|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL
|
Facility
|
IP
|
$1,429.60
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$900.65 |
| Max. Negotiated Rate |
$1,286.64 |
| Rate for Payer: Aetna Commercial |
$1,215.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$929.24
|
| Rate for Payer: Cash Price |
$1,143.68
|
| Rate for Payer: Cofinity Commercial |
$1,000.72
|
| Rate for Payer: Cofinity Commercial |
$1,229.46
|
| Rate for Payer: Healthscope Commercial |
$1,286.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,215.16
|
| Rate for Payer: PHP Commercial |
$1,215.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,000.72
|
| Rate for Payer: Priority Health SBD |
$900.65
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL
|
Facility
|
OP
|
$1,429.60
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.10 |
| Max. Negotiated Rate |
$1,286.64 |
| Rate for Payer: Aetna Commercial |
$1,215.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$929.24
|
| Rate for Payer: BCBS Complete |
$571.84
|
| Rate for Payer: BCBS Trust/PPO |
$174.64
|
| Rate for Payer: Cash Price |
$1,143.68
|
| Rate for Payer: Cash Price |
$1,143.68
|
| Rate for Payer: Cofinity Commercial |
$1,229.46
|
| Rate for Payer: Cofinity Commercial |
$1,000.72
|
| Rate for Payer: Healthscope Commercial |
$1,286.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,215.16
|
| Rate for Payer: PHP Commercial |
$1,215.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,000.72
|
| Rate for Payer: Priority Health SBD |
$900.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.11
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$50.10
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR SINGLE LEVEL
|
Facility
|
IP
|
$1,475.91
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$929.82 |
| Max. Negotiated Rate |
$1,328.32 |
| Rate for Payer: Aetna Commercial |
$1,254.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$959.34
|
| Rate for Payer: Cash Price |
$1,180.73
|
| Rate for Payer: Cofinity Commercial |
$1,033.14
|
| Rate for Payer: Cofinity Commercial |
$1,269.28
|
| Rate for Payer: Healthscope Commercial |
$1,328.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,254.52
|
| Rate for Payer: PHP Commercial |
$1,254.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.14
|
| Rate for Payer: Priority Health SBD |
$929.82
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR SINGLE LEVEL
|
Facility
|
OP
|
$1,475.91
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$108.71 |
| Max. Negotiated Rate |
$1,463.00 |
| Rate for Payer: Aetna Commercial |
$1,254.52
|
| Rate for Payer: Aetna Medicare |
$843.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$959.34
|
| 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 |
$464.92
|
| Rate for Payer: BCN Medicare Advantage |
$811.03
|
| Rate for Payer: Cash Price |
$1,180.73
|
| Rate for Payer: Cash Price |
$1,180.73
|
| Rate for Payer: Cofinity Commercial |
$1,269.28
|
| Rate for Payer: Cofinity Commercial |
$1,033.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.03
|
| Rate for Payer: Healthscope Commercial |
$1,328.32
|
| 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 |
$1,254.52
|
| Rate for Payer: PACE Medicare |
$770.48
|
| Rate for Payer: PACE SWMI |
$811.03
|
| Rate for Payer: PHP Commercial |
$1,254.52
|
| 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 |
$1,033.14
|
| Rate for Payer: Priority Health Medicare |
$811.03
|
| Rate for Payer: Priority Health SBD |
$929.82
|
| Rate for Payer: Railroad Medicare Medicare |
$811.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.58
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.03
|
| Rate for Payer: UHC Exchange |
$108.71
|
| Rate for Payer: UHC Medicare Advantage |
$835.36
|
| Rate for Payer: VA VA |
$811.03
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SAC SINGLE LEVEL BIL
|
Facility
|
IP
|
$1,162.01
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$732.07 |
| Max. Negotiated Rate |
$1,045.81 |
| Rate for Payer: Aetna Commercial |
$987.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$755.31
|
| Rate for Payer: Cash Price |
$929.61
|
| Rate for Payer: Cofinity Commercial |
$813.41
|
| Rate for Payer: Cofinity Commercial |
$999.33
|
| Rate for Payer: Healthscope Commercial |
$1,045.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$987.71
|
| Rate for Payer: PHP Commercial |
$987.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.41
|
| Rate for Payer: Priority Health SBD |
$732.07
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SAC SINGLE LEVEL BIL
|
Facility
|
OP
|
$1,162.01
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$108.71 |
| Max. Negotiated Rate |
$1,463.00 |
| Rate for Payer: Aetna Commercial |
$987.71
|
| Rate for Payer: Aetna Medicare |
$843.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$755.31
|
| 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 |
$464.92
|
| Rate for Payer: BCN Medicare Advantage |
$811.03
|
| Rate for Payer: Cash Price |
$929.61
|
| Rate for Payer: Cash Price |
$929.61
|
| Rate for Payer: Cofinity Commercial |
$999.33
|
| Rate for Payer: Cofinity Commercial |
$813.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.03
|
| Rate for Payer: Healthscope Commercial |
$1,045.81
|
| 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 |
$987.71
|
| Rate for Payer: PACE Medicare |
$770.48
|
| Rate for Payer: PACE SWMI |
$811.03
|
| Rate for Payer: PHP Commercial |
$987.71
|
| 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 |
$813.41
|
| Rate for Payer: Priority Health Medicare |
$811.03
|
| Rate for Payer: Priority Health SBD |
$732.07
|
| Rate for Payer: Railroad Medicare Medicare |
$811.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.58
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.03
|
| Rate for Payer: UHC Exchange |
$108.71
|
| Rate for Payer: UHC Medicare Advantage |
$835.36
|
| Rate for Payer: VA VA |
$811.03
|
|
|
HC INJECTION TURBINATE THERAPEUTIC
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT 30200
|
| Hospital Charge Code |
76100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.94 |
| Max. Negotiated Rate |
$1,408.21 |
| Rate for Payer: Aetna Commercial |
$1,147.50
|
| Rate for Payer: Aetna Medicare |
$509.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$877.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$611.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$611.96
|
| Rate for Payer: BCBS Complete |
$281.21
|
| Rate for Payer: BCBS MAPPO |
$489.57
|
| Rate for Payer: BCBS Trust/PPO |
$60.87
|
| Rate for Payer: BCN Medicare Advantage |
$489.57
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cofinity Commercial |
$1,161.00
|
| Rate for Payer: Cofinity Commercial |
$945.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.57
|
| Rate for Payer: Healthscope Commercial |
$1,215.00
|
| Rate for Payer: Mclaren Medicaid |
$267.79
|
| Rate for Payer: Mclaren Medicare |
$489.57
|
| Rate for Payer: Meridian Medicaid |
$281.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$514.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.50
|
| Rate for Payer: PACE Medicare |
$465.09
|
| Rate for Payer: PACE SWMI |
$489.57
|
| Rate for Payer: PHP Commercial |
$1,147.50
|
| Rate for Payer: PHP Medicare Advantage |
$489.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,408.21
|
| Rate for Payer: Priority Health Medicare |
$489.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,126.56
|
| Rate for Payer: Priority Health SBD |
$850.50
|
| Rate for Payer: Railroad Medicare Medicare |
$489.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$489.57
|
| Rate for Payer: UHC Exchange |
$58.94
|
| Rate for Payer: UHC Medicare Advantage |
$504.26
|
| Rate for Payer: VA VA |
$489.57
|
|
|
HC INJECTION TURBINATE THERAPEUTIC
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT 30200
|
| Hospital Charge Code |
76100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$850.50 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Aetna Commercial |
$1,147.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$877.50
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cofinity Commercial |
$1,161.00
|
| Rate for Payer: Cofinity Commercial |
$945.00
|
| Rate for Payer: Healthscope Commercial |
$1,215.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.50
|
| Rate for Payer: PHP Commercial |
$1,147.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.00
|
| Rate for Payer: Priority Health SBD |
$850.50
|
|
|
HC INJECTION VENOGRAM
|
Facility
|
IP
|
$555.85
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
36100095
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$350.19 |
| Max. Negotiated Rate |
$500.26 |
| Rate for Payer: Aetna Commercial |
$472.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$361.30
|
| Rate for Payer: Cash Price |
$444.68
|
| Rate for Payer: Cofinity Commercial |
$389.10
|
| Rate for Payer: Cofinity Commercial |
$478.03
|
| Rate for Payer: Healthscope Commercial |
$500.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$472.47
|
| Rate for Payer: PHP Commercial |
$472.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.10
|
| Rate for Payer: Priority Health SBD |
$350.19
|
|
|
HC INJECTION VENOGRAM
|
Facility
|
OP
|
$555.85
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
36100095
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$45.51 |
| Max. Negotiated Rate |
$1,060.66 |
| Rate for Payer: Aetna Commercial |
$472.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$361.30
|
| Rate for Payer: BCBS Complete |
$222.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,060.66
|
| Rate for Payer: Cash Price |
$444.68
|
| Rate for Payer: Cash Price |
$444.68
|
| Rate for Payer: Cofinity Commercial |
$478.03
|
| Rate for Payer: Cofinity Commercial |
$389.10
|
| Rate for Payer: Healthscope Commercial |
$500.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$472.47
|
| Rate for Payer: PHP Commercial |
$472.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.10
|
| Rate for Payer: Priority Health SBD |
$350.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.06
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$45.51
|
|
|
HC INJECTION WRIST ARTHROGRAM
|
Facility
|
OP
|
$1,129.61
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
36100039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$70.73 |
| Max. Negotiated Rate |
$1,016.65 |
| Rate for Payer: Aetna Commercial |
$960.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.25
|
| Rate for Payer: BCBS Complete |
$451.84
|
| Rate for Payer: BCBS Trust/PPO |
$163.01
|
| Rate for Payer: Cash Price |
$903.69
|
| Rate for Payer: Cash Price |
$903.69
|
| Rate for Payer: Cofinity Commercial |
$790.73
|
| Rate for Payer: Cofinity Commercial |
$971.46
|
| Rate for Payer: Healthscope Commercial |
$1,016.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$960.17
|
| Rate for Payer: PHP Commercial |
$960.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$790.73
|
| Rate for Payer: Priority Health SBD |
$711.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.80
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$70.73
|
|
|
HC INJECTION WRIST ARTHROGRAM
|
Facility
|
IP
|
$1,129.61
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
36100039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$711.65 |
| Max. Negotiated Rate |
$1,016.65 |
| Rate for Payer: Aetna Commercial |
$960.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.25
|
| Rate for Payer: Cash Price |
$903.69
|
| Rate for Payer: Cofinity Commercial |
$790.73
|
| Rate for Payer: Cofinity Commercial |
$971.46
|
| Rate for Payer: Healthscope Commercial |
$1,016.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$960.17
|
| Rate for Payer: PHP Commercial |
$960.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$790.73
|
| Rate for Payer: Priority Health SBD |
$711.65
|
|
|
HC INJECT/IRRIGATE CORPORA CAVERNOSA
|
Facility
|
IP
|
$366.05
|
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$230.61 |
| Max. Negotiated Rate |
$329.44 |
| Rate for Payer: Aetna Commercial |
$311.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.93
|
| Rate for Payer: Cash Price |
$292.84
|
| Rate for Payer: Cofinity Commercial |
$314.80
|
| Rate for Payer: Cofinity Commercial |
$256.24
|
| Rate for Payer: Healthscope Commercial |
$329.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.14
|
| Rate for Payer: PHP Commercial |
$311.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.24
|
| Rate for Payer: Priority Health SBD |
$230.61
|
|
|
HC INJECT/IRRIGATE CORPORA CAVERNOSA
|
Facility
|
OP
|
$366.05
|
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.42 |
| Max. Negotiated Rate |
$329.44 |
| Rate for Payer: Aetna Commercial |
$311.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.93
|
| Rate for Payer: BCBS Complete |
$146.42
|
| Rate for Payer: Cash Price |
$292.84
|
| Rate for Payer: Cofinity Commercial |
$256.24
|
| Rate for Payer: Cofinity Commercial |
$314.80
|
| Rate for Payer: Healthscope Commercial |
$329.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.14
|
| Rate for Payer: PHP Commercial |
$311.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.24
|
| Rate for Payer: Priority Health SBD |
$230.61
|
|
|
HC INJECT PORTAL VEIN
|
Facility
|
OP
|
$2,726.36
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
36100543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$310.09 |
| Max. Negotiated Rate |
$3,915.88 |
| Rate for Payer: Aetna Commercial |
$2,317.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,772.13
|
| Rate for Payer: BCBS Complete |
$1,090.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,915.88
|
| Rate for Payer: Cash Price |
$2,181.09
|
| Rate for Payer: Cash Price |
$2,181.09
|
| Rate for Payer: Cofinity Commercial |
$2,344.67
|
| Rate for Payer: Cofinity Commercial |
$1,908.45
|
| Rate for Payer: Healthscope Commercial |
$2,453.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,317.41
|
| Rate for Payer: PHP Commercial |
$2,317.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.45
|
| Rate for Payer: Priority Health SBD |
$1,717.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.10
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$310.09
|
|
|
HC INJECT PORTAL VEIN
|
Facility
|
IP
|
$2,726.36
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
36100543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,717.61 |
| Max. Negotiated Rate |
$2,453.72 |
| Rate for Payer: Aetna Commercial |
$2,317.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,772.13
|
| Rate for Payer: Cash Price |
$2,181.09
|
| Rate for Payer: Cofinity Commercial |
$1,908.45
|
| Rate for Payer: Cofinity Commercial |
$2,344.67
|
| Rate for Payer: Healthscope Commercial |
$2,453.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,317.41
|
| Rate for Payer: PHP Commercial |
$2,317.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.45
|
| Rate for Payer: Priority Health SBD |
$1,717.61
|
|
|
HC INJECT PROC PENILE PLAQUE
|
Facility
|
OP
|
$354.07
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.44 |
| Max. Negotiated Rate |
$644.30 |
| Rate for Payer: Aetna Commercial |
$300.96
|
| Rate for Payer: Aetna Medicare |
$228.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.89
|
| Rate for Payer: BCBS Complete |
$126.32
|
| Rate for Payer: BCBS MAPPO |
$219.91
|
| Rate for Payer: BCBS Trust/PPO |
$134.32
|
| Rate for Payer: BCN Medicare Advantage |
$219.91
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cofinity Commercial |
$247.85
|
| Rate for Payer: Cofinity Commercial |
$304.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.91
|
| Rate for Payer: Healthscope Commercial |
$318.66
|
| Rate for Payer: Mclaren Medicaid |
$120.29
|
| Rate for Payer: Mclaren Medicare |
$219.91
|
| Rate for Payer: Meridian Medicaid |
$126.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.96
|
| Rate for Payer: PACE Medicare |
$208.91
|
| Rate for Payer: PACE SWMI |
$219.91
|
| Rate for Payer: PHP Commercial |
$300.96
|
| Rate for Payer: PHP Medicare Advantage |
$219.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$644.30
|
| Rate for Payer: Priority Health Medicare |
$219.91
|
| Rate for Payer: Priority Health Narrow Network |
$515.44
|
| Rate for Payer: Priority Health SBD |
$223.06
|
| Rate for Payer: Railroad Medicare Medicare |
$219.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.91
|
| Rate for Payer: UHC Exchange |
$86.44
|
| Rate for Payer: UHC Medicare Advantage |
$226.51
|
| Rate for Payer: VA VA |
$219.91
|
|
|
HC INJECT PROC PENILE PLAQUE
|
Facility
|
IP
|
$354.07
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.06 |
| Max. Negotiated Rate |
$318.66 |
| Rate for Payer: Aetna Commercial |
$300.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.15
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cofinity Commercial |
$247.85
|
| Rate for Payer: Cofinity Commercial |
$304.50
|
| Rate for Payer: Healthscope Commercial |
$318.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.96
|
| Rate for Payer: PHP Commercial |
$300.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.85
|
| Rate for Payer: Priority Health SBD |
$223.06
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 1 OR 2 MUSCLES
|
Facility
|
IP
|
$366.80
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
36100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.08 |
| Max. Negotiated Rate |
$330.12 |
| Rate for Payer: Aetna Commercial |
$311.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.42
|
| Rate for Payer: Cash Price |
$293.44
|
| Rate for Payer: Cofinity Commercial |
$256.76
|
| Rate for Payer: Cofinity Commercial |
$315.45
|
| Rate for Payer: Healthscope Commercial |
$330.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.78
|
| Rate for Payer: PHP Commercial |
$311.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.76
|
| Rate for Payer: Priority Health SBD |
$231.08
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 1 OR 2 MUSCLES
|
Facility
|
OP
|
$366.80
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
36100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$330.12 |
| Rate for Payer: Aetna Commercial |
$311.78
|
| Rate for Payer: Aetna Medicare |
$274.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.42
|
| Rate for Payer: BCBS Complete |
$151.38
|
| Rate for Payer: BCBS MAPPO |
$263.54
|
| Rate for Payer: BCBS Trust/PPO |
$169.96
|
| Rate for Payer: BCN Medicare Advantage |
$263.54
|
| Rate for Payer: Cash Price |
$293.44
|
| Rate for Payer: Cash Price |
$293.44
|
| Rate for Payer: Cofinity Commercial |
$315.45
|
| Rate for Payer: Cofinity Commercial |
$256.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.54
|
| Rate for Payer: Healthscope Commercial |
$330.12
|
| Rate for Payer: Mclaren Medicaid |
$144.16
|
| Rate for Payer: Mclaren Medicare |
$263.54
|
| Rate for Payer: Meridian Medicaid |
$151.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.78
|
| Rate for Payer: PACE Medicare |
$250.36
|
| Rate for Payer: PACE SWMI |
$263.54
|
| Rate for Payer: PHP Commercial |
$311.78
|
| Rate for Payer: PHP Medicare Advantage |
$263.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.76
|
| Rate for Payer: Priority Health Medicare |
$263.54
|
| Rate for Payer: Priority Health SBD |
$231.08
|
| Rate for Payer: Railroad Medicare Medicare |
$263.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.54
|
| Rate for Payer: UHC Exchange |
$36.02
|
| Rate for Payer: UHC Medicare Advantage |
$271.45
|
| Rate for Payer: VA VA |
$263.54
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 3 OR MORE MUSCLES
|
Facility
|
IP
|
$478.11
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
36100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$301.21 |
| Max. Negotiated Rate |
$430.30 |
| Rate for Payer: Aetna Commercial |
$406.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.77
|
| Rate for Payer: Cash Price |
$382.49
|
| Rate for Payer: Cofinity Commercial |
$334.68
|
| Rate for Payer: Cofinity Commercial |
$411.17
|
| Rate for Payer: Healthscope Commercial |
$430.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$406.39
|
| Rate for Payer: PHP Commercial |
$406.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.68
|
| Rate for Payer: Priority Health SBD |
$301.21
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 3 OR MORE MUSCLES
|
Facility
|
OP
|
$478.11
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
36100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$813.49 |
| Rate for Payer: Aetna Commercial |
$406.39
|
| Rate for Payer: Aetna Medicare |
$274.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.42
|
| Rate for Payer: BCBS Complete |
$151.38
|
| Rate for Payer: BCBS MAPPO |
$263.54
|
| Rate for Payer: BCBS Trust/PPO |
$169.96
|
| Rate for Payer: BCN Medicare Advantage |
$263.54
|
| Rate for Payer: Cash Price |
$382.49
|
| Rate for Payer: Cash Price |
$382.49
|
| Rate for Payer: Cofinity Commercial |
$411.17
|
| Rate for Payer: Cofinity Commercial |
$334.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.54
|
| Rate for Payer: Healthscope Commercial |
$430.30
|
| Rate for Payer: Mclaren Medicaid |
$144.16
|
| Rate for Payer: Mclaren Medicare |
$263.54
|
| Rate for Payer: Meridian Medicaid |
$151.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$406.39
|
| Rate for Payer: PACE Medicare |
$250.36
|
| Rate for Payer: PACE SWMI |
$263.54
|
| Rate for Payer: PHP Commercial |
$406.39
|
| Rate for Payer: PHP Medicare Advantage |
$263.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.49
|
| Rate for Payer: Priority Health Medicare |
$263.54
|
| Rate for Payer: Priority Health Narrow Network |
$650.79
|
| Rate for Payer: Priority Health SBD |
$301.21
|
| Rate for Payer: Railroad Medicare Medicare |
$263.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.54
|
| Rate for Payer: UHC Exchange |
$40.93
|
| Rate for Payer: UHC Medicare Advantage |
$271.45
|
| Rate for Payer: VA VA |
$263.54
|
|
|
HC INJ ENOXAPARIN SODIUM PER 10 MG
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63600151
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: BCBS Complete |
$6.12
|
| Rate for Payer: BCBS Trust/PPO |
$2.00
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$9.64
|
|
|
HC INJ ENOXAPARIN SODIUM PER 10 MG
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63600151
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$9.64
|
|
|
HC INJ ENZYME PALMAR FASCIAL CORD
|
Facility
|
OP
|
$332.99
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.29 |
| Max. Negotiated Rate |
$329.42 |
| Rate for Payer: Aetna Commercial |
$283.04
|
| Rate for Payer: Aetna Medicare |
$274.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.42
|
| Rate for Payer: BCBS Complete |
$151.38
|
| Rate for Payer: BCBS MAPPO |
$263.54
|
| Rate for Payer: BCBS Trust/PPO |
$32.29
|
| Rate for Payer: BCN Medicare Advantage |
$263.54
|
| Rate for Payer: Cash Price |
$266.39
|
| Rate for Payer: Cash Price |
$266.39
|
| Rate for Payer: Cofinity Commercial |
$286.37
|
| Rate for Payer: Cofinity Commercial |
$233.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.54
|
| Rate for Payer: Healthscope Commercial |
$299.69
|
| Rate for Payer: Mclaren Medicaid |
$144.16
|
| Rate for Payer: Mclaren Medicare |
$263.54
|
| Rate for Payer: Meridian Medicaid |
$151.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.04
|
| Rate for Payer: PACE Medicare |
$250.36
|
| Rate for Payer: PACE SWMI |
$263.54
|
| Rate for Payer: PHP Commercial |
$283.04
|
| Rate for Payer: PHP Medicare Advantage |
$263.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.09
|
| Rate for Payer: Priority Health Medicare |
$263.54
|
| Rate for Payer: Priority Health SBD |
$209.78
|
| Rate for Payer: Railroad Medicare Medicare |
$263.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.54
|
| Rate for Payer: UHC Exchange |
$64.51
|
| Rate for Payer: UHC Medicare Advantage |
$271.45
|
| Rate for Payer: VA VA |
$263.54
|
|
