|
HC INJ ANES FEMORAL CONT
|
Facility
|
OP
|
$1,855.22
|
|
|
Service Code
|
CPT 64448
|
| Hospital Charge Code |
36100395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$76.59 |
| Max. Negotiated Rate |
$2,741.59 |
| Rate for Payer: Aetna Commercial |
$1,576.94
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,205.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$508.24
|
| Rate for Payer: BCN Commercial |
$508.24
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$1,484.18
|
| Rate for Payer: Cash Price |
$1,484.18
|
| Rate for Payer: Cash Price |
$1,484.18
|
| Rate for Payer: Cofinity Commercial |
$1,298.65
|
| Rate for Payer: Cofinity Commercial |
$1,595.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,298.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,484.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,669.70
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,576.94
|
| Rate for Payer: Nomi Health Commercial |
$1,831.81
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$1,576.94
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,741.59
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,193.27
|
| Rate for Payer: Priority Health SBD |
$1,168.79
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.59
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$491.10
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJ ANES FEMORAL CONT
|
Facility
|
IP
|
$1,855.22
|
|
|
Service Code
|
CPT 64448
|
| Hospital Charge Code |
36100395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,168.79 |
| Max. Negotiated Rate |
$1,669.70 |
| Rate for Payer: Aetna Commercial |
$1,576.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,205.89
|
| Rate for Payer: Cash Price |
$1,484.18
|
| Rate for Payer: Cofinity Commercial |
$1,298.65
|
| Rate for Payer: Cofinity Commercial |
$1,595.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,298.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,484.18
|
| Rate for Payer: Healthscope Commercial |
$1,669.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,576.94
|
| Rate for Payer: PHP Commercial |
$1,576.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.89
|
| Rate for Payer: Priority Health SBD |
$1,168.79
|
|
|
HC INJ ANES MIDDLE OR LOWER SPINE SYMPATHETIC NERVES
|
Facility
|
IP
|
$1,267.21
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
36100604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$798.34 |
| Max. Negotiated Rate |
$1,140.49 |
| Rate for Payer: Aetna Commercial |
$1,077.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.69
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cofinity Commercial |
$1,089.80
|
| Rate for Payer: Cofinity Commercial |
$887.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$887.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.77
|
| Rate for Payer: Healthscope Commercial |
$1,140.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.13
|
| Rate for Payer: PHP Commercial |
$1,077.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.69
|
| Rate for Payer: Priority Health SBD |
$798.34
|
|
|
HC INJ ANES MIDDLE OR LOWER SPINE SYMPATHETIC NERVES
|
Facility
|
OP
|
$1,267.21
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
36100604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.10 |
| Max. Negotiated Rate |
$2,741.59 |
| Rate for Payer: Aetna Commercial |
$1,077.13
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$460.10
|
| Rate for Payer: BCN Commercial |
$460.10
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cofinity Commercial |
$1,089.80
|
| Rate for Payer: Cofinity Commercial |
$887.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$887.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,140.49
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.13
|
| Rate for Payer: Nomi Health Commercial |
$1,831.81
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$1,077.13
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,741.59
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,193.27
|
| Rate for Payer: Priority Health SBD |
$798.34
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,455.41
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$491.10
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJ ANESTH AND/OR STEROID AXILLARY NERVE
|
Facility
|
OP
|
$1,911.24
|
|
|
Service Code
|
CPT 64417
|
| Hospital Charge Code |
36100599
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$67.77 |
| Max. Negotiated Rate |
$2,741.59 |
| Rate for Payer: Aetna Commercial |
$1,624.55
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,242.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$308.62
|
| Rate for Payer: BCN Commercial |
$308.62
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$1,528.99
|
| Rate for Payer: Cash Price |
$1,528.99
|
| Rate for Payer: Cash Price |
$1,528.99
|
| Rate for Payer: Cofinity Commercial |
$1,337.87
|
| Rate for Payer: Cofinity Commercial |
$1,643.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,337.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,528.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,720.12
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,624.55
|
| Rate for Payer: Nomi Health Commercial |
$1,831.81
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$1,624.55
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,242.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,741.59
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,193.27
|
| Rate for Payer: Priority Health SBD |
$1,204.08
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.77
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$491.10
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJ ANESTH AND/OR STEROID AXILLARY NERVE
|
Facility
|
IP
|
$1,911.24
|
|
|
Service Code
|
CPT 64417
|
| Hospital Charge Code |
36100599
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,204.08 |
| Max. Negotiated Rate |
$1,720.12 |
| Rate for Payer: Aetna Commercial |
$1,624.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,242.31
|
| Rate for Payer: Cash Price |
$1,528.99
|
| Rate for Payer: Cofinity Commercial |
$1,337.87
|
| Rate for Payer: Cofinity Commercial |
$1,643.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,337.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,528.99
|
| Rate for Payer: Healthscope Commercial |
$1,720.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,624.55
|
| Rate for Payer: PHP Commercial |
$1,624.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,242.31
|
| Rate for Payer: Priority Health SBD |
$1,204.08
|
|
|
HC INJ ANESTH AND/OR STEROID BRACHIAL PLEXUS
|
Facility
|
IP
|
$3,172.12
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
37100005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,998.44 |
| Max. Negotiated Rate |
$2,854.91 |
| Rate for Payer: Aetna Commercial |
$2,696.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,061.88
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cofinity Commercial |
$2,220.48
|
| Rate for Payer: Cofinity Commercial |
$2,728.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,220.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,537.70
|
| Rate for Payer: Healthscope Commercial |
$2,854.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,696.30
|
| Rate for Payer: PHP Commercial |
$2,696.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.88
|
| Rate for Payer: Priority Health SBD |
$1,998.44
|
|
|
HC INJ ANESTH AND/OR STEROID BRACHIAL PLEXUS
|
Facility
|
OP
|
$3,172.12
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
37100005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$73.63 |
| Max. Negotiated Rate |
$2,854.91 |
| Rate for Payer: Aetna Commercial |
$2,696.30
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,061.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$360.07
|
| Rate for Payer: BCN Commercial |
$360.07
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cofinity Commercial |
$2,728.02
|
| Rate for Payer: Cofinity Commercial |
$2,220.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,220.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,537.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$2,854.91
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,696.30
|
| Rate for Payer: Nomi Health Commercial |
$1,831.81
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$2,696.30
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,741.59
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,193.27
|
| Rate for Payer: Priority Health SBD |
$1,998.44
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.63
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$491.10
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJ ANESTH AND/OR STEROID SCIATIC NERVE
|
Facility
|
OP
|
$2,549.64
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
37100008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$60.23 |
| Max. Negotiated Rate |
$2,294.68 |
| Rate for Payer: Aetna Commercial |
$2,167.19
|
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,657.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$60.23
|
| Rate for Payer: BCN Commercial |
$60.23
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$2,039.71
|
| Rate for Payer: Cash Price |
$2,039.71
|
| Rate for Payer: Cash Price |
$2,039.71
|
| Rate for Payer: Cofinity Commercial |
$2,192.69
|
| Rate for Payer: Cofinity Commercial |
$1,784.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,784.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,039.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$2,294.68
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,167.19
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$2,167.19
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Priority Health SBD |
$1,606.27
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.00
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$382.01
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC INJ ANESTH AND/OR STEROID SCIATIC NERVE
|
Facility
|
IP
|
$2,549.64
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
37100008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,606.27 |
| Max. Negotiated Rate |
$2,294.68 |
| Rate for Payer: Aetna Commercial |
$2,167.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,657.27
|
| Rate for Payer: Cash Price |
$2,039.71
|
| Rate for Payer: Cofinity Commercial |
$1,784.75
|
| Rate for Payer: Cofinity Commercial |
$2,192.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,784.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,039.71
|
| Rate for Payer: Healthscope Commercial |
$2,294.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,167.19
|
| Rate for Payer: PHP Commercial |
$2,167.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.27
|
| Rate for Payer: Priority Health SBD |
$1,606.27
|
|
|
HC INJ ANESTH AND/OR STEROID SUPRASCAPULAR NERVE
|
Facility
|
OP
|
$975.46
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
36100600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Commercial |
$829.14
|
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$72.49
|
| Rate for Payer: BCN Commercial |
$72.49
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cofinity Commercial |
$682.82
|
| Rate for Payer: Cofinity Commercial |
$838.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$682.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$877.91
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.14
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$829.14
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Priority Health SBD |
$614.54
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.80
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$382.01
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC INJ ANESTH AND/OR STEROID SUPRASCAPULAR NERVE
|
Facility
|
IP
|
$975.46
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
36100600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$614.54 |
| Max. Negotiated Rate |
$877.91 |
| Rate for Payer: Aetna Commercial |
$829.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.05
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cofinity Commercial |
$682.82
|
| Rate for Payer: Cofinity Commercial |
$838.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$682.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.37
|
| Rate for Payer: Healthscope Commercial |
$877.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.14
|
| Rate for Payer: PHP Commercial |
$829.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.05
|
| Rate for Payer: Priority Health SBD |
$614.54
|
|
|
HC INJ ANESTHETIC FEMORAL
|
Facility
|
IP
|
$1,534.27
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
36100391
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$966.59 |
| Max. Negotiated Rate |
$1,380.84 |
| Rate for Payer: Aetna Commercial |
$1,304.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$997.28
|
| Rate for Payer: Cash Price |
$1,227.42
|
| Rate for Payer: Cofinity Commercial |
$1,073.99
|
| Rate for Payer: Cofinity Commercial |
$1,319.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,073.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,227.42
|
| Rate for Payer: Healthscope Commercial |
$1,380.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,304.13
|
| Rate for Payer: PHP Commercial |
$1,304.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.28
|
| Rate for Payer: Priority Health SBD |
$966.59
|
|
|
HC INJ ANESTHETIC FEMORAL
|
Facility
|
OP
|
$1,534.27
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
36100391
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Commercial |
$1,304.13
|
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$997.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$47.96
|
| Rate for Payer: BCN Commercial |
$47.96
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$1,227.42
|
| Rate for Payer: Cash Price |
$1,227.42
|
| Rate for Payer: Cash Price |
$1,227.42
|
| Rate for Payer: Cofinity Commercial |
$1,319.47
|
| Rate for Payer: Cofinity Commercial |
$1,073.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,073.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,227.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$1,380.84
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,304.13
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$1,304.13
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Priority Health SBD |
$966.59
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.69
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$382.01
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC INJ ANESTH PERIPH NERVE
|
Facility
|
OP
|
$890.33
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
36100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.28 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Commercial |
$756.78
|
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$414.76
|
| Rate for Payer: BCN Commercial |
$414.76
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$712.26
|
| Rate for Payer: Cash Price |
$712.26
|
| Rate for Payer: Cash Price |
$712.26
|
| Rate for Payer: Cofinity Commercial |
$765.68
|
| Rate for Payer: Cofinity Commercial |
$623.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$623.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$712.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$801.30
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$756.78
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$756.78
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Priority Health SBD |
$560.91
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.28
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$382.01
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC INJ ANESTH PERIPH NERVE
|
Facility
|
IP
|
$890.33
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
36100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.91 |
| Max. Negotiated Rate |
$801.30 |
| Rate for Payer: Aetna Commercial |
$756.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.71
|
| Rate for Payer: Cash Price |
$712.26
|
| Rate for Payer: Cofinity Commercial |
$623.23
|
| Rate for Payer: Cofinity Commercial |
$765.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$623.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$712.26
|
| Rate for Payer: Healthscope Commercial |
$801.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$756.78
|
| Rate for Payer: PHP Commercial |
$756.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.71
|
| Rate for Payer: Priority Health SBD |
$560.91
|
|
|
HC INJ ANESTH/STEROID BRACHIAL PLEXUS CONT
|
Facility
|
OP
|
$3,172.12
|
|
|
Service Code
|
CPT 64416
|
| Hospital Charge Code |
37100010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$81.99 |
| Max. Negotiated Rate |
$2,854.91 |
| Rate for Payer: Aetna Commercial |
$2,696.30
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,061.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$398.64
|
| Rate for Payer: BCN Commercial |
$398.64
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cofinity Commercial |
$2,728.02
|
| Rate for Payer: Cofinity Commercial |
$2,220.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,220.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,537.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$2,854.91
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,696.30
|
| Rate for Payer: Nomi Health Commercial |
$1,831.81
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$2,696.30
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,741.59
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,193.27
|
| Rate for Payer: Priority Health SBD |
$1,998.44
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.99
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$491.10
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJ ANESTH/STEROID BRACHIAL PLEXUS CONT
|
Facility
|
IP
|
$3,172.12
|
|
|
Service Code
|
CPT 64416
|
| Hospital Charge Code |
37100010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,998.44 |
| Max. Negotiated Rate |
$2,854.91 |
| Rate for Payer: Aetna Commercial |
$2,696.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,061.88
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cofinity Commercial |
$2,220.48
|
| Rate for Payer: Cofinity Commercial |
$2,728.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,220.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,537.70
|
| Rate for Payer: Healthscope Commercial |
$2,854.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,696.30
|
| Rate for Payer: PHP Commercial |
$2,696.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.88
|
| Rate for Payer: Priority Health SBD |
$1,998.44
|
|
|
HC INJ ANESTH/STEROID SCIATIC NERVE CONT
|
Facility
|
OP
|
$3,180.56
|
|
|
Service Code
|
CPT 64446
|
| Hospital Charge Code |
37000020
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$2,862.50 |
| Rate for Payer: Aetna Commercial |
$2,703.48
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,067.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$422.67
|
| Rate for Payer: BCN Commercial |
$422.67
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$2,544.45
|
| Rate for Payer: Cash Price |
$2,544.45
|
| Rate for Payer: Cash Price |
$2,544.45
|
| Rate for Payer: Cofinity Commercial |
$2,735.28
|
| Rate for Payer: Cofinity Commercial |
$2,226.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,226.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,544.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$2,862.50
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,703.48
|
| Rate for Payer: Nomi Health Commercial |
$1,831.81
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$2,703.48
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,067.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,741.59
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,193.27
|
| Rate for Payer: Priority Health SBD |
$2,003.75
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.20
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$491.10
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJ ANESTH/STEROID SCIATIC NERVE CONT
|
Facility
|
IP
|
$3,180.56
|
|
|
Service Code
|
CPT 64446
|
| Hospital Charge Code |
37000020
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2,003.75 |
| Max. Negotiated Rate |
$2,862.50 |
| Rate for Payer: Aetna Commercial |
$2,703.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,067.36
|
| Rate for Payer: Cash Price |
$2,544.45
|
| Rate for Payer: Cofinity Commercial |
$2,226.39
|
| Rate for Payer: Cofinity Commercial |
$2,735.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,226.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,544.45
|
| Rate for Payer: Healthscope Commercial |
$2,862.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,703.48
|
| Rate for Payer: PHP Commercial |
$2,703.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,067.36
|
| Rate for Payer: Priority Health SBD |
$2,003.75
|
|
|
HC INJ ANEST/STEROID ILIOING ILIOHYPOGAST NRV
|
Facility
|
OP
|
$975.46
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
76100270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.31 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Commercial |
$829.14
|
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$414.76
|
| Rate for Payer: BCN Commercial |
$414.76
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cofinity Commercial |
$838.90
|
| Rate for Payer: Cofinity Commercial |
$682.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$682.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$877.91
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.14
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$829.14
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Priority Health SBD |
$614.54
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.31
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$382.01
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC INJ ANEST/STEROID ILIOING ILIOHYPOGAST NRV
|
Facility
|
IP
|
$975.46
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
76100270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$614.54 |
| Max. Negotiated Rate |
$877.91 |
| Rate for Payer: Aetna Commercial |
$829.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.05
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cofinity Commercial |
$682.82
|
| Rate for Payer: Cofinity Commercial |
$838.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$682.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.37
|
| Rate for Payer: Healthscope Commercial |
$877.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.14
|
| Rate for Payer: PHP Commercial |
$829.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.05
|
| Rate for Payer: Priority Health SBD |
$614.54
|
|
|
HC INJ BEBTELOVIMAB
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
77100034
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$305.55 |
| Max. Negotiated Rate |
$436.50 |
| Rate for Payer: Aetna Commercial |
$412.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.25
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$339.50
|
| Rate for Payer: Cofinity Commercial |
$417.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$339.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.00
|
| Rate for Payer: Healthscope Commercial |
$436.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.25
|
| Rate for Payer: PHP Commercial |
$412.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health SBD |
$305.55
|
|
|
HC INJ BEBTELOVIMAB
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
77100034
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$184.07 |
| Max. Negotiated Rate |
$1,030.23 |
| Rate for Payer: Aetna Commercial |
$412.25
|
| Rate for Payer: Aetna Medicare |
$357.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$429.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$429.26
|
| Rate for Payer: BCBS Complete |
$193.27
|
| Rate for Payer: BCBS MAPPO |
$343.41
|
| Rate for Payer: BCN Medicare Advantage |
$343.41
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$339.50
|
| Rate for Payer: Cofinity Commercial |
$417.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$339.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$343.41
|
| Rate for Payer: Healthscope Commercial |
$436.50
|
| Rate for Payer: Mclaren Medicaid |
$184.07
|
| Rate for Payer: Mclaren Medicare |
$343.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$360.58
|
| Rate for Payer: Meridian Medicaid |
$193.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$394.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.25
|
| Rate for Payer: Nomi Health Commercial |
$1,030.23
|
| Rate for Payer: PACE Medicare |
$326.24
|
| Rate for Payer: PACE SWMI |
$343.41
|
| Rate for Payer: PHP Commercial |
$412.25
|
| Rate for Payer: PHP Medicare Advantage |
$343.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$184.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$350.50
|
| Rate for Payer: Priority Health Medicare |
$343.41
|
| Rate for Payer: Priority Health Narrow Network |
$280.40
|
| Rate for Payer: Priority Health SBD |
$305.55
|
| Rate for Payer: Railroad Medicare Medicare |
$343.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$966.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$343.41
|
| Rate for Payer: UHC Medicare Advantage |
$343.41
|
| Rate for Payer: UHCCP Medicaid |
$193.34
|
| Rate for Payer: VA VA |
$343.41
|
|
|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$20.88 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$20.88
|
| Rate for Payer: BCN Commercial |
$20.88
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
|
