for Payer: BCN Commercial |
$827.51
|
| Rate for Payer: Cash Price |
$853.87
|
| Rate for Payer: Cofinity Commercial |
$1,003.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.87
|
| Rate for Payer: Healthscope Commercial |
$1,067.34
|
| Rate for Payer: Healthscope Whirlpool |
$1,035.32
|
| Rate for Payer: Mclaren Commercial |
$960.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$907.24
|
| Rate for Payer: Nomi Health Commercial |
$875.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$935.20
|
| Rate for Payer: Priority Health Narrow Network |
$748.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$939.26
|
|
|
HC INJECTION PLANTAR DIGIT
|
Facility
|
IP
|
$351.66
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.58 |
| Max. Negotiated Rate |
$351.66 |
| Rate for Payer: Aetna Commercial |
$316.49
|
| Rate for Payer: ASR ASR |
$341.11
|
| Rate for Payer: ASR Commercial |
$341.11
|
| Rate for Payer: BCBS Trust/PPO |
$286.57
|
| Rate for Payer: BCN Commercial |
$272.64
|
| Rate for Payer: Cash Price |
$281.33
|
| Rate for Payer: Cofinity Commercial |
$330.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.33
|
| Rate for Payer: Healthscope Commercial |
$351.66
|
| Rate for Payer: Healthscope Whirlpool |
$341.11
|
| Rate for Payer: Mclaren Commercial |
$316.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.91
|
| Rate for Payer: Nomi Health Commercial |
$288.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.46
|
|
|
HC INJECTION PLANTAR DIGIT
|
Facility
|
OP
|
$351.66
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$446.23 |
| Rate for Payer: Aetna Commercial |
$316.49
|
| Rate for Payer: Aetna Medicare |
$287.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: ASR ASR |
$341.11
|
| Rate for Payer: ASR Commercial |
$341.11
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCBS Trust/PPO |
$287.97
|
| Rate for Payer: BCN Commercial |
$272.64
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Cash Price |
$281.33
|
| Rate for Payer: Cash Price |
$281.33
|
| Rate for Payer: Cofinity Commercial |
$330.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| Rate for Payer: Healthscope Commercial |
$351.66
|
| Rate for Payer: Healthscope Whirlpool |
$341.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$287.89
|
| Rate for Payer: Mclaren Commercial |
$316.49
|
| Rate for Payer: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.91
|
| Rate for Payer: Nomi Health Commercial |
$288.36
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Commercial |
$316.68
|
| Rate for Payer: PHP Medicaid |
$154.31
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$308.12
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Priority Health Narrow Network |
$246.51
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Exchange |
$446.23
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP DNSP |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$154.31
|
| Rate for Payer: VA VA |
$287.89
|
|
|
HC INJECTION PLANTAR DIGIT BILATERAL
|
Facility
|
IP
|
$527.48
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.86 |
| Max. Negotiated Rate |
$527.48 |
| Rate for Payer: Aetna Commercial |
$474.73
|
| Rate for Payer: ASR ASR |
$511.66
|
| Rate for Payer: ASR Commercial |
$511.66
|
| Rate for Payer: BCBS Trust/PPO |
$429.84
|
| Rate for Payer: BCN Commercial |
$408.96
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cofinity Commercial |
$495.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.98
|
| Rate for Payer: Healthscope Commercial |
$527.48
|
| Rate for Payer: Healthscope Whirlpool |
$511.66
|
| Rate for Payer: Mclaren Commercial |
$474.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.36
|
| Rate for Payer: Nomi Health Commercial |
$432.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$464.18
|
|
|
HC INJECTION PLANTAR DIGIT BILATERAL
|
Facility
|
OP
|
$527.48
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$527.48 |
| Rate for Payer: Aetna Commercial |
$474.73
|
| Rate for Payer: Aetna Medicare |
$287.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: ASR ASR |
$511.66
|
| Rate for Payer: ASR Commercial |
$511.66
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCBS Trust/PPO |
$431.95
|
| Rate for Payer: BCN Commercial |
$408.96
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cofinity Commercial |
$495.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| Rate for Payer: Healthscope Commercial |
$527.48
|
| Rate for Payer: Healthscope Whirlpool |
$511.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$287.89
|
| Rate for Payer: Mclaren Commercial |
$474.73
|
| Rate for Payer: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.36
|
| Rate for Payer: Nomi Health Commercial |
$432.53
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Commercial |
$316.68
|
| Rate for Payer: PHP Medicaid |
$154.31
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$462.18
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Priority Health Narrow Network |
$369.76
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$464.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Exchange |
$446.23
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP DNSP |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$154.31
|
| Rate for Payer: VA VA |
$287.89
|
|
|
HC INJECTION PLATELET PLASMA W/IMG HARVEST/PREP
|
Facility
|
IP
|
$805.80
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
76100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$523.77 |
| Max. Negotiated Rate |
$805.80 |
| Rate for Payer: Aetna Commercial |
$725.22
|
| Rate for Payer: ASR ASR |
$781.63
|
| Rate for Payer: ASR Commercial |
$781.63
|
| Rate for Payer: BCBS Trust/PPO |
$656.65
|
| Rate for Payer: BCN Commercial |
$624.74
|
| 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: Healthscope Commercial |
$805.80
|
| Rate for Payer: Healthscope Whirlpool |
$781.63
|
| Rate for Payer: Mclaren Commercial |
$725.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$684.93
|
| Rate for Payer: Nomi Health Commercial |
$660.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$709.10
|
|
|
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 |
$208.60 |
| Max. Negotiated Rate |
$805.80 |
| Rate for Payer: Aetna Commercial |
$725.22
|
| Rate for Payer: Aetna Medicare |
$389.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$486.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$486.48
|
| Rate for Payer: ASR ASR |
$781.63
|
| Rate for Payer: ASR Commercial |
$781.63
|
| Rate for Payer: BCBS Complete |
$219.03
|
| Rate for Payer: BCBS MAPPO |
$389.18
|
| Rate for Payer: BCBS Trust/PPO |
$659.87
|
| Rate for Payer: BCN Commercial |
$624.74
|
| Rate for Payer: BCN Medicare Advantage |
$389.18
|
| 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 |
$389.18
|
| Rate for Payer: Healthscope Commercial |
$805.80
|
| Rate for Payer: Healthscope Whirlpool |
$781.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.18
|
| Rate for Payer: Mclaren Commercial |
$725.22
|
| Rate for Payer: Mclaren Medicaid |
$208.60
|
| Rate for Payer: Mclaren Medicare |
$389.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$408.64
|
| Rate for Payer: Meridian Medicaid |
$219.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$447.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$684.93
|
| Rate for Payer: Nomi Health Commercial |
$660.76
|
| Rate for Payer: PACE Medicare |
$369.72
|
| Rate for Payer: PACE SWMI |
$389.18
|
| Rate for Payer: PHP Commercial |
$428.10
|
| Rate for Payer: PHP Medicaid |
$208.60
|
| Rate for Payer: PHP Medicare Advantage |
$389.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.60
|
| 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 |
$389.18
|
| Rate for Payer: Priority Health Narrow Network |
$564.87
|
| Rate for Payer: Railroad Medicare Medicare |
$389.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$709.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.18
|
| Rate for Payer: UHC Exchange |
$603.23
|
| Rate for Payer: UHC Medicare Advantage |
$389.18
|
| Rate for Payer: UHCCP DNSP |
$389.18
|
| Rate for Payer: UHCCP Medicaid |
$208.60
|
| Rate for Payer: VA VA |
$389.18
|
|
|
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 PROC CYSTOGRAPHY VOIDING
|
Facility
|
OP
|
$1,310.34
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
36100251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$524.14 |
| 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: 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 |
$1,148.12
|
| Rate for Payer: Priority Health Narrow Network |
$918.55
|
| 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: 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 |
$563.86
|
| Rate for Payer: Priority Health Narrow Network |
$451.11
|
| 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
|
OP
|
$15.61
|
|
|
Service Code
|
CPT J2550
|
| Hospital Charge Code |
63600100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.24 |
| 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: 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 |
$13.68
|
| Rate for Payer: Priority Health Narrow Network |
$10.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.74
|
|
