|
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 |
$0.11 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.13
|
| 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 Commercial |
$0.14
|
| Rate for Payer: Nomi Health Commercial |
$0.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.12
|
| Rate for Payer: PHP Commercial |
$0.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.11
|
| 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 |
$0.03 |
| 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 |
$0.03
|
| Rate for Payer: BCBS MAPPO |
$0.04
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.13
|
| 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: Mclaren Medicaid |
$0.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.04
|
| Rate for Payer: Meridian Medicaid |
$0.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.14
|
| Rate for Payer: Nomi Health Commercial |
$0.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.12
|
| 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 Choice Medicaid |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.14
|
| Rate for Payer: Priority Health Medicare |
$0.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.11
|
| 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 Exchange |
$0.04
|
| Rate for Payer: UHC Medicaid |
$0.03
|
| Rate for Payer: UHC Medicare Advantage |
$0.04
|
| Rate for Payer: UHCCP Medicaid |
$0.03
|
| 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
|
$942.13
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
36100020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$655.72 |
| Max. Negotiated Rate |
$847.92 |
| Rate for Payer: Aetna Commercial |
$800.81
|
| Rate for Payer: BCBS Trust/PPO |
$778.11
|
| Rate for Payer: BCN Commercial |
$778.11
|
| Rate for Payer: Cash Price |
$753.70
|
| Rate for Payer: Cofinity Commercial |
$810.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$753.70
|
| Rate for Payer: Healthscope Commercial |
$847.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$706.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$800.81
|
| Rate for Payer: Nomi Health Commercial |
$772.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$706.60
|
| Rate for Payer: PHP Commercial |
$800.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$819.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$655.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$829.07
|
| Rate for Payer: UHC Core |
$786.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$706.60
|
|
|
HC INJECTION THERAPEUTIC SINUS TRACT
|
Facility
|
OP
|
$942.13
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
36100020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$166.10 |
| Max. Negotiated Rate |
$847.92 |
| Rate for Payer: Aetna Commercial |
$800.81
|
| Rate for Payer: Aetna Medicare |
$244.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.42
|
| Rate for Payer: BCBS Complete |
$174.39
|
| Rate for Payer: BCBS MAPPO |
$235.53
|
| Rate for Payer: BCBS Trust/PPO |
$774.53
|
| Rate for Payer: BCN Commercial |
$774.53
|
| Rate for Payer: BCN Medicare Advantage |
$235.53
|
| Rate for Payer: Cash Price |
$753.70
|
| Rate for Payer: Cofinity Commercial |
$810.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$753.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.53
|
| Rate for Payer: Healthscope Commercial |
$847.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$706.60
|
| Rate for Payer: Mclaren Medicaid |
$166.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.31
|
| Rate for Payer: Meridian Medicaid |
$174.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$259.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$800.81
|
| Rate for Payer: Nomi Health Commercial |
$772.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$706.60
|
| Rate for Payer: PACE Senior Care Partners |
$223.76
|
| Rate for Payer: PACE SWMI |
$235.53
|
| Rate for Payer: PHP Commercial |
$800.81
|
| Rate for Payer: PHP Medicare Advantage |
$235.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$819.65
|
| Rate for Payer: Priority Health Medicare |
$237.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$655.72
|
| Rate for Payer: Railroad Medicare Medicare |
$235.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$829.07
|
| Rate for Payer: UHC Core |
$786.68
|
| Rate for Payer: UHC Exchange |
$235.53
|
| Rate for Payer: UHC Medicaid |
$166.10
|
| Rate for Payer: UHC Medicare Advantage |
$235.53
|
| Rate for Payer: UHCCP Medicaid |
$166.10
|
| Rate for Payer: VA VA |
$235.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$706.60
|
|
|
HC INJECTION TRANSFORAMINAL CERVICAL OR THORACIC
|
Facility
|
OP
|
$1,758.91
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$310.10 |
| Max. Negotiated Rate |
$1,583.02 |
| Rate for Payer: Aetna Commercial |
$1,495.07
|
| Rate for Payer: Aetna Medicare |
$457.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$549.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$549.66
|
| Rate for Payer: BCBS Complete |
$325.57
|
| Rate for Payer: BCBS MAPPO |
$439.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,446.00
|
| Rate for Payer: BCN Commercial |
$1,446.00
|
| Rate for Payer: BCN Medicare Advantage |
$439.73
|
| Rate for Payer: Cash Price |
$1,407.13
|
| Rate for Payer: Cofinity Commercial |
$1,512.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,407.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.73
|
| Rate for Payer: Healthscope Commercial |
$1,583.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,319.18
|
| Rate for Payer: Mclaren Medicaid |
$310.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.71
|
| Rate for Payer: Meridian Medicaid |
$325.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$505.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$483.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,495.07
|
| Rate for Payer: Nomi Health Commercial |
$1,442.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,319.18
|
| Rate for Payer: PACE Senior Care Partners |
$417.74
|
| Rate for Payer: PACE SWMI |
$439.73
|
| Rate for Payer: PHP Commercial |
$1,495.07
|
| Rate for Payer: PHP Medicare Advantage |
$439.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$310.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,530.25
|
| Rate for Payer: Priority Health Medicare |
$444.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,224.20
|
| Rate for Payer: Railroad Medicare Medicare |
$439.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,547.84
|
| Rate for Payer: UHC Core |
$1,468.69
|
| Rate for Payer: UHC Exchange |
$439.73
|
| Rate for Payer: UHC Medicaid |
$310.10
|
| Rate for Payer: UHC Medicare Advantage |
$439.73
|
| Rate for Payer: UHCCP Medicaid |
$310.10
|
| Rate for Payer: VA VA |
$439.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,319.18
|
|
|
HC INJECTION TRANSFORAMINAL CERVICAL OR THORACIC
|
Facility
|
IP
|
$1,758.91
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,224.20 |
| Max. Negotiated Rate |
$1,583.02 |
| Rate for Payer: Aetna Commercial |
$1,495.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,452.68
|
| Rate for Payer: BCN Commercial |
$1,452.68
|
| Rate for Payer: Cash Price |
$1,407.13
|
| Rate for Payer: Cofinity Commercial |
$1,512.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,407.13
|
| Rate for Payer: Healthscope Commercial |
$1,583.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,319.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,495.07
|
| Rate for Payer: Nomi Health Commercial |
$1,442.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,319.18
|
| Rate for Payer: PHP Commercial |
$1,495.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,530.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,224.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,547.84
|
| Rate for Payer: UHC Core |
$1,468.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,319.18
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC BIL
|
Facility
|
IP
|
$2,638.36
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100623
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,836.30 |
| Max. Negotiated Rate |
$2,374.52 |
| Rate for Payer: Aetna Commercial |
$2,242.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,179.02
|
| Rate for Payer: BCN Commercial |
$2,179.02
|
| Rate for Payer: Cash Price |
$2,110.69
|
| Rate for Payer: Cofinity Commercial |
$2,268.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,110.69
|
| Rate for Payer: Healthscope Commercial |
$2,374.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,978.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,242.61
|
| Rate for Payer: Nomi Health Commercial |
$2,163.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,978.77
|
| Rate for Payer: PHP Commercial |
$2,242.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,295.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,836.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,321.76
|
| Rate for Payer: UHC Core |
$2,203.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,978.77
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC BIL
|
Facility
|
OP
|
$2,638.36
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100623
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$465.14 |
| Max. Negotiated Rate |
$2,374.52 |
| Rate for Payer: Aetna Commercial |
$2,242.61
|
| Rate for Payer: Aetna Medicare |
$685.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$824.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$824.49
|
| Rate for Payer: BCBS Complete |
$488.36
|
| Rate for Payer: BCBS MAPPO |
$659.59
|
| Rate for Payer: BCBS Trust/PPO |
$2,169.00
|
| Rate for Payer: BCN Commercial |
$2,169.00
|
| Rate for Payer: BCN Medicare Advantage |
$659.59
|
| Rate for Payer: Cash Price |
$2,110.69
|
| Rate for Payer: Cofinity Commercial |
$2,268.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,110.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$659.59
|
| Rate for Payer: Healthscope Commercial |
$2,374.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,978.77
|
| Rate for Payer: Mclaren Medicaid |
$465.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$692.57
|
| Rate for Payer: Meridian Medicaid |
$488.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$758.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$725.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,242.61
|
| Rate for Payer: Nomi Health Commercial |
$2,163.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,978.77
|
| Rate for Payer: PACE Senior Care Partners |
$626.61
|
| Rate for Payer: PACE SWMI |
$659.59
|
| Rate for Payer: PHP Commercial |
$2,242.61
|
| Rate for Payer: PHP Medicare Advantage |
$659.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,295.37
|
| Rate for Payer: Priority Health Medicare |
$666.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,836.30
|
| Rate for Payer: Railroad Medicare Medicare |
$659.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,321.76
|
| Rate for Payer: UHC Core |
$2,203.03
|
| Rate for Payer: UHC Exchange |
$659.59
|
| Rate for Payer: UHC Medicaid |
$465.14
|
| Rate for Payer: UHC Medicare Advantage |
$659.59
|
| Rate for Payer: UHCCP Medicaid |
$465.14
|
| Rate for Payer: VA VA |
$659.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,978.77
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EA ADD
|
Facility
|
OP
|
$929.72
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$163.91 |
| Max. Negotiated Rate |
$836.75 |
| Rate for Payer: Aetna Commercial |
$790.26
|
| Rate for Payer: Aetna Medicare |
$241.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$290.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$290.54
|
| Rate for Payer: BCBS Complete |
$172.09
|
| Rate for Payer: BCBS MAPPO |
$232.43
|
| Rate for Payer: BCBS Trust/PPO |
$764.32
|
| Rate for Payer: BCN Commercial |
$764.32
|
| Rate for Payer: BCN Medicare Advantage |
$232.43
|
| Rate for Payer: Cash Price |
$743.78
|
| Rate for Payer: Cofinity Commercial |
$799.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$743.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.43
|
| Rate for Payer: Healthscope Commercial |
$836.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$697.29
|
| Rate for Payer: Mclaren Medicaid |
$163.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.05
|
| Rate for Payer: Meridian Medicaid |
$172.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$255.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$790.26
|
| Rate for Payer: Nomi Health Commercial |
$762.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$697.29
|
| Rate for Payer: PACE Senior Care Partners |
$220.81
|
| Rate for Payer: PACE SWMI |
$232.43
|
| Rate for Payer: PHP Commercial |
$790.26
|
| Rate for Payer: PHP Medicare Advantage |
$232.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$808.86
|
| Rate for Payer: Priority Health Medicare |
$234.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$647.09
|
| Rate for Payer: Railroad Medicare Medicare |
$232.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$818.15
|
| Rate for Payer: UHC Core |
$776.32
|
| Rate for Payer: UHC Exchange |
$232.43
|
| Rate for Payer: UHC Medicaid |
$163.91
|
| Rate for Payer: UHC Medicare Advantage |
$232.43
|
| Rate for Payer: UHCCP Medicaid |
$163.91
|
| Rate for Payer: VA VA |
$232.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$697.29
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EA ADD
|
Facility
|
IP
|
$929.72
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$647.09 |
| Max. Negotiated Rate |
$836.75 |
| Rate for Payer: Aetna Commercial |
$790.26
|
| Rate for Payer: BCBS Trust/PPO |
$767.86
|
| Rate for Payer: BCN Commercial |
$767.86
|
| Rate for Payer: Cash Price |
$743.78
|
| Rate for Payer: Cofinity Commercial |
$799.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$743.78
|
| Rate for Payer: Healthscope Commercial |
$836.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$697.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$790.26
|
| Rate for Payer: Nomi Health Commercial |
$762.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$697.29
|
| Rate for Payer: PHP Commercial |
$790.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$808.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$647.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$818.15
|
| Rate for Payer: UHC Core |
$776.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$697.29
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL
|
Facility
|
OP
|
$1,394.58
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$245.86 |
| Max. Negotiated Rate |
$1,255.12 |
| Rate for Payer: Aetna Commercial |
$1,185.39
|
| Rate for Payer: Aetna Medicare |
$362.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.81
|
| Rate for Payer: BCBS Complete |
$258.14
|
| Rate for Payer: BCBS MAPPO |
$348.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,146.48
|
| Rate for Payer: BCN Commercial |
$1,146.48
|
| Rate for Payer: BCN Medicare Advantage |
$348.64
|
| Rate for Payer: Cash Price |
$1,115.66
|
| Rate for Payer: Cofinity Commercial |
$1,199.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,115.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.64
|
| Rate for Payer: Healthscope Commercial |
$1,255.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,045.93
|
| Rate for Payer: Mclaren Medicaid |
$245.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$366.08
|
| Rate for Payer: Meridian Medicaid |
$258.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$383.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,185.39
|
| Rate for Payer: Nomi Health Commercial |
$1,143.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,045.93
|
| Rate for Payer: PACE Senior Care Partners |
$331.21
|
| Rate for Payer: PACE SWMI |
$348.64
|
| Rate for Payer: PHP Commercial |
$1,185.39
|
| Rate for Payer: PHP Medicare Advantage |
$348.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$245.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,213.28
|
| Rate for Payer: Priority Health Medicare |
$352.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$970.63
|
| Rate for Payer: Railroad Medicare Medicare |
$348.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,227.23
|
| Rate for Payer: UHC Core |
$1,164.47
|
| Rate for Payer: UHC Exchange |
$348.64
|
| Rate for Payer: UHC Medicaid |
$245.86
|
| Rate for Payer: UHC Medicare Advantage |
$348.64
|
| Rate for Payer: UHCCP Medicaid |
$245.86
|
| Rate for Payer: VA VA |
$348.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,045.93
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL
|
Facility
|
IP
|
$1,394.58
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$970.63 |
| Max. Negotiated Rate |
$1,255.12 |
| Rate for Payer: Aetna Commercial |
$1,185.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,151.78
|
| Rate for Payer: BCN Commercial |
$1,151.78
|
| Rate for Payer: Cash Price |
$1,115.66
|
| Rate for Payer: Cofinity Commercial |
$1,199.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,115.66
|
| Rate for Payer: Healthscope Commercial |
$1,255.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,045.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,185.39
|
| Rate for Payer: Nomi Health Commercial |
$1,143.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,045.93
|
| Rate for Payer: PHP Commercial |
$1,185.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,213.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$970.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,227.23
|
| Rate for Payer: UHC Core |
$1,164.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,045.93
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL
|
Facility
|
OP
|
$991.57
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$174.81 |
| Max. Negotiated Rate |
$892.41 |
| Rate for Payer: Aetna Commercial |
$842.83
|
| Rate for Payer: Aetna Medicare |
$257.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$309.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$309.87
|
| Rate for Payer: BCBS Complete |
$183.54
|
| Rate for Payer: BCBS MAPPO |
$247.89
|
| Rate for Payer: BCBS Trust/PPO |
$815.17
|
| Rate for Payer: BCN Commercial |
$815.17
|
| Rate for Payer: BCN Medicare Advantage |
$247.89
|
| Rate for Payer: Cash Price |
$793.26
|
| Rate for Payer: Cofinity Commercial |
$852.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$247.89
|
| Rate for Payer: Healthscope Commercial |
$892.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.68
|
| Rate for Payer: Mclaren Medicaid |
$174.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$260.29
|
| Rate for Payer: Meridian Medicaid |
$183.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$285.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$272.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.83
|
| Rate for Payer: Nomi Health Commercial |
$813.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$743.68
|
| Rate for Payer: PACE Senior Care Partners |
$235.50
|
| Rate for Payer: PACE SWMI |
$247.89
|
| Rate for Payer: PHP Commercial |
$842.83
|
| Rate for Payer: PHP Medicare Advantage |
$247.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$862.67
|
| Rate for Payer: Priority Health Medicare |
$250.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$247.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$872.58
|
| Rate for Payer: UHC Core |
$827.96
|
| Rate for Payer: UHC Exchange |
$247.89
|
| Rate for Payer: UHC Medicaid |
$174.81
|
| Rate for Payer: UHC Medicare Advantage |
$247.89
|
| Rate for Payer: UHCCP Medicaid |
$174.81
|
| Rate for Payer: VA VA |
$247.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.68
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL
|
Facility
|
IP
|
$991.57
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$690.13 |
| Max. Negotiated Rate |
$892.41 |
| Rate for Payer: Aetna Commercial |
$842.83
|
| Rate for Payer: BCBS Trust/PPO |
$818.94
|
| Rate for Payer: BCN Commercial |
$818.94
|
| Rate for Payer: Cash Price |
$793.26
|
| Rate for Payer: Cofinity Commercial |
$852.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.26
|
| Rate for Payer: Healthscope Commercial |
$892.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.83
|
| Rate for Payer: Nomi Health Commercial |
$813.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$743.68
|
| Rate for Payer: PHP Commercial |
$842.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$862.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$872.58
|
| Rate for Payer: UHC Core |
$827.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.68
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL
|
Facility
|
IP
|
$1,487.35
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,035.20 |
| Max. Negotiated Rate |
$1,338.62 |
| Rate for Payer: Aetna Commercial |
$1,264.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,228.40
|
| Rate for Payer: BCN Commercial |
$1,228.40
|
| Rate for Payer: Cash Price |
$1,189.88
|
| Rate for Payer: Cofinity Commercial |
$1,279.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,189.88
|
| Rate for Payer: Healthscope Commercial |
$1,338.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,115.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.25
|
| Rate for Payer: Nomi Health Commercial |
$1,219.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,115.51
|
| Rate for Payer: PHP Commercial |
$1,264.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,293.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,035.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,308.87
|
| Rate for Payer: UHC Core |
$1,241.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,115.51
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL
|
Facility
|
OP
|
$1,487.35
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$262.22 |
| Max. Negotiated Rate |
$1,338.62 |
| Rate for Payer: Aetna Commercial |
$1,264.25
|
| Rate for Payer: Aetna Medicare |
$386.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.80
|
| Rate for Payer: BCBS Complete |
$275.31
|
| Rate for Payer: BCBS MAPPO |
$371.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,222.75
|
| Rate for Payer: BCN Commercial |
$1,222.75
|
| Rate for Payer: BCN Medicare Advantage |
$371.84
|
| Rate for Payer: Cash Price |
$1,189.88
|
| Rate for Payer: Cofinity Commercial |
$1,279.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,189.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.84
|
| Rate for Payer: Healthscope Commercial |
$1,338.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,115.51
|
| Rate for Payer: Mclaren Medicaid |
$262.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.43
|
| Rate for Payer: Meridian Medicaid |
$275.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.25
|
| Rate for Payer: Nomi Health Commercial |
$1,219.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,115.51
|
| Rate for Payer: PACE Senior Care Partners |
$353.25
|
| Rate for Payer: PACE SWMI |
$371.84
|
| Rate for Payer: PHP Commercial |
$1,264.25
|
| Rate for Payer: PHP Medicare Advantage |
$371.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$262.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,293.99
|
| Rate for Payer: Priority Health Medicare |
$375.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,035.20
|
| Rate for Payer: Railroad Medicare Medicare |
$371.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,308.87
|
| Rate for Payer: UHC Core |
$1,241.94
|
| Rate for Payer: UHC Exchange |
$371.84
|
| Rate for Payer: UHC Medicaid |
$262.22
|
| Rate for Payer: UHC Medicare Advantage |
$371.84
|
| Rate for Payer: UHCCP Medicaid |
$262.22
|
| Rate for Payer: VA VA |
$371.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,115.51
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR SINGLE LEVEL
|
Facility
|
OP
|
$1,567.72
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$276.39 |
| Max. Negotiated Rate |
$1,410.95 |
| Rate for Payer: Aetna Commercial |
$1,332.56
|
| Rate for Payer: Aetna Medicare |
$407.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.91
|
| Rate for Payer: BCBS Complete |
$290.18
|
| Rate for Payer: BCBS MAPPO |
$391.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,288.82
|
| Rate for Payer: BCN Commercial |
$1,288.82
|
| Rate for Payer: BCN Medicare Advantage |
$391.93
|
| Rate for Payer: Cash Price |
$1,254.18
|
| Rate for Payer: Cofinity Commercial |
$1,348.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,254.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.93
|
| Rate for Payer: Healthscope Commercial |
$1,410.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,175.79
|
| Rate for Payer: Mclaren Medicaid |
$276.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.53
|
| Rate for Payer: Meridian Medicaid |
$290.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$431.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,332.56
|
| Rate for Payer: Nomi Health Commercial |
$1,285.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,175.79
|
| Rate for Payer: PACE Senior Care Partners |
$372.33
|
| Rate for Payer: PACE SWMI |
$391.93
|
| Rate for Payer: PHP Commercial |
$1,332.56
|
| Rate for Payer: PHP Medicare Advantage |
$391.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$276.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,363.92
|
| Rate for Payer: Priority Health Medicare |
$395.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,091.13
|
| Rate for Payer: Railroad Medicare Medicare |
$391.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,379.59
|
| Rate for Payer: UHC Core |
$1,309.05
|
| Rate for Payer: UHC Exchange |
$391.93
|
| Rate for Payer: UHC Medicaid |
$276.39
|
| Rate for Payer: UHC Medicare Advantage |
$391.93
|
| Rate for Payer: UHCCP Medicaid |
$276.39
|
| Rate for Payer: VA VA |
$391.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,175.79
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR SINGLE LEVEL
|
Facility
|
IP
|
$1,567.72
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,091.13 |
| Max. Negotiated Rate |
$1,410.95 |
| Rate for Payer: Aetna Commercial |
$1,332.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,294.78
|
| Rate for Payer: BCN Commercial |
$1,294.78
|
| Rate for Payer: Cash Price |
$1,254.18
|
| Rate for Payer: Cofinity Commercial |
$1,348.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,254.18
|
| Rate for Payer: Healthscope Commercial |
$1,410.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,175.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,332.56
|
| Rate for Payer: Nomi Health Commercial |
$1,285.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,175.79
|
| Rate for Payer: PHP Commercial |
$1,332.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,363.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,091.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,379.59
|
| Rate for Payer: UHC Core |
$1,309.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,175.79
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SAC SINGLE LEVEL BIL
|
Facility
|
OP
|
$1,208.96
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$213.14 |
| Max. Negotiated Rate |
$1,088.06 |
| Rate for Payer: Aetna Commercial |
$1,027.62
|
| Rate for Payer: Aetna Medicare |
$314.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$377.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$377.80
|
| Rate for Payer: BCBS Complete |
$223.78
|
| Rate for Payer: BCBS MAPPO |
$302.24
|
| Rate for Payer: BCBS Trust/PPO |
$993.89
|
| Rate for Payer: BCN Commercial |
$993.89
|
| Rate for Payer: BCN Medicare Advantage |
$302.24
|
| Rate for Payer: Cash Price |
$967.17
|
| Rate for Payer: Cofinity Commercial |
$1,039.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$967.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.24
|
| Rate for Payer: Healthscope Commercial |
$1,088.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$906.72
|
| Rate for Payer: Mclaren Medicaid |
$213.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$317.35
|
| Rate for Payer: Meridian Medicaid |
$223.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$347.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$332.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,027.62
|
| Rate for Payer: Nomi Health Commercial |
$991.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$906.72
|
| Rate for Payer: PACE Senior Care Partners |
$287.13
|
| Rate for Payer: PACE SWMI |
$302.24
|
| Rate for Payer: PHP Commercial |
$1,027.62
|
| Rate for Payer: PHP Medicare Advantage |
$302.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,051.80
|
| Rate for Payer: Priority Health Medicare |
$305.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$841.44
|
| Rate for Payer: Railroad Medicare Medicare |
$302.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,063.88
|
| Rate for Payer: UHC Core |
$1,009.48
|
| Rate for Payer: UHC Exchange |
$302.24
|
| Rate for Payer: UHC Medicaid |
$213.14
|
| Rate for Payer: UHC Medicare Advantage |
$302.24
|
| Rate for Payer: UHCCP Medicaid |
$213.14
|
| Rate for Payer: VA VA |
$302.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$906.72
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SAC SINGLE LEVEL BIL
|
Facility
|
IP
|
$1,208.96
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$841.44 |
| Max. Negotiated Rate |
$1,088.06 |
| Rate for Payer: Aetna Commercial |
$1,027.62
|
| Rate for Payer: BCBS Trust/PPO |
$998.48
|
| Rate for Payer: BCN Commercial |
$998.48
|
| Rate for Payer: Cash Price |
$967.17
|
| Rate for Payer: Cofinity Commercial |
$1,039.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$967.17
|
| Rate for Payer: Healthscope Commercial |
$1,088.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$906.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,027.62
|
| Rate for Payer: Nomi Health Commercial |
$991.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$906.72
|
| Rate for Payer: PHP Commercial |
$1,027.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,051.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$841.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,063.88
|
| Rate for Payer: UHC Core |
$1,009.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$906.72
|
|
|
HC INJECTION TURBINATE THERAPEUTIC
|
Facility
|
OP
|
$1,404.54
|
|
|
Service Code
|
CPT 30200
|
| Hospital Charge Code |
76100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.62 |
| Max. Negotiated Rate |
$1,264.09 |
| Rate for Payer: Aetna Commercial |
$1,193.86
|
| Rate for Payer: Aetna Medicare |
$365.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$438.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$438.92
|
| Rate for Payer: BCBS Complete |
$259.98
|
| Rate for Payer: BCBS MAPPO |
$351.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,154.67
|
| Rate for Payer: BCN Commercial |
$1,154.67
|
| Rate for Payer: BCN Medicare Advantage |
$351.13
|
| Rate for Payer: Cash Price |
$1,123.63
|
| Rate for Payer: Cofinity Commercial |
$1,207.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$351.13
|
| Rate for Payer: Healthscope Commercial |
$1,264.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,053.40
|
| Rate for Payer: Mclaren Medicaid |
$247.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$368.69
|
| Rate for Payer: Meridian Medicaid |
$259.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$403.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$386.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,193.86
|
| Rate for Payer: Nomi Health Commercial |
$1,151.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,053.40
|
| Rate for Payer: PACE Senior Care Partners |
$333.58
|
| Rate for Payer: PACE SWMI |
$351.13
|
| Rate for Payer: PHP Commercial |
$1,193.86
|
| Rate for Payer: PHP Medicare Advantage |
$351.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$247.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,221.95
|
| Rate for Payer: Priority Health Medicare |
$354.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$977.56
|
| Rate for Payer: Railroad Medicare Medicare |
$351.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,236.00
|
| Rate for Payer: UHC Core |
$1,172.79
|
| Rate for Payer: UHC Exchange |
$351.13
|
| Rate for Payer: UHC Medicaid |
$247.62
|
| Rate for Payer: UHC Medicare Advantage |
$351.13
|
| Rate for Payer: UHCCP Medicaid |
$247.62
|
| Rate for Payer: VA VA |
$351.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,053.40
|
|
|
HC INJECTION TURBINATE THERAPEUTIC
|
Facility
|
IP
|
$1,404.54
|
|
|
Service Code
|
CPT 30200
|
| Hospital Charge Code |
76100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$977.56 |
| Max. Negotiated Rate |
$1,264.09 |
| Rate for Payer: Aetna Commercial |
$1,193.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,160.01
|
| Rate for Payer: BCN Commercial |
$1,160.01
|
| Rate for Payer: Cash Price |
$1,123.63
|
| Rate for Payer: Cofinity Commercial |
$1,207.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.63
|
| Rate for Payer: Healthscope Commercial |
$1,264.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,053.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,193.86
|
| Rate for Payer: Nomi Health Commercial |
$1,151.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,053.40
|
| Rate for Payer: PHP Commercial |
$1,193.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,221.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$977.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,236.00
|
| Rate for Payer: UHC Core |
$1,172.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,053.40
|
|
|
HC INJECTION VENOGRAM
|
Facility
|
IP
|
$595.32
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
36100095
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$414.34 |
| Max. Negotiated Rate |
$535.79 |
| Rate for Payer: Aetna Commercial |
$506.02
|
| Rate for Payer: BCBS Trust/PPO |
$491.67
|
| Rate for Payer: BCN Commercial |
$491.67
|
| Rate for Payer: Cash Price |
$476.26
|
| Rate for Payer: Cofinity Commercial |
$511.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.26
|
| Rate for Payer: Healthscope Commercial |
$535.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.02
|
| Rate for Payer: Nomi Health Commercial |
$488.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.49
|
| Rate for Payer: PHP Commercial |
$506.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$517.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$414.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$523.88
|
| Rate for Payer: UHC Core |
$497.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.49
|
|
|
HC INJECTION VENOGRAM
|
Facility
|
OP
|
$595.32
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
36100095
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.95 |
| Max. Negotiated Rate |
$535.79 |
| Rate for Payer: Aetna Commercial |
$506.02
|
| Rate for Payer: Aetna Medicare |
$154.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$186.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$186.04
|
| Rate for Payer: BCBS Complete |
$110.19
|
| Rate for Payer: BCBS MAPPO |
$148.83
|
| Rate for Payer: BCBS Trust/PPO |
$489.41
|
| Rate for Payer: BCN Commercial |
$489.41
|
| Rate for Payer: BCN Medicare Advantage |
$148.83
|
| Rate for Payer: Cash Price |
$476.26
|
| Rate for Payer: Cofinity Commercial |
$511.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.83
|
| Rate for Payer: Healthscope Commercial |
$535.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.49
|
| Rate for Payer: Mclaren Medicaid |
$104.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.27
|
| Rate for Payer: Meridian Medicaid |
$110.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$163.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.02
|
| Rate for Payer: Nomi Health Commercial |
$488.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.49
|
| Rate for Payer: PACE Senior Care Partners |
$141.39
|
| Rate for Payer: PACE SWMI |
$148.83
|
| Rate for Payer: PHP Commercial |
$506.02
|
| Rate for Payer: PHP Medicare Advantage |
$148.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$517.93
|
| Rate for Payer: Priority Health Medicare |
$150.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$414.34
|
| Rate for Payer: Railroad Medicare Medicare |
$148.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$523.88
|
| Rate for Payer: UHC Core |
$497.09
|
| Rate for Payer: UHC Exchange |
$148.83
|
| Rate for Payer: UHC Medicaid |
$104.95
|
| Rate for Payer: UHC Medicare Advantage |
$148.83
|
| Rate for Payer: UHCCP Medicaid |
$104.95
|
| Rate for Payer: VA VA |
$148.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.49
|
|
|
HC INJECTION WRIST ARTHROGRAM
|
Facility
|
OP
|
$1,175.24
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
36100039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$207.19 |
| Max. Negotiated Rate |
$1,057.72 |
| Rate for Payer: Aetna Commercial |
$998.95
|
| Rate for Payer: Aetna Medicare |
$305.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$367.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$367.26
|
| Rate for Payer: BCBS Complete |
$217.54
|
| Rate for Payer: BCBS MAPPO |
$293.81
|
| Rate for Payer: BCBS Trust/PPO |
$966.16
|
| Rate for Payer: BCN Commercial |
$966.16
|
| Rate for Payer: BCN Medicare Advantage |
$293.81
|
| Rate for Payer: Cash Price |
$940.19
|
| Rate for Payer: Cofinity Commercial |
$1,010.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$293.81
|
| Rate for Payer: Healthscope Commercial |
$1,057.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$881.43
|
| Rate for Payer: Mclaren Medicaid |
$207.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$308.50
|
| Rate for Payer: Meridian Medicaid |
$217.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$337.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$323.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$998.95
|
| Rate for Payer: Nomi Health Commercial |
$963.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$881.43
|
| Rate for Payer: PACE Senior Care Partners |
$279.12
|
| Rate for Payer: PACE SWMI |
$293.81
|
| Rate for Payer: PHP Commercial |
$998.95
|
| Rate for Payer: PHP Medicare Advantage |
$293.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$207.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,022.46
|
| Rate for Payer: Priority Health Medicare |
$296.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$817.97
|
| Rate for Payer: Railroad Medicare Medicare |
$293.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,034.21
|
| Rate for Payer: UHC Core |
$981.33
|
| Rate for Payer: UHC Exchange |
$293.81
|
| Rate for Payer: UHC Medicaid |
$207.19
|
| Rate for Payer: UHC Medicare Advantage |
$293.81
|
| Rate for Payer: UHCCP Medicaid |
$207.19
|
| Rate for Payer: VA VA |
$293.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$881.43
|
|
