|
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: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.13
|
| 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: Lakeland Regional Health Systems Commercial |
$0.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.14
|
| Rate for Payer: PHP Commercial |
$0.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.14
|
| Rate for Payer: UHC Core |
$0.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.12
|
|
|
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 |
$0.04 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Aetna Medicare |
$0.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.05
|
| Rate for Payer: BCBS Complete |
$0.06
|
| Rate for Payer: BCBS MAPPO |
$0.04
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: BCN Medicare Advantage |
$0.04
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cofinity Commercial |
$0.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.04
|
| Rate for Payer: Healthscope Commercial |
$0.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.14
|
| Rate for Payer: PACE Senior Care Partners |
$0.04
|
| Rate for Payer: PACE SWMI |
$0.04
|
| Rate for Payer: PHP Commercial |
$0.14
|
| Rate for Payer: PHP Medicare Advantage |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.14
|
| Rate for Payer: Priority Health Medicare |
$0.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.10
|
| Rate for Payer: Railroad Medicare Medicare |
$0.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.14
|
| Rate for Payer: UHC Core |
$0.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.04
|
| Rate for Payer: UHC Medicare Advantage |
$0.04
|
| Rate for Payer: VA VA |
$0.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.12
|
|
|
HC INJECTION THERAPEUTIC SINUS TRACT
|
Facility
|
IP
|
$905.55
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
36100020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$552.29 |
| Max. Negotiated Rate |
$815.00 |
| Rate for Payer: Aetna Commercial |
$769.72
|
| Rate for Payer: BCBS Trust/PPO |
$699.81
|
| Rate for Payer: BCN Commercial |
$699.81
|
| Rate for Payer: Cash Price |
$724.44
|
| Rate for Payer: Cofinity Commercial |
$778.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.44
|
| Rate for Payer: Healthscope Commercial |
$815.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$679.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$769.72
|
| Rate for Payer: PHP Commercial |
$769.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$787.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$796.88
|
| Rate for Payer: UHC Core |
$756.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$679.16
|
|
|
HC INJECTION THERAPEUTIC SINUS TRACT
|
Facility
|
OP
|
$905.55
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
36100020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$215.07 |
| Max. Negotiated Rate |
$1,050.44 |
| Rate for Payer: Aetna Commercial |
$769.72
|
| Rate for Payer: Aetna Medicare |
$235.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$282.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$282.98
|
| Rate for Payer: BCBS Complete |
$1,050.44
|
| Rate for Payer: BCBS MAPPO |
$226.39
|
| Rate for Payer: BCBS Trust/PPO |
$704.07
|
| Rate for Payer: BCN Commercial |
$704.07
|
| Rate for Payer: BCN Medicare Advantage |
$226.39
|
| Rate for Payer: Cash Price |
$724.44
|
| Rate for Payer: Cash Price |
$724.44
|
| Rate for Payer: Cofinity Commercial |
$778.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.39
|
| Rate for Payer: Healthscope Commercial |
$815.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$679.16
|
| Rate for Payer: Mclaren Medicaid |
$1,000.42
|
| Rate for Payer: Meridian Medicaid |
$1,050.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$237.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$769.72
|
| Rate for Payer: PACE Senior Care Partners |
$215.07
|
| Rate for Payer: PACE SWMI |
$226.39
|
| Rate for Payer: PHP Commercial |
$769.72
|
| Rate for Payer: PHP Medicare Advantage |
$226.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,000.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$787.83
|
| Rate for Payer: Priority Health Medicare |
$226.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.29
|
| Rate for Payer: Railroad Medicare Medicare |
$226.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$796.88
|
| Rate for Payer: UHC Core |
$756.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$226.39
|
| Rate for Payer: UHC Medicare Advantage |
$233.18
|
| Rate for Payer: VA VA |
$226.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$679.16
|
|
|
HC INJECTION TRANSFORAMINAL CERVICAL OR THORACIC
|
Facility
|
IP
|
$1,690.61
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,031.10 |
| Max. Negotiated Rate |
$1,521.55 |
| Rate for Payer: Aetna Commercial |
$1,437.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,306.50
|
| Rate for Payer: BCN Commercial |
$1,306.50
|
| Rate for Payer: Cash Price |
$1,352.49
|
| Rate for Payer: Cofinity Commercial |
$1,453.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,352.49
|
| Rate for Payer: Healthscope Commercial |
$1,521.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,267.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,437.02
|
| Rate for Payer: PHP Commercial |
$1,437.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,183.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,470.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,031.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,487.74
|
| Rate for Payer: UHC Core |
$1,411.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,267.96
|
|
|
HC INJECTION TRANSFORAMINAL CERVICAL OR THORACIC
|
Facility
|
OP
|
$1,690.61
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$401.52 |
| Max. Negotiated Rate |
$1,521.55 |
| Rate for Payer: Aetna Commercial |
$1,437.02
|
| Rate for Payer: Aetna Medicare |
$439.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$528.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$528.32
|
| Rate for Payer: BCBS Complete |
$627.82
|
| Rate for Payer: BCBS MAPPO |
$422.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,314.45
|
| Rate for Payer: BCN Commercial |
$1,314.45
|
| Rate for Payer: BCN Medicare Advantage |
$422.65
|
| Rate for Payer: Cash Price |
$1,352.49
|
| Rate for Payer: Cash Price |
$1,352.49
|
| Rate for Payer: Cofinity Commercial |
$1,453.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,352.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$422.65
|
| Rate for Payer: Healthscope Commercial |
$1,521.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,267.96
|
| Rate for Payer: Mclaren Medicaid |
$597.92
|
| Rate for Payer: Meridian Medicaid |
$627.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$443.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$486.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,437.02
|
| Rate for Payer: PACE Senior Care Partners |
$401.52
|
| Rate for Payer: PACE SWMI |
$422.65
|
| Rate for Payer: PHP Commercial |
$1,437.02
|
| Rate for Payer: PHP Medicare Advantage |
$422.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,183.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,470.83
|
| Rate for Payer: Priority Health Medicare |
$422.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,031.10
|
| Rate for Payer: Railroad Medicare Medicare |
$422.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,487.74
|
| Rate for Payer: UHC Core |
$1,411.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$422.65
|
| Rate for Payer: UHC Medicare Advantage |
$435.33
|
| Rate for Payer: VA VA |
$422.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,267.96
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC BIL
|
Facility
|
IP
|
$2,535.91
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100623
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,546.65 |
| Max. Negotiated Rate |
$2,282.32 |
| Rate for Payer: Aetna Commercial |
$2,155.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,959.75
|
| Rate for Payer: BCN Commercial |
$1,959.75
|
| Rate for Payer: Cash Price |
$2,028.73
|
| Rate for Payer: Cofinity Commercial |
$2,180.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,028.73
|
| Rate for Payer: Healthscope Commercial |
$2,282.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,901.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,155.52
|
| Rate for Payer: PHP Commercial |
$2,155.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,775.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,206.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,546.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,231.60
|
| Rate for Payer: UHC Core |
$2,117.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,901.93
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC BIL
|
Facility
|
OP
|
$2,535.91
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100623
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$597.92 |
| Max. Negotiated Rate |
$2,282.32 |
| Rate for Payer: Aetna Commercial |
$2,155.52
|
| Rate for Payer: Aetna Medicare |
$659.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$792.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$792.47
|
| Rate for Payer: BCBS Complete |
$627.82
|
| Rate for Payer: BCBS MAPPO |
$633.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,971.67
|
| Rate for Payer: BCN Commercial |
$1,971.67
|
| Rate for Payer: BCN Medicare Advantage |
$633.98
|
| Rate for Payer: Cash Price |
$2,028.73
|
| Rate for Payer: Cash Price |
$2,028.73
|
| Rate for Payer: Cofinity Commercial |
$2,180.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,028.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$633.98
|
| Rate for Payer: Healthscope Commercial |
$2,282.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,901.93
|
| Rate for Payer: Mclaren Medicaid |
$597.92
|
| Rate for Payer: Meridian Medicaid |
$627.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$665.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$729.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,155.52
|
| Rate for Payer: PACE Senior Care Partners |
$602.28
|
| Rate for Payer: PACE SWMI |
$633.98
|
| Rate for Payer: PHP Commercial |
$2,155.52
|
| Rate for Payer: PHP Medicare Advantage |
$633.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,775.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,206.24
|
| Rate for Payer: Priority Health Medicare |
$633.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,546.65
|
| Rate for Payer: Railroad Medicare Medicare |
$633.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,231.60
|
| Rate for Payer: UHC Core |
$2,117.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$633.98
|
| Rate for Payer: UHC Medicare Advantage |
$653.00
|
| Rate for Payer: VA VA |
$633.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,901.93
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EA ADD
|
Facility
|
IP
|
$893.62
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$545.02 |
| Max. Negotiated Rate |
$804.26 |
| Rate for Payer: Aetna Commercial |
$759.58
|
| Rate for Payer: BCBS Trust/PPO |
$690.59
|
| Rate for Payer: BCN Commercial |
$690.59
|
| Rate for Payer: Cash Price |
$714.90
|
| Rate for Payer: Cofinity Commercial |
$768.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$714.90
|
| Rate for Payer: Healthscope Commercial |
$804.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$759.58
|
| Rate for Payer: PHP Commercial |
$759.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$625.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$777.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$545.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$786.39
|
| Rate for Payer: UHC Core |
$746.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.22
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EA ADD
|
Facility
|
OP
|
$893.62
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$212.23 |
| Max. Negotiated Rate |
$804.26 |
| Rate for Payer: Aetna Commercial |
$759.58
|
| Rate for Payer: Aetna Medicare |
$232.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$279.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$279.26
|
| Rate for Payer: BCBS Complete |
$357.45
|
| Rate for Payer: BCBS MAPPO |
$223.40
|
| Rate for Payer: BCBS Trust/PPO |
$694.79
|
| Rate for Payer: BCN Commercial |
$694.79
|
| Rate for Payer: BCN Medicare Advantage |
$223.40
|
| Rate for Payer: Cash Price |
$714.90
|
| Rate for Payer: Cofinity Commercial |
$768.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$714.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.40
|
| Rate for Payer: Healthscope Commercial |
$804.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$234.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$759.58
|
| Rate for Payer: PACE Senior Care Partners |
$212.23
|
| Rate for Payer: PACE SWMI |
$223.40
|
| Rate for Payer: PHP Commercial |
$759.58
|
| Rate for Payer: PHP Medicare Advantage |
$223.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$625.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$777.45
|
| Rate for Payer: Priority Health Medicare |
$223.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$545.02
|
| Rate for Payer: Railroad Medicare Medicare |
$223.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$786.39
|
| Rate for Payer: UHC Core |
$746.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.40
|
| Rate for Payer: UHC Medicare Advantage |
$230.11
|
| Rate for Payer: VA VA |
$223.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.22
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL
|
Facility
|
IP
|
$1,340.43
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$817.53 |
| Max. Negotiated Rate |
$1,206.39 |
| Rate for Payer: Aetna Commercial |
$1,139.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,035.88
|
| Rate for Payer: BCN Commercial |
$1,035.88
|
| Rate for Payer: Cash Price |
$1,072.34
|
| Rate for Payer: Cofinity Commercial |
$1,152.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,072.34
|
| Rate for Payer: Healthscope Commercial |
$1,206.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,005.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,139.37
|
| Rate for Payer: PHP Commercial |
$1,139.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$938.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,166.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$817.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,179.58
|
| Rate for Payer: UHC Core |
$1,119.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,005.32
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL
|
Facility
|
OP
|
$1,340.43
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$318.35 |
| Max. Negotiated Rate |
$1,206.39 |
| Rate for Payer: Aetna Commercial |
$1,139.37
|
| Rate for Payer: Aetna Medicare |
$348.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$418.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$418.88
|
| Rate for Payer: BCBS Complete |
$536.17
|
| Rate for Payer: BCBS MAPPO |
$335.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,042.18
|
| Rate for Payer: BCN Commercial |
$1,042.18
|
| Rate for Payer: BCN Medicare Advantage |
$335.11
|
| Rate for Payer: Cash Price |
$1,072.34
|
| Rate for Payer: Cofinity Commercial |
$1,152.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,072.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.11
|
| Rate for Payer: Healthscope Commercial |
$1,206.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,005.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$351.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$385.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,139.37
|
| Rate for Payer: PACE Senior Care Partners |
$318.35
|
| Rate for Payer: PACE SWMI |
$335.11
|
| Rate for Payer: PHP Commercial |
$1,139.37
|
| Rate for Payer: PHP Medicare Advantage |
$335.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$938.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,166.17
|
| Rate for Payer: Priority Health Medicare |
$335.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$817.53
|
| Rate for Payer: Railroad Medicare Medicare |
$335.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,179.58
|
| Rate for Payer: UHC Core |
$1,119.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$335.11
|
| Rate for Payer: UHC Medicare Advantage |
$345.16
|
| Rate for Payer: VA VA |
$335.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,005.32
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL
|
Facility
|
OP
|
$953.07
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$226.35 |
| Max. Negotiated Rate |
$857.76 |
| Rate for Payer: Aetna Commercial |
$810.11
|
| Rate for Payer: Aetna Medicare |
$247.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.83
|
| Rate for Payer: BCBS Complete |
$381.23
|
| Rate for Payer: BCBS MAPPO |
$238.27
|
| Rate for Payer: BCBS Trust/PPO |
$741.01
|
| Rate for Payer: BCN Commercial |
$741.01
|
| Rate for Payer: BCN Medicare Advantage |
$238.27
|
| Rate for Payer: Cash Price |
$762.46
|
| Rate for Payer: Cofinity Commercial |
$819.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$762.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.27
|
| Rate for Payer: Healthscope Commercial |
$857.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$714.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$810.11
|
| Rate for Payer: PACE Senior Care Partners |
$226.35
|
| Rate for Payer: PACE SWMI |
$238.27
|
| Rate for Payer: PHP Commercial |
$810.11
|
| Rate for Payer: PHP Medicare Advantage |
$238.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$667.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$829.17
|
| Rate for Payer: Priority Health Medicare |
$238.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$581.28
|
| Rate for Payer: Railroad Medicare Medicare |
$238.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$838.70
|
| Rate for Payer: UHC Core |
$795.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.27
|
| Rate for Payer: UHC Medicare Advantage |
$245.42
|
| Rate for Payer: VA VA |
$238.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$714.80
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL
|
Facility
|
IP
|
$953.07
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$581.28 |
| Max. Negotiated Rate |
$857.76 |
| Rate for Payer: Aetna Commercial |
$810.11
|
| Rate for Payer: BCBS Trust/PPO |
$736.53
|
| Rate for Payer: BCN Commercial |
$736.53
|
| Rate for Payer: Cash Price |
$762.46
|
| Rate for Payer: Cofinity Commercial |
$819.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$762.46
|
| Rate for Payer: Healthscope Commercial |
$857.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$714.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$810.11
|
| Rate for Payer: PHP Commercial |
$810.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$667.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$829.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$581.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$838.70
|
| Rate for Payer: UHC Core |
$795.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$714.80
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL
|
Facility
|
OP
|
$1,429.60
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$339.53 |
| Max. Negotiated Rate |
$1,286.64 |
| Rate for Payer: Aetna Commercial |
$1,215.16
|
| Rate for Payer: Aetna Medicare |
$371.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.75
|
| Rate for Payer: BCBS Complete |
$571.84
|
| Rate for Payer: BCBS MAPPO |
$357.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,111.51
|
| Rate for Payer: BCN Commercial |
$1,111.51
|
| Rate for Payer: BCN Medicare Advantage |
$357.40
|
| Rate for Payer: Cash Price |
$1,143.68
|
| Rate for Payer: Cofinity Commercial |
$1,229.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.40
|
| Rate for Payer: Healthscope Commercial |
$1,286.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,072.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$375.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$411.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,215.16
|
| Rate for Payer: PACE Senior Care Partners |
$339.53
|
| Rate for Payer: PACE SWMI |
$357.40
|
| Rate for Payer: PHP Commercial |
$1,215.16
|
| Rate for Payer: PHP Medicare Advantage |
$357.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,000.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,243.75
|
| Rate for Payer: Priority Health Medicare |
$357.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$871.91
|
| Rate for Payer: Railroad Medicare Medicare |
$357.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,258.05
|
| Rate for Payer: UHC Core |
$1,193.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.40
|
| Rate for Payer: UHC Medicare Advantage |
$368.12
|
| Rate for Payer: VA VA |
$357.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,072.20
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL
|
Facility
|
IP
|
$1,429.60
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$871.91 |
| Max. Negotiated Rate |
$1,286.64 |
| Rate for Payer: Aetna Commercial |
$1,215.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,104.79
|
| Rate for Payer: BCN Commercial |
$1,104.79
|
| Rate for Payer: Cash Price |
$1,143.68
|
| Rate for Payer: Cofinity Commercial |
$1,229.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.68
|
| Rate for Payer: Healthscope Commercial |
$1,286.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,072.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,215.16
|
| Rate for Payer: PHP Commercial |
$1,215.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,000.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,243.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$871.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,258.05
|
| Rate for Payer: UHC Core |
$1,193.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,072.20
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR SINGLE LEVEL
|
Facility
|
OP
|
$1,475.91
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$350.53 |
| Max. Negotiated Rate |
$1,328.32 |
| Rate for Payer: Aetna Commercial |
$1,254.52
|
| Rate for Payer: Aetna Medicare |
$383.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$461.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$461.22
|
| Rate for Payer: BCBS Complete |
$627.82
|
| Rate for Payer: BCBS MAPPO |
$368.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,147.52
|
| Rate for Payer: BCN Commercial |
$1,147.52
|
| Rate for Payer: BCN Medicare Advantage |
$368.98
|
| Rate for Payer: Cash Price |
$1,180.73
|
| Rate for Payer: Cash Price |
$1,180.73
|
| Rate for Payer: Cofinity Commercial |
$1,269.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,180.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$368.98
|
| Rate for Payer: Healthscope Commercial |
$1,328.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,106.93
|
| Rate for Payer: Mclaren Medicaid |
$597.92
|
| Rate for Payer: Meridian Medicaid |
$627.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$387.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$424.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,254.52
|
| Rate for Payer: PACE Senior Care Partners |
$350.53
|
| Rate for Payer: PACE SWMI |
$368.98
|
| Rate for Payer: PHP Commercial |
$1,254.52
|
| Rate for Payer: PHP Medicare Advantage |
$368.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,284.04
|
| Rate for Payer: Priority Health Medicare |
$368.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$900.16
|
| Rate for Payer: Railroad Medicare Medicare |
$368.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,298.80
|
| Rate for Payer: UHC Core |
$1,232.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$368.98
|
| Rate for Payer: UHC Medicare Advantage |
$380.05
|
| Rate for Payer: VA VA |
$368.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,106.93
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR SINGLE LEVEL
|
Facility
|
IP
|
$1,475.91
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$900.16 |
| Max. Negotiated Rate |
$1,328.32 |
| Rate for Payer: Aetna Commercial |
$1,254.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,140.58
|
| Rate for Payer: BCN Commercial |
$1,140.58
|
| Rate for Payer: Cash Price |
$1,180.73
|
| Rate for Payer: Cofinity Commercial |
$1,269.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,180.73
|
| Rate for Payer: Healthscope Commercial |
$1,328.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,106.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,254.52
|
| Rate for Payer: PHP Commercial |
$1,254.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,284.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$900.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,298.80
|
| Rate for Payer: UHC Core |
$1,232.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,106.93
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SAC SINGLE LEVEL BIL
|
Facility
|
OP
|
$1,162.01
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$275.98 |
| Max. Negotiated Rate |
$1,045.81 |
| Rate for Payer: Aetna Commercial |
$987.71
|
| Rate for Payer: Aetna Medicare |
$302.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$363.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$363.13
|
| Rate for Payer: BCBS Complete |
$627.82
|
| Rate for Payer: BCBS MAPPO |
$290.50
|
| Rate for Payer: BCBS Trust/PPO |
$903.46
|
| Rate for Payer: BCN Commercial |
$903.46
|
| Rate for Payer: BCN Medicare Advantage |
$290.50
|
| Rate for Payer: Cash Price |
$929.61
|
| Rate for Payer: Cash Price |
$929.61
|
| Rate for Payer: Cofinity Commercial |
$999.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$290.50
|
| Rate for Payer: Healthscope Commercial |
$1,045.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$871.51
|
| Rate for Payer: Mclaren Medicaid |
$597.92
|
| Rate for Payer: Meridian Medicaid |
$627.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$305.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$334.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$987.71
|
| Rate for Payer: PACE Senior Care Partners |
$275.98
|
| Rate for Payer: PACE SWMI |
$290.50
|
| Rate for Payer: PHP Commercial |
$987.71
|
| Rate for Payer: PHP Medicare Advantage |
$290.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,010.95
|
| Rate for Payer: Priority Health Medicare |
$290.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$708.71
|
| Rate for Payer: Railroad Medicare Medicare |
$290.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,022.57
|
| Rate for Payer: UHC Core |
$970.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$290.50
|
| Rate for Payer: UHC Medicare Advantage |
$299.22
|
| Rate for Payer: VA VA |
$290.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$871.51
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SAC SINGLE LEVEL BIL
|
Facility
|
IP
|
$1,162.01
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$708.71 |
| Max. Negotiated Rate |
$1,045.81 |
| Rate for Payer: Aetna Commercial |
$987.71
|
| Rate for Payer: BCBS Trust/PPO |
$898.00
|
| Rate for Payer: BCN Commercial |
$898.00
|
| Rate for Payer: Cash Price |
$929.61
|
| Rate for Payer: Cofinity Commercial |
$999.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.61
|
| Rate for Payer: Healthscope Commercial |
$1,045.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$871.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$987.71
|
| Rate for Payer: PHP Commercial |
$987.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,010.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$708.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,022.57
|
| Rate for Payer: UHC Core |
$970.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$871.51
|
|
|
HC INJECTION TURBINATE THERAPEUTIC
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT 30200
|
| Hospital Charge Code |
76100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$823.36 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Aetna Commercial |
$1,147.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,043.28
|
| Rate for Payer: BCN Commercial |
$1,043.28
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cofinity Commercial |
$1,161.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,080.00
|
| Rate for Payer: Healthscope Commercial |
$1,215.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,012.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.50
|
| Rate for Payer: PHP Commercial |
$1,147.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,174.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$823.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,188.00
|
| Rate for Payer: UHC Core |
$1,127.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,012.50
|
|
|
HC INJECTION TURBINATE THERAPEUTIC
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT 30200
|
| Hospital Charge Code |
76100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.62 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Aetna Commercial |
$1,147.50
|
| Rate for Payer: Aetna Medicare |
$351.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$421.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$421.88
|
| Rate for Payer: BCBS Complete |
$378.97
|
| Rate for Payer: BCBS MAPPO |
$337.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.62
|
| Rate for Payer: BCN Commercial |
$1,049.62
|
| Rate for Payer: BCN Medicare Advantage |
$337.50
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cofinity Commercial |
$1,161.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,080.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.50
|
| Rate for Payer: Healthscope Commercial |
$1,215.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,012.50
|
| Rate for Payer: Mclaren Medicaid |
$360.93
|
| Rate for Payer: Meridian Medicaid |
$378.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$354.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$388.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.50
|
| Rate for Payer: PACE Senior Care Partners |
$320.62
|
| Rate for Payer: PACE SWMI |
$337.50
|
| Rate for Payer: PHP Commercial |
$1,147.50
|
| Rate for Payer: PHP Medicare Advantage |
$337.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$360.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,174.50
|
| Rate for Payer: Priority Health Medicare |
$337.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$823.36
|
| Rate for Payer: Railroad Medicare Medicare |
$337.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,188.00
|
| Rate for Payer: UHC Core |
$1,127.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$337.50
|
| Rate for Payer: UHC Medicare Advantage |
$347.62
|
| Rate for Payer: VA VA |
$337.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,012.50
|
|
|
HC INJECTION VENOGRAM
|
Facility
|
OP
|
$555.85
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
36100095
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$132.01 |
| Max. Negotiated Rate |
$500.26 |
| Rate for Payer: Aetna Commercial |
$472.47
|
| Rate for Payer: Aetna Medicare |
$144.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.70
|
| Rate for Payer: BCBS Complete |
$222.34
|
| Rate for Payer: BCBS MAPPO |
$138.96
|
| Rate for Payer: BCBS Trust/PPO |
$432.17
|
| Rate for Payer: BCN Commercial |
$432.17
|
| Rate for Payer: BCN Medicare Advantage |
$138.96
|
| Rate for Payer: Cash Price |
$444.68
|
| Rate for Payer: Cofinity Commercial |
$478.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.96
|
| Rate for Payer: Healthscope Commercial |
$500.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$416.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$472.47
|
| Rate for Payer: PACE Senior Care Partners |
$132.01
|
| Rate for Payer: PACE SWMI |
$138.96
|
| Rate for Payer: PHP Commercial |
$472.47
|
| Rate for Payer: PHP Medicare Advantage |
$138.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$483.59
|
| Rate for Payer: Priority Health Medicare |
$138.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$339.01
|
| Rate for Payer: Railroad Medicare Medicare |
$138.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$489.15
|
| Rate for Payer: UHC Core |
$464.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.96
|
| Rate for Payer: UHC Medicare Advantage |
$143.13
|
| Rate for Payer: VA VA |
$138.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$416.89
|
|
|
HC INJECTION VENOGRAM
|
Facility
|
IP
|
$555.85
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
36100095
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$339.01 |
| Max. Negotiated Rate |
$500.26 |
| Rate for Payer: Aetna Commercial |
$472.47
|
| Rate for Payer: BCBS Trust/PPO |
$429.56
|
| Rate for Payer: BCN Commercial |
$429.56
|
| Rate for Payer: Cash Price |
$444.68
|
| Rate for Payer: Cofinity Commercial |
$478.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.68
|
| Rate for Payer: Healthscope Commercial |
$500.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$416.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$472.47
|
| Rate for Payer: PHP Commercial |
$472.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$483.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$339.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$489.15
|
| Rate for Payer: UHC Core |
$464.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$416.89
|
|
|
HC INJECTION WRIST ARTHROGRAM
|
Facility
|
IP
|
$1,129.61
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
36100039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$688.95 |
| Max. Negotiated Rate |
$1,016.65 |
| Rate for Payer: Aetna Commercial |
$960.17
|
| Rate for Payer: BCBS Trust/PPO |
$872.96
|
| Rate for Payer: BCN Commercial |
$872.96
|
| Rate for Payer: Cash Price |
$903.69
|
| Rate for Payer: Cofinity Commercial |
$971.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.69
|
| Rate for Payer: Healthscope Commercial |
$1,016.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$847.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$960.17
|
| Rate for Payer: PHP Commercial |
$960.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$790.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$982.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$688.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$994.06
|
| Rate for Payer: UHC Core |
$943.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$847.21
|
|
