|
HC INJ LUMB W MYELO LS SAME MD
|
Facility
|
OP
|
$2,204.53
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
36100462
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$413.00 |
| Max. Negotiated Rate |
$2,204.53 |
| Rate for Payer: Aetna Commercial |
$1,984.08
|
| Rate for Payer: Aetna Medicare |
$770.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$963.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$963.16
|
| Rate for Payer: ASR ASR |
$2,138.39
|
| Rate for Payer: ASR Commercial |
$2,138.39
|
| Rate for Payer: BCBS Complete |
$433.65
|
| Rate for Payer: BCBS MAPPO |
$770.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,805.29
|
| Rate for Payer: BCN Commercial |
$1,709.17
|
| Rate for Payer: BCN Medicare Advantage |
$770.53
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cofinity Commercial |
$2,072.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$770.53
|
| Rate for Payer: Healthscope Commercial |
$2,204.53
|
| Rate for Payer: Healthscope Whirlpool |
$2,138.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$770.53
|
| Rate for Payer: Mclaren Commercial |
$1,984.08
|
| Rate for Payer: Mclaren Medicaid |
$413.00
|
| Rate for Payer: Mclaren Medicare |
$770.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$809.06
|
| Rate for Payer: Meridian Medicaid |
$433.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$886.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.85
|
| Rate for Payer: Nomi Health Commercial |
$1,807.71
|
| Rate for Payer: PACE Medicare |
$732.00
|
| Rate for Payer: PACE SWMI |
$770.53
|
| Rate for Payer: PHP Commercial |
$847.58
|
| Rate for Payer: PHP Medicaid |
$413.00
|
| Rate for Payer: PHP Medicare Advantage |
$770.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,931.61
|
| Rate for Payer: Priority Health Medicare |
$770.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,545.38
|
| Rate for Payer: Railroad Medicare Medicare |
$770.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,939.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$770.53
|
| Rate for Payer: UHC Exchange |
$1,194.32
|
| Rate for Payer: UHC Medicare Advantage |
$770.53
|
| Rate for Payer: UHCCP DNSP |
$770.53
|
| Rate for Payer: UHCCP Medicaid |
$413.00
|
| Rate for Payer: VA VA |
$770.53
|
|
|
HC INJ LUMB W MYELO LS SAME MD
|
Facility
|
IP
|
$2,204.53
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
36100462
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,432.94 |
| Max. Negotiated Rate |
$2,204.53 |
| Rate for Payer: Aetna Commercial |
$1,984.08
|
| Rate for Payer: ASR ASR |
$2,138.39
|
| Rate for Payer: ASR Commercial |
$2,138.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,796.47
|
| Rate for Payer: BCN Commercial |
$1,709.17
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cofinity Commercial |
$2,072.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.62
|
| Rate for Payer: Healthscope Commercial |
$2,204.53
|
| Rate for Payer: Healthscope Whirlpool |
$2,138.39
|
| Rate for Payer: Mclaren Commercial |
$1,984.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.85
|
| Rate for Payer: Nomi Health Commercial |
$1,807.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,939.99
|
|
|
HC INJ LUMB W MYELO THOR SAME MD
|
Facility
|
IP
|
$2,204.53
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
36100461
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,432.94 |
| Max. Negotiated Rate |
$2,204.53 |
| Rate for Payer: Aetna Commercial |
$1,984.08
|
| Rate for Payer: ASR ASR |
$2,138.39
|
| Rate for Payer: ASR Commercial |
$2,138.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,796.47
|
| Rate for Payer: BCN Commercial |
$1,709.17
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cofinity Commercial |
$2,072.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.62
|
| Rate for Payer: Healthscope Commercial |
$2,204.53
|
| Rate for Payer: Healthscope Whirlpool |
$2,138.39
|
| Rate for Payer: Mclaren Commercial |
$1,984.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.85
|
| Rate for Payer: Nomi Health Commercial |
$1,807.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,939.99
|
|
|
HC INJ LUMB W MYELO THOR SAME MD
|
Facility
|
OP
|
$2,204.53
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
36100461
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$413.00 |
| Max. Negotiated Rate |
$2,204.53 |
| Rate for Payer: Aetna Commercial |
$1,984.08
|
| Rate for Payer: Aetna Medicare |
$770.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$963.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$963.16
|
| Rate for Payer: ASR ASR |
$2,138.39
|
| Rate for Payer: ASR Commercial |
$2,138.39
|
| Rate for Payer: BCBS Complete |
$433.65
|
| Rate for Payer: BCBS MAPPO |
$770.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,805.29
|
| Rate for Payer: BCN Commercial |
$1,709.17
|
| Rate for Payer: BCN Medicare Advantage |
$770.53
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cofinity Commercial |
$2,072.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$770.53
|
| Rate for Payer: Healthscope Commercial |
$2,204.53
|
| Rate for Payer: Healthscope Whirlpool |
$2,138.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$770.53
|
| Rate for Payer: Mclaren Commercial |
$1,984.08
|
| Rate for Payer: Mclaren Medicaid |
$413.00
|
| Rate for Payer: Mclaren Medicare |
$770.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$809.06
|
| Rate for Payer: Meridian Medicaid |
$433.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$886.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.85
|
| Rate for Payer: Nomi Health Commercial |
$1,807.71
|
| Rate for Payer: PACE Medicare |
$732.00
|
| Rate for Payer: PACE SWMI |
$770.53
|
| Rate for Payer: PHP Commercial |
$847.58
|
| Rate for Payer: PHP Medicaid |
$413.00
|
| Rate for Payer: PHP Medicare Advantage |
$770.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,931.61
|
| Rate for Payer: Priority Health Medicare |
$770.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,545.38
|
| Rate for Payer: Railroad Medicare Medicare |
$770.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,939.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$770.53
|
| Rate for Payer: UHC Exchange |
$1,194.32
|
| Rate for Payer: UHC Medicare Advantage |
$770.53
|
| Rate for Payer: UHCCP DNSP |
$770.53
|
| Rate for Payer: UHCCP Medicaid |
$413.00
|
| Rate for Payer: VA VA |
$770.53
|
|
|
HC INJ LYMPHANGIOGRAPHY
|
Facility
|
OP
|
$1,305.17
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
36100445
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$522.07 |
| Max. Negotiated Rate |
$1,305.17 |
| Rate for Payer: Aetna Commercial |
$1,174.65
|
| Rate for Payer: Aetna Medicare |
$652.59
|
| Rate for Payer: ASR ASR |
$1,266.01
|
| Rate for Payer: ASR Commercial |
$1,266.01
|
| Rate for Payer: BCBS Complete |
$522.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,068.80
|
| Rate for Payer: BCN Commercial |
$1,011.90
|
| Rate for Payer: Cash Price |
$1,044.14
|
| Rate for Payer: Cofinity Commercial |
$1,226.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,044.14
|
| Rate for Payer: Healthscope Commercial |
$1,305.17
|
| Rate for Payer: Healthscope Whirlpool |
$1,266.01
|
| Rate for Payer: Mclaren Commercial |
$1,174.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,109.39
|
| Rate for Payer: Nomi Health Commercial |
$1,070.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,143.59
|
| Rate for Payer: Priority Health Narrow Network |
$914.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,148.55
|
|
|
HC INJ LYMPHANGIOGRAPHY
|
Facility
|
IP
|
$1,305.17
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
36100445
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$848.36 |
| Max. Negotiated Rate |
$1,305.17 |
| Rate for Payer: Aetna Commercial |
$1,174.65
|
| Rate for Payer: ASR ASR |
$1,266.01
|
| Rate for Payer: ASR Commercial |
$1,266.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,063.58
|
| Rate for Payer: BCN Commercial |
$1,011.90
|
| Rate for Payer: Cash Price |
$1,044.14
|
| Rate for Payer: Cofinity Commercial |
$1,226.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,044.14
|
| Rate for Payer: Healthscope Commercial |
$1,305.17
|
| Rate for Payer: Healthscope Whirlpool |
$1,266.01
|
| Rate for Payer: Mclaren Commercial |
$1,174.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,109.39
|
| Rate for Payer: Nomi Health Commercial |
$1,070.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,148.55
|
|
|
HC INJ, METHYLPREDNISOLONE ACETATE, 1 MG
|
Facility
|
IP
|
$0.52
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
63600239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Aetna Commercial |
$0.47
|
| Rate for Payer: ASR ASR |
$0.50
|
| Rate for Payer: ASR Commercial |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.42
|
| Rate for Payer: BCN Commercial |
$0.40
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cofinity Commercial |
$0.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.42
|
| Rate for Payer: Healthscope Commercial |
$0.52
|
| Rate for Payer: Healthscope Whirlpool |
$0.50
|
| Rate for Payer: Mclaren Commercial |
$0.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.44
|
| Rate for Payer: Nomi Health Commercial |
$0.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.46
|
|
|
HC INJ, METHYLPREDNISOLONE ACETATE, 1 MG
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
63600239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Aetna Commercial |
$0.47
|
| Rate for Payer: Aetna Medicare |
$0.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.15
|
| Rate for Payer: ASR ASR |
$0.50
|
| Rate for Payer: ASR Commercial |
$0.50
|
| Rate for Payer: BCBS Complete |
$0.07
|
| Rate for Payer: BCBS MAPPO |
$0.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.43
|
| Rate for Payer: BCN Commercial |
$0.40
|
| Rate for Payer: BCN Medicare Advantage |
$0.12
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cash Price |
$0.42
|
| Rate for Payer: Cofinity Commercial |
$0.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.12
|
| Rate for Payer: Healthscope Commercial |
$0.52
|
| Rate for Payer: Healthscope Whirlpool |
$0.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.12
|
| Rate for Payer: Mclaren Commercial |
$0.47
|
| Rate for Payer: Mclaren Medicaid |
$0.06
|
| Rate for Payer: Mclaren Medicare |
$0.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.13
|
| Rate for Payer: Meridian Medicaid |
$0.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.44
|
| Rate for Payer: Nomi Health Commercial |
$0.43
|
| Rate for Payer: PACE Medicare |
$0.11
|
| Rate for Payer: PACE SWMI |
$0.12
|
| Rate for Payer: PHP Commercial |
$0.13
|
| Rate for Payer: PHP Medicaid |
$0.06
|
| Rate for Payer: PHP Medicare Advantage |
$0.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.46
|
| Rate for Payer: Priority Health Medicare |
$0.12
|
| Rate for Payer: Priority Health Narrow Network |
$0.36
|
| Rate for Payer: Railroad Medicare Medicare |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.19
|
| Rate for Payer: UHC Medicare Advantage |
$0.12
|
| Rate for Payer: UHCCP DNSP |
$0.12
|
| Rate for Payer: UHCCP Medicaid |
$0.06
|
| Rate for Payer: VA VA |
$0.12
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, 5 MG
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
63600240
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$2.34
|
| Rate for Payer: Aetna Medicare |
$0.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.26
|
| Rate for Payer: ASR ASR |
$2.52
|
| Rate for Payer: ASR Commercial |
$2.52
|
| Rate for Payer: BCBS Complete |
$0.12
|
| Rate for Payer: BCBS MAPPO |
$0.21
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.21
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.21
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Healthscope Whirlpool |
$2.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.21
|
| Rate for Payer: Mclaren Commercial |
$2.34
|
| Rate for Payer: Mclaren Medicaid |
$0.11
|
| Rate for Payer: Mclaren Medicare |
$0.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.22
|
| Rate for Payer: Meridian Medicaid |
$0.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: Nomi Health Commercial |
$2.13
|
| Rate for Payer: PACE Medicare |
$0.20
|
| Rate for Payer: PACE SWMI |
$0.21
|
| Rate for Payer: PHP Commercial |
$0.23
|
| Rate for Payer: PHP Medicaid |
$0.11
|
| Rate for Payer: PHP Medicare Advantage |
$0.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.28
|
| Rate for Payer: Priority Health Medicare |
$0.21
|
| Rate for Payer: Priority Health Narrow Network |
$1.82
|
| Rate for Payer: Railroad Medicare Medicare |
$0.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.21
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UHC Medicare Advantage |
$0.21
|
| Rate for Payer: UHCCP DNSP |
$0.21
|
| Rate for Payer: UHCCP Medicaid |
$0.11
|
| Rate for Payer: VA VA |
$0.21
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, 5 MG
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
63600240
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$2.34
|
| Rate for Payer: ASR ASR |
$2.52
|
| Rate for Payer: ASR Commercial |
$2.52
|
| Rate for Payer: BCBS Trust/PPO |
$2.12
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Healthscope Whirlpool |
$2.52
|
| Rate for Payer: Mclaren Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: Nomi Health Commercial |
$2.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.29
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 125MG
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
63600102
|
|
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 INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 125MG
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
63600102
|
|
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 INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 40MG
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
63600101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Narrow Network |
$14.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 40MG
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
63600101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC INJ NERV BLOCK GREAT OCCIPTL
|
Facility
|
IP
|
$264.38
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
36100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.85 |
| Max. Negotiated Rate |
$264.38 |
| Rate for Payer: Aetna Commercial |
$237.94
|
| Rate for Payer: ASR ASR |
$256.45
|
| Rate for Payer: ASR Commercial |
$256.45
|
| Rate for Payer: BCBS Trust/PPO |
$215.44
|
| Rate for Payer: BCN Commercial |
$204.97
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cofinity Commercial |
$248.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.50
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: Healthscope Whirlpool |
$256.45
|
| Rate for Payer: Mclaren Commercial |
$237.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.72
|
| Rate for Payer: Nomi Health Commercial |
$216.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.65
|
|
|
HC INJ NERV BLOCK GREAT OCCIPTL
|
Facility
|
OP
|
$264.38
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
36100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$446.23 |
| Rate for Payer: Aetna Commercial |
$237.94
|
| 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 |
$256.45
|
| Rate for Payer: ASR Commercial |
$256.45
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCBS Trust/PPO |
$216.50
|
| Rate for Payer: BCN Commercial |
$204.97
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cofinity Commercial |
$248.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: Healthscope Whirlpool |
$256.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$287.89
|
| Rate for Payer: Mclaren Commercial |
$237.94
|
| 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 |
$224.72
|
| Rate for Payer: Nomi Health Commercial |
$216.79
|
| 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 |
$171.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$231.65
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Priority Health Narrow Network |
$185.33
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.65
|
| 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 INJ ONABOTULINUMTOXINA PER 1 UNIT
|
Facility
|
IP
|
$8.16
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: ASR ASR |
$7.92
|
| Rate for Payer: ASR Commercial |
$7.92
|
| Rate for Payer: BCBS Trust/PPO |
$6.65
|
| Rate for Payer: BCN Commercial |
$6.33
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cofinity Commercial |
$7.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.53
|
| Rate for Payer: Healthscope Commercial |
$8.16
|
| Rate for Payer: Healthscope Whirlpool |
$7.92
|
| Rate for Payer: Mclaren Commercial |
$7.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.94
|
| Rate for Payer: Nomi Health Commercial |
$6.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.18
|
|
|
HC INJ ONABOTULINUMTOXINA PER 1 UNIT
|
Facility
|
OP
|
$8.16
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$10.07 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.12
|
| Rate for Payer: ASR ASR |
$7.92
|
| Rate for Payer: ASR Commercial |
$7.92
|
| Rate for Payer: BCBS Complete |
$3.66
|
| Rate for Payer: BCBS MAPPO |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$6.68
|
| Rate for Payer: BCN Commercial |
$6.33
|
| Rate for Payer: BCN Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cofinity Commercial |
$7.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$8.16
|
| Rate for Payer: Healthscope Whirlpool |
$7.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.50
|
| Rate for Payer: Mclaren Commercial |
$7.34
|
| Rate for Payer: Mclaren Medicaid |
$3.48
|
| Rate for Payer: Mclaren Medicare |
$6.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.83
|
| Rate for Payer: Meridian Medicaid |
$3.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.94
|
| Rate for Payer: Nomi Health Commercial |
$6.69
|
| Rate for Payer: PACE Medicare |
$6.17
|
| Rate for Payer: PACE SWMI |
$6.50
|
| Rate for Payer: PHP Commercial |
$7.15
|
| Rate for Payer: PHP Medicaid |
$3.48
|
| Rate for Payer: PHP Medicare Advantage |
$6.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.15
|
| Rate for Payer: Priority Health Medicare |
$6.50
|
| Rate for Payer: Priority Health Narrow Network |
$5.72
|
| Rate for Payer: Railroad Medicare Medicare |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.50
|
| Rate for Payer: UHC Exchange |
$10.07
|
| Rate for Payer: UHC Medicare Advantage |
$6.50
|
| Rate for Payer: UHCCP DNSP |
$6.50
|
| Rate for Payer: UHCCP Medicaid |
$3.48
|
| Rate for Payer: VA VA |
$6.50
|
|
|
HC INJ, PENICILLIN G BENZATHINE, 100,000 UNITS
|
Facility
|
IP
|
$17.18
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$15.46
|
| Rate for Payer: ASR ASR |
$16.66
|
| Rate for Payer: ASR Commercial |
$16.66
|
| Rate for Payer: BCBS Trust/PPO |
$14.00
|
| Rate for Payer: BCN Commercial |
$13.32
|
| Rate for Payer: Cash Price |
$13.74
|
| Rate for Payer: Cofinity Commercial |
$16.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.74
|
| Rate for Payer: Healthscope Commercial |
$17.18
|
| Rate for Payer: Healthscope Whirlpool |
$16.66
|
| Rate for Payer: Mclaren Commercial |
$15.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.60
|
| Rate for Payer: Nomi Health Commercial |
$14.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.12
|
|
|
HC INJ, PENICILLIN G BENZATHINE, 100,000 UNITS
|
Facility
|
OP
|
$17.18
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$46.52 |
| Rate for Payer: Aetna Commercial |
$15.46
|
| Rate for Payer: Aetna Medicare |
$30.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.51
|
| Rate for Payer: ASR ASR |
$16.66
|
| Rate for Payer: ASR Commercial |
$16.66
|
| Rate for Payer: BCBS Complete |
$16.89
|
| Rate for Payer: BCBS MAPPO |
$30.01
|
| Rate for Payer: BCBS Trust/PPO |
$14.07
|
| Rate for Payer: BCN Commercial |
$13.32
|
| Rate for Payer: BCN Medicare Advantage |
$30.01
|
| Rate for Payer: Cash Price |
$13.74
|
| Rate for Payer: Cash Price |
$13.74
|
| Rate for Payer: Cofinity Commercial |
$16.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.01
|
| Rate for Payer: Healthscope Commercial |
$17.18
|
| Rate for Payer: Healthscope Whirlpool |
$16.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$30.01
|
| Rate for Payer: Mclaren Commercial |
$15.46
|
| Rate for Payer: Mclaren Medicaid |
$16.09
|
| Rate for Payer: Mclaren Medicare |
$30.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.51
|
| Rate for Payer: Meridian Medicaid |
$16.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.60
|
| Rate for Payer: Nomi Health Commercial |
$14.09
|
| Rate for Payer: PACE Medicare |
$28.51
|
| Rate for Payer: PACE SWMI |
$30.01
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: PHP Medicaid |
$16.09
|
| Rate for Payer: PHP Medicare Advantage |
$30.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.05
|
| Rate for Payer: Priority Health Medicare |
$30.01
|
| Rate for Payer: Priority Health Narrow Network |
$12.04
|
| Rate for Payer: Railroad Medicare Medicare |
$30.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.01
|
| Rate for Payer: UHC Exchange |
$46.52
|
| Rate for Payer: UHC Medicare Advantage |
$30.01
|
| Rate for Payer: UHCCP DNSP |
$30.01
|
| Rate for Payer: UHCCP Medicaid |
$16.09
|
| Rate for Payer: VA VA |
$30.01
|
|
|
HC INJ SELECT R VENT/ATRIAL ANGIO HRT CATH
|
Facility
|
OP
|
$683.54
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
36000110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$273.42 |
| Max. Negotiated Rate |
$683.54 |
| Rate for Payer: Aetna Commercial |
$615.19
|
| Rate for Payer: Aetna Medicare |
$341.77
|
| Rate for Payer: ASR ASR |
$663.03
|
| Rate for Payer: ASR Commercial |
$663.03
|
| Rate for Payer: BCBS Complete |
$273.42
|
| Rate for Payer: BCBS Trust/PPO |
$559.75
|
| Rate for Payer: BCN Commercial |
$529.95
|
| Rate for Payer: Cash Price |
$546.83
|
| Rate for Payer: Cofinity Commercial |
$642.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$546.83
|
| Rate for Payer: Healthscope Commercial |
$683.54
|
| Rate for Payer: Healthscope Whirlpool |
$663.03
|
| Rate for Payer: Mclaren Commercial |
$615.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.01
|
| Rate for Payer: Nomi Health Commercial |
$560.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$598.92
|
| Rate for Payer: Priority Health Narrow Network |
$479.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$601.52
|
|
|
HC INJ SELECT R VENT/ATRIAL ANGIO HRT CATH
|
Facility
|
IP
|
$683.54
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
36000110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$444.30 |
| Max. Negotiated Rate |
$683.54 |
| Rate for Payer: Aetna Commercial |
$615.19
|
| Rate for Payer: ASR ASR |
$663.03
|
| Rate for Payer: ASR Commercial |
$663.03
|
| Rate for Payer: BCBS Trust/PPO |
$557.02
|
| Rate for Payer: BCN Commercial |
$529.95
|
| Rate for Payer: Cash Price |
$546.83
|
| Rate for Payer: Cofinity Commercial |
$642.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$546.83
|
| Rate for Payer: Healthscope Commercial |
$683.54
|
| Rate for Payer: Healthscope Whirlpool |
$663.03
|
| Rate for Payer: Mclaren Commercial |
$615.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.01
|
| Rate for Payer: Nomi Health Commercial |
$560.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$601.52
|
|
|
HC INJ TIXAGEVIMAB AND CILGAVIMAB
|
Facility
|
OP
|
$208.08
|
|
|
Service Code
|
HCPCS M0220
|
| Hospital Charge Code |
77100033
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$83.23 |
| Max. Negotiated Rate |
$208.08 |
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: Aetna Medicare |
$104.04
|
| Rate for Payer: ASR ASR |
$201.84
|
| Rate for Payer: ASR Commercial |
$201.84
|
| Rate for Payer: BCBS Complete |
$83.23
|
| Rate for Payer: BCBS Trust/PPO |
$170.40
|
| Rate for Payer: BCN Commercial |
$161.32
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$195.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Healthscope Commercial |
$208.08
|
| Rate for Payer: Healthscope Whirlpool |
$201.84
|
| Rate for Payer: Mclaren Commercial |
$187.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.87
|
| Rate for Payer: Nomi Health Commercial |
$170.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.32
|
| Rate for Payer: Priority Health Narrow Network |
$145.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.11
|
|
|
HC INJ TIXAGEVIMAB AND CILGAVIMAB
|
Facility
|
IP
|
$208.08
|
|
|
Service Code
|
HCPCS M0220
|
| Hospital Charge Code |
77100033
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$135.25 |
| Max. Negotiated Rate |
$208.08 |
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: ASR ASR |
$201.84
|
| Rate for Payer: ASR Commercial |
$201.84
|
| Rate for Payer: BCBS Trust/PPO |
$169.56
|
| Rate for Payer: BCN Commercial |
$161.32
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$195.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Healthscope Commercial |
$208.08
|
| Rate for Payer: Healthscope Whirlpool |
$201.84
|
| Rate for Payer: Mclaren Commercial |
$187.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.87
|
| Rate for Payer: Nomi Health Commercial |
$170.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.11
|
|
|
HC INJ, TRIAMCINOLONE ACETONIDE, NOT SPECIFIED, 10 MG
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
63600103
|
|
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
|
|
