|
HC INHIBIN B, CMPT
|
Facility
|
OP
|
$48.96
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$13.52
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Cofinity Commercial |
$34.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$30.84
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC Core |
$22.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT
|
Facility
|
OP
|
$177.38
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$369.96 |
| Rate for Payer: Aetna Commercial |
$150.77
|
| Rate for Payer: Aetna Medicare |
$122.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$147.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$147.02
|
| Rate for Payer: BCBS Complete |
$67.56
|
| Rate for Payer: BCBS MAPPO |
$117.62
|
| Rate for Payer: BCN Medicare Advantage |
$117.62
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cofinity Commercial |
$152.55
|
| Rate for Payer: Cofinity Commercial |
$124.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.62
|
| Rate for Payer: Healthscope Commercial |
$159.64
|
| Rate for Payer: Mclaren Medicaid |
$64.34
|
| Rate for Payer: Mclaren Medicare |
$117.62
|
| Rate for Payer: Meridian Medicaid |
$67.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.77
|
| Rate for Payer: PACE Medicare |
$111.74
|
| Rate for Payer: PACE SWMI |
$117.62
|
| Rate for Payer: PHP Commercial |
$150.77
|
| Rate for Payer: PHP Medicare Advantage |
$117.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.96
|
| Rate for Payer: Priority Health Medicare |
$117.62
|
| Rate for Payer: Priority Health Narrow Network |
$295.97
|
| Rate for Payer: Priority Health SBD |
$111.75
|
| Rate for Payer: Railroad Medicare Medicare |
$117.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.62
|
| Rate for Payer: UHC Exchange |
$127.70
|
| Rate for Payer: UHC Medicare Advantage |
$121.15
|
| Rate for Payer: VA VA |
$117.62
|
|
|
HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT
|
Facility
|
IP
|
$177.38
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$111.75 |
| Max. Negotiated Rate |
$159.64 |
| Rate for Payer: Aetna Commercial |
$150.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.30
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cofinity Commercial |
$124.17
|
| Rate for Payer: Cofinity Commercial |
$152.55
|
| Rate for Payer: Healthscope Commercial |
$159.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.77
|
| Rate for Payer: PHP Commercial |
$150.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.17
|
| Rate for Payer: Priority Health SBD |
$111.75
|
|
|
HC INITIATION PROLONGED INFUSION REQUIRING PUMP
|
Facility
|
IP
|
$568.31
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000012
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$358.04 |
| Max. Negotiated Rate |
$511.48 |
| Rate for Payer: Aetna Commercial |
$483.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$369.40
|
| Rate for Payer: Cash Price |
$454.65
|
| Rate for Payer: Cofinity Commercial |
$397.82
|
| Rate for Payer: Cofinity Commercial |
$488.75
|
| Rate for Payer: Healthscope Commercial |
$511.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$483.06
|
| Rate for Payer: PHP Commercial |
$483.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.82
|
| Rate for Payer: Priority Health SBD |
$358.04
|
|
|
HC INITIATION PROLONGED INFUSION REQUIRING PUMP
|
Facility
|
OP
|
$568.31
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000012
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$164.83 |
| Max. Negotiated Rate |
$844.87 |
| Rate for Payer: Aetna Commercial |
$483.06
|
| Rate for Payer: Aetna Medicare |
$313.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$369.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$376.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$376.68
|
| Rate for Payer: BCBS Complete |
$173.09
|
| Rate for Payer: BCBS MAPPO |
$301.34
|
| Rate for Payer: BCBS Trust/PPO |
$601.88
|
| Rate for Payer: BCN Medicare Advantage |
$301.34
|
| Rate for Payer: Cash Price |
$454.65
|
| Rate for Payer: Cash Price |
$454.65
|
| Rate for Payer: Cofinity Commercial |
$488.75
|
| Rate for Payer: Cofinity Commercial |
$397.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.34
|
| Rate for Payer: Healthscope Commercial |
$511.48
|
| Rate for Payer: Mclaren Medicaid |
$164.83
|
| Rate for Payer: Mclaren Medicare |
$301.34
|
| Rate for Payer: Meridian Medicaid |
$173.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$316.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$483.06
|
| Rate for Payer: PACE Medicare |
$286.27
|
| Rate for Payer: PACE SWMI |
$301.34
|
| Rate for Payer: PHP Commercial |
$483.06
|
| Rate for Payer: PHP Medicare Advantage |
$301.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.82
|
| Rate for Payer: Priority Health Medicare |
$301.34
|
| Rate for Payer: Priority Health SBD |
$358.04
|
| Rate for Payer: Railroad Medicare Medicare |
$301.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$844.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$301.34
|
| Rate for Payer: UHC Exchange |
$575.89
|
| Rate for Payer: UHC Medicare Advantage |
$310.38
|
| Rate for Payer: VA VA |
$301.34
|
|
|
HC INITIAT MED TX IN ER
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS G2213
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$97.65 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Aetna Commercial |
$131.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.75
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$108.50
|
| Rate for Payer: Cofinity Commercial |
$133.30
|
| Rate for Payer: Healthscope Commercial |
$139.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.75
|
| Rate for Payer: PHP Commercial |
$131.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.50
|
| Rate for Payer: Priority Health SBD |
$97.65
|
|
|
HC INITIAT MED TX IN ER
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS G2213
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.94 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Aetna Commercial |
$131.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.75
|
| Rate for Payer: BCBS Complete |
$62.00
|
| Rate for Payer: BCBS Trust/PPO |
$75.23
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$108.50
|
| Rate for Payer: Cofinity Commercial |
$133.30
|
| Rate for Payer: Healthscope Commercial |
$139.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.75
|
| Rate for Payer: PHP Commercial |
$131.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.50
|
| Rate for Payer: Priority Health SBD |
$97.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.83
|
| Rate for Payer: UHC Exchange |
$58.94
|
|
|
HC INIT SUB PSYCH 1ST 30 MIN
|
Facility
|
IP
|
$124.44
|
|
|
Service Code
|
CPT G2214
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.89
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cofinity Commercial |
$87.11
|
| Rate for Payer: Cofinity Commercial |
$107.02
|
| Rate for Payer: Healthscope Commercial |
$112.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.77
|
| Rate for Payer: PHP Commercial |
$105.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.11
|
| Rate for Payer: Priority Health SBD |
$78.40
|
|
|
HC INIT SUB PSYCH 1ST 30 MIN
|
Facility
|
OP
|
$124.44
|
|
|
Service Code
|
CPT G2214
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.33 |
| Max. Negotiated Rate |
$227.45 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Medicare |
$82.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.14
|
| Rate for Payer: BCBS Complete |
$45.56
|
| Rate for Payer: BCBS MAPPO |
$79.31
|
| Rate for Payer: BCN Medicare Advantage |
$79.31
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cofinity Commercial |
$87.11
|
| Rate for Payer: Cofinity Commercial |
$107.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.31
|
| Rate for Payer: Healthscope Commercial |
$112.00
|
| Rate for Payer: Mclaren Medicaid |
$43.38
|
| Rate for Payer: Mclaren Medicare |
$79.31
|
| Rate for Payer: Meridian Medicaid |
$45.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.77
|
| Rate for Payer: PACE Medicare |
$75.34
|
| Rate for Payer: PACE SWMI |
$79.31
|
| Rate for Payer: PHP Commercial |
$105.77
|
| Rate for Payer: PHP Medicare Advantage |
$79.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.45
|
| Rate for Payer: Priority Health Medicare |
$79.31
|
| Rate for Payer: Priority Health Narrow Network |
$181.96
|
| Rate for Payer: Priority Health SBD |
$78.40
|
| Rate for Payer: Railroad Medicare Medicare |
$79.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.31
|
| Rate for Payer: UHC Exchange |
$37.33
|
| Rate for Payer: UHC Medicare Advantage |
$81.69
|
| Rate for Payer: VA VA |
$79.31
|
|
|
HC INJ AIR CONTRAST PERITONEAL CAVITY
|
Facility
|
IP
|
$945.56
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
36100446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$595.70 |
| Max. Negotiated Rate |
$851.00 |
| Rate for Payer: Aetna Commercial |
$803.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$614.61
|
| Rate for Payer: Cash Price |
$756.45
|
| Rate for Payer: Cofinity Commercial |
$661.89
|
| Rate for Payer: Cofinity Commercial |
$813.18
|
| Rate for Payer: Healthscope Commercial |
$851.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$803.73
|
| Rate for Payer: PHP Commercial |
$803.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.89
|
| Rate for Payer: Priority Health SBD |
$595.70
|
|
|
HC INJ AIR CONTRAST PERITONEAL CAVITY
|
Facility
|
OP
|
$945.56
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
36100446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.44 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$803.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$614.61
|
| Rate for Payer: BCBS Complete |
$378.22
|
| Rate for Payer: BCBS Trust/PPO |
$271.10
|
| Rate for Payer: Cash Price |
$756.45
|
| Rate for Payer: Cash Price |
$756.45
|
| Rate for Payer: Cofinity Commercial |
$813.18
|
| Rate for Payer: Cofinity Commercial |
$661.89
|
| Rate for Payer: Healthscope Commercial |
$851.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$803.73
|
| Rate for Payer: PHP Commercial |
$803.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.89
|
| Rate for Payer: Priority Health SBD |
$595.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.08
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$86.44
|
|
|
HC INJ ANES CELIAC PLEXUS
|
Facility
|
IP
|
$1,242.36
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
36100605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$782.69 |
| Max. Negotiated Rate |
$1,118.12 |
| Rate for Payer: Aetna Commercial |
$1,056.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.53
|
| Rate for Payer: Cash Price |
$993.89
|
| Rate for Payer: Cofinity Commercial |
$1,068.43
|
| Rate for Payer: Cofinity Commercial |
$869.65
|
| Rate for Payer: Healthscope Commercial |
$1,118.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,056.01
|
| Rate for Payer: PHP Commercial |
$1,056.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$869.65
|
| Rate for Payer: Priority Health SBD |
$782.69
|
|
|
HC INJ ANES CELIAC PLEXUS
|
Facility
|
OP
|
$1,242.36
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
36100605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$123.12 |
| Max. Negotiated Rate |
$1,463.00 |
| Rate for Payer: Aetna Commercial |
$1,056.01
|
| Rate for Payer: Aetna Medicare |
$843.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.53
|
| 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 |
$387.12
|
| Rate for Payer: BCN Medicare Advantage |
$811.03
|
| Rate for Payer: Cash Price |
$993.89
|
| Rate for Payer: Cash Price |
$993.89
|
| Rate for Payer: Cofinity Commercial |
$869.65
|
| Rate for Payer: Cofinity Commercial |
$1,068.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.03
|
| Rate for Payer: Healthscope Commercial |
$1,118.12
|
| 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 |
$1,056.01
|
| Rate for Payer: PACE Medicare |
$770.48
|
| Rate for Payer: PACE SWMI |
$811.03
|
| Rate for Payer: PHP Commercial |
$1,056.01
|
| 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 |
$869.65
|
| Rate for Payer: Priority Health Medicare |
$811.03
|
| Rate for Payer: Priority Health SBD |
$782.69
|
| Rate for Payer: Railroad Medicare Medicare |
$811.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.43
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.03
|
| Rate for Payer: UHC Exchange |
$123.12
|
| Rate for Payer: UHC Medicare Advantage |
$835.36
|
| Rate for Payer: VA VA |
$811.03
|
|
|
HC INJ ANES FEMORAL CONT
|
Facility
|
OP
|
$1,818.84
|
|
|
Service Code
|
CPT 64448
|
| Hospital Charge Code |
36100395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$1,636.96 |
| Rate for Payer: Aetna Commercial |
$1,546.01
|
| Rate for Payer: Aetna Medicare |
$843.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,182.25
|
| 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 |
$493.55
|
| Rate for Payer: BCN Medicare Advantage |
$811.03
|
| Rate for Payer: Cash Price |
$1,455.07
|
| Rate for Payer: Cash Price |
$1,455.07
|
| Rate for Payer: Cofinity Commercial |
$1,564.20
|
| Rate for Payer: Cofinity Commercial |
$1,273.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.03
|
| Rate for Payer: Healthscope Commercial |
$1,636.96
|
| 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 |
$1,546.01
|
| Rate for Payer: PACE Medicare |
$770.48
|
| Rate for Payer: PACE SWMI |
$811.03
|
| Rate for Payer: PHP Commercial |
$1,546.01
|
| 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 |
$1,273.19
|
| Rate for Payer: Priority Health Medicare |
$811.03
|
| Rate for Payer: Priority Health SBD |
$1,145.87
|
| Rate for Payer: Railroad Medicare Medicare |
$811.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.72
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.03
|
| Rate for Payer: UHC Exchange |
$69.75
|
| Rate for Payer: UHC Medicare Advantage |
$835.36
|
| Rate for Payer: VA VA |
$811.03
|
|
|
HC INJ ANES FEMORAL CONT
|
Facility
|
IP
|
$1,818.84
|
|
|
Service Code
|
CPT 64448
|
| Hospital Charge Code |
36100395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$1,636.96 |
| Rate for Payer: Aetna Commercial |
$1,546.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,182.25
|
| Rate for Payer: Cash Price |
$1,455.07
|
| Rate for Payer: Cofinity Commercial |
$1,564.20
|
| Rate for Payer: Cofinity Commercial |
$1,273.19
|
| Rate for Payer: Healthscope Commercial |
$1,636.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,546.01
|
| Rate for Payer: PHP Commercial |
$1,546.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,273.19
|
| Rate for Payer: Priority Health SBD |
$1,145.87
|
|
|
HC INJ ANES MIDDLE OR LOWER SPINE SYMPATHETIC NERVES
|
Facility
|
IP
|
$1,242.36
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
36100604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$782.69 |
| Max. Negotiated Rate |
$1,118.12 |
| Rate for Payer: Aetna Commercial |
$1,056.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.53
|
| Rate for Payer: Cash Price |
$993.89
|
| Rate for Payer: Cofinity Commercial |
$1,068.43
|
| Rate for Payer: Cofinity Commercial |
$869.65
|
| Rate for Payer: Healthscope Commercial |
$1,118.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,056.01
|
| Rate for Payer: PHP Commercial |
$1,056.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$869.65
|
| Rate for Payer: Priority Health SBD |
$782.69
|
|
|
HC INJ ANES MIDDLE OR LOWER SPINE SYMPATHETIC NERVES
|
Facility
|
OP
|
$1,242.36
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
36100604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$83.17 |
| Max. Negotiated Rate |
$1,463.00 |
| Rate for Payer: Aetna Commercial |
$1,056.01
|
| Rate for Payer: Aetna Medicare |
$843.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.53
|
| 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 |
$446.81
|
| Rate for Payer: BCN Medicare Advantage |
$811.03
|
| Rate for Payer: Cash Price |
$993.89
|
| Rate for Payer: Cash Price |
$993.89
|
| Rate for Payer: Cofinity Commercial |
$869.65
|
| Rate for Payer: Cofinity Commercial |
$1,068.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.03
|
| Rate for Payer: Healthscope Commercial |
$1,118.12
|
| 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 |
$1,056.01
|
| Rate for Payer: PACE Medicare |
$770.48
|
| Rate for Payer: PACE SWMI |
$811.03
|
| Rate for Payer: PHP Commercial |
$1,056.01
|
| 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 |
$869.65
|
| Rate for Payer: Priority Health Medicare |
$811.03
|
| Rate for Payer: Priority Health SBD |
$782.69
|
| Rate for Payer: Railroad Medicare Medicare |
$811.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.49
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.03
|
| Rate for Payer: UHC Exchange |
$83.17
|
| Rate for Payer: UHC Medicare Advantage |
$835.36
|
| Rate for Payer: VA VA |
$811.03
|
|
|
HC INJ ANESTH AND/OR STEROID AXILLARY NERVE
|
Facility
|
IP
|
$1,873.76
|
|
|
Service Code
|
CPT 64417
|
| Hospital Charge Code |
36100599
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,180.47 |
| Max. Negotiated Rate |
$1,686.38 |
| Rate for Payer: Aetna Commercial |
$1,592.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,217.94
|
| Rate for Payer: Cash Price |
$1,499.01
|
| Rate for Payer: Cofinity Commercial |
$1,311.63
|
| Rate for Payer: Cofinity Commercial |
$1,611.43
|
| Rate for Payer: Healthscope Commercial |
$1,686.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,592.70
|
| Rate for Payer: PHP Commercial |
$1,592.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,311.63
|
| Rate for Payer: Priority Health SBD |
$1,180.47
|
|
|
HC INJ ANESTH AND/OR STEROID AXILLARY NERVE
|
Facility
|
OP
|
$1,873.76
|
|
|
Service Code
|
CPT 64417
|
| Hospital Charge Code |
36100599
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$1,686.38 |
| Rate for Payer: Aetna Commercial |
$1,592.70
|
| Rate for Payer: Aetna Medicare |
$843.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,217.94
|
| 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 |
$299.70
|
| Rate for Payer: BCN Medicare Advantage |
$811.03
|
| Rate for Payer: Cash Price |
$1,499.01
|
| Rate for Payer: Cash Price |
$1,499.01
|
| Rate for Payer: Cofinity Commercial |
$1,311.63
|
| Rate for Payer: Cofinity Commercial |
$1,611.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.03
|
| Rate for Payer: Healthscope Commercial |
$1,686.38
|
| 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 |
$1,592.70
|
| Rate for Payer: PACE Medicare |
$770.48
|
| Rate for Payer: PACE SWMI |
$811.03
|
| Rate for Payer: PHP Commercial |
$1,592.70
|
| 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 |
$1,311.63
|
| Rate for Payer: Priority Health Medicare |
$811.03
|
| Rate for Payer: Priority Health SBD |
$1,180.47
|
| Rate for Payer: Railroad Medicare Medicare |
$811.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.43
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.03
|
| Rate for Payer: UHC Exchange |
$62.21
|
| Rate for Payer: UHC Medicare Advantage |
$835.36
|
| Rate for Payer: VA VA |
$811.03
|
|
|
HC INJ ANESTH AND/OR STEROID BRACHIAL PLEXUS
|
Facility
|
OP
|
$3,109.92
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
37100005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$67.45 |
| Max. Negotiated Rate |
$2,798.93 |
| Rate for Payer: Aetna Commercial |
$2,643.43
|
| Rate for Payer: Aetna Medicare |
$843.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,021.45
|
| 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 |
$349.66
|
| Rate for Payer: BCN Medicare Advantage |
$811.03
|
| Rate for Payer: Cash Price |
$2,487.94
|
| Rate for Payer: Cash Price |
$2,487.94
|
| Rate for Payer: Cofinity Commercial |
$2,674.53
|
| Rate for Payer: Cofinity Commercial |
$2,176.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.03
|
| Rate for Payer: Healthscope Commercial |
$2,798.93
|
| 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 |
$2,643.43
|
| Rate for Payer: PACE Medicare |
$770.48
|
| Rate for Payer: PACE SWMI |
$811.03
|
| Rate for Payer: PHP Commercial |
$2,643.43
|
| 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 |
$2,176.94
|
| Rate for Payer: Priority Health Medicare |
$811.03
|
| Rate for Payer: Priority Health SBD |
$1,959.25
|
| Rate for Payer: Railroad Medicare Medicare |
$811.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.03
|
| Rate for Payer: UHC Exchange |
$67.45
|
| Rate for Payer: UHC Medicare Advantage |
$835.36
|
| Rate for Payer: VA VA |
$811.03
|
|
|
HC INJ ANESTH AND/OR STEROID BRACHIAL PLEXUS
|
Facility
|
IP
|
$3,109.92
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
37100005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,959.25 |
| Max. Negotiated Rate |
$2,798.93 |
| Rate for Payer: Aetna Commercial |
$2,643.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,021.45
|
| Rate for Payer: Cash Price |
$2,487.94
|
| Rate for Payer: Cofinity Commercial |
$2,176.94
|
| Rate for Payer: Cofinity Commercial |
$2,674.53
|
| Rate for Payer: Healthscope Commercial |
$2,798.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,643.43
|
| Rate for Payer: PHP Commercial |
$2,643.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,176.94
|
| Rate for Payer: Priority Health SBD |
$1,959.25
|
|
|
HC INJ ANESTH AND/OR STEROID SCIATIC NERVE
|
Facility
|
OP
|
$2,549.64
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
37100008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$58.49 |
| Max. Negotiated Rate |
$2,294.68 |
| Rate for Payer: Aetna Commercial |
$2,167.19
|
| Rate for Payer: Aetna Medicare |
$639.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,657.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.16
|
| Rate for Payer: BCBS Complete |
$353.45
|
| Rate for Payer: BCBS MAPPO |
$615.33
|
| Rate for Payer: BCBS Trust/PPO |
$58.49
|
| Rate for Payer: BCN Medicare Advantage |
$615.33
|
| Rate for Payer: Cash Price |
$2,039.71
|
| Rate for Payer: Cash Price |
$2,039.71
|
| Rate for Payer: Cofinity Commercial |
$2,192.69
|
| Rate for Payer: Cofinity Commercial |
$1,784.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.33
|
| Rate for Payer: Healthscope Commercial |
$2,294.68
|
| Rate for Payer: Mclaren Medicaid |
$336.59
|
| Rate for Payer: Mclaren Medicare |
$615.33
|
| Rate for Payer: Meridian Medicaid |
$353.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,167.19
|
| Rate for Payer: PACE Medicare |
$584.56
|
| Rate for Payer: PACE SWMI |
$615.33
|
| Rate for Payer: PHP Commercial |
$2,167.19
|
| Rate for Payer: PHP Medicare Advantage |
$615.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,784.75
|
| Rate for Payer: Priority Health Medicare |
$615.33
|
| Rate for Payer: Priority Health SBD |
$1,606.27
|
| Rate for Payer: Railroad Medicare Medicare |
$615.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.33
|
| Rate for Payer: UHC Exchange |
$70.07
|
| Rate for Payer: UHC Medicare Advantage |
$633.79
|
| Rate for Payer: VA VA |
$615.33
|
|
|
HC INJ ANESTH AND/OR STEROID SCIATIC NERVE
|
Facility
|
IP
|
$2,549.64
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
37100008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,606.27 |
| Max. Negotiated Rate |
$2,294.68 |
| Rate for Payer: Aetna Commercial |
$2,167.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,657.27
|
| Rate for Payer: Cash Price |
$2,039.71
|
| Rate for Payer: Cofinity Commercial |
$1,784.75
|
| Rate for Payer: Cofinity Commercial |
$2,192.69
|
| Rate for Payer: Healthscope Commercial |
$2,294.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,167.19
|
| Rate for Payer: PHP Commercial |
$2,167.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,784.75
|
| Rate for Payer: Priority Health SBD |
$1,606.27
|
|
|
HC INJ ANESTH AND/OR STEROID SUPRASCAPULAR NERVE
|
Facility
|
IP
|
$956.33
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
36100600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$602.49 |
| Max. Negotiated Rate |
$860.70 |
| Rate for Payer: Aetna Commercial |
$812.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$621.61
|
| Rate for Payer: Cash Price |
$765.06
|
| Rate for Payer: Cofinity Commercial |
$669.43
|
| Rate for Payer: Cofinity Commercial |
$822.44
|
| Rate for Payer: Healthscope Commercial |
$860.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$812.88
|
| Rate for Payer: PHP Commercial |
$812.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$669.43
|
| Rate for Payer: Priority Health SBD |
$602.49
|
|
|
HC INJ ANESTH AND/OR STEROID SUPRASCAPULAR NERVE
|
Facility
|
OP
|
$956.33
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
36100600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$54.03 |
| Max. Negotiated Rate |
$1,463.00 |
| Rate for Payer: Aetna Commercial |
$812.88
|
| Rate for Payer: Aetna Medicare |
$639.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$621.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.16
|
| Rate for Payer: BCBS Complete |
$353.45
|
| Rate for Payer: BCBS MAPPO |
$615.33
|
| Rate for Payer: BCBS Trust/PPO |
$70.39
|
| Rate for Payer: BCN Medicare Advantage |
$615.33
|
| Rate for Payer: Cash Price |
$765.06
|
| Rate for Payer: Cash Price |
$765.06
|
| Rate for Payer: Cofinity Commercial |
$822.44
|
| Rate for Payer: Cofinity Commercial |
$669.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.33
|
| Rate for Payer: Healthscope Commercial |
$860.70
|
| Rate for Payer: Mclaren Medicaid |
$336.59
|
| Rate for Payer: Mclaren Medicare |
$615.33
|
| Rate for Payer: Meridian Medicaid |
$353.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$812.88
|
| Rate for Payer: PACE Medicare |
$584.56
|
| Rate for Payer: PACE SWMI |
$615.33
|
| Rate for Payer: PHP Commercial |
$812.88
|
| Rate for Payer: PHP Medicare Advantage |
$615.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$669.43
|
| Rate for Payer: Priority Health Medicare |
$615.33
|
| Rate for Payer: Priority Health SBD |
$602.49
|
| Rate for Payer: Railroad Medicare Medicare |
$615.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.43
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.33
|
| Rate for Payer: UHC Exchange |
$54.03
|
| Rate for Payer: UHC Medicare Advantage |
$633.79
|
| Rate for Payer: VA VA |
$615.33
|
|
