|
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 Commercial |
$0.11
|
| Rate for Payer: Cofinity Commercial |
$0.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.11
|
| 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: PHP Commercial |
$0.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.10
|
| Rate for Payer: Priority Health SBD |
$0.10
|
|
|
HC INJECTION, TESTOSTERONE CYPIONATE, 1 MG
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
CPT J1071
|
| Hospital Charge Code |
63600109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Aetna Medicare |
$0.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.10
|
| Rate for Payer: BCBS Complete |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cofinity Commercial |
$0.11
|
| Rate for Payer: Cofinity Commercial |
$0.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.11
|
| 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: PHP Commercial |
$0.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.10
|
| Rate for Payer: Priority Health SBD |
$0.10
|
|
|
HC INJECTION THERAPEUTIC SINUS TRACT
|
Facility
|
OP
|
$923.66
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
36100020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$41.70 |
| Max. Negotiated Rate |
$4,561.52 |
| Rate for Payer: Aetna Commercial |
$785.11
|
| Rate for Payer: Aetna Medicare |
$1,509.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$600.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,814.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,814.16
|
| Rate for Payer: BCBS Complete |
$816.81
|
| Rate for Payer: BCBS MAPPO |
$1,451.33
|
| Rate for Payer: BCBS Trust/PPO |
$41.70
|
| Rate for Payer: BCN Commercial |
$41.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.33
|
| Rate for Payer: Cash Price |
$738.93
|
| Rate for Payer: Cash Price |
$738.93
|
| Rate for Payer: Cash Price |
$738.93
|
| Rate for Payer: Cofinity Commercial |
$646.56
|
| Rate for Payer: Cofinity Commercial |
$794.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$646.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$738.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.33
|
| Rate for Payer: Healthscope Commercial |
$831.29
|
| Rate for Payer: Mclaren Medicaid |
$777.91
|
| Rate for Payer: Mclaren Medicare |
$1,451.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,523.90
|
| Rate for Payer: Meridian Medicaid |
$816.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,669.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.11
|
| Rate for Payer: Nomi Health Commercial |
$3,047.79
|
| Rate for Payer: PACE Medicare |
$1,378.76
|
| Rate for Payer: PACE SWMI |
$1,451.33
|
| Rate for Payer: PHP Commercial |
$785.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$777.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,561.52
|
| Rate for Payer: Priority Health Medicare |
$1,451.33
|
| Rate for Payer: Priority Health Narrow Network |
$3,649.22
|
| Rate for Payer: Priority Health SBD |
$581.91
|
| Rate for Payer: Railroad Medicare Medicare |
$1,451.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.79
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,451.33
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,451.33
|
| Rate for Payer: UHCCP Medicaid |
$817.10
|
| Rate for Payer: VA VA |
$1,451.33
|
|
|
HC INJECTION THERAPEUTIC SINUS TRACT
|
Facility
|
IP
|
$923.66
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
36100020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$581.91 |
| Max. Negotiated Rate |
$831.29 |
| Rate for Payer: Aetna Commercial |
$785.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$600.38
|
| Rate for Payer: Cash Price |
$738.93
|
| Rate for Payer: Cofinity Commercial |
$646.56
|
| Rate for Payer: Cofinity Commercial |
$794.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$646.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$738.93
|
| Rate for Payer: Healthscope Commercial |
$831.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.11
|
| Rate for Payer: PHP Commercial |
$785.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.38
|
| Rate for Payer: Priority Health SBD |
$581.91
|
|
|
HC INJECTION TRANSFORAMINAL CERVICAL OR THORACIC
|
Facility
|
IP
|
$1,724.42
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,086.38 |
| Max. Negotiated Rate |
$1,551.98 |
| Rate for Payer: Aetna Commercial |
$1,465.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,120.87
|
| Rate for Payer: Cash Price |
$1,379.54
|
| Rate for Payer: Cofinity Commercial |
$1,207.09
|
| Rate for Payer: Cofinity Commercial |
$1,483.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,207.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,379.54
|
| Rate for Payer: Healthscope Commercial |
$1,551.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,465.76
|
| Rate for Payer: PHP Commercial |
$1,465.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,120.87
|
| Rate for Payer: Priority Health SBD |
$1,086.38
|
|
|
HC INJECTION TRANSFORAMINAL CERVICAL OR THORACIC
|
Facility
|
OP
|
$1,724.42
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.96 |
| Max. Negotiated Rate |
$2,741.59 |
| Rate for Payer: Aetna Commercial |
$1,465.76
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,120.87
|
| 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 |
$525.97
|
| Rate for Payer: BCN Commercial |
$525.97
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$1,379.54
|
| Rate for Payer: Cash Price |
$1,379.54
|
| Rate for Payer: Cash Price |
$1,379.54
|
| Rate for Payer: Cofinity Commercial |
$1,207.09
|
| Rate for Payer: Cofinity Commercial |
$1,483.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,207.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,379.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,551.98
|
| 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 |
$1,465.76
|
| 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 |
$1,465.76
|
| 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 |
$1,120.87
|
| 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 |
$1,086.38
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.96
|
| 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 INJECTION TRANSFORAMIN CERVICAL OR THORACIC BIL
|
Facility
|
OP
|
$2,586.63
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100623
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.96 |
| Max. Negotiated Rate |
$2,741.59 |
| Rate for Payer: Aetna Commercial |
$2,198.64
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,681.31
|
| 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 |
$525.97
|
| Rate for Payer: BCN Commercial |
$525.97
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$2,069.30
|
| Rate for Payer: Cash Price |
$2,069.30
|
| Rate for Payer: Cash Price |
$2,069.30
|
| Rate for Payer: Cofinity Commercial |
$1,810.64
|
| Rate for Payer: Cofinity Commercial |
$2,224.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,810.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,069.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$2,327.97
|
| 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 |
$2,198.64
|
| 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 |
$2,198.64
|
| 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 |
$1,681.31
|
| 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 |
$1,629.58
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.96
|
| 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 INJECTION TRANSFORAMIN CERVICAL OR THORACIC BIL
|
Facility
|
IP
|
$2,586.63
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100623
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,629.58 |
| Max. Negotiated Rate |
$2,327.97 |
| Rate for Payer: Aetna Commercial |
$2,198.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,681.31
|
| Rate for Payer: Cash Price |
$2,069.30
|
| Rate for Payer: Cofinity Commercial |
$1,810.64
|
| Rate for Payer: Cofinity Commercial |
$2,224.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,810.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,069.30
|
| Rate for Payer: Healthscope Commercial |
$2,327.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,198.64
|
| Rate for Payer: PHP Commercial |
$2,198.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,681.31
|
| Rate for Payer: Priority Health SBD |
$1,629.58
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EA ADD
|
Facility
|
OP
|
$911.49
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.27 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$774.77
|
| Rate for Payer: Aetna Medicare |
$455.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.47
|
| Rate for Payer: BCBS Complete |
$364.60
|
| Rate for Payer: BCBS Trust/PPO |
$231.31
|
| Rate for Payer: BCN Commercial |
$231.31
|
| Rate for Payer: Cash Price |
$729.19
|
| Rate for Payer: Cash Price |
$729.19
|
| Rate for Payer: Cash Price |
$729.19
|
| Rate for Payer: Cofinity Commercial |
$638.04
|
| Rate for Payer: Cofinity Commercial |
$783.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$638.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.19
|
| Rate for Payer: Healthscope Commercial |
$820.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.77
|
| Rate for Payer: PHP Commercial |
$774.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.47
|
| Rate for Payer: Priority Health SBD |
$574.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.27
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EA ADD
|
Facility
|
IP
|
$911.49
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$574.24 |
| Max. Negotiated Rate |
$820.34 |
| Rate for Payer: Aetna Commercial |
$774.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.47
|
| Rate for Payer: Cash Price |
$729.19
|
| Rate for Payer: Cofinity Commercial |
$638.04
|
| Rate for Payer: Cofinity Commercial |
$783.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$638.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.19
|
| Rate for Payer: Healthscope Commercial |
$820.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.77
|
| Rate for Payer: PHP Commercial |
$774.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.47
|
| Rate for Payer: Priority Health SBD |
$574.24
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL
|
Facility
|
IP
|
$1,367.24
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$861.36 |
| Max. Negotiated Rate |
$1,230.52 |
| Rate for Payer: Aetna Commercial |
$1,162.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.71
|
| Rate for Payer: Cash Price |
$1,093.79
|
| Rate for Payer: Cofinity Commercial |
$1,175.83
|
| Rate for Payer: Cofinity Commercial |
$957.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$957.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,093.79
|
| Rate for Payer: Healthscope Commercial |
$1,230.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,162.15
|
| Rate for Payer: PHP Commercial |
$1,162.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$888.71
|
| Rate for Payer: Priority Health SBD |
$861.36
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL
|
Facility
|
OP
|
$1,367.24
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.27 |
| Max. Negotiated Rate |
$1,230.52 |
| Rate for Payer: Aetna Commercial |
$1,162.15
|
| Rate for Payer: Aetna Medicare |
$683.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.71
|
| Rate for Payer: BCBS Complete |
$546.90
|
| Rate for Payer: BCBS Trust/PPO |
$231.31
|
| Rate for Payer: BCN Commercial |
$231.31
|
| Rate for Payer: Cash Price |
$1,093.79
|
| Rate for Payer: Cash Price |
$1,093.79
|
| Rate for Payer: Cash Price |
$1,093.79
|
| Rate for Payer: Cofinity Commercial |
$1,175.83
|
| Rate for Payer: Cofinity Commercial |
$957.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$957.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,093.79
|
| Rate for Payer: Healthscope Commercial |
$1,230.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,162.15
|
| Rate for Payer: PHP Commercial |
$1,162.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$888.71
|
| Rate for Payer: Priority Health SBD |
$861.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.27
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL
|
Facility
|
IP
|
$972.13
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$612.44 |
| Max. Negotiated Rate |
$874.92 |
| Rate for Payer: Aetna Commercial |
$826.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.88
|
| Rate for Payer: Cash Price |
$777.70
|
| Rate for Payer: Cofinity Commercial |
$680.49
|
| Rate for Payer: Cofinity Commercial |
$836.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$680.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.70
|
| Rate for Payer: Healthscope Commercial |
$874.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$826.31
|
| Rate for Payer: PHP Commercial |
$826.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.88
|
| Rate for Payer: Priority Health SBD |
$612.44
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL
|
Facility
|
OP
|
$972.13
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$54.35 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$826.31
|
| Rate for Payer: Aetna Medicare |
$486.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.88
|
| Rate for Payer: BCBS Complete |
$388.85
|
| Rate for Payer: BCBS Trust/PPO |
$179.84
|
| Rate for Payer: BCN Commercial |
$179.84
|
| Rate for Payer: Cash Price |
$777.70
|
| Rate for Payer: Cash Price |
$777.70
|
| Rate for Payer: Cash Price |
$777.70
|
| Rate for Payer: Cofinity Commercial |
$680.49
|
| Rate for Payer: Cofinity Commercial |
$836.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$680.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.70
|
| Rate for Payer: Healthscope Commercial |
$874.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$826.31
|
| Rate for Payer: PHP Commercial |
$826.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.88
|
| Rate for Payer: Priority Health SBD |
$612.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.35
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL
|
Facility
|
OP
|
$1,458.19
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$54.35 |
| Max. Negotiated Rate |
$1,312.37 |
| Rate for Payer: Aetna Commercial |
$1,239.46
|
| Rate for Payer: Aetna Medicare |
$729.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$947.82
|
| Rate for Payer: BCBS Complete |
$583.28
|
| Rate for Payer: BCBS Trust/PPO |
$179.84
|
| Rate for Payer: BCN Commercial |
$179.84
|
| Rate for Payer: Cash Price |
$1,166.55
|
| Rate for Payer: Cash Price |
$1,166.55
|
| Rate for Payer: Cash Price |
$1,166.55
|
| Rate for Payer: Cofinity Commercial |
$1,020.73
|
| Rate for Payer: Cofinity Commercial |
$1,254.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,020.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.55
|
| Rate for Payer: Healthscope Commercial |
$1,312.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.46
|
| Rate for Payer: PHP Commercial |
$1,239.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.82
|
| Rate for Payer: Priority Health SBD |
$918.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.35
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL
|
Facility
|
IP
|
$1,458.19
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.66 |
| Max. Negotiated Rate |
$1,312.37 |
| Rate for Payer: Aetna Commercial |
$1,239.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$947.82
|
| Rate for Payer: Cash Price |
$1,166.55
|
| Rate for Payer: Cofinity Commercial |
$1,020.73
|
| Rate for Payer: Cofinity Commercial |
$1,254.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,020.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.55
|
| Rate for Payer: Healthscope Commercial |
$1,312.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.46
|
| Rate for Payer: PHP Commercial |
$1,239.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.82
|
| Rate for Payer: Priority Health SBD |
$918.66
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR SINGLE LEVEL
|
Facility
|
OP
|
$1,536.98
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.73 |
| Max. Negotiated Rate |
$2,741.59 |
| Rate for Payer: Aetna Commercial |
$1,306.43
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.04
|
| 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 |
$478.76
|
| Rate for Payer: BCN Commercial |
$478.76
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$1,229.58
|
| Rate for Payer: Cash Price |
$1,229.58
|
| Rate for Payer: Cash Price |
$1,229.58
|
| Rate for Payer: Cofinity Commercial |
$1,075.89
|
| Rate for Payer: Cofinity Commercial |
$1,321.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,075.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,383.28
|
| 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 |
$1,306.43
|
| 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 |
$1,306.43
|
| 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 |
$999.04
|
| 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 |
$968.30
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.73
|
| 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 INJECTION TRANSFORAMIN LUMB OR SACR SINGLE LEVEL
|
Facility
|
IP
|
$1,536.98
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$968.30 |
| Max. Negotiated Rate |
$1,383.28 |
| Rate for Payer: Aetna Commercial |
$1,306.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.04
|
| Rate for Payer: Cash Price |
$1,229.58
|
| Rate for Payer: Cofinity Commercial |
$1,075.89
|
| Rate for Payer: Cofinity Commercial |
$1,321.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,075.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.58
|
| Rate for Payer: Healthscope Commercial |
$1,383.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,306.43
|
| Rate for Payer: PHP Commercial |
$1,306.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$999.04
|
| Rate for Payer: Priority Health SBD |
$968.30
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SAC SINGLE LEVEL BIL
|
Facility
|
IP
|
$1,185.25
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$746.71 |
| Max. Negotiated Rate |
$1,066.72 |
| Rate for Payer: Aetna Commercial |
$1,007.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$770.41
|
| Rate for Payer: Cash Price |
$948.20
|
| Rate for Payer: Cofinity Commercial |
$1,019.32
|
| Rate for Payer: Cofinity Commercial |
$829.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$829.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.20
|
| Rate for Payer: Healthscope Commercial |
$1,066.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.46
|
| Rate for Payer: PHP Commercial |
$1,007.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.41
|
| Rate for Payer: Priority Health SBD |
$746.71
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SAC SINGLE LEVEL BIL
|
Facility
|
OP
|
$1,185.25
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.73 |
| Max. Negotiated Rate |
$2,741.59 |
| Rate for Payer: Aetna Commercial |
$1,007.46
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$770.41
|
| 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 |
$478.76
|
| Rate for Payer: BCN Commercial |
$478.76
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$948.20
|
| Rate for Payer: Cash Price |
$948.20
|
| Rate for Payer: Cash Price |
$948.20
|
| Rate for Payer: Cofinity Commercial |
$1,019.32
|
| Rate for Payer: Cofinity Commercial |
$829.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$829.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,066.72
|
| 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 |
$1,007.46
|
| 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 |
$1,007.46
|
| 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 |
$770.41
|
| 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 |
$746.71
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.73
|
| 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 INJECTION TURBINATE THERAPEUTIC
|
Facility
|
IP
|
$1,377.00
|
|
|
Service Code
|
CPT 30200
|
| Hospital Charge Code |
76100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$867.51 |
| Max. Negotiated Rate |
$1,239.30 |
| Rate for Payer: Aetna Commercial |
$1,170.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$895.05
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cofinity Commercial |
$1,184.22
|
| Rate for Payer: Cofinity Commercial |
$963.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$963.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.60
|
| Rate for Payer: Healthscope Commercial |
$1,239.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.45
|
| Rate for Payer: PHP Commercial |
$1,170.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.05
|
| Rate for Payer: Priority Health SBD |
$867.51
|
|
|
HC INJECTION TURBINATE THERAPEUTIC
|
Facility
|
OP
|
$1,377.00
|
|
|
Service Code
|
CPT 30200
|
| Hospital Charge Code |
76100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.60 |
| Max. Negotiated Rate |
$1,568.21 |
| Rate for Payer: Aetna Commercial |
$1,170.45
|
| Rate for Payer: Aetna Medicare |
$518.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$895.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.69
|
| Rate for Payer: BCBS Complete |
$280.81
|
| Rate for Payer: BCBS MAPPO |
$498.95
|
| Rate for Payer: BCBS Trust/PPO |
$62.68
|
| Rate for Payer: BCN Commercial |
$62.68
|
| Rate for Payer: BCN Medicare Advantage |
$498.95
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cofinity Commercial |
$963.90
|
| Rate for Payer: Cofinity Commercial |
$1,184.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$963.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.95
|
| Rate for Payer: Healthscope Commercial |
$1,239.30
|
| Rate for Payer: Mclaren Medicaid |
$267.44
|
| Rate for Payer: Mclaren Medicare |
$498.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.90
|
| Rate for Payer: Meridian Medicaid |
$280.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.45
|
| Rate for Payer: Nomi Health Commercial |
$1,047.80
|
| Rate for Payer: PACE Medicare |
$474.00
|
| Rate for Payer: PACE SWMI |
$498.95
|
| Rate for Payer: PHP Commercial |
$1,170.45
|
| Rate for Payer: PHP Medicare Advantage |
$498.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,568.21
|
| Rate for Payer: Priority Health Medicare |
$498.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,254.57
|
| Rate for Payer: Priority Health SBD |
$867.51
|
| Rate for Payer: Railroad Medicare Medicare |
$498.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.60
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.95
|
| Rate for Payer: UHC Medicare Advantage |
$498.95
|
| Rate for Payer: UHCCP Medicaid |
$280.91
|
| Rate for Payer: VA VA |
$498.95
|
|
|
HC INJECTION VENOGRAM
|
Facility
|
OP
|
$566.97
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
36100095
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$1,092.22 |
| Rate for Payer: Aetna Commercial |
$481.92
|
| Rate for Payer: Aetna Medicare |
$283.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$368.53
|
| Rate for Payer: BCBS Complete |
$226.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,092.22
|
| Rate for Payer: BCN Commercial |
$1,092.22
|
| Rate for Payer: Cash Price |
$453.58
|
| Rate for Payer: Cash Price |
$453.58
|
| Rate for Payer: Cash Price |
$453.58
|
| Rate for Payer: Cofinity Commercial |
$396.88
|
| Rate for Payer: Cofinity Commercial |
$487.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$396.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.58
|
| Rate for Payer: Healthscope Commercial |
$510.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.92
|
| Rate for Payer: PHP Commercial |
$481.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.53
|
| Rate for Payer: Priority Health SBD |
$357.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.16
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION VENOGRAM
|
Facility
|
IP
|
$566.97
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
36100095
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$357.19 |
| Max. Negotiated Rate |
$510.27 |
| Rate for Payer: Aetna Commercial |
$481.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$368.53
|
| Rate for Payer: Cash Price |
$453.58
|
| Rate for Payer: Cofinity Commercial |
$396.88
|
| Rate for Payer: Cofinity Commercial |
$487.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$396.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.58
|
| Rate for Payer: Healthscope Commercial |
$510.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.92
|
| Rate for Payer: PHP Commercial |
$481.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.53
|
| Rate for Payer: Priority Health SBD |
$357.19
|
|
|
HC INJECTION WRIST ARTHROGRAM
|
Facility
|
OP
|
$1,152.20
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
36100039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$76.94 |
| Max. Negotiated Rate |
$1,036.98 |
| Rate for Payer: Aetna Commercial |
$979.37
|
| Rate for Payer: Aetna Medicare |
$576.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$748.93
|
| Rate for Payer: BCBS Complete |
$460.88
|
| Rate for Payer: BCBS Trust/PPO |
$167.86
|
| Rate for Payer: BCN Commercial |
$167.86
|
| Rate for Payer: Cash Price |
$921.76
|
| Rate for Payer: Cash Price |
$921.76
|
| Rate for Payer: Cash Price |
$921.76
|
| Rate for Payer: Cofinity Commercial |
$806.54
|
| Rate for Payer: Cofinity Commercial |
$990.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$806.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$921.76
|
| Rate for Payer: Healthscope Commercial |
$1,036.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$979.37
|
| Rate for Payer: PHP Commercial |
$979.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$748.93
|
| Rate for Payer: Priority Health SBD |
$725.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.94
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
