|
HC INJ ANES MIDDLE OR LOWER SPINE SYMPATHETIC NERVES
|
Facility
|
IP
|
$1,292.55
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
36100604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$814.31 |
| Max. Negotiated Rate |
$1,163.30 |
| Rate for Payer: Aetna Commercial |
$1,098.67
|
| Rate for Payer: Aetna Commercial |
$1,648.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$840.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,260.25
|
| Rate for Payer: Cash Price |
$1,034.04
|
| Rate for Payer: Cash Price |
$1,551.07
|
| Rate for Payer: Cofinity Advantage |
$904.78
|
| Rate for Payer: Cofinity Advantage |
$1,357.19
|
| Rate for Payer: Cofinity Commercial |
$1,111.59
|
| Rate for Payer: Cofinity Commercial |
$1,667.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,551.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,034.04
|
| Rate for Payer: Healthscope Commercial |
$1,744.96
|
| Rate for Payer: Healthscope Commercial |
$1,163.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,098.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,648.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$969.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,454.13
|
| Rate for Payer: PHP Commercial |
$1,098.67
|
| Rate for Payer: PHP Commercial |
$1,648.01
|
| Rate for Payer: Priority Health SBD |
$814.31
|
| Rate for Payer: Priority Health SBD |
$1,221.47
|
|
|
HC INJ ANESTH AND/OR STEROID AXILLARY NERVE
|
Facility
|
IP
|
$1,949.46
|
|
|
Service Code
|
CPT 64417
|
| Hospital Charge Code |
36100599
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,228.16 |
| Max. Negotiated Rate |
$1,754.51 |
| Rate for Payer: Aetna Commercial |
$1,657.04
|
| Rate for Payer: Aetna Commercial |
$2,485.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,267.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,900.73
|
| Rate for Payer: Cash Price |
$1,559.57
|
| Rate for Payer: Cash Price |
$2,339.36
|
| Rate for Payer: Cofinity Advantage |
$1,364.62
|
| Rate for Payer: Cofinity Advantage |
$2,046.94
|
| Rate for Payer: Cofinity Commercial |
$1,676.54
|
| Rate for Payer: Cofinity Commercial |
$2,514.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,339.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,559.57
|
| Rate for Payer: Healthscope Commercial |
$2,631.78
|
| Rate for Payer: Healthscope Commercial |
$1,754.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,657.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,485.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,462.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,193.15
|
| Rate for Payer: PHP Commercial |
$1,657.04
|
| Rate for Payer: PHP Commercial |
$2,485.57
|
| Rate for Payer: Priority Health SBD |
$1,228.16
|
| Rate for Payer: Priority Health SBD |
$1,842.25
|
|
|
HC INJ ANESTH AND/OR STEROID AXILLARY NERVE
|
Facility
|
OP
|
$1,949.46
|
|
|
Service Code
|
CPT 64417
|
| Hospital Charge Code |
36100599
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$395.31 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna Commercial |
$1,657.04
|
| Rate for Payer: Aetna Commercial |
$2,485.57
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,900.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,267.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$395.31
|
| Rate for Payer: BCBS Trust/PPO |
$395.31
|
| Rate for Payer: BCN Commercial |
$395.31
|
| Rate for Payer: BCN Commercial |
$395.31
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$1,559.57
|
| Rate for Payer: Cash Price |
$1,559.57
|
| Rate for Payer: Cash Price |
$1,559.57
|
| Rate for Payer: Cash Price |
$2,339.36
|
| Rate for Payer: Cash Price |
$2,339.36
|
| Rate for Payer: Cash Price |
$2,339.36
|
| Rate for Payer: Cofinity Advantage |
$1,364.62
|
| Rate for Payer: Cofinity Advantage |
$2,046.94
|
| Rate for Payer: Cofinity Commercial |
$1,676.54
|
| Rate for Payer: Cofinity Commercial |
$2,514.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,339.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,559.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,754.51
|
| Rate for Payer: Healthscope Commercial |
$2,631.78
|
| Rate for Payer: Mclaren Medicaid |
$460.91
|
| Rate for Payer: Mclaren Medicaid |
$460.91
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,657.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,485.57
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,193.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,462.10
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$1,657.04
|
| Rate for Payer: PHP Commercial |
$2,485.57
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health SBD |
$1,228.16
|
| Rate for Payer: Priority Health SBD |
$1,842.25
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC INJ ANESTH AND/OR STEROID BRACHIAL PLEXUS
|
Facility
|
IP
|
$4,853.34
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
37100005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$3,057.60 |
| Max. Negotiated Rate |
$4,368.01 |
| Rate for Payer: Aetna Commercial |
$4,125.34
|
| Rate for Payer: Aetna Commercial |
$2,750.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,103.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,154.67
|
| Rate for Payer: Cash Price |
$2,588.45
|
| Rate for Payer: Cash Price |
$3,882.67
|
| Rate for Payer: Cofinity Advantage |
$3,397.34
|
| Rate for Payer: Cofinity Advantage |
$2,264.89
|
| Rate for Payer: Cofinity Commercial |
$2,782.58
|
| Rate for Payer: Cofinity Commercial |
$4,173.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,588.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,882.67
|
| Rate for Payer: Healthscope Commercial |
$2,912.00
|
| Rate for Payer: Healthscope Commercial |
$4,368.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,125.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,750.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,640.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,426.67
|
| Rate for Payer: PHP Commercial |
$2,750.23
|
| Rate for Payer: PHP Commercial |
$4,125.34
|
| Rate for Payer: Priority Health SBD |
$2,038.40
|
| Rate for Payer: Priority Health SBD |
$3,057.60
|
|
|
HC INJ ANESTH AND/OR STEROID BRACHIAL PLEXUS
|
Facility
|
OP
|
$4,853.34
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
37100005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$4,368.01 |
| Rate for Payer: Aetna Commercial |
$4,125.34
|
| Rate for Payer: Aetna Commercial |
$2,750.23
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,154.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,103.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$461.20
|
| Rate for Payer: BCBS Trust/PPO |
$461.20
|
| Rate for Payer: BCN Commercial |
$461.20
|
| Rate for Payer: BCN Commercial |
$461.20
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$3,882.67
|
| Rate for Payer: Cash Price |
$2,588.45
|
| Rate for Payer: Cash Price |
$2,588.45
|
| Rate for Payer: Cash Price |
$3,882.67
|
| Rate for Payer: Cash Price |
$3,882.67
|
| Rate for Payer: Cash Price |
$2,588.45
|
| Rate for Payer: Cofinity Advantage |
$2,264.89
|
| Rate for Payer: Cofinity Advantage |
$3,397.34
|
| Rate for Payer: Cofinity Commercial |
$4,173.87
|
| Rate for Payer: Cofinity Commercial |
$2,782.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,588.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,882.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$4,368.01
|
| Rate for Payer: Healthscope Commercial |
$2,912.00
|
| Rate for Payer: Mclaren Medicaid |
$460.91
|
| Rate for Payer: Mclaren Medicaid |
$460.91
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,750.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,125.34
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,426.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,640.01
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$2,750.23
|
| Rate for Payer: PHP Commercial |
$4,125.34
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health SBD |
$3,057.60
|
| Rate for Payer: Priority Health SBD |
$2,038.40
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,154.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,103.11
|
| Rate for Payer: UHC Core |
$1,685.73
|
| Rate for Payer: UHC Core |
$2,528.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Exchange |
$1,271.58
|
| Rate for Payer: UHC Exchange |
$1,907.36
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC INJ ANESTH AND/OR STEROID SCIATIC NERVE
|
Facility
|
OP
|
$2,600.63
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
37100008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$77.15 |
| Max. Negotiated Rate |
$2,340.57 |
| Rate for Payer: Aetna Commercial |
$2,210.54
|
| Rate for Payer: Aetna Commercial |
$3,315.81
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,535.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,690.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$77.15
|
| Rate for Payer: BCBS Trust/PPO |
$77.15
|
| Rate for Payer: BCN Commercial |
$77.15
|
| Rate for Payer: BCN Commercial |
$77.15
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$2,080.50
|
| Rate for Payer: Cash Price |
$2,080.50
|
| Rate for Payer: Cash Price |
$3,120.76
|
| Rate for Payer: Cash Price |
$3,120.76
|
| Rate for Payer: Cash Price |
$3,120.76
|
| Rate for Payer: Cash Price |
$2,080.50
|
| Rate for Payer: Cofinity Advantage |
$2,730.66
|
| Rate for Payer: Cofinity Advantage |
$1,820.44
|
| Rate for Payer: Cofinity Commercial |
$2,236.54
|
| Rate for Payer: Cofinity Commercial |
$3,354.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,120.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,080.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$2,340.57
|
| Rate for Payer: Healthscope Commercial |
$3,510.86
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,210.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,315.81
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,925.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,950.47
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$2,210.54
|
| Rate for Payer: PHP Commercial |
$3,315.81
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health SBD |
$2,457.60
|
| Rate for Payer: Priority Health SBD |
$1,638.40
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,690.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,535.62
|
| Rate for Payer: UHC Core |
$2,032.39
|
| Rate for Payer: UHC Core |
$1,354.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$1,533.07
|
| Rate for Payer: UHC Exchange |
$1,022.05
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC INJ ANESTH AND/OR STEROID SCIATIC NERVE
|
Facility
|
IP
|
$2,600.63
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
37100008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,638.40 |
| Max. Negotiated Rate |
$2,340.57 |
| Rate for Payer: Aetna Commercial |
$2,210.54
|
| Rate for Payer: Aetna Commercial |
$3,315.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,690.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,535.62
|
| Rate for Payer: Cash Price |
$2,080.50
|
| Rate for Payer: Cash Price |
$3,120.76
|
| Rate for Payer: Cofinity Advantage |
$1,820.44
|
| Rate for Payer: Cofinity Advantage |
$2,730.66
|
| Rate for Payer: Cofinity Commercial |
$2,236.54
|
| Rate for Payer: Cofinity Commercial |
$3,354.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,120.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,080.50
|
| Rate for Payer: Healthscope Commercial |
$3,510.86
|
| Rate for Payer: Healthscope Commercial |
$2,340.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,210.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,315.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,950.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,925.71
|
| Rate for Payer: PHP Commercial |
$2,210.54
|
| Rate for Payer: PHP Commercial |
$3,315.81
|
| Rate for Payer: Priority Health SBD |
$1,638.40
|
| Rate for Payer: Priority Health SBD |
$2,457.60
|
|
|
HC INJ ANESTH AND/OR STEROID SUPRASCAPULAR NERVE
|
Facility
|
OP
|
$1,492.45
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
36100600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$92.85 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Commercial |
$1,268.58
|
| Rate for Payer: Aetna Commercial |
$845.72
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$970.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$92.85
|
| Rate for Payer: BCBS Trust/PPO |
$92.85
|
| Rate for Payer: BCN Commercial |
$92.85
|
| Rate for Payer: BCN Commercial |
$92.85
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$1,193.96
|
| Rate for Payer: Cash Price |
$1,193.96
|
| Rate for Payer: Cash Price |
$1,193.96
|
| Rate for Payer: Cash Price |
$795.98
|
| Rate for Payer: Cash Price |
$795.98
|
| Rate for Payer: Cash Price |
$795.98
|
| Rate for Payer: Cofinity Advantage |
$1,044.71
|
| Rate for Payer: Cofinity Advantage |
$696.48
|
| Rate for Payer: Cofinity Commercial |
$1,283.51
|
| Rate for Payer: Cofinity Commercial |
$855.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,193.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$1,343.20
|
| Rate for Payer: Healthscope Commercial |
$895.47
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,268.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.72
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$746.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,119.34
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$1,268.58
|
| Rate for Payer: PHP Commercial |
$845.72
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health SBD |
$940.24
|
| Rate for Payer: Priority Health SBD |
$626.83
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC INJ ANESTH AND/OR STEROID SUPRASCAPULAR NERVE
|
Facility
|
IP
|
$1,492.45
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
36100600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$940.24 |
| Max. Negotiated Rate |
$1,343.20 |
| Rate for Payer: Aetna Commercial |
$1,268.58
|
| Rate for Payer: Aetna Commercial |
$845.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$970.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.73
|
| Rate for Payer: Cash Price |
$1,193.96
|
| Rate for Payer: Cash Price |
$795.98
|
| Rate for Payer: Cofinity Advantage |
$1,044.71
|
| Rate for Payer: Cofinity Advantage |
$696.48
|
| Rate for Payer: Cofinity Commercial |
$1,283.51
|
| Rate for Payer: Cofinity Commercial |
$855.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,193.96
|
| Rate for Payer: Healthscope Commercial |
$895.47
|
| Rate for Payer: Healthscope Commercial |
$1,343.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,268.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,119.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$746.23
|
| Rate for Payer: PHP Commercial |
$1,268.58
|
| Rate for Payer: PHP Commercial |
$845.72
|
| Rate for Payer: Priority Health SBD |
$940.24
|
| Rate for Payer: Priority Health SBD |
$626.83
|
|
|
HC INJ ANESTHETIC FEMORAL
|
Facility
|
OP
|
$1,564.96
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
36100391
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$61.43 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Commercial |
$1,330.22
|
| Rate for Payer: Aetna Commercial |
$1,995.32
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,525.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,017.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$61.43
|
| Rate for Payer: BCBS Trust/PPO |
$61.43
|
| Rate for Payer: BCN Commercial |
$61.43
|
| Rate for Payer: BCN Commercial |
$61.43
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$1,251.97
|
| Rate for Payer: Cash Price |
$1,251.97
|
| Rate for Payer: Cash Price |
$1,877.95
|
| Rate for Payer: Cash Price |
$1,877.95
|
| Rate for Payer: Cash Price |
$1,877.95
|
| Rate for Payer: Cash Price |
$1,251.97
|
| Rate for Payer: Cofinity Advantage |
$1,643.21
|
| Rate for Payer: Cofinity Advantage |
$1,095.47
|
| Rate for Payer: Cofinity Commercial |
$1,345.87
|
| Rate for Payer: Cofinity Commercial |
$2,018.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,877.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,251.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$1,408.46
|
| Rate for Payer: Healthscope Commercial |
$2,112.70
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,330.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,995.32
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,760.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,173.72
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$1,330.22
|
| Rate for Payer: PHP Commercial |
$1,995.32
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health SBD |
$1,478.89
|
| Rate for Payer: Priority Health SBD |
$985.92
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,017.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,525.84
|
| Rate for Payer: UHC Core |
$1,223.02
|
| Rate for Payer: UHC Core |
$815.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$922.54
|
| Rate for Payer: UHC Exchange |
$615.03
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC INJ ANESTHETIC FEMORAL
|
Facility
|
IP
|
$1,564.96
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
36100391
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$985.92 |
| Max. Negotiated Rate |
$1,408.46 |
| Rate for Payer: Aetna Commercial |
$1,330.22
|
| Rate for Payer: Aetna Commercial |
$1,995.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,017.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,525.84
|
| Rate for Payer: Cash Price |
$1,251.97
|
| Rate for Payer: Cash Price |
$1,877.95
|
| Rate for Payer: Cofinity Advantage |
$1,095.47
|
| Rate for Payer: Cofinity Advantage |
$1,643.21
|
| Rate for Payer: Cofinity Commercial |
$1,345.87
|
| Rate for Payer: Cofinity Commercial |
$2,018.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,877.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,251.97
|
| Rate for Payer: Healthscope Commercial |
$2,112.70
|
| Rate for Payer: Healthscope Commercial |
$1,408.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,330.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,995.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,173.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,760.58
|
| Rate for Payer: PHP Commercial |
$1,330.22
|
| Rate for Payer: PHP Commercial |
$1,995.32
|
| Rate for Payer: Priority Health SBD |
$985.92
|
| Rate for Payer: Priority Health SBD |
$1,478.89
|
|
|
HC INJ ANESTH PERIPH NERVE
|
Facility
|
OP
|
$1,362.21
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
36100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Commercial |
$1,157.88
|
| Rate for Payer: Aetna Commercial |
$771.92
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$531.26
|
| Rate for Payer: BCBS Trust/PPO |
$531.26
|
| Rate for Payer: BCN Commercial |
$531.26
|
| Rate for Payer: BCN Commercial |
$531.26
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$1,089.77
|
| Rate for Payer: Cash Price |
$1,089.77
|
| Rate for Payer: Cash Price |
$726.51
|
| Rate for Payer: Cash Price |
$726.51
|
| Rate for Payer: Cash Price |
$726.51
|
| Rate for Payer: Cash Price |
$1,089.77
|
| Rate for Payer: Cofinity Advantage |
$635.70
|
| Rate for Payer: Cofinity Advantage |
$953.55
|
| Rate for Payer: Cofinity Commercial |
$1,171.50
|
| Rate for Payer: Cofinity Commercial |
$781.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$726.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$1,225.99
|
| Rate for Payer: Healthscope Commercial |
$817.33
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$771.92
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$681.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,021.66
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$1,157.88
|
| Rate for Payer: PHP Commercial |
$771.92
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health SBD |
$572.13
|
| Rate for Payer: Priority Health SBD |
$858.19
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$885.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$590.29
|
| Rate for Payer: UHC Core |
$473.14
|
| Rate for Payer: UHC Core |
$709.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$356.90
|
| Rate for Payer: UHC Exchange |
$535.35
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC INJ ANESTH PERIPH NERVE
|
Facility
|
IP
|
$1,362.21
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
36100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$858.19 |
| Max. Negotiated Rate |
$1,225.99 |
| Rate for Payer: Aetna Commercial |
$1,157.88
|
| Rate for Payer: Aetna Commercial |
$771.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.29
|
| Rate for Payer: Cash Price |
$1,089.77
|
| Rate for Payer: Cash Price |
$726.51
|
| Rate for Payer: Cofinity Advantage |
$953.55
|
| Rate for Payer: Cofinity Advantage |
$635.70
|
| Rate for Payer: Cofinity Commercial |
$1,171.50
|
| Rate for Payer: Cofinity Commercial |
$781.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$726.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.77
|
| Rate for Payer: Healthscope Commercial |
$817.33
|
| Rate for Payer: Healthscope Commercial |
$1,225.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$771.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,021.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$681.11
|
| Rate for Payer: PHP Commercial |
$1,157.88
|
| Rate for Payer: PHP Commercial |
$771.92
|
| Rate for Payer: Priority Health SBD |
$858.19
|
| Rate for Payer: Priority Health SBD |
$572.13
|
|
|
HC INJ ANESTH/STEROID BRACHIAL PLEXUS CONT
|
Facility
|
IP
|
$3,235.56
|
|
|
Service Code
|
CPT 64416
|
| Hospital Charge Code |
37100010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2,038.40 |
| Max. Negotiated Rate |
$2,912.00 |
| Rate for Payer: Aetna Commercial |
$2,750.23
|
| Rate for Payer: Aetna Commercial |
$4,125.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,103.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,154.67
|
| Rate for Payer: Cash Price |
$2,588.45
|
| Rate for Payer: Cash Price |
$3,882.67
|
| Rate for Payer: Cofinity Advantage |
$2,264.89
|
| Rate for Payer: Cofinity Advantage |
$3,397.34
|
| Rate for Payer: Cofinity Commercial |
$2,782.58
|
| Rate for Payer: Cofinity Commercial |
$4,173.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,882.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,588.45
|
| Rate for Payer: Healthscope Commercial |
$4,368.01
|
| Rate for Payer: Healthscope Commercial |
$2,912.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,750.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,125.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,426.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,640.01
|
| Rate for Payer: PHP Commercial |
$2,750.23
|
| Rate for Payer: PHP Commercial |
$4,125.34
|
| Rate for Payer: Priority Health SBD |
$2,038.40
|
| Rate for Payer: Priority Health SBD |
$3,057.60
|
|
|
HC INJ ANESTH/STEROID BRACHIAL PLEXUS CONT
|
Facility
|
OP
|
$3,235.56
|
|
|
Service Code
|
CPT 64416
|
| Hospital Charge Code |
37100010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,912.00 |
| Rate for Payer: Aetna Commercial |
$2,750.23
|
| Rate for Payer: Aetna Commercial |
$4,125.34
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,154.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,103.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$510.60
|
| Rate for Payer: BCBS Trust/PPO |
$510.60
|
| Rate for Payer: BCN Commercial |
$510.60
|
| Rate for Payer: BCN Commercial |
$510.60
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$2,588.45
|
| Rate for Payer: Cash Price |
$2,588.45
|
| Rate for Payer: Cash Price |
$3,882.67
|
| Rate for Payer: Cash Price |
$3,882.67
|
| Rate for Payer: Cash Price |
$3,882.67
|
| Rate for Payer: Cash Price |
$2,588.45
|
| Rate for Payer: Cofinity Advantage |
$3,397.34
|
| Rate for Payer: Cofinity Advantage |
$2,264.89
|
| Rate for Payer: Cofinity Commercial |
$2,782.58
|
| Rate for Payer: Cofinity Commercial |
$4,173.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,882.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,588.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$2,912.00
|
| Rate for Payer: Healthscope Commercial |
$4,368.01
|
| Rate for Payer: Mclaren Medicaid |
$460.91
|
| Rate for Payer: Mclaren Medicaid |
$460.91
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,750.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,125.34
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,640.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,426.67
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$2,750.23
|
| Rate for Payer: PHP Commercial |
$4,125.34
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health SBD |
$3,057.60
|
| Rate for Payer: Priority Health SBD |
$2,038.40
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,103.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,154.67
|
| Rate for Payer: UHC Core |
$2,528.59
|
| Rate for Payer: UHC Core |
$1,685.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Exchange |
$1,907.36
|
| Rate for Payer: UHC Exchange |
$1,271.58
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC INJ ANESTH/STEROID SCIATIC NERVE CONT
|
Facility
|
IP
|
$4,866.26
|
|
|
Service Code
|
CPT 64446
|
| Hospital Charge Code |
37000020
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$3,065.74 |
| Max. Negotiated Rate |
$4,379.63 |
| Rate for Payer: Aetna Commercial |
$4,136.32
|
| Rate for Payer: Aetna Commercial |
$2,757.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,163.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,108.71
|
| Rate for Payer: Cash Price |
$2,595.34
|
| Rate for Payer: Cash Price |
$3,893.01
|
| Rate for Payer: Cofinity Advantage |
$3,406.38
|
| Rate for Payer: Cofinity Advantage |
$2,270.92
|
| Rate for Payer: Cofinity Commercial |
$2,789.99
|
| Rate for Payer: Cofinity Commercial |
$4,184.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,893.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,595.34
|
| Rate for Payer: Healthscope Commercial |
$4,379.63
|
| Rate for Payer: Healthscope Commercial |
$2,919.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,136.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,757.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,433.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,649.70
|
| Rate for Payer: PHP Commercial |
$2,757.54
|
| Rate for Payer: PHP Commercial |
$4,136.32
|
| Rate for Payer: Priority Health SBD |
$3,065.74
|
| Rate for Payer: Priority Health SBD |
$2,043.83
|
|
|
HC INJ ANESTH/STEROID SCIATIC NERVE CONT
|
Facility
|
OP
|
$4,866.26
|
|
|
Service Code
|
CPT 64446
|
| Hospital Charge Code |
37000020
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$4,379.63 |
| Rate for Payer: Aetna Commercial |
$4,136.32
|
| Rate for Payer: Aetna Commercial |
$2,757.54
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,163.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,108.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$541.39
|
| Rate for Payer: BCBS Trust/PPO |
$541.39
|
| Rate for Payer: BCN Commercial |
$541.39
|
| Rate for Payer: BCN Commercial |
$541.39
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$3,893.01
|
| Rate for Payer: Cash Price |
$2,595.34
|
| Rate for Payer: Cash Price |
$2,595.34
|
| Rate for Payer: Cash Price |
$3,893.01
|
| Rate for Payer: Cash Price |
$3,893.01
|
| Rate for Payer: Cash Price |
$2,595.34
|
| Rate for Payer: Cofinity Advantage |
$2,270.92
|
| Rate for Payer: Cofinity Advantage |
$3,406.38
|
| Rate for Payer: Cofinity Commercial |
$4,184.98
|
| Rate for Payer: Cofinity Commercial |
$2,789.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,595.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,893.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$4,379.63
|
| Rate for Payer: Healthscope Commercial |
$2,919.75
|
| Rate for Payer: Mclaren Medicaid |
$460.91
|
| Rate for Payer: Mclaren Medicaid |
$460.91
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,757.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,136.32
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,433.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,649.70
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$2,757.54
|
| Rate for Payer: PHP Commercial |
$4,136.32
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health SBD |
$3,065.74
|
| Rate for Payer: Priority Health SBD |
$2,043.83
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,163.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,108.71
|
| Rate for Payer: UHC Core |
$1,690.21
|
| Rate for Payer: UHC Core |
$2,535.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Exchange |
$1,274.96
|
| Rate for Payer: UHC Exchange |
$1,912.44
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC INJ ANEST/STEROID ILIOING ILIOHYPOGAST NRV
|
Facility
|
OP
|
$994.97
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
76100270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Commercial |
$845.72
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$531.26
|
| Rate for Payer: BCN Commercial |
$531.26
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$795.98
|
| Rate for Payer: Cash Price |
$795.98
|
| Rate for Payer: Cash Price |
$795.98
|
| Rate for Payer: Cofinity Advantage |
$696.48
|
| Rate for Payer: Cofinity Commercial |
$855.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$895.47
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.72
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$746.23
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$845.72
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health SBD |
$626.83
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$646.73
|
| Rate for Payer: UHC Core |
$518.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$391.02
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC INJ ANEST/STEROID ILIOING ILIOHYPOGAST NRV
|
Facility
|
IP
|
$994.97
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
76100270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$626.83 |
| Max. Negotiated Rate |
$895.47 |
| Rate for Payer: Aetna Commercial |
$845.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.73
|
| Rate for Payer: Cash Price |
$795.98
|
| Rate for Payer: Cofinity Advantage |
$696.48
|
| Rate for Payer: Cofinity Commercial |
$855.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.98
|
| Rate for Payer: Healthscope Commercial |
$895.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$746.23
|
| Rate for Payer: PHP Commercial |
$845.72
|
| Rate for Payer: Priority Health SBD |
$626.83
|
|
|
HC INJ BEBTELOVIMAB
|
Facility
|
OP
|
$494.70
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
77100034
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$194.42 |
| Max. Negotiated Rate |
$445.23 |
| Rate for Payer: Aetna Commercial |
$420.50
|
| Rate for Payer: Aetna Medicare |
$247.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.56
|
| Rate for Payer: BCBS Complete |
$197.88
|
| Rate for Payer: Cash Price |
$395.76
|
| Rate for Payer: Cofinity Advantage |
$346.29
|
| Rate for Payer: Cofinity Commercial |
$425.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.76
|
| Rate for Payer: Healthscope Commercial |
$445.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$395.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.02
|
| Rate for Payer: PHP Commercial |
$420.50
|
| Rate for Payer: Priority Health SBD |
$311.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.56
|
| Rate for Payer: UHC Core |
$257.74
|
| Rate for Payer: UHC Exchange |
$194.42
|
|
|
HC INJ BEBTELOVIMAB
|
Facility
|
IP
|
$494.70
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
77100034
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$311.66 |
| Max. Negotiated Rate |
$445.23 |
| Rate for Payer: Aetna Commercial |
$420.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.56
|
| Rate for Payer: Cash Price |
$395.76
|
| Rate for Payer: Cofinity Advantage |
$346.29
|
| Rate for Payer: Cofinity Commercial |
$425.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.76
|
| Rate for Payer: Healthscope Commercial |
$445.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.02
|
| Rate for Payer: PHP Commercial |
$420.50
|
| Rate for Payer: Priority Health SBD |
$311.66
|
|
|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.37
|
|
|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.49 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$10.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS Trust/PPO |
$17.31
|
| Rate for Payer: BCN Commercial |
$17.31
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.40
|
| Rate for Payer: UHC Core |
$11.40
|
| Rate for Payer: UHC Exchange |
$11.40
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
OP
|
$1,125.53
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna Commercial |
$956.70
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$731.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$461.20
|
| Rate for Payer: BCN Commercial |
$461.20
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cofinity Advantage |
$787.87
|
| Rate for Payer: Cofinity Commercial |
$967.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,012.98
|
| Rate for Payer: Mclaren Medicaid |
$460.91
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.70
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$844.15
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$956.70
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health SBD |
$709.08
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
IP
|
$1,125.53
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$709.08 |
| Max. Negotiated Rate |
$1,012.98 |
| Rate for Payer: Aetna Commercial |
$956.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$731.59
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cofinity Advantage |
$787.87
|
| Rate for Payer: Cofinity Commercial |
$967.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.42
|
| Rate for Payer: Healthscope Commercial |
$1,012.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$844.15
|
| Rate for Payer: PHP Commercial |
$956.70
|
| Rate for Payer: Priority Health SBD |
$709.08
|
|
