|
HC INJECTION, TESTOSTERONE CYPIONATE, 1 MG
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
CPT J1071
|
| Hospital Charge Code |
63600109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.10
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cofinity Advantage |
$0.11
|
| Rate for Payer: Cofinity Commercial |
$0.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.13
|
| Rate for Payer: Healthscope Commercial |
$0.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.12
|
| Rate for Payer: PHP Commercial |
$0.14
|
| Rate for Payer: Priority Health SBD |
$0.10
|
|
|
HC INJECTION THERAPEUTIC SINUS TRACT
|
Facility
|
OP
|
$942.13
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
36100020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$4,999.64 |
| Rate for Payer: Aetna Commercial |
$800.81
|
| Rate for Payer: Aetna Medicare |
$1,607.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,932.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,932.50
|
| Rate for Payer: BCBS Complete |
$849.06
|
| Rate for Payer: BCBS MAPPO |
$1,546.00
|
| Rate for Payer: BCBS Trust/PPO |
$53.41
|
| Rate for Payer: BCN Commercial |
$53.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,546.00
|
| Rate for Payer: Cash Price |
$753.70
|
| Rate for Payer: Cash Price |
$753.70
|
| Rate for Payer: Cash Price |
$753.70
|
| Rate for Payer: Cofinity Advantage |
$659.49
|
| Rate for Payer: Cofinity Commercial |
$810.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$753.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,546.00
|
| Rate for Payer: Healthscope Commercial |
$847.92
|
| Rate for Payer: Mclaren Medicaid |
$808.56
|
| Rate for Payer: Mclaren Medicare |
$1,546.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,623.30
|
| Rate for Payer: Meridian Medicaid |
$1,623.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,777.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,700.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$800.81
|
| Rate for Payer: Nomi Health Commercial |
$4,638.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$706.60
|
| Rate for Payer: PACE Medicare |
$1,468.70
|
| Rate for Payer: PACE SWMI |
$1,546.00
|
| Rate for Payer: PHP Commercial |
$800.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,546.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,999.64
|
| Rate for Payer: Priority Health Medicare |
$1,546.00
|
| Rate for Payer: Priority Health SBD |
$593.54
|
| Rate for Payer: Priority Health Tiered Network |
$3,999.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,546.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,546.00
|
| Rate for Payer: UHC Medicaid |
$808.56
|
| Rate for Payer: UHCCP Medicaid |
$808.56
|
| Rate for Payer: VA VA |
$1,546.00
|
|
|
HC INJECTION THERAPEUTIC SINUS TRACT
|
Facility
|
IP
|
$942.13
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
36100020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$593.54 |
| Max. Negotiated Rate |
$847.92 |
| Rate for Payer: Aetna Commercial |
$800.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.38
|
| Rate for Payer: Cash Price |
$753.70
|
| Rate for Payer: Cofinity Advantage |
$659.49
|
| Rate for Payer: Cofinity Commercial |
$810.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$753.70
|
| Rate for Payer: Healthscope Commercial |
$847.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$800.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$706.60
|
| Rate for Payer: PHP Commercial |
$800.81
|
| Rate for Payer: Priority Health SBD |
$593.54
|
|
|
HC INJECTION TRANSFORAMINAL CERVICAL OR THORACIC
|
Facility
|
OP
|
$1,758.91
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna Commercial |
$1,495.07
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,143.29
|
| 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 |
$673.70
|
| Rate for Payer: BCN Commercial |
$673.70
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$1,407.13
|
| Rate for Payer: Cash Price |
$1,407.13
|
| Rate for Payer: Cash Price |
$1,407.13
|
| Rate for Payer: Cofinity Advantage |
$1,231.24
|
| Rate for Payer: Cofinity Commercial |
$1,512.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,407.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,583.02
|
| 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 |
$1,495.07
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,319.18
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$1,495.07
|
| 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 |
$1,108.11
|
| 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 INJECTION TRANSFORAMINAL CERVICAL OR THORACIC
|
Facility
|
IP
|
$1,758.91
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,108.11 |
| Max. Negotiated Rate |
$1,583.02 |
| Rate for Payer: Aetna Commercial |
$1,495.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,143.29
|
| Rate for Payer: Cash Price |
$1,407.13
|
| Rate for Payer: Cofinity Advantage |
$1,231.24
|
| Rate for Payer: Cofinity Commercial |
$1,512.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,407.13
|
| Rate for Payer: Healthscope Commercial |
$1,583.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,495.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,319.18
|
| Rate for Payer: PHP Commercial |
$1,495.07
|
| Rate for Payer: Priority Health SBD |
$1,108.11
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC BIL
|
Facility
|
OP
|
$2,638.36
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100623
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna Commercial |
$2,242.61
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,714.93
|
| 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 |
$673.70
|
| Rate for Payer: BCN Commercial |
$673.70
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$2,110.69
|
| Rate for Payer: Cash Price |
$2,110.69
|
| Rate for Payer: Cash Price |
$2,110.69
|
| Rate for Payer: Cofinity Advantage |
$1,846.85
|
| Rate for Payer: Cofinity Commercial |
$2,268.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,110.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$2,374.52
|
| 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 |
$2,242.61
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,978.77
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$2,242.61
|
| 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 |
$1,662.17
|
| 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 INJECTION TRANSFORAMIN CERVICAL OR THORACIC BIL
|
Facility
|
IP
|
$2,638.36
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100623
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,662.17 |
| Max. Negotiated Rate |
$2,374.52 |
| Rate for Payer: Aetna Commercial |
$2,242.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,714.93
|
| Rate for Payer: Cash Price |
$2,110.69
|
| Rate for Payer: Cofinity Advantage |
$1,846.85
|
| Rate for Payer: Cofinity Commercial |
$2,268.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,110.69
|
| Rate for Payer: Healthscope Commercial |
$2,374.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,242.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,978.77
|
| Rate for Payer: PHP Commercial |
$2,242.61
|
| Rate for Payer: Priority Health SBD |
$1,662.17
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EA ADD
|
Facility
|
OP
|
$929.72
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$296.28 |
| Max. Negotiated Rate |
$836.75 |
| Rate for Payer: Aetna Commercial |
$790.26
|
| Rate for Payer: Aetna Medicare |
$464.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$604.32
|
| Rate for Payer: BCBS Complete |
$371.89
|
| Rate for Payer: BCBS Trust/PPO |
$296.28
|
| Rate for Payer: BCN Commercial |
$296.28
|
| Rate for Payer: Cash Price |
$743.78
|
| Rate for Payer: Cash Price |
$743.78
|
| Rate for Payer: Cofinity Advantage |
$650.80
|
| Rate for Payer: Cofinity Commercial |
$799.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$743.78
|
| Rate for Payer: Healthscope Commercial |
$836.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$743.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$790.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$697.29
|
| Rate for Payer: PHP Commercial |
$790.26
|
| Rate for Payer: Priority Health SBD |
$585.72
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EA ADD
|
Facility
|
IP
|
$929.72
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$585.72 |
| Max. Negotiated Rate |
$836.75 |
| Rate for Payer: Aetna Commercial |
$790.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$604.32
|
| Rate for Payer: Cash Price |
$743.78
|
| Rate for Payer: Cofinity Advantage |
$650.80
|
| Rate for Payer: Cofinity Commercial |
$799.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$743.78
|
| Rate for Payer: Healthscope Commercial |
$836.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$790.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$697.29
|
| Rate for Payer: PHP Commercial |
$790.26
|
| Rate for Payer: Priority Health SBD |
$585.72
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL
|
Facility
|
IP
|
$1,394.58
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$878.59 |
| Max. Negotiated Rate |
$1,255.12 |
| Rate for Payer: Aetna Commercial |
$1,185.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$906.48
|
| Rate for Payer: Cash Price |
$1,115.66
|
| Rate for Payer: Cofinity Advantage |
$976.21
|
| Rate for Payer: Cofinity Commercial |
$1,199.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,115.66
|
| Rate for Payer: Healthscope Commercial |
$1,255.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,185.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,045.93
|
| Rate for Payer: PHP Commercial |
$1,185.39
|
| Rate for Payer: Priority Health SBD |
$878.59
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL
|
Facility
|
OP
|
$1,394.58
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$296.28 |
| Max. Negotiated Rate |
$1,255.12 |
| Rate for Payer: Aetna Commercial |
$1,185.39
|
| Rate for Payer: Aetna Medicare |
$697.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$906.48
|
| Rate for Payer: BCBS Complete |
$557.83
|
| Rate for Payer: BCBS Trust/PPO |
$296.28
|
| Rate for Payer: BCN Commercial |
$296.28
|
| Rate for Payer: Cash Price |
$1,115.66
|
| Rate for Payer: Cash Price |
$1,115.66
|
| Rate for Payer: Cofinity Advantage |
$976.21
|
| Rate for Payer: Cofinity Commercial |
$1,199.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,115.66
|
| Rate for Payer: Healthscope Commercial |
$1,255.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,115.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,185.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,045.93
|
| Rate for Payer: PHP Commercial |
$1,185.39
|
| Rate for Payer: Priority Health SBD |
$878.59
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL
|
Facility
|
OP
|
$991.57
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$230.35 |
| Max. Negotiated Rate |
$892.41 |
| Rate for Payer: Aetna Commercial |
$842.83
|
| Rate for Payer: Aetna Medicare |
$495.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.52
|
| Rate for Payer: BCBS Complete |
$396.63
|
| Rate for Payer: BCBS Trust/PPO |
$230.35
|
| Rate for Payer: BCN Commercial |
$230.35
|
| Rate for Payer: Cash Price |
$793.26
|
| Rate for Payer: Cash Price |
$793.26
|
| Rate for Payer: Cofinity Advantage |
$694.10
|
| Rate for Payer: Cofinity Commercial |
$852.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.26
|
| Rate for Payer: Healthscope Commercial |
$892.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$793.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$743.68
|
| Rate for Payer: PHP Commercial |
$842.83
|
| Rate for Payer: Priority Health SBD |
$624.69
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL
|
Facility
|
IP
|
$991.57
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$624.69 |
| Max. Negotiated Rate |
$892.41 |
| Rate for Payer: Aetna Commercial |
$842.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.52
|
| Rate for Payer: Cash Price |
$793.26
|
| Rate for Payer: Cofinity Advantage |
$694.10
|
| Rate for Payer: Cofinity Commercial |
$852.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.26
|
| Rate for Payer: Healthscope Commercial |
$892.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$743.68
|
| Rate for Payer: PHP Commercial |
$842.83
|
| Rate for Payer: Priority Health SBD |
$624.69
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL
|
Facility
|
OP
|
$1,487.35
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$230.35 |
| Max. Negotiated Rate |
$1,338.62 |
| Rate for Payer: Aetna Commercial |
$1,264.25
|
| Rate for Payer: Aetna Medicare |
$743.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$966.78
|
| Rate for Payer: BCBS Complete |
$594.94
|
| Rate for Payer: BCBS Trust/PPO |
$230.35
|
| Rate for Payer: BCN Commercial |
$230.35
|
| Rate for Payer: Cash Price |
$1,189.88
|
| Rate for Payer: Cash Price |
$1,189.88
|
| Rate for Payer: Cofinity Advantage |
$1,041.14
|
| Rate for Payer: Cofinity Commercial |
$1,279.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,189.88
|
| Rate for Payer: Healthscope Commercial |
$1,338.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,189.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,115.51
|
| Rate for Payer: PHP Commercial |
$1,264.25
|
| Rate for Payer: Priority Health SBD |
$937.03
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL
|
Facility
|
IP
|
$1,487.35
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$937.03 |
| Max. Negotiated Rate |
$1,338.62 |
| Rate for Payer: Aetna Commercial |
$1,264.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$966.78
|
| Rate for Payer: Cash Price |
$1,189.88
|
| Rate for Payer: Cofinity Advantage |
$1,041.14
|
| Rate for Payer: Cofinity Commercial |
$1,279.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,189.88
|
| Rate for Payer: Healthscope Commercial |
$1,338.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,115.51
|
| Rate for Payer: PHP Commercial |
$1,264.25
|
| Rate for Payer: Priority Health SBD |
$937.03
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR SINGLE LEVEL
|
Facility
|
IP
|
$1,567.72
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$987.66 |
| Max. Negotiated Rate |
$1,410.95 |
| Rate for Payer: Aetna Commercial |
$1,332.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,019.02
|
| Rate for Payer: Cash Price |
$1,254.18
|
| Rate for Payer: Cofinity Advantage |
$1,097.40
|
| Rate for Payer: Cofinity Commercial |
$1,348.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,254.18
|
| Rate for Payer: Healthscope Commercial |
$1,410.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,332.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,175.79
|
| Rate for Payer: PHP Commercial |
$1,332.56
|
| Rate for Payer: Priority Health SBD |
$987.66
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR SINGLE LEVEL
|
Facility
|
OP
|
$1,567.72
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna Commercial |
$1,332.56
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,019.02
|
| 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 |
$613.23
|
| Rate for Payer: BCN Commercial |
$613.23
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$1,254.18
|
| Rate for Payer: Cash Price |
$1,254.18
|
| Rate for Payer: Cash Price |
$1,254.18
|
| Rate for Payer: Cofinity Advantage |
$1,097.40
|
| Rate for Payer: Cofinity Commercial |
$1,348.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,254.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,410.95
|
| 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 |
$1,332.56
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,175.79
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$1,332.56
|
| 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 |
$987.66
|
| 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 INJECTION TRANSFORAMIN LUMB OR SAC SINGLE LEVEL BIL
|
Facility
|
OP
|
$1,208.96
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna Commercial |
$1,027.62
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$785.82
|
| 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 |
$613.23
|
| Rate for Payer: BCN Commercial |
$613.23
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$967.17
|
| Rate for Payer: Cash Price |
$967.17
|
| Rate for Payer: Cash Price |
$967.17
|
| Rate for Payer: Cofinity Advantage |
$846.27
|
| Rate for Payer: Cofinity Commercial |
$1,039.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$967.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,088.06
|
| 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 |
$1,027.62
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$906.72
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$1,027.62
|
| 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 |
$761.64
|
| 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 INJECTION TRANSFORAMIN LUMB OR SAC SINGLE LEVEL BIL
|
Facility
|
IP
|
$1,208.96
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$761.64 |
| Max. Negotiated Rate |
$1,088.06 |
| Rate for Payer: Aetna Commercial |
$1,027.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$785.82
|
| Rate for Payer: Cash Price |
$967.17
|
| Rate for Payer: Cofinity Advantage |
$846.27
|
| Rate for Payer: Cofinity Commercial |
$1,039.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$967.17
|
| Rate for Payer: Healthscope Commercial |
$1,088.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,027.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$906.72
|
| Rate for Payer: PHP Commercial |
$1,027.62
|
| Rate for Payer: Priority Health SBD |
$761.64
|
|
|
HC INJECTION TURBINATE THERAPEUTIC
|
Facility
|
IP
|
$1,404.54
|
|
|
Service Code
|
CPT 30200
|
| Hospital Charge Code |
76100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$884.86 |
| Max. Negotiated Rate |
$1,264.09 |
| Rate for Payer: Aetna Commercial |
$1,193.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$912.95
|
| Rate for Payer: Cash Price |
$1,123.63
|
| Rate for Payer: Cofinity Advantage |
$983.18
|
| Rate for Payer: Cofinity Commercial |
$1,207.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.63
|
| Rate for Payer: Healthscope Commercial |
$1,264.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,193.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,053.40
|
| Rate for Payer: PHP Commercial |
$1,193.86
|
| Rate for Payer: Priority Health SBD |
$884.86
|
|
|
HC INJECTION TURBINATE THERAPEUTIC
|
Facility
|
OP
|
$1,404.54
|
|
|
Service Code
|
CPT 30200
|
| Hospital Charge Code |
76100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.29 |
| Max. Negotiated Rate |
$1,737.88 |
| Rate for Payer: Aetna Commercial |
$1,193.86
|
| Rate for Payer: Aetna Medicare |
$558.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$912.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.74
|
| Rate for Payer: BCBS Complete |
$295.13
|
| Rate for Payer: BCBS MAPPO |
$537.39
|
| Rate for Payer: BCBS Trust/PPO |
$80.29
|
| Rate for Payer: BCN Commercial |
$80.29
|
| Rate for Payer: BCN Medicare Advantage |
$537.39
|
| Rate for Payer: Cash Price |
$1,123.63
|
| Rate for Payer: Cash Price |
$1,123.63
|
| Rate for Payer: Cash Price |
$1,123.63
|
| Rate for Payer: Cofinity Advantage |
$983.18
|
| Rate for Payer: Cofinity Commercial |
$1,207.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.39
|
| Rate for Payer: Healthscope Commercial |
$1,264.09
|
| Rate for Payer: Mclaren Medicaid |
$281.05
|
| Rate for Payer: Mclaren Medicare |
$537.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.26
|
| Rate for Payer: Meridian Medicaid |
$564.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,193.86
|
| Rate for Payer: Nomi Health Commercial |
$1,612.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,053.40
|
| Rate for Payer: PACE Medicare |
$510.52
|
| Rate for Payer: PACE SWMI |
$537.39
|
| Rate for Payer: PHP Commercial |
$1,193.86
|
| Rate for Payer: PHP Medicare Advantage |
$537.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,737.88
|
| Rate for Payer: Priority Health Medicare |
$537.39
|
| Rate for Payer: Priority Health SBD |
$884.86
|
| Rate for Payer: Priority Health Tiered Network |
$1,390.30
|
| Rate for Payer: Railroad Medicare Medicare |
$537.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$912.95
|
| Rate for Payer: UHC Core |
$731.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$537.39
|
| Rate for Payer: UHC Exchange |
$551.98
|
| Rate for Payer: UHC Medicaid |
$281.05
|
| Rate for Payer: UHCCP Medicaid |
$281.05
|
| Rate for Payer: VA VA |
$537.39
|
|
|
HC INJECTION VENOGRAM
|
Facility
|
OP
|
$595.32
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
36100095
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$238.13 |
| Max. Negotiated Rate |
$1,399.00 |
| Rate for Payer: Aetna Commercial |
$506.02
|
| Rate for Payer: Aetna Medicare |
$297.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.96
|
| Rate for Payer: BCBS Complete |
$238.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,399.00
|
| Rate for Payer: BCN Commercial |
$1,399.00
|
| Rate for Payer: Cash Price |
$476.26
|
| Rate for Payer: Cash Price |
$476.26
|
| Rate for Payer: Cofinity Advantage |
$416.72
|
| Rate for Payer: Cofinity Commercial |
$511.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.26
|
| Rate for Payer: Healthscope Commercial |
$535.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$476.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.49
|
| Rate for Payer: PHP Commercial |
$506.02
|
| Rate for Payer: Priority Health SBD |
$375.05
|
|
|
HC INJECTION VENOGRAM
|
Facility
|
IP
|
$595.32
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
36100095
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$375.05 |
| Max. Negotiated Rate |
$535.79 |
| Rate for Payer: Aetna Commercial |
$506.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.96
|
| Rate for Payer: Cash Price |
$476.26
|
| Rate for Payer: Cofinity Advantage |
$416.72
|
| Rate for Payer: Cofinity Commercial |
$511.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.26
|
| Rate for Payer: Healthscope Commercial |
$535.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.49
|
| Rate for Payer: PHP Commercial |
$506.02
|
| Rate for Payer: Priority Health SBD |
$375.05
|
|
|
HC INJECTION WRIST ARTHROGRAM
|
Facility
|
IP
|
$1,175.24
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
36100039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$740.40 |
| Max. Negotiated Rate |
$1,057.72 |
| Rate for Payer: Aetna Commercial |
$998.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.91
|
| Rate for Payer: Cash Price |
$940.19
|
| Rate for Payer: Cofinity Advantage |
$822.67
|
| Rate for Payer: Cofinity Commercial |
$1,010.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.19
|
| Rate for Payer: Healthscope Commercial |
$1,057.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$998.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$881.43
|
| Rate for Payer: PHP Commercial |
$998.95
|
| Rate for Payer: Priority Health SBD |
$740.40
|
|
|
HC INJECTION WRIST ARTHROGRAM
|
Facility
|
OP
|
$1,175.24
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
36100039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$215.00 |
| Max. Negotiated Rate |
$1,057.72 |
| Rate for Payer: Aetna Commercial |
$998.95
|
| Rate for Payer: Aetna Medicare |
$587.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.91
|
| Rate for Payer: BCBS Complete |
$470.10
|
| Rate for Payer: BCBS Trust/PPO |
$215.00
|
| Rate for Payer: BCN Commercial |
$215.00
|
| Rate for Payer: Cash Price |
$940.19
|
| Rate for Payer: Cash Price |
$940.19
|
| Rate for Payer: Cofinity Advantage |
$822.67
|
| Rate for Payer: Cofinity Commercial |
$1,010.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.19
|
| Rate for Payer: Healthscope Commercial |
$1,057.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$940.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$998.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$881.43
|
| Rate for Payer: PHP Commercial |
$998.95
|
| Rate for Payer: Priority Health SBD |
$740.40
|
|
