|
HC INJ ANESTH AND/OR STEROID BRACHIAL PLEXUS
|
Facility
|
IP
|
$3,172.12
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
37100005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2,061.88 |
| Max. Negotiated Rate |
$2,854.91 |
| Rate for Payer: Aetna Commercial |
$2,696.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,589.40
|
| Rate for Payer: BCN Commercial |
$2,451.41
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cofinity Commercial |
$2,728.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,537.70
|
| Rate for Payer: Healthscope Commercial |
$2,854.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,379.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,696.30
|
| Rate for Payer: Nomi Health Commercial |
$2,601.14
|
| Rate for Payer: PHP Commercial |
$2,696.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.88
|
| Rate for Payer: Priority Health HMO/PPO |
$2,759.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,125.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,791.47
|
| Rate for Payer: UHC Core |
$2,648.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,379.09
|
|
|
HC INJ ANESTH AND/OR STEROID SCIATIC NERVE
|
Facility
|
IP
|
$2,549.64
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
37100008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,657.27 |
| Max. Negotiated Rate |
$2,294.68 |
| Rate for Payer: Aetna Commercial |
$2,167.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,081.27
|
| Rate for Payer: BCN Commercial |
$1,970.36
|
| Rate for Payer: Cash Price |
$2,039.71
|
| Rate for Payer: Cofinity Commercial |
$2,192.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,039.71
|
| Rate for Payer: Healthscope Commercial |
$2,294.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,912.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,167.19
|
| Rate for Payer: Nomi Health Commercial |
$2,090.70
|
| Rate for Payer: PHP Commercial |
$2,167.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.27
|
| Rate for Payer: Priority Health HMO/PPO |
$2,218.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,708.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,243.68
|
| Rate for Payer: UHC Core |
$2,128.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,912.23
|
|
|
HC INJ ANESTH AND/OR STEROID SCIATIC NERVE
|
Facility
|
OP
|
$2,549.64
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
37100008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$500.69 |
| Max. Negotiated Rate |
$2,294.68 |
| Rate for Payer: Aetna Commercial |
$2,167.19
|
| Rate for Payer: Aetna Medicare |
$662.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$796.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$796.76
|
| Rate for Payer: BCBS Complete |
$525.76
|
| Rate for Payer: BCBS MAPPO |
$637.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,096.06
|
| Rate for Payer: BCN Commercial |
$1,982.35
|
| Rate for Payer: BCN Medicare Advantage |
$637.41
|
| Rate for Payer: Cash Price |
$2,039.71
|
| Rate for Payer: Cash Price |
$2,039.71
|
| Rate for Payer: Cofinity Commercial |
$2,192.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,039.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.41
|
| Rate for Payer: Healthscope Commercial |
$2,294.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,912.23
|
| Rate for Payer: Mclaren Medicaid |
$500.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$669.28
|
| Rate for Payer: Meridian Medicaid |
$525.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,167.19
|
| Rate for Payer: Nomi Health Commercial |
$2,090.70
|
| Rate for Payer: PACE Senior Care Partners |
$605.54
|
| Rate for Payer: PACE SWMI |
$637.41
|
| Rate for Payer: PHP Commercial |
$2,167.19
|
| Rate for Payer: PHP Medicare Advantage |
$637.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.27
|
| Rate for Payer: Priority Health HMO/PPO |
$2,218.19
|
| Rate for Payer: Priority Health Medicare |
$643.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,708.26
|
| Rate for Payer: Railroad Medicare Medicare |
$637.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,243.68
|
| Rate for Payer: UHC Core |
$2,128.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.41
|
| Rate for Payer: UHC Exchange |
$637.41
|
| Rate for Payer: UHC Medicare Advantage |
$637.41
|
| Rate for Payer: UHCCP Medicaid |
$500.69
|
| Rate for Payer: VA VA |
$637.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,912.23
|
|
|
HC INJ ANESTH AND/OR STEROID SUPRASCAPULAR NERVE
|
Facility
|
IP
|
$975.46
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
36100600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$634.05 |
| Max. Negotiated Rate |
$877.91 |
| Rate for Payer: Aetna Commercial |
$829.14
|
| Rate for Payer: BCBS Trust/PPO |
$796.27
|
| Rate for Payer: BCN Commercial |
$753.84
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cofinity Commercial |
$838.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.37
|
| Rate for Payer: Healthscope Commercial |
$877.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$731.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.14
|
| Rate for Payer: Nomi Health Commercial |
$799.88
|
| Rate for Payer: PHP Commercial |
$829.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.05
|
| Rate for Payer: Priority Health HMO/PPO |
$848.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$653.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.40
|
| Rate for Payer: UHC Core |
$814.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$731.60
|
|
|
HC INJ ANESTH AND/OR STEROID SUPRASCAPULAR NERVE
|
Facility
|
OP
|
$975.46
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
36100600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$231.67 |
| Max. Negotiated Rate |
$877.91 |
| Rate for Payer: Aetna Commercial |
$829.14
|
| Rate for Payer: Aetna Medicare |
$253.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$304.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$304.83
|
| Rate for Payer: BCBS Complete |
$525.76
|
| Rate for Payer: BCBS MAPPO |
$243.87
|
| Rate for Payer: BCBS Trust/PPO |
$801.93
|
| Rate for Payer: BCN Commercial |
$758.42
|
| Rate for Payer: BCN Medicare Advantage |
$243.87
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cofinity Commercial |
$838.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.87
|
| Rate for Payer: Healthscope Commercial |
$877.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$731.60
|
| Rate for Payer: Mclaren Medicaid |
$500.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.06
|
| Rate for Payer: Meridian Medicaid |
$525.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$280.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.14
|
| Rate for Payer: Nomi Health Commercial |
$799.88
|
| Rate for Payer: PACE Senior Care Partners |
$231.67
|
| Rate for Payer: PACE SWMI |
$243.87
|
| Rate for Payer: PHP Commercial |
$829.14
|
| Rate for Payer: PHP Medicare Advantage |
$243.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.05
|
| Rate for Payer: Priority Health HMO/PPO |
$848.65
|
| Rate for Payer: Priority Health Medicare |
$246.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$653.56
|
| Rate for Payer: Railroad Medicare Medicare |
$243.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.40
|
| Rate for Payer: UHC Core |
$814.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$243.87
|
| Rate for Payer: UHC Exchange |
$243.87
|
| Rate for Payer: UHC Medicare Advantage |
$243.87
|
| Rate for Payer: UHCCP Medicaid |
$500.69
|
| Rate for Payer: VA VA |
$243.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$731.60
|
|
|
HC INJ ANESTHETIC FEMORAL
|
Facility
|
IP
|
$1,534.27
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
36100391
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$997.28 |
| Max. Negotiated Rate |
$1,380.84 |
| Rate for Payer: Aetna Commercial |
$1,304.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,252.42
|
| Rate for Payer: BCN Commercial |
$1,185.68
|
| Rate for Payer: Cash Price |
$1,227.42
|
| Rate for Payer: Cofinity Commercial |
$1,319.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,227.42
|
| Rate for Payer: Healthscope Commercial |
$1,380.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,150.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,304.13
|
| Rate for Payer: Nomi Health Commercial |
$1,258.10
|
| Rate for Payer: PHP Commercial |
$1,304.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.28
|
| Rate for Payer: Priority Health HMO/PPO |
$1,334.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,027.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,350.16
|
| Rate for Payer: UHC Core |
$1,281.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,150.70
|
|
|
HC INJ ANESTHETIC FEMORAL
|
Facility
|
OP
|
$1,534.27
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
36100391
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$364.39 |
| Max. Negotiated Rate |
$1,380.84 |
| Rate for Payer: Aetna Commercial |
$1,304.13
|
| Rate for Payer: Aetna Medicare |
$398.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$479.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$479.46
|
| Rate for Payer: BCBS Complete |
$525.76
|
| Rate for Payer: BCBS MAPPO |
$383.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,261.32
|
| Rate for Payer: BCN Commercial |
$1,192.89
|
| Rate for Payer: BCN Medicare Advantage |
$383.57
|
| Rate for Payer: Cash Price |
$1,227.42
|
| Rate for Payer: Cash Price |
$1,227.42
|
| Rate for Payer: Cofinity Commercial |
$1,319.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,227.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$383.57
|
| Rate for Payer: Healthscope Commercial |
$1,380.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,150.70
|
| Rate for Payer: Mclaren Medicaid |
$500.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$402.75
|
| Rate for Payer: Meridian Medicaid |
$525.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,304.13
|
| Rate for Payer: Nomi Health Commercial |
$1,258.10
|
| Rate for Payer: PACE Senior Care Partners |
$364.39
|
| Rate for Payer: PACE SWMI |
$383.57
|
| Rate for Payer: PHP Commercial |
$1,304.13
|
| Rate for Payer: PHP Medicare Advantage |
$383.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.28
|
| Rate for Payer: Priority Health HMO/PPO |
$1,334.81
|
| Rate for Payer: Priority Health Medicare |
$387.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,027.96
|
| Rate for Payer: Railroad Medicare Medicare |
$383.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,350.16
|
| Rate for Payer: UHC Core |
$1,281.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$383.57
|
| Rate for Payer: UHC Exchange |
$383.57
|
| Rate for Payer: UHC Medicare Advantage |
$383.57
|
| Rate for Payer: UHCCP Medicaid |
$500.69
|
| Rate for Payer: VA VA |
$383.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,150.70
|
|
|
HC INJ ANESTH PERIPH NERVE
|
Facility
|
OP
|
$890.33
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
36100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.45 |
| Max. Negotiated Rate |
$801.30 |
| Rate for Payer: Aetna Commercial |
$756.78
|
| Rate for Payer: Aetna Medicare |
$231.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$278.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$278.23
|
| Rate for Payer: BCBS Complete |
$525.76
|
| Rate for Payer: BCBS MAPPO |
$222.58
|
| Rate for Payer: BCBS Trust/PPO |
$731.94
|
| Rate for Payer: BCN Commercial |
$692.23
|
| Rate for Payer: BCN Medicare Advantage |
$222.58
|
| Rate for Payer: Cash Price |
$712.26
|
| Rate for Payer: Cash Price |
$712.26
|
| Rate for Payer: Cofinity Commercial |
$765.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$712.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.58
|
| Rate for Payer: Healthscope Commercial |
$801.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$667.75
|
| Rate for Payer: Mclaren Medicaid |
$500.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.71
|
| Rate for Payer: Meridian Medicaid |
$525.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$255.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$756.78
|
| Rate for Payer: Nomi Health Commercial |
$730.07
|
| Rate for Payer: PACE Senior Care Partners |
$211.45
|
| Rate for Payer: PACE SWMI |
$222.58
|
| Rate for Payer: PHP Commercial |
$756.78
|
| Rate for Payer: PHP Medicare Advantage |
$222.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.71
|
| Rate for Payer: Priority Health HMO/PPO |
$774.59
|
| Rate for Payer: Priority Health Medicare |
$224.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$596.52
|
| Rate for Payer: Railroad Medicare Medicare |
$222.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$783.49
|
| Rate for Payer: UHC Core |
$743.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.58
|
| Rate for Payer: UHC Exchange |
$222.58
|
| Rate for Payer: UHC Medicare Advantage |
$222.58
|
| Rate for Payer: UHCCP Medicaid |
$500.69
|
| Rate for Payer: VA VA |
$222.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$667.75
|
|
|
HC INJ ANESTH PERIPH NERVE
|
Facility
|
IP
|
$890.33
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
36100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$578.71 |
| Max. Negotiated Rate |
$801.30 |
| Rate for Payer: Aetna Commercial |
$756.78
|
| Rate for Payer: BCBS Trust/PPO |
$726.78
|
| Rate for Payer: BCN Commercial |
$688.05
|
| Rate for Payer: Cash Price |
$712.26
|
| Rate for Payer: Cofinity Commercial |
$765.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$712.26
|
| Rate for Payer: Healthscope Commercial |
$801.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$667.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$756.78
|
| Rate for Payer: Nomi Health Commercial |
$730.07
|
| Rate for Payer: PHP Commercial |
$756.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.71
|
| Rate for Payer: Priority Health HMO/PPO |
$774.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$596.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$783.49
|
| Rate for Payer: UHC Core |
$743.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$667.75
|
|
|
HC INJ ANESTH/STEROID BRACHIAL PLEXUS CONT
|
Facility
|
OP
|
$3,172.12
|
|
|
Service Code
|
CPT 64416
|
| Hospital Charge Code |
37100010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$643.68 |
| Max. Negotiated Rate |
$2,854.91 |
| Rate for Payer: Aetna Commercial |
$2,696.30
|
| Rate for Payer: Aetna Medicare |
$824.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$991.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$991.29
|
| Rate for Payer: BCBS Complete |
$675.91
|
| Rate for Payer: BCBS MAPPO |
$793.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,607.80
|
| Rate for Payer: BCN Commercial |
$2,466.32
|
| Rate for Payer: BCN Medicare Advantage |
$793.03
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cofinity Commercial |
$2,728.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,537.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$793.03
|
| Rate for Payer: Healthscope Commercial |
$2,854.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,379.09
|
| Rate for Payer: Mclaren Medicaid |
$643.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$832.68
|
| Rate for Payer: Meridian Medicaid |
$675.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$911.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,696.30
|
| Rate for Payer: Nomi Health Commercial |
$2,601.14
|
| Rate for Payer: PACE Senior Care Partners |
$753.38
|
| Rate for Payer: PACE SWMI |
$793.03
|
| Rate for Payer: PHP Commercial |
$2,696.30
|
| Rate for Payer: PHP Medicare Advantage |
$793.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.88
|
| Rate for Payer: Priority Health HMO/PPO |
$2,759.74
|
| Rate for Payer: Priority Health Medicare |
$800.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,125.32
|
| Rate for Payer: Railroad Medicare Medicare |
$793.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,791.47
|
| Rate for Payer: UHC Core |
$2,648.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$793.03
|
| Rate for Payer: UHC Exchange |
$793.03
|
| Rate for Payer: UHC Medicare Advantage |
$793.03
|
| Rate for Payer: UHCCP Medicaid |
$643.68
|
| Rate for Payer: VA VA |
$793.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,379.09
|
|
|
HC INJ ANESTH/STEROID BRACHIAL PLEXUS CONT
|
Facility
|
IP
|
$3,172.12
|
|
|
Service Code
|
CPT 64416
|
| Hospital Charge Code |
37100010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2,061.88 |
| Max. Negotiated Rate |
$2,854.91 |
| Rate for Payer: Aetna Commercial |
$2,696.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,589.40
|
| Rate for Payer: BCN Commercial |
$2,451.41
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cofinity Commercial |
$2,728.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,537.70
|
| Rate for Payer: Healthscope Commercial |
$2,854.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,379.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,696.30
|
| Rate for Payer: Nomi Health Commercial |
$2,601.14
|
| Rate for Payer: PHP Commercial |
$2,696.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.88
|
| Rate for Payer: Priority Health HMO/PPO |
$2,759.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,125.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,791.47
|
| Rate for Payer: UHC Core |
$2,648.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,379.09
|
|
|
HC INJ ANESTH/STEROID SCIATIC NERVE CONT
|
Facility
|
OP
|
$3,180.56
|
|
|
Service Code
|
CPT 64446
|
| Hospital Charge Code |
37000020
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$643.68 |
| Max. Negotiated Rate |
$2,862.50 |
| Rate for Payer: Aetna Commercial |
$2,703.48
|
| Rate for Payer: Aetna Medicare |
$826.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$993.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$993.92
|
| Rate for Payer: BCBS Complete |
$675.91
|
| Rate for Payer: BCBS MAPPO |
$795.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,614.74
|
| Rate for Payer: BCN Commercial |
$2,472.89
|
| Rate for Payer: BCN Medicare Advantage |
$795.14
|
| Rate for Payer: Cash Price |
$2,544.45
|
| Rate for Payer: Cash Price |
$2,544.45
|
| Rate for Payer: Cofinity Commercial |
$2,735.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,544.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$795.14
|
| Rate for Payer: Healthscope Commercial |
$2,862.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,385.42
|
| Rate for Payer: Mclaren Medicaid |
$643.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$834.90
|
| Rate for Payer: Meridian Medicaid |
$675.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$914.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,703.48
|
| Rate for Payer: Nomi Health Commercial |
$2,608.06
|
| Rate for Payer: PACE Senior Care Partners |
$755.38
|
| Rate for Payer: PACE SWMI |
$795.14
|
| Rate for Payer: PHP Commercial |
$2,703.48
|
| Rate for Payer: PHP Medicare Advantage |
$795.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,067.36
|
| Rate for Payer: Priority Health HMO/PPO |
$2,767.09
|
| Rate for Payer: Priority Health Medicare |
$803.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,130.98
|
| Rate for Payer: Railroad Medicare Medicare |
$795.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,798.89
|
| Rate for Payer: UHC Core |
$2,655.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$795.14
|
| Rate for Payer: UHC Exchange |
$795.14
|
| Rate for Payer: UHC Medicare Advantage |
$795.14
|
| Rate for Payer: UHCCP Medicaid |
$643.68
|
| Rate for Payer: VA VA |
$795.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,385.42
|
|
|
HC INJ ANESTH/STEROID SCIATIC NERVE CONT
|
Facility
|
IP
|
$3,180.56
|
|
|
Service Code
|
CPT 64446
|
| Hospital Charge Code |
37000020
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2,067.36 |
| Max. Negotiated Rate |
$2,862.50 |
| Rate for Payer: Aetna Commercial |
$2,703.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,596.29
|
| Rate for Payer: BCN Commercial |
$2,457.94
|
| Rate for Payer: Cash Price |
$2,544.45
|
| Rate for Payer: Cofinity Commercial |
$2,735.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,544.45
|
| Rate for Payer: Healthscope Commercial |
$2,862.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,385.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,703.48
|
| Rate for Payer: Nomi Health Commercial |
$2,608.06
|
| Rate for Payer: PHP Commercial |
$2,703.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,067.36
|
| Rate for Payer: Priority Health HMO/PPO |
$2,767.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,130.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,798.89
|
| Rate for Payer: UHC Core |
$2,655.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,385.42
|
|
|
HC INJ ANEST/STEROID ILIOING ILIOHYPOGAST NRV
|
Facility
|
IP
|
$975.46
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
76100270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$634.05 |
| Max. Negotiated Rate |
$877.91 |
| Rate for Payer: Aetna Commercial |
$829.14
|
| Rate for Payer: BCBS Trust/PPO |
$796.27
|
| Rate for Payer: BCN Commercial |
$753.84
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cofinity Commercial |
$838.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.37
|
| Rate for Payer: Healthscope Commercial |
$877.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$731.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.14
|
| Rate for Payer: Nomi Health Commercial |
$799.88
|
| Rate for Payer: PHP Commercial |
$829.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.05
|
| Rate for Payer: Priority Health HMO/PPO |
$848.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$653.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.40
|
| Rate for Payer: UHC Core |
$814.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$731.60
|
|
|
HC INJ ANEST/STEROID ILIOING ILIOHYPOGAST NRV
|
Facility
|
OP
|
$975.46
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
76100270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.67 |
| Max. Negotiated Rate |
$877.91 |
| Rate for Payer: Aetna Commercial |
$829.14
|
| Rate for Payer: Aetna Medicare |
$253.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$304.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$304.83
|
| Rate for Payer: BCBS Complete |
$525.76
|
| Rate for Payer: BCBS MAPPO |
$243.87
|
| Rate for Payer: BCBS Trust/PPO |
$801.93
|
| Rate for Payer: BCN Commercial |
$758.42
|
| Rate for Payer: BCN Medicare Advantage |
$243.87
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cofinity Commercial |
$838.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.87
|
| Rate for Payer: Healthscope Commercial |
$877.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$731.60
|
| Rate for Payer: Mclaren Medicaid |
$500.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.06
|
| Rate for Payer: Meridian Medicaid |
$525.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$280.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.14
|
| Rate for Payer: Nomi Health Commercial |
$799.88
|
| Rate for Payer: PACE Senior Care Partners |
$231.67
|
| Rate for Payer: PACE SWMI |
$243.87
|
| Rate for Payer: PHP Commercial |
$829.14
|
| Rate for Payer: PHP Medicare Advantage |
$243.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.05
|
| Rate for Payer: Priority Health HMO/PPO |
$848.65
|
| Rate for Payer: Priority Health Medicare |
$246.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$653.56
|
| Rate for Payer: Railroad Medicare Medicare |
$243.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.40
|
| Rate for Payer: UHC Core |
$814.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$243.87
|
| Rate for Payer: UHC Exchange |
$243.87
|
| Rate for Payer: UHC Medicare Advantage |
$243.87
|
| Rate for Payer: UHCCP Medicaid |
$500.69
|
| Rate for Payer: VA VA |
$243.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$731.60
|
|
|
HC INJ BEBTELOVIMAB
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
77100034
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$315.25 |
| Max. Negotiated Rate |
$436.50 |
| Rate for Payer: Aetna Commercial |
$412.25
|
| Rate for Payer: BCBS Trust/PPO |
$395.91
|
| Rate for Payer: BCN Commercial |
$374.81
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$417.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.00
|
| Rate for Payer: Healthscope Commercial |
$436.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.25
|
| Rate for Payer: Nomi Health Commercial |
$397.70
|
| Rate for Payer: PHP Commercial |
$412.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health HMO/PPO |
$421.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.80
|
| Rate for Payer: UHC Core |
$404.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.75
|
|
|
HC INJ BEBTELOVIMAB
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
77100034
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$115.19 |
| Max. Negotiated Rate |
$436.50 |
| Rate for Payer: Aetna Commercial |
$412.25
|
| Rate for Payer: Aetna Medicare |
$126.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$151.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$151.56
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: BCBS MAPPO |
$121.25
|
| Rate for Payer: BCBS Trust/PPO |
$398.72
|
| Rate for Payer: BCN Commercial |
$377.09
|
| Rate for Payer: BCN Medicare Advantage |
$121.25
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$417.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.25
|
| Rate for Payer: Healthscope Commercial |
$436.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.25
|
| Rate for Payer: Nomi Health Commercial |
$397.70
|
| Rate for Payer: PACE Senior Care Partners |
$115.19
|
| Rate for Payer: PACE SWMI |
$121.25
|
| Rate for Payer: PHP Commercial |
$412.25
|
| Rate for Payer: PHP Medicare Advantage |
$121.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health HMO/PPO |
$421.95
|
| Rate for Payer: Priority Health Medicare |
$122.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.95
|
| Rate for Payer: Railroad Medicare Medicare |
$121.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.80
|
| Rate for Payer: UHC Core |
$404.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.25
|
| Rate for Payer: UHC Exchange |
$121.25
|
| Rate for Payer: UHC Medicare Advantage |
$121.25
|
| Rate for Payer: VA VA |
$121.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.75
|
|
|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.20
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
OP
|
$1,103.46
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$262.07 |
| Max. Negotiated Rate |
$993.11 |
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: Aetna Medicare |
$286.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$344.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$344.83
|
| Rate for Payer: BCBS Complete |
$675.91
|
| Rate for Payer: BCBS MAPPO |
$275.87
|
| Rate for Payer: BCBS Trust/PPO |
$907.15
|
| Rate for Payer: BCN Commercial |
$857.94
|
| Rate for Payer: BCN Medicare Advantage |
$275.87
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.87
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.60
|
| Rate for Payer: Mclaren Medicaid |
$643.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$289.66
|
| Rate for Payer: Meridian Medicaid |
$675.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$904.84
|
| Rate for Payer: PACE Senior Care Partners |
$262.07
|
| Rate for Payer: PACE SWMI |
$275.87
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: PHP Medicare Advantage |
$275.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health HMO/PPO |
$960.01
|
| Rate for Payer: Priority Health Medicare |
$278.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$739.32
|
| Rate for Payer: Railroad Medicare Medicare |
$275.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.04
|
| Rate for Payer: UHC Core |
$921.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.87
|
| Rate for Payer: UHC Exchange |
$275.87
|
| Rate for Payer: UHC Medicare Advantage |
$275.87
|
| Rate for Payer: UHCCP Medicaid |
$643.68
|
| Rate for Payer: VA VA |
$275.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.60
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
IP
|
$1,103.46
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$717.25 |
| Max. Negotiated Rate |
$993.11 |
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: BCBS Trust/PPO |
$900.75
|
| Rate for Payer: BCN Commercial |
$852.75
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$904.84
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health HMO/PPO |
$960.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$739.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.04
|
| Rate for Payer: UHC Core |
$921.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.60
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
OP
|
$1,103.46
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$262.07 |
| Max. Negotiated Rate |
$993.11 |
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: Aetna Medicare |
$286.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$344.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$344.83
|
| Rate for Payer: BCBS Complete |
$675.91
|
| Rate for Payer: BCBS MAPPO |
$275.87
|
| Rate for Payer: BCBS Trust/PPO |
$907.15
|
| Rate for Payer: BCN Commercial |
$857.94
|
| Rate for Payer: BCN Medicare Advantage |
$275.87
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.87
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.60
|
| Rate for Payer: Mclaren Medicaid |
$643.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$289.66
|
| Rate for Payer: Meridian Medicaid |
$675.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$904.84
|
| Rate for Payer: PACE Senior Care Partners |
$262.07
|
| Rate for Payer: PACE SWMI |
$275.87
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: PHP Medicare Advantage |
$275.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health HMO/PPO |
$960.01
|
| Rate for Payer: Priority Health Medicare |
$278.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$739.32
|
| Rate for Payer: Railroad Medicare Medicare |
$275.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.04
|
| Rate for Payer: UHC Core |
$921.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.87
|
| Rate for Payer: UHC Exchange |
$275.87
|
| Rate for Payer: UHC Medicare Advantage |
$275.87
|
| Rate for Payer: UHCCP Medicaid |
$643.68
|
| Rate for Payer: VA VA |
$275.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.60
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
IP
|
$1,103.46
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$717.25 |
| Max. Negotiated Rate |
$993.11 |
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: BCBS Trust/PPO |
$900.75
|
| Rate for Payer: BCN Commercial |
$852.75
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$904.84
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health HMO/PPO |
$960.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$739.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.04
|
| Rate for Payer: UHC Core |
$921.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.60
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
IP
|
$1,103.46
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$717.25 |
| Max. Negotiated Rate |
$993.11 |
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: BCBS Trust/PPO |
$900.75
|
| Rate for Payer: BCN Commercial |
$852.75
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$904.84
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health HMO/PPO |
$960.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$739.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.04
|
| Rate for Payer: UHC Core |
$921.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.60
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
OP
|
$1,103.46
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$262.07 |
| Max. Negotiated Rate |
$993.11 |
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: Aetna Medicare |
$286.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$344.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$344.83
|
| Rate for Payer: BCBS Complete |
$675.91
|
| Rate for Payer: BCBS MAPPO |
$275.87
|
| Rate for Payer: BCBS Trust/PPO |
$907.15
|
| Rate for Payer: BCN Commercial |
$857.94
|
| Rate for Payer: BCN Medicare Advantage |
$275.87
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.87
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.60
|
| Rate for Payer: Mclaren Medicaid |
$643.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$289.66
|
| Rate for Payer: Meridian Medicaid |
$675.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$904.84
|
| Rate for Payer: PACE Senior Care Partners |
$262.07
|
| Rate for Payer: PACE SWMI |
$275.87
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: PHP Medicare Advantage |
$275.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health HMO/PPO |
$960.01
|
| Rate for Payer: Priority Health Medicare |
$278.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$739.32
|
| Rate for Payer: Railroad Medicare Medicare |
$275.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.04
|
| Rate for Payer: UHC Core |
$921.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.87
|
| Rate for Payer: UHC Exchange |
$275.87
|
| Rate for Payer: UHC Medicare Advantage |
$275.87
|
| Rate for Payer: UHCCP Medicaid |
$643.68
|
| Rate for Payer: VA VA |
$275.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.60
|
|
