|
HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NR OR BRANCH SHOULDER EA ADDL NRV
|
Facility
|
IP
|
$1,242.44
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
36100596
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$782.74 |
| Max. Negotiated Rate |
$1,118.20 |
| Rate for Payer: Aetna Commercial |
$1,056.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.59
|
| Rate for Payer: Cash Price |
$993.95
|
| Rate for Payer: Cofinity Commercial |
$869.71
|
| Rate for Payer: Cofinity Commercial |
$1,068.50
|
| Rate for Payer: Healthscope Commercial |
$1,118.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,056.07
|
| Rate for Payer: PHP Commercial |
$1,056.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$869.71
|
| Rate for Payer: Priority Health SBD |
$782.74
|
|
|
HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NRV OR BRANCH HIP EA ADDL NRV
|
Facility
|
IP
|
$1,242.44
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
36100598
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$782.74 |
| Max. Negotiated Rate |
$1,118.20 |
| Rate for Payer: Aetna Commercial |
$1,056.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.59
|
| Rate for Payer: Cash Price |
$993.95
|
| Rate for Payer: Cofinity Commercial |
$1,068.50
|
| Rate for Payer: Cofinity Commercial |
$869.71
|
| Rate for Payer: Healthscope Commercial |
$1,118.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,056.07
|
| Rate for Payer: PHP Commercial |
$1,056.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$869.71
|
| Rate for Payer: Priority Health SBD |
$782.74
|
|
|
HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NRV OR BRANCH HIP EA ADDL NRV
|
Facility
|
OP
|
$1,242.44
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
36100598
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.04 |
| Max. Negotiated Rate |
$2,563.14 |
| Rate for Payer: Aetna Commercial |
$1,056.07
|
| Rate for Payer: Aetna Medicare |
$843.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,013.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,013.79
|
| Rate for Payer: BCBS Complete |
$465.86
|
| Rate for Payer: BCBS MAPPO |
$811.03
|
| Rate for Payer: BCBS Trust/PPO |
$64.04
|
| Rate for Payer: BCN Medicare Advantage |
$811.03
|
| Rate for Payer: Cash Price |
$993.95
|
| Rate for Payer: Cash Price |
$993.95
|
| Rate for Payer: Cofinity Commercial |
$1,068.50
|
| Rate for Payer: Cofinity Commercial |
$869.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.03
|
| Rate for Payer: Healthscope Commercial |
$1,118.20
|
| Rate for Payer: Mclaren Medicaid |
$443.63
|
| Rate for Payer: Mclaren Medicare |
$811.03
|
| Rate for Payer: Meridian Medicaid |
$465.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$851.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$932.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,056.07
|
| Rate for Payer: PACE Medicare |
$770.48
|
| Rate for Payer: PACE SWMI |
$811.03
|
| Rate for Payer: PHP Commercial |
$1,056.07
|
| Rate for Payer: PHP Medicare Advantage |
$811.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$869.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,563.14
|
| Rate for Payer: Priority Health Medicare |
$811.03
|
| Rate for Payer: Priority Health Narrow Network |
$2,050.51
|
| Rate for Payer: Priority Health SBD |
$782.74
|
| Rate for Payer: Railroad Medicare Medicare |
$811.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.23
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.03
|
| Rate for Payer: UHC Exchange |
$116.57
|
| Rate for Payer: UHC Medicare Advantage |
$835.36
|
| Rate for Payer: VA VA |
$811.03
|
|
|
HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NRV OR BRANCH HIP SNG NRV
|
Facility
|
IP
|
$1,242.44
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
36100597
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$782.74 |
| Max. Negotiated Rate |
$1,118.20 |
| Rate for Payer: Aetna Commercial |
$1,056.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.59
|
| Rate for Payer: Cash Price |
$993.95
|
| Rate for Payer: Cofinity Commercial |
$1,068.50
|
| Rate for Payer: Cofinity Commercial |
$869.71
|
| Rate for Payer: Healthscope Commercial |
$1,118.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,056.07
|
| Rate for Payer: PHP Commercial |
$1,056.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$869.71
|
| Rate for Payer: Priority Health SBD |
$782.74
|
|
|
HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NRV OR BRANCH HIP SNG NRV
|
Facility
|
OP
|
$1,242.44
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
36100597
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.04 |
| Max. Negotiated Rate |
$2,563.14 |
| Rate for Payer: Aetna Commercial |
$1,056.07
|
| Rate for Payer: Aetna Medicare |
$843.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,013.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,013.79
|
| Rate for Payer: BCBS Complete |
$465.86
|
| Rate for Payer: BCBS MAPPO |
$811.03
|
| Rate for Payer: BCBS Trust/PPO |
$64.04
|
| Rate for Payer: BCN Medicare Advantage |
$811.03
|
| Rate for Payer: Cash Price |
$993.95
|
| Rate for Payer: Cash Price |
$993.95
|
| Rate for Payer: Cofinity Commercial |
$869.71
|
| Rate for Payer: Cofinity Commercial |
$1,068.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.03
|
| Rate for Payer: Healthscope Commercial |
$1,118.20
|
| Rate for Payer: Mclaren Medicaid |
$443.63
|
| Rate for Payer: Mclaren Medicare |
$811.03
|
| Rate for Payer: Meridian Medicaid |
$465.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$851.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$932.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,056.07
|
| Rate for Payer: PACE Medicare |
$770.48
|
| Rate for Payer: PACE SWMI |
$811.03
|
| Rate for Payer: PHP Commercial |
$1,056.07
|
| Rate for Payer: PHP Medicare Advantage |
$811.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$869.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,563.14
|
| Rate for Payer: Priority Health Medicare |
$811.03
|
| Rate for Payer: Priority Health Narrow Network |
$2,050.51
|
| Rate for Payer: Priority Health SBD |
$782.74
|
| Rate for Payer: Railroad Medicare Medicare |
$811.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.23
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.03
|
| Rate for Payer: UHC Exchange |
$116.57
|
| Rate for Payer: UHC Medicare Advantage |
$835.36
|
| Rate for Payer: VA VA |
$811.03
|
|
|
HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NRV OR BRANCH SHOULDER SNG NRV
|
Facility
|
IP
|
$1,242.44
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
36100595
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$782.74 |
| Max. Negotiated Rate |
$1,118.20 |
| Rate for Payer: Aetna Commercial |
$1,056.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.59
|
| Rate for Payer: Cash Price |
$993.95
|
| Rate for Payer: Cofinity Commercial |
$1,068.50
|
| Rate for Payer: Cofinity Commercial |
$869.71
|
| Rate for Payer: Healthscope Commercial |
$1,118.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,056.07
|
| Rate for Payer: PHP Commercial |
$1,056.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$869.71
|
| Rate for Payer: Priority Health SBD |
$782.74
|
|
|
HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NRV OR BRANCH SHOULDER SNG NRV
|
Facility
|
OP
|
$1,242.44
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
36100595
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.04 |
| Max. Negotiated Rate |
$2,563.14 |
| Rate for Payer: Aetna Commercial |
$1,056.07
|
| Rate for Payer: Aetna Medicare |
$843.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,013.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,013.79
|
| Rate for Payer: BCBS Complete |
$465.86
|
| Rate for Payer: BCBS MAPPO |
$811.03
|
| Rate for Payer: BCBS Trust/PPO |
$64.04
|
| Rate for Payer: BCN Medicare Advantage |
$811.03
|
| Rate for Payer: Cash Price |
$993.95
|
| Rate for Payer: Cash Price |
$993.95
|
| Rate for Payer: Cofinity Commercial |
$869.71
|
| Rate for Payer: Cofinity Commercial |
$1,068.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.03
|
| Rate for Payer: Healthscope Commercial |
$1,118.20
|
| Rate for Payer: Mclaren Medicaid |
$443.63
|
| Rate for Payer: Mclaren Medicare |
$811.03
|
| Rate for Payer: Meridian Medicaid |
$465.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$851.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$932.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,056.07
|
| Rate for Payer: PACE Medicare |
$770.48
|
| Rate for Payer: PACE SWMI |
$811.03
|
| Rate for Payer: PHP Commercial |
$1,056.07
|
| Rate for Payer: PHP Medicare Advantage |
$811.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$869.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,563.14
|
| Rate for Payer: Priority Health Medicare |
$811.03
|
| Rate for Payer: Priority Health Narrow Network |
$2,050.51
|
| Rate for Payer: Priority Health SBD |
$782.74
|
| Rate for Payer: Railroad Medicare Medicare |
$811.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.23
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.03
|
| Rate for Payer: UHC Exchange |
$116.57
|
| Rate for Payer: UHC Medicare Advantage |
$835.36
|
| Rate for Payer: VA VA |
$811.03
|
|
|
HC ABLATION AV NODE
|
Facility
|
OP
|
$8,390.89
|
|
|
Service Code
|
CPT 93650
|
| Hospital Charge Code |
48100044
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$556.65 |
| Max. Negotiated Rate |
$8,306.42 |
| Rate for Payer: Aetna Commercial |
$7,132.26
|
| Rate for Payer: Aetna Medicare |
$6,910.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,454.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,306.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,306.42
|
| Rate for Payer: BCBS Complete |
$3,816.97
|
| Rate for Payer: BCBS MAPPO |
$6,645.14
|
| Rate for Payer: BCBS Trust/PPO |
$718.41
|
| Rate for Payer: BCN Medicare Advantage |
$6,645.14
|
| Rate for Payer: Cash Price |
$6,712.71
|
| Rate for Payer: Cash Price |
$6,712.71
|
| Rate for Payer: Cofinity Commercial |
$5,873.62
|
| Rate for Payer: Cofinity Commercial |
$7,216.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,645.14
|
| Rate for Payer: Healthscope Commercial |
$7,551.80
|
| Rate for Payer: Mclaren Medicaid |
$3,634.89
|
| Rate for Payer: Mclaren Medicare |
$6,645.14
|
| Rate for Payer: Meridian Medicaid |
$3,816.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,977.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,641.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,132.26
|
| Rate for Payer: PACE Medicare |
$6,312.88
|
| Rate for Payer: PACE SWMI |
$6,645.14
|
| Rate for Payer: PHP Commercial |
$7,132.26
|
| Rate for Payer: PHP Medicare Advantage |
$6,645.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,634.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,873.62
|
| Rate for Payer: Priority Health Medicare |
$6,645.14
|
| Rate for Payer: Priority Health SBD |
$5,286.26
|
| Rate for Payer: Railroad Medicare Medicare |
$6,645.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$612.32
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,645.14
|
| Rate for Payer: UHC Exchange |
$556.65
|
| Rate for Payer: UHC Medicare Advantage |
$6,844.49
|
| Rate for Payer: VA VA |
$6,645.14
|
|
|
HC ABLATION AV NODE
|
Facility
|
IP
|
$8,390.89
|
|
|
Service Code
|
CPT 93650
|
| Hospital Charge Code |
48100044
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,286.26 |
| Max. Negotiated Rate |
$7,551.80 |
| Rate for Payer: Aetna Commercial |
$7,132.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,454.08
|
| Rate for Payer: Cash Price |
$6,712.71
|
| Rate for Payer: Cofinity Commercial |
$5,873.62
|
| Rate for Payer: Cofinity Commercial |
$7,216.17
|
| Rate for Payer: Healthscope Commercial |
$7,551.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,132.26
|
| Rate for Payer: PHP Commercial |
$7,132.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,873.62
|
| Rate for Payer: Priority Health SBD |
$5,286.26
|
|
|
HC ABLATION BONE
|
Facility
|
OP
|
$6,643.07
|
|
|
Service Code
|
CPT 20982
|
| Hospital Charge Code |
36100480
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$354.29 |
| Max. Negotiated Rate |
$19,834.21 |
| Rate for Payer: Aetna Commercial |
$5,646.61
|
| Rate for Payer: Aetna Medicare |
$12,179.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,318.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,638.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,638.36
|
| Rate for Payer: BCBS Complete |
$6,726.62
|
| Rate for Payer: BCBS MAPPO |
$11,710.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,299.99
|
| Rate for Payer: BCN Medicare Advantage |
$11,710.69
|
| Rate for Payer: Cash Price |
$5,314.46
|
| Rate for Payer: Cash Price |
$5,314.46
|
| Rate for Payer: Cofinity Commercial |
$5,713.04
|
| Rate for Payer: Cofinity Commercial |
$4,650.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,710.69
|
| Rate for Payer: Healthscope Commercial |
$5,978.76
|
| Rate for Payer: Mclaren Medicaid |
$6,405.75
|
| Rate for Payer: Mclaren Medicare |
$11,710.69
|
| Rate for Payer: Meridian Medicaid |
$6,726.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,296.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,467.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,646.61
|
| Rate for Payer: PACE Medicare |
$11,125.16
|
| Rate for Payer: PACE SWMI |
$11,710.69
|
| Rate for Payer: PHP Commercial |
$5,646.61
|
| Rate for Payer: PHP Medicare Advantage |
$11,710.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,405.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,650.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,834.21
|
| Rate for Payer: Priority Health Medicare |
$11,710.69
|
| Rate for Payer: Priority Health Narrow Network |
$15,867.37
|
| Rate for Payer: Priority Health SBD |
$4,185.13
|
| Rate for Payer: Railroad Medicare Medicare |
$11,710.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.72
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,710.69
|
| Rate for Payer: UHC Exchange |
$354.29
|
| Rate for Payer: UHC Medicare Advantage |
$12,062.01
|
| Rate for Payer: VA VA |
$11,710.69
|
|
|
HC ABLATION BONE
|
Facility
|
IP
|
$6,643.07
|
|
|
Service Code
|
CPT 20982
|
| Hospital Charge Code |
36100480
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,185.13 |
| Max. Negotiated Rate |
$5,978.76 |
| Rate for Payer: Aetna Commercial |
$5,646.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,318.00
|
| Rate for Payer: Cash Price |
$5,314.46
|
| Rate for Payer: Cofinity Commercial |
$4,650.15
|
| Rate for Payer: Cofinity Commercial |
$5,713.04
|
| Rate for Payer: Healthscope Commercial |
$5,978.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,646.61
|
| Rate for Payer: PHP Commercial |
$5,646.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,650.15
|
| Rate for Payer: Priority Health SBD |
$4,185.13
|
|
|
HC ABLATION BY NEUROLYTIC AGENT FACET JT C OR T EA ADDL JOINT
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
36100591
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.16 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.15
|
| Rate for Payer: BCBS Complete |
$428.40
|
| Rate for Payer: BCBS Trust/PPO |
$374.62
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$749.70
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$910.35
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.70
|
| Rate for Payer: Priority Health SBD |
$674.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.68
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$65.16
|
|
|
HC ABLATION BY NEUROLYTIC AGENT FACET JT C OR T EA ADDL JOINT
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
36100591
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$674.73 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.15
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$749.70
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$910.35
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.70
|
| Rate for Payer: Priority Health SBD |
$674.73
|
|
|
HC ABLATION BY NEUROLYTIC AGENT FACET JT C OR T SNG LVL
|
Facility
|
OP
|
$2,630.61
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
36100590
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$187.95 |
| Max. Negotiated Rate |
$5,467.25 |
| Rate for Payer: Aetna Commercial |
$2,236.02
|
| Rate for Payer: Aetna Medicare |
$1,786.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,709.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,147.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,147.49
|
| Rate for Payer: BCBS Complete |
$986.81
|
| Rate for Payer: BCBS MAPPO |
$1,717.99
|
| Rate for Payer: BCBS Trust/PPO |
$767.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,717.99
|
| Rate for Payer: Cash Price |
$2,104.49
|
| Rate for Payer: Cash Price |
$2,104.49
|
| Rate for Payer: Cofinity Commercial |
$2,262.32
|
| Rate for Payer: Cofinity Commercial |
$1,841.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,717.99
|
| Rate for Payer: Healthscope Commercial |
$2,367.55
|
| Rate for Payer: Mclaren Medicaid |
$939.74
|
| Rate for Payer: Mclaren Medicare |
$1,717.99
|
| Rate for Payer: Meridian Medicaid |
$986.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,803.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,975.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,236.02
|
| Rate for Payer: PACE Medicare |
$1,632.09
|
| Rate for Payer: PACE SWMI |
$1,717.99
|
| Rate for Payer: PHP Commercial |
$2,236.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,717.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$939.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,467.25
|
| Rate for Payer: Priority Health Medicare |
$1,717.99
|
| Rate for Payer: Priority Health Narrow Network |
$4,373.80
|
| Rate for Payer: Priority Health SBD |
$1,657.28
|
| Rate for Payer: Railroad Medicare Medicare |
$1,717.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.74
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,717.99
|
| Rate for Payer: UHC Exchange |
$187.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,769.53
|
| Rate for Payer: VA VA |
$1,717.99
|
|
|
HC ABLATION BY NEUROLYTIC AGENT FACET JT C OR T SNG LVL
|
Facility
|
IP
|
$2,630.61
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
36100590
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,657.28 |
| Max. Negotiated Rate |
$2,367.55 |
| Rate for Payer: Aetna Commercial |
$2,236.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,709.90
|
| Rate for Payer: Cash Price |
$2,104.49
|
| Rate for Payer: Cofinity Commercial |
$1,841.43
|
| Rate for Payer: Cofinity Commercial |
$2,262.32
|
| Rate for Payer: Healthscope Commercial |
$2,367.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,236.02
|
| Rate for Payer: PHP Commercial |
$2,236.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.43
|
| Rate for Payer: Priority Health SBD |
$1,657.28
|
|
|
HC ABLATION BY NEUROLYTIC AGENT FACET JT L OR S EA ADDL JOINT
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
36100593
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.15
|
| Rate for Payer: BCBS Complete |
$428.40
|
| Rate for Payer: BCBS Trust/PPO |
$340.82
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$749.70
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$910.35
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.70
|
| Rate for Payer: Priority Health SBD |
$674.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.67
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$56.97
|
|
|
HC ABLATION BY NEUROLYTIC AGENT FACET JT L OR S EA ADDL JOINT
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
36100593
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$674.73 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.15
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$749.70
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$910.35
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.70
|
| Rate for Payer: Priority Health SBD |
$674.73
|
|
|
HC ABLATION BY NEUROLYTIC AGENT FACET JT L OR S SNG LVL
|
Facility
|
OP
|
$2,630.61
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
36100592
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.28 |
| Max. Negotiated Rate |
$5,467.25 |
| Rate for Payer: Aetna Commercial |
$2,236.02
|
| Rate for Payer: Aetna Medicare |
$1,786.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,709.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,147.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,147.49
|
| Rate for Payer: BCBS Complete |
$986.81
|
| Rate for Payer: BCBS MAPPO |
$1,717.99
|
| Rate for Payer: BCBS Trust/PPO |
$860.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,717.99
|
| Rate for Payer: Cash Price |
$2,104.49
|
| Rate for Payer: Cash Price |
$2,104.49
|
| Rate for Payer: Cofinity Commercial |
$1,841.43
|
| Rate for Payer: Cofinity Commercial |
$2,262.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,717.99
|
| Rate for Payer: Healthscope Commercial |
$2,367.55
|
| Rate for Payer: Mclaren Medicaid |
$939.74
|
| Rate for Payer: Mclaren Medicare |
$1,717.99
|
| Rate for Payer: Meridian Medicaid |
$986.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,803.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,975.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,236.02
|
| Rate for Payer: PACE Medicare |
$1,632.09
|
| Rate for Payer: PACE SWMI |
$1,717.99
|
| Rate for Payer: PHP Commercial |
$2,236.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,717.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$939.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,467.25
|
| Rate for Payer: Priority Health Medicare |
$1,717.99
|
| Rate for Payer: Priority Health Narrow Network |
$4,373.80
|
| Rate for Payer: Priority Health SBD |
$1,657.28
|
| Rate for Payer: Railroad Medicare Medicare |
$1,717.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.11
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,717.99
|
| Rate for Payer: UHC Exchange |
$188.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,769.53
|
| Rate for Payer: VA VA |
$1,717.99
|
|
|
HC ABLATION BY NEUROLYTIC AGENT FACET JT L OR S SNG LVL
|
Facility
|
IP
|
$2,630.61
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
36100592
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,657.28 |
| Max. Negotiated Rate |
$2,367.55 |
| Rate for Payer: Aetna Commercial |
$2,236.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,709.90
|
| Rate for Payer: Cash Price |
$2,104.49
|
| Rate for Payer: Cofinity Commercial |
$2,262.32
|
| Rate for Payer: Cofinity Commercial |
$1,841.43
|
| Rate for Payer: Healthscope Commercial |
$2,367.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,236.02
|
| Rate for Payer: PHP Commercial |
$2,236.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.43
|
| Rate for Payer: Priority Health SBD |
$1,657.28
|
|
|
HC ABLATION CATHETER
|
Facility
|
IP
|
$4,261.53
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
27200008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,684.76 |
| Max. Negotiated Rate |
$3,835.38 |
| Rate for Payer: Aetna Commercial |
$3,622.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,769.99
|
| Rate for Payer: Cash Price |
$3,409.22
|
| Rate for Payer: Cofinity Commercial |
$2,983.07
|
| Rate for Payer: Cofinity Commercial |
$3,664.92
|
| Rate for Payer: Healthscope Commercial |
$3,835.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,622.30
|
| Rate for Payer: PHP Commercial |
$3,622.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,983.07
|
| Rate for Payer: Priority Health SBD |
$2,684.76
|
|
|
HC ABLATION CATHETER
|
Facility
|
OP
|
$4,261.53
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
27200008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$3,835.38 |
| Rate for Payer: Aetna Commercial |
$3,622.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,769.99
|
| Rate for Payer: BCBS Complete |
$1,704.61
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$3,409.22
|
| Rate for Payer: Cash Price |
$3,409.22
|
| Rate for Payer: Cofinity Commercial |
$3,664.92
|
| Rate for Payer: Cofinity Commercial |
$2,983.07
|
| Rate for Payer: Healthscope Commercial |
$3,835.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,622.30
|
| Rate for Payer: PHP Commercial |
$3,622.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,983.07
|
| Rate for Payer: Priority Health SBD |
$2,684.76
|
|
|
HC ABLATION CATHETER (8/10 MM TIP
|
Facility
|
IP
|
$5,796.29
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
27200009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,651.66 |
| Max. Negotiated Rate |
$5,216.66 |
| Rate for Payer: Aetna Commercial |
$4,926.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,767.59
|
| Rate for Payer: Cash Price |
$4,637.03
|
| Rate for Payer: Cofinity Commercial |
$4,057.40
|
| Rate for Payer: Cofinity Commercial |
$4,984.81
|
| Rate for Payer: Healthscope Commercial |
$5,216.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,926.85
|
| Rate for Payer: PHP Commercial |
$4,926.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,057.40
|
| Rate for Payer: Priority Health SBD |
$3,651.66
|
|
|
HC ABLATION CATHETER (8/10 MM TIP
|
Facility
|
OP
|
$5,796.29
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
27200009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$5,216.66 |
| Rate for Payer: Aetna Commercial |
$4,926.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,767.59
|
| Rate for Payer: BCBS Complete |
$2,318.52
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$4,637.03
|
| Rate for Payer: Cash Price |
$4,637.03
|
| Rate for Payer: Cofinity Commercial |
$4,057.40
|
| Rate for Payer: Cofinity Commercial |
$4,984.81
|
| Rate for Payer: Healthscope Commercial |
$5,216.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,926.85
|
| Rate for Payer: PHP Commercial |
$4,926.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,057.40
|
| Rate for Payer: Priority Health SBD |
$3,651.66
|
|
|
HC ABLATION CATH EXTRAVASC TISSUE
|
Facility
|
IP
|
$7,080.84
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,460.93 |
| Max. Negotiated Rate |
$6,372.76 |
| Rate for Payer: Aetna Commercial |
$6,018.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,602.55
|
| Rate for Payer: Cash Price |
$5,664.67
|
| Rate for Payer: Cofinity Commercial |
$4,956.59
|
| Rate for Payer: Cofinity Commercial |
$6,089.52
|
| Rate for Payer: Healthscope Commercial |
$6,372.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,018.71
|
| Rate for Payer: PHP Commercial |
$6,018.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,956.59
|
| Rate for Payer: Priority Health SBD |
$4,460.93
|
|
|
HC ABLATION CATH EXTRAVASC TISSUE
|
Facility
|
OP
|
$7,080.84
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$6,372.76 |
| Rate for Payer: Aetna Commercial |
$6,018.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,602.55
|
| Rate for Payer: BCBS Complete |
$2,832.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$5,664.67
|
| Rate for Payer: Cash Price |
$5,664.67
|
| Rate for Payer: Cofinity Commercial |
$4,956.59
|
| Rate for Payer: Cofinity Commercial |
$6,089.52
|
| Rate for Payer: Healthscope Commercial |
$6,372.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,018.71
|
| Rate for Payer: PHP Commercial |
$6,018.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,956.59
|
| Rate for Payer: Priority Health SBD |
$4,460.93
|
|
