|
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 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 |
$465.40 |
| Max. Negotiated Rate |
$1,345.83 |
| Rate for Payer: Aetna Commercial |
$1,074.25
|
| Rate for Payer: Aetna Medicare |
$868.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: ASR ASR |
$1,157.80
|
| Rate for Payer: ASR Commercial |
$1,157.80
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCBS Trust/PPO |
$977.45
|
| Rate for Payer: BCN Commercial |
$925.41
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| 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 |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$1,193.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,157.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$868.28
|
| Rate for Payer: Mclaren Commercial |
$1,074.25
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,014.57
|
| Rate for Payer: Nomi Health Commercial |
$978.76
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$955.11
|
| Rate for Payer: PHP Medicaid |
$465.40
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| 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 |
$868.28
|
| Rate for Payer: Priority Health Narrow Network |
$836.72
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,050.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,345.83
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP DNSP |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: VA VA |
$868.28
|
|
|
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 |
$208.85 |
| Max. Negotiated Rate |
$603.96 |
| Rate for Payer: Aetna Commercial |
$296.36
|
| Rate for Payer: Aetna Medicare |
$389.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: ASR ASR |
$319.41
|
| Rate for Payer: ASR Commercial |
$319.41
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCBS Trust/PPO |
$269.66
|
| Rate for Payer: BCN Commercial |
$255.30
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| 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 |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$329.29
|
| Rate for Payer: Healthscope Whirlpool |
$319.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.65
|
| Rate for Payer: Mclaren Commercial |
$296.36
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.90
|
| Rate for Payer: Nomi Health Commercial |
$270.02
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: PHP Medicaid |
$208.85
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| 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 |
$389.65
|
| Rate for Payer: Priority Health Narrow Network |
$230.83
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$603.96
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP DNSP |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
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 |
$603.96 |
| Rate for Payer: Aetna Commercial |
$227.54
|
| Rate for Payer: Aetna Medicare |
$389.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: ASR ASR |
$245.24
|
| Rate for Payer: ASR Commercial |
$245.24
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCBS Trust/PPO |
$207.03
|
| Rate for Payer: BCN Commercial |
$196.01
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| 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 |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$252.82
|
| Rate for Payer: Healthscope Whirlpool |
$245.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.65
|
| Rate for Payer: Mclaren Commercial |
$227.54
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.90
|
| Rate for Payer: Nomi Health Commercial |
$207.31
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: PHP Medicaid |
$208.85
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| 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 |
$389.65
|
| Rate for Payer: Priority Health Narrow Network |
$177.23
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$603.96
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP DNSP |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
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 |
$777.11
|
| 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 |
$777.11
|
| 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 SHOULDER ARTHROGRAM
|
Facility
|
OP
|
$863.45
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
36100037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$345.38 |
| Max. Negotiated Rate |
$863.45 |
| Rate for Payer: Aetna Commercial |
$777.11
|
| Rate for Payer: Aetna Medicare |
$431.73
|
| 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: 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 |
$777.11
|
| 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 |
$756.55
|
| Rate for Payer: Priority Health Narrow Network |
$605.28
|
| 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 |
$194.35
|
| 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 |
$116.74 |
| 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: 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 |
$255.71
|
| Rate for Payer: Priority Health Narrow Network |
$204.58
|
| 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
|
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 |
$829.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$889.90
|
|
|
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 |
$1,011.25 |
| 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: 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 |
$829.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$886.06
|
| Rate for Payer: Priority Health Narrow Network |
$708.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$889.90
|
|
|
HC INJECTION SI JOINT BIL ANESTHESIA/STEROID
|
Facility
|
OP
|
$1,047.85
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$419.14 |
| Max. Negotiated Rate |
$1,047.85 |
| Rate for Payer: Aetna Commercial |
$943.07
|
| Rate for Payer: Aetna Medicare |
$523.92
|
| Rate for Payer: ASR ASR |
$1,016.41
|
| Rate for Payer: ASR Commercial |
$1,016.41
|
| Rate for Payer: BCBS Complete |
$419.14
|
| Rate for Payer: BCBS Trust/PPO |
$858.08
|
| Rate for Payer: BCN Commercial |
$812.40
|
| Rate for Payer: Cash Price |
$838.28
|
| Rate for Payer: Cofinity Commercial |
$984.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.28
|
| Rate for Payer: Healthscope Commercial |
$1,047.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,016.41
|
| Rate for Payer: Mclaren Commercial |
$943.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.67
|
| Rate for Payer: Nomi Health Commercial |
$859.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$681.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$918.13
|
| Rate for Payer: Priority Health Narrow Network |
$734.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$922.11
|
|
|
HC INJECTION SI JOINT BIL ANESTHESIA/STEROID
|
Facility
|
IP
|
$1,047.85
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$681.10 |
| Max. Negotiated Rate |
$1,047.85 |
| Rate for Payer: Aetna Commercial |
$943.07
|
| Rate for Payer: ASR ASR |
$1,016.41
|
| Rate for Payer: ASR Commercial |
$1,016.41
|
| Rate for Payer: BCBS Trust/PPO |
$853.89
|
| Rate for Payer: BCN Commercial |
$812.40
|
| Rate for Payer: Cash Price |
$838.28
|
| Rate for Payer: Cofinity Commercial |
$984.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.28
|
| Rate for Payer: Healthscope Commercial |
$1,047.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,016.41
|
| Rate for Payer: Mclaren Commercial |
$943.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.67
|
| Rate for Payer: Nomi Health Commercial |
$859.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$681.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$922.11
|
|
|
HC INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$279.36
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
36100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.58 |
| Max. Negotiated Rate |
$279.36 |
| Rate for Payer: Aetna Commercial |
$251.42
|
| Rate for Payer: ASR ASR |
$270.98
|
| Rate for Payer: ASR Commercial |
$270.98
|
| Rate for Payer: BCBS Trust/PPO |
$227.65
|
| Rate for Payer: BCN Commercial |
$216.59
|
| Rate for Payer: Cash Price |
$223.49
|
| Rate for Payer: Cofinity Commercial |
$262.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.49
|
| Rate for Payer: Healthscope Commercial |
$279.36
|
| Rate for Payer: Healthscope Whirlpool |
$270.98
|
| Rate for Payer: Mclaren Commercial |
$251.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.46
|
| Rate for Payer: Nomi Health Commercial |
$229.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.84
|
|
|
HC INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$279.36
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
36100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$446.23 |
| Rate for Payer: Aetna Commercial |
$251.42
|
| 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 |
$270.98
|
| Rate for Payer: ASR Commercial |
$270.98
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCBS Trust/PPO |
$228.77
|
| Rate for Payer: BCN Commercial |
$216.59
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Cash Price |
$223.49
|
| Rate for Payer: Cash Price |
$223.49
|
| Rate for Payer: Cofinity Commercial |
$262.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| Rate for Payer: Healthscope Commercial |
$279.36
|
| Rate for Payer: Healthscope Whirlpool |
$270.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$287.89
|
| Rate for Payer: Mclaren Commercial |
$251.42
|
| 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 |
$237.46
|
| Rate for Payer: Nomi Health Commercial |
$229.08
|
| 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 |
$181.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.78
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Priority Health Narrow Network |
$195.83
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.84
|
| 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 SPLENOPOTOGRAM SPLENOPORTOG
|
Facility
|
IP
|
$437.63
|
|
|
Service Code
|
CPT 38200
|
| Hospital Charge Code |
36100183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$284.46 |
| Max. Negotiated Rate |
$437.63 |
| Rate for Payer: Aetna Commercial |
$393.87
|
| Rate for Payer: ASR ASR |
$424.50
|
| Rate for Payer: ASR Commercial |
$424.50
|
| Rate for Payer: BCBS Trust/PPO |
$356.62
|
| Rate for Payer: BCN Commercial |
$339.29
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$411.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Healthscope Commercial |
$437.63
|
| Rate for Payer: Healthscope Whirlpool |
$424.50
|
| Rate for Payer: Mclaren Commercial |
$393.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: Nomi Health Commercial |
$358.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.11
|
|
|
HC INJECTION SPLENOPOTOGRAM SPLENOPORTOG
|
Facility
|
OP
|
$437.63
|
|
|
Service Code
|
CPT 38200
|
| Hospital Charge Code |
36100183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$175.05 |
| Max. Negotiated Rate |
$437.63 |
| Rate for Payer: Aetna Commercial |
$393.87
|
| Rate for Payer: Aetna Medicare |
$218.81
|
| Rate for Payer: ASR ASR |
$424.50
|
| Rate for Payer: ASR Commercial |
$424.50
|
| Rate for Payer: BCBS Complete |
$175.05
|
| Rate for Payer: BCBS Trust/PPO |
$358.38
|
| Rate for Payer: BCN Commercial |
$339.29
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$411.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Healthscope Commercial |
$437.63
|
| Rate for Payer: Healthscope Whirlpool |
$424.50
|
| Rate for Payer: Mclaren Commercial |
$393.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: Nomi Health Commercial |
$358.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$383.45
|
| Rate for Payer: Priority Health Narrow Network |
$306.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.11
|
|
|
HC INJECTIONS SCLEROSANT FOR SPIDER VEINS /TRNK
|
Facility
|
IP
|
$1,085.28
|
|
|
Service Code
|
CPT 36468
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$705.43 |
| Max. Negotiated Rate |
$1,085.28 |
| Rate for Payer: Aetna Commercial |
$976.75
|
| Rate for Payer: ASR ASR |
$1,052.72
|
| Rate for Payer: ASR Commercial |
$1,052.72
|
| Rate for Payer: BCBS Trust/PPO |
$884.39
|
| Rate for Payer: BCN Commercial |
$841.42
|
| Rate for Payer: Cash Price |
$868.22
|
| Rate for Payer: Cofinity Commercial |
$1,020.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$868.22
|
| Rate for Payer: Healthscope Commercial |
$1,085.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,052.72
|
| Rate for Payer: Mclaren Commercial |
$976.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$922.49
|
| Rate for Payer: Nomi Health Commercial |
$889.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$955.05
|
|
|
HC INJECTIONS SCLEROSANT FOR SPIDER VEINS /TRNK
|
Facility
|
OP
|
$1,085.28
|
|
|
Service Code
|
CPT 36468
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,085.28 |
| Rate for Payer: Aetna Commercial |
$976.75
|
| Rate for Payer: Aetna Medicare |
$389.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: ASR ASR |
$1,052.72
|
| Rate for Payer: ASR Commercial |
$1,052.72
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCBS Trust/PPO |
$888.74
|
| Rate for Payer: BCN Commercial |
$841.42
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$868.22
|
| Rate for Payer: Cash Price |
$868.22
|
| Rate for Payer: Cofinity Commercial |
$1,020.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$868.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$1,085.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,052.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.65
|
| Rate for Payer: Mclaren Commercial |
$976.75
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$922.49
|
| Rate for Payer: Nomi Health Commercial |
$889.93
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: PHP Medicaid |
$208.85
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$950.92
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health Narrow Network |
$760.78
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$955.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$603.96
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP DNSP |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
HC INJECTION, TESTOSTERONE CYPIONATE, 1 MG
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
CPT J1071
|
| Hospital Charge Code |
63600109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: ASR ASR |
$0.16
|
| Rate for Payer: ASR Commercial |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cofinity Commercial |
$0.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.13
|
| Rate for Payer: Healthscope Commercial |
$0.16
|
| Rate for Payer: Healthscope Whirlpool |
$0.16
|
| Rate for Payer: Mclaren Commercial |
$0.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.14
|
| Rate for Payer: Nomi Health Commercial |
$0.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.14
|
|
|
HC INJECTION, TESTOSTERONE CYPIONATE, 1 MG
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
CPT J1071
|
| Hospital Charge Code |
63600109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Aetna Medicare |
$0.08
|
| Rate for Payer: ASR ASR |
$0.16
|
| Rate for Payer: ASR Commercial |
$0.16
|
| Rate for Payer: BCBS Complete |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cofinity Commercial |
$0.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.13
|
| Rate for Payer: Healthscope Commercial |
$0.16
|
| Rate for Payer: Healthscope Whirlpool |
$0.16
|
| Rate for Payer: Mclaren Commercial |
$0.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.14
|
| Rate for Payer: Nomi Health Commercial |
$0.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.14
|
| Rate for Payer: Priority Health Narrow Network |
$0.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.14
|
|
