|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC BIL
|
Facility
|
OP
|
$2,586.63
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100623
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$614.32 |
| Max. Negotiated Rate |
$2,327.97 |
| Rate for Payer: Aetna Commercial |
$2,198.64
|
| Rate for Payer: Aetna Medicare |
$672.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$808.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$808.32
|
| Rate for Payer: BCBS Complete |
$675.91
|
| Rate for Payer: BCBS MAPPO |
$646.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,126.47
|
| Rate for Payer: BCN Commercial |
$2,011.10
|
| Rate for Payer: BCN Medicare Advantage |
$646.66
|
| Rate for Payer: Cash Price |
$2,069.30
|
| Rate for Payer: Cash Price |
$2,069.30
|
| Rate for Payer: Cofinity Commercial |
$2,224.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,069.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$646.66
|
| Rate for Payer: Healthscope Commercial |
$2,327.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,939.97
|
| Rate for Payer: Mclaren Medicaid |
$643.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$678.99
|
| Rate for Payer: Meridian Medicaid |
$675.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$743.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,198.64
|
| Rate for Payer: Nomi Health Commercial |
$2,121.04
|
| Rate for Payer: PACE Senior Care Partners |
$614.32
|
| Rate for Payer: PACE SWMI |
$646.66
|
| Rate for Payer: PHP Commercial |
$2,198.64
|
| Rate for Payer: PHP Medicare Advantage |
$646.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,681.31
|
| Rate for Payer: Priority Health HMO/PPO |
$2,250.37
|
| Rate for Payer: Priority Health Medicare |
$653.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,733.04
|
| Rate for Payer: Railroad Medicare Medicare |
$646.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,276.23
|
| Rate for Payer: UHC Core |
$2,159.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$646.66
|
| Rate for Payer: UHC Exchange |
$646.66
|
| Rate for Payer: UHC Medicare Advantage |
$646.66
|
| Rate for Payer: UHCCP Medicaid |
$643.68
|
| Rate for Payer: VA VA |
$646.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,939.97
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EA ADD
|
Facility
|
IP
|
$911.49
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$592.47 |
| Max. Negotiated Rate |
$820.34 |
| Rate for Payer: Aetna Commercial |
$774.77
|
| Rate for Payer: BCBS Trust/PPO |
$744.05
|
| Rate for Payer: BCN Commercial |
$704.40
|
| Rate for Payer: Cash Price |
$729.19
|
| Rate for Payer: Cofinity Commercial |
$783.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.19
|
| Rate for Payer: Healthscope Commercial |
$820.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.77
|
| Rate for Payer: Nomi Health Commercial |
$747.42
|
| Rate for Payer: PHP Commercial |
$774.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.47
|
| Rate for Payer: Priority Health HMO/PPO |
$793.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$610.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$802.11
|
| Rate for Payer: UHC Core |
$761.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.62
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EA ADD
|
Facility
|
OP
|
$911.49
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$216.48 |
| Max. Negotiated Rate |
$820.34 |
| Rate for Payer: Aetna Commercial |
$774.77
|
| Rate for Payer: Aetna Medicare |
$236.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$284.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$284.84
|
| Rate for Payer: BCBS Complete |
$364.60
|
| Rate for Payer: BCBS MAPPO |
$227.87
|
| Rate for Payer: BCBS Trust/PPO |
$749.34
|
| Rate for Payer: BCN Commercial |
$708.68
|
| Rate for Payer: BCN Medicare Advantage |
$227.87
|
| Rate for Payer: Cash Price |
$729.19
|
| Rate for Payer: Cofinity Commercial |
$783.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.87
|
| Rate for Payer: Healthscope Commercial |
$820.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$239.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$262.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.77
|
| Rate for Payer: Nomi Health Commercial |
$747.42
|
| Rate for Payer: PACE Senior Care Partners |
$216.48
|
| Rate for Payer: PACE SWMI |
$227.87
|
| Rate for Payer: PHP Commercial |
$774.77
|
| Rate for Payer: PHP Medicare Advantage |
$227.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.47
|
| Rate for Payer: Priority Health HMO/PPO |
$793.00
|
| Rate for Payer: Priority Health Medicare |
$230.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$610.70
|
| Rate for Payer: Railroad Medicare Medicare |
$227.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$802.11
|
| Rate for Payer: UHC Core |
$761.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$227.87
|
| Rate for Payer: UHC Exchange |
$227.87
|
| Rate for Payer: UHC Medicare Advantage |
$227.87
|
| Rate for Payer: VA VA |
$227.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.62
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL
|
Facility
|
IP
|
$1,367.24
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$888.71 |
| Max. Negotiated Rate |
$1,230.52 |
| Rate for Payer: Aetna Commercial |
$1,162.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,116.08
|
| Rate for Payer: BCN Commercial |
$1,056.60
|
| Rate for Payer: Cash Price |
$1,093.79
|
| Rate for Payer: Cofinity Commercial |
$1,175.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,093.79
|
| Rate for Payer: Healthscope Commercial |
$1,230.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,025.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,162.15
|
| Rate for Payer: Nomi Health Commercial |
$1,121.14
|
| Rate for Payer: PHP Commercial |
$1,162.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$888.71
|
| Rate for Payer: Priority Health HMO/PPO |
$1,189.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$916.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,203.17
|
| Rate for Payer: UHC Core |
$1,141.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,025.43
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL
|
Facility
|
OP
|
$1,367.24
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$324.72 |
| Max. Negotiated Rate |
$1,230.52 |
| Rate for Payer: Aetna Commercial |
$1,162.15
|
| Rate for Payer: Aetna Medicare |
$355.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.26
|
| Rate for Payer: BCBS Complete |
$546.90
|
| Rate for Payer: BCBS MAPPO |
$341.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,124.01
|
| Rate for Payer: BCN Commercial |
$1,063.03
|
| Rate for Payer: BCN Medicare Advantage |
$341.81
|
| Rate for Payer: Cash Price |
$1,093.79
|
| Rate for Payer: Cofinity Commercial |
$1,175.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,093.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.81
|
| Rate for Payer: Healthscope Commercial |
$1,230.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,025.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$358.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,162.15
|
| Rate for Payer: Nomi Health Commercial |
$1,121.14
|
| Rate for Payer: PACE Senior Care Partners |
$324.72
|
| Rate for Payer: PACE SWMI |
$341.81
|
| Rate for Payer: PHP Commercial |
$1,162.15
|
| Rate for Payer: PHP Medicare Advantage |
$341.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$888.71
|
| Rate for Payer: Priority Health HMO/PPO |
$1,189.50
|
| Rate for Payer: Priority Health Medicare |
$345.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$916.05
|
| Rate for Payer: Railroad Medicare Medicare |
$341.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,203.17
|
| Rate for Payer: UHC Core |
$1,141.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$341.81
|
| Rate for Payer: UHC Exchange |
$341.81
|
| Rate for Payer: UHC Medicare Advantage |
$341.81
|
| Rate for Payer: VA VA |
$341.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,025.43
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL
|
Facility
|
IP
|
$972.13
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$631.88 |
| Max. Negotiated Rate |
$874.92 |
| Rate for Payer: Aetna Commercial |
$826.31
|
| Rate for Payer: BCBS Trust/PPO |
$793.55
|
| Rate for Payer: BCN Commercial |
$751.26
|
| Rate for Payer: Cash Price |
$777.70
|
| Rate for Payer: Cofinity Commercial |
$836.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.70
|
| Rate for Payer: Healthscope Commercial |
$874.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$729.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$826.31
|
| Rate for Payer: Nomi Health Commercial |
$797.15
|
| Rate for Payer: PHP Commercial |
$826.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.88
|
| Rate for Payer: Priority Health HMO/PPO |
$845.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$651.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$855.47
|
| Rate for Payer: UHC Core |
$811.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$729.10
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL
|
Facility
|
OP
|
$972.13
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$230.88 |
| Max. Negotiated Rate |
$874.92 |
| Rate for Payer: Aetna Commercial |
$826.31
|
| Rate for Payer: Aetna Medicare |
$252.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$303.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$303.79
|
| Rate for Payer: BCBS Complete |
$388.85
|
| Rate for Payer: BCBS MAPPO |
$243.03
|
| Rate for Payer: BCBS Trust/PPO |
$799.19
|
| Rate for Payer: BCN Commercial |
$755.83
|
| Rate for Payer: BCN Medicare Advantage |
$243.03
|
| Rate for Payer: Cash Price |
$777.70
|
| Rate for Payer: Cofinity Commercial |
$836.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.03
|
| Rate for Payer: Healthscope Commercial |
$874.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$729.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$255.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$279.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$826.31
|
| Rate for Payer: Nomi Health Commercial |
$797.15
|
| Rate for Payer: PACE Senior Care Partners |
$230.88
|
| Rate for Payer: PACE SWMI |
$243.03
|
| Rate for Payer: PHP Commercial |
$826.31
|
| Rate for Payer: PHP Medicare Advantage |
$243.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.88
|
| Rate for Payer: Priority Health HMO/PPO |
$845.75
|
| Rate for Payer: Priority Health Medicare |
$245.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$651.33
|
| Rate for Payer: Railroad Medicare Medicare |
$243.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$855.47
|
| Rate for Payer: UHC Core |
$811.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$243.03
|
| Rate for Payer: UHC Exchange |
$243.03
|
| Rate for Payer: UHC Medicare Advantage |
$243.03
|
| Rate for Payer: VA VA |
$243.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$729.10
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL
|
Facility
|
IP
|
$1,458.19
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$947.82 |
| Max. Negotiated Rate |
$1,312.37 |
| Rate for Payer: Aetna Commercial |
$1,239.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,190.32
|
| Rate for Payer: BCN Commercial |
$1,126.89
|
| Rate for Payer: Cash Price |
$1,166.55
|
| Rate for Payer: Cofinity Commercial |
$1,254.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.55
|
| Rate for Payer: Healthscope Commercial |
$1,312.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,093.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.46
|
| Rate for Payer: Nomi Health Commercial |
$1,195.72
|
| Rate for Payer: PHP Commercial |
$1,239.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.82
|
| Rate for Payer: Priority Health HMO/PPO |
$1,268.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$976.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,283.21
|
| Rate for Payer: UHC Core |
$1,217.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,093.64
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL
|
Facility
|
OP
|
$1,458.19
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$346.32 |
| Max. Negotiated Rate |
$1,312.37 |
| Rate for Payer: Aetna Commercial |
$1,239.46
|
| Rate for Payer: Aetna Medicare |
$379.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$455.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$455.68
|
| Rate for Payer: BCBS Complete |
$583.28
|
| Rate for Payer: BCBS MAPPO |
$364.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,198.78
|
| Rate for Payer: BCN Commercial |
$1,133.74
|
| Rate for Payer: BCN Medicare Advantage |
$364.55
|
| Rate for Payer: Cash Price |
$1,166.55
|
| Rate for Payer: Cofinity Commercial |
$1,254.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$364.55
|
| Rate for Payer: Healthscope Commercial |
$1,312.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,093.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$382.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$419.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.46
|
| Rate for Payer: Nomi Health Commercial |
$1,195.72
|
| Rate for Payer: PACE Senior Care Partners |
$346.32
|
| Rate for Payer: PACE SWMI |
$364.55
|
| Rate for Payer: PHP Commercial |
$1,239.46
|
| Rate for Payer: PHP Medicare Advantage |
$364.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.82
|
| Rate for Payer: Priority Health HMO/PPO |
$1,268.63
|
| Rate for Payer: Priority Health Medicare |
$368.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$976.99
|
| Rate for Payer: Railroad Medicare Medicare |
$364.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,283.21
|
| Rate for Payer: UHC Core |
$1,217.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$364.55
|
| Rate for Payer: UHC Exchange |
$364.55
|
| Rate for Payer: UHC Medicare Advantage |
$364.55
|
| Rate for Payer: VA VA |
$364.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,093.64
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR SINGLE LEVEL
|
Facility
|
OP
|
$1,536.98
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$365.03 |
| Max. Negotiated Rate |
$1,383.28 |
| Rate for Payer: Aetna Commercial |
$1,306.43
|
| Rate for Payer: Aetna Medicare |
$399.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$480.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$480.31
|
| Rate for Payer: BCBS Complete |
$675.91
|
| Rate for Payer: BCBS MAPPO |
$384.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,263.55
|
| Rate for Payer: BCN Commercial |
$1,195.00
|
| Rate for Payer: BCN Medicare Advantage |
$384.25
|
| Rate for Payer: Cash Price |
$1,229.58
|
| Rate for Payer: Cash Price |
$1,229.58
|
| Rate for Payer: Cofinity Commercial |
$1,321.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.25
|
| Rate for Payer: Healthscope Commercial |
$1,383.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,152.73
|
| Rate for Payer: Mclaren Medicaid |
$643.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.46
|
| Rate for Payer: Meridian Medicaid |
$675.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,306.43
|
| Rate for Payer: Nomi Health Commercial |
$1,260.32
|
| Rate for Payer: PACE Senior Care Partners |
$365.03
|
| Rate for Payer: PACE SWMI |
$384.25
|
| Rate for Payer: PHP Commercial |
$1,306.43
|
| Rate for Payer: PHP Medicare Advantage |
$384.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$999.04
|
| Rate for Payer: Priority Health HMO/PPO |
$1,337.17
|
| Rate for Payer: Priority Health Medicare |
$388.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,029.78
|
| Rate for Payer: Railroad Medicare Medicare |
$384.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,352.54
|
| Rate for Payer: UHC Core |
$1,283.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$384.25
|
| Rate for Payer: UHC Exchange |
$384.25
|
| Rate for Payer: UHC Medicare Advantage |
$384.25
|
| Rate for Payer: UHCCP Medicaid |
$643.68
|
| Rate for Payer: VA VA |
$384.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,152.73
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR SINGLE LEVEL
|
Facility
|
IP
|
$1,536.98
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$999.04 |
| Max. Negotiated Rate |
$1,383.28 |
| Rate for Payer: Aetna Commercial |
$1,306.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,254.64
|
| Rate for Payer: BCN Commercial |
$1,187.78
|
| Rate for Payer: Cash Price |
$1,229.58
|
| Rate for Payer: Cofinity Commercial |
$1,321.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.58
|
| Rate for Payer: Healthscope Commercial |
$1,383.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,152.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,306.43
|
| Rate for Payer: Nomi Health Commercial |
$1,260.32
|
| Rate for Payer: PHP Commercial |
$1,306.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$999.04
|
| Rate for Payer: Priority Health HMO/PPO |
$1,337.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,029.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,352.54
|
| Rate for Payer: UHC Core |
$1,283.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,152.73
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SAC SINGLE LEVEL BIL
|
Facility
|
OP
|
$1,185.25
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$281.50 |
| Max. Negotiated Rate |
$1,066.72 |
| Rate for Payer: Aetna Commercial |
$1,007.46
|
| Rate for Payer: Aetna Medicare |
$308.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$370.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$370.39
|
| Rate for Payer: BCBS Complete |
$675.91
|
| Rate for Payer: BCBS MAPPO |
$296.31
|
| Rate for Payer: BCBS Trust/PPO |
$974.39
|
| Rate for Payer: BCN Commercial |
$921.53
|
| Rate for Payer: BCN Medicare Advantage |
$296.31
|
| Rate for Payer: Cash Price |
$948.20
|
| Rate for Payer: Cash Price |
$948.20
|
| Rate for Payer: Cofinity Commercial |
$1,019.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.31
|
| Rate for Payer: Healthscope Commercial |
$1,066.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$888.94
|
| Rate for Payer: Mclaren Medicaid |
$643.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.13
|
| Rate for Payer: Meridian Medicaid |
$675.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$340.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.46
|
| Rate for Payer: Nomi Health Commercial |
$971.90
|
| Rate for Payer: PACE Senior Care Partners |
$281.50
|
| Rate for Payer: PACE SWMI |
$296.31
|
| Rate for Payer: PHP Commercial |
$1,007.46
|
| Rate for Payer: PHP Medicare Advantage |
$296.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.41
|
| Rate for Payer: Priority Health HMO/PPO |
$1,031.17
|
| Rate for Payer: Priority Health Medicare |
$299.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$794.12
|
| Rate for Payer: Railroad Medicare Medicare |
$296.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,043.02
|
| Rate for Payer: UHC Core |
$989.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.31
|
| Rate for Payer: UHC Exchange |
$296.31
|
| Rate for Payer: UHC Medicare Advantage |
$296.31
|
| Rate for Payer: UHCCP Medicaid |
$643.68
|
| Rate for Payer: VA VA |
$296.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$888.94
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SAC SINGLE LEVEL BIL
|
Facility
|
IP
|
$1,185.25
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$770.41 |
| Max. Negotiated Rate |
$1,066.72 |
| Rate for Payer: Aetna Commercial |
$1,007.46
|
| Rate for Payer: BCBS Trust/PPO |
$967.52
|
| Rate for Payer: BCN Commercial |
$915.96
|
| Rate for Payer: Cash Price |
$948.20
|
| Rate for Payer: Cofinity Commercial |
$1,019.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.20
|
| Rate for Payer: Healthscope Commercial |
$1,066.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$888.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.46
|
| Rate for Payer: Nomi Health Commercial |
$971.90
|
| Rate for Payer: PHP Commercial |
$1,007.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.41
|
| Rate for Payer: Priority Health HMO/PPO |
$1,031.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$794.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,043.02
|
| Rate for Payer: UHC Core |
$989.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$888.94
|
|
|
HC INJECTION TURBINATE THERAPEUTIC
|
Facility
|
OP
|
$1,377.00
|
|
|
Service Code
|
CPT 30200
|
| Hospital Charge Code |
76100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.04 |
| Max. Negotiated Rate |
$1,239.30 |
| Rate for Payer: Aetna Commercial |
$1,170.45
|
| Rate for Payer: Aetna Medicare |
$358.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$430.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$430.31
|
| Rate for Payer: BCBS Complete |
$386.62
|
| Rate for Payer: BCBS MAPPO |
$344.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,132.03
|
| Rate for Payer: BCN Commercial |
$1,070.62
|
| Rate for Payer: BCN Medicare Advantage |
$344.25
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cofinity Commercial |
$1,184.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$344.25
|
| Rate for Payer: Healthscope Commercial |
$1,239.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.75
|
| Rate for Payer: Mclaren Medicaid |
$368.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$361.46
|
| Rate for Payer: Meridian Medicaid |
$386.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$395.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.45
|
| Rate for Payer: Nomi Health Commercial |
$1,129.14
|
| Rate for Payer: PACE Senior Care Partners |
$327.04
|
| Rate for Payer: PACE SWMI |
$344.25
|
| Rate for Payer: PHP Commercial |
$1,170.45
|
| Rate for Payer: PHP Medicare Advantage |
$344.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1,197.99
|
| Rate for Payer: Priority Health Medicare |
$347.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$922.59
|
| Rate for Payer: Railroad Medicare Medicare |
$344.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,211.76
|
| Rate for Payer: UHC Core |
$1,149.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$344.25
|
| Rate for Payer: UHC Exchange |
$344.25
|
| Rate for Payer: UHC Medicare Advantage |
$344.25
|
| Rate for Payer: UHCCP Medicaid |
$368.19
|
| Rate for Payer: VA VA |
$344.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.75
|
|
|
HC INJECTION TURBINATE THERAPEUTIC
|
Facility
|
IP
|
$1,377.00
|
|
|
Service Code
|
CPT 30200
|
| Hospital Charge Code |
76100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$895.05 |
| Max. Negotiated Rate |
$1,239.30 |
| Rate for Payer: Aetna Commercial |
$1,170.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,124.05
|
| Rate for Payer: BCN Commercial |
$1,064.15
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cofinity Commercial |
$1,184.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.60
|
| Rate for Payer: Healthscope Commercial |
$1,239.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.45
|
| Rate for Payer: Nomi Health Commercial |
$1,129.14
|
| Rate for Payer: PHP Commercial |
$1,170.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1,197.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$922.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,211.76
|
| Rate for Payer: UHC Core |
$1,149.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.75
|
|
|
HC INJECTION VENOGRAM
|
Facility
|
IP
|
$566.97
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
36100095
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$368.53 |
| Max. Negotiated Rate |
$510.27 |
| Rate for Payer: Aetna Commercial |
$481.92
|
| Rate for Payer: BCBS Trust/PPO |
$462.82
|
| Rate for Payer: BCN Commercial |
$438.15
|
| Rate for Payer: Cash Price |
$453.58
|
| Rate for Payer: Cofinity Commercial |
$487.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.58
|
| Rate for Payer: Healthscope Commercial |
$510.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$425.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.92
|
| Rate for Payer: Nomi Health Commercial |
$464.92
|
| Rate for Payer: PHP Commercial |
$481.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.53
|
| Rate for Payer: Priority Health HMO/PPO |
$493.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$498.93
|
| Rate for Payer: UHC Core |
$473.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$425.23
|
|
|
HC INJECTION VENOGRAM
|
Facility
|
OP
|
$566.97
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
36100095
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$134.66 |
| Max. Negotiated Rate |
$510.27 |
| Rate for Payer: Aetna Commercial |
$481.92
|
| Rate for Payer: Aetna Medicare |
$147.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.18
|
| Rate for Payer: BCBS Complete |
$226.79
|
| Rate for Payer: BCBS MAPPO |
$141.74
|
| Rate for Payer: BCBS Trust/PPO |
$466.11
|
| Rate for Payer: BCN Commercial |
$440.82
|
| Rate for Payer: BCN Medicare Advantage |
$141.74
|
| Rate for Payer: Cash Price |
$453.58
|
| Rate for Payer: Cofinity Commercial |
$487.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.74
|
| Rate for Payer: Healthscope Commercial |
$510.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$425.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.92
|
| Rate for Payer: Nomi Health Commercial |
$464.92
|
| Rate for Payer: PACE Senior Care Partners |
$134.66
|
| Rate for Payer: PACE SWMI |
$141.74
|
| Rate for Payer: PHP Commercial |
$481.92
|
| Rate for Payer: PHP Medicare Advantage |
$141.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.53
|
| Rate for Payer: Priority Health HMO/PPO |
$493.26
|
| Rate for Payer: Priority Health Medicare |
$143.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.87
|
| Rate for Payer: Railroad Medicare Medicare |
$141.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$498.93
|
| Rate for Payer: UHC Core |
$473.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.74
|
| Rate for Payer: UHC Exchange |
$141.74
|
| Rate for Payer: UHC Medicare Advantage |
$141.74
|
| Rate for Payer: VA VA |
$141.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$425.23
|
|
|
HC INJECTION WRIST ARTHROGRAM
|
Facility
|
IP
|
$1,152.20
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
36100039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$748.93 |
| Max. Negotiated Rate |
$1,036.98 |
| Rate for Payer: Aetna Commercial |
$979.37
|
| Rate for Payer: BCBS Trust/PPO |
$940.54
|
| Rate for Payer: BCN Commercial |
$890.42
|
| Rate for Payer: Cash Price |
$921.76
|
| Rate for Payer: Cofinity Commercial |
$990.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$921.76
|
| Rate for Payer: Healthscope Commercial |
$1,036.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$864.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$979.37
|
| Rate for Payer: Nomi Health Commercial |
$944.80
|
| Rate for Payer: PHP Commercial |
$979.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$748.93
|
| Rate for Payer: Priority Health HMO/PPO |
$1,002.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$771.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,013.94
|
| Rate for Payer: UHC Core |
$962.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$864.15
|
|
|
HC INJECTION WRIST ARTHROGRAM
|
Facility
|
OP
|
$1,152.20
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
36100039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$273.65 |
| Max. Negotiated Rate |
$1,036.98 |
| Rate for Payer: Aetna Commercial |
$979.37
|
| Rate for Payer: Aetna Medicare |
$299.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$360.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$360.06
|
| Rate for Payer: BCBS Complete |
$460.88
|
| Rate for Payer: BCBS MAPPO |
$288.05
|
| Rate for Payer: BCBS Trust/PPO |
$947.22
|
| Rate for Payer: BCN Commercial |
$895.84
|
| Rate for Payer: BCN Medicare Advantage |
$288.05
|
| Rate for Payer: Cash Price |
$921.76
|
| Rate for Payer: Cofinity Commercial |
$990.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$921.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$288.05
|
| Rate for Payer: Healthscope Commercial |
$1,036.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$864.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$979.37
|
| Rate for Payer: Nomi Health Commercial |
$944.80
|
| Rate for Payer: PACE Senior Care Partners |
$273.65
|
| Rate for Payer: PACE SWMI |
$288.05
|
| Rate for Payer: PHP Commercial |
$979.37
|
| Rate for Payer: PHP Medicare Advantage |
$288.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$748.93
|
| Rate for Payer: Priority Health HMO/PPO |
$1,002.41
|
| Rate for Payer: Priority Health Medicare |
$290.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$771.97
|
| Rate for Payer: Railroad Medicare Medicare |
$288.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,013.94
|
| Rate for Payer: UHC Core |
$962.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$288.05
|
| Rate for Payer: UHC Exchange |
$288.05
|
| Rate for Payer: UHC Medicare Advantage |
$288.05
|
| Rate for Payer: VA VA |
$288.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$864.15
|
|
|
HC INJECT/IRRIGATE CORPORA CAVERNOSA
|
Facility
|
IP
|
$373.37
|
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.69 |
| Max. Negotiated Rate |
$336.03 |
| Rate for Payer: Aetna Commercial |
$317.36
|
| Rate for Payer: BCBS Trust/PPO |
$304.78
|
| Rate for Payer: BCN Commercial |
$288.54
|
| Rate for Payer: Cash Price |
$298.70
|
| Rate for Payer: Cofinity Commercial |
$321.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.70
|
| Rate for Payer: Healthscope Commercial |
$336.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.36
|
| Rate for Payer: Nomi Health Commercial |
$306.16
|
| Rate for Payer: PHP Commercial |
$317.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.69
|
| Rate for Payer: Priority Health HMO/PPO |
$324.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.57
|
| Rate for Payer: UHC Core |
$311.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.03
|
|
|
HC INJECT/IRRIGATE CORPORA CAVERNOSA
|
Facility
|
OP
|
$373.37
|
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.68 |
| Max. Negotiated Rate |
$336.03 |
| Rate for Payer: Aetna Commercial |
$317.36
|
| Rate for Payer: Aetna Medicare |
$97.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.68
|
| Rate for Payer: BCBS Complete |
$149.35
|
| Rate for Payer: BCBS MAPPO |
$93.34
|
| Rate for Payer: BCBS Trust/PPO |
$306.95
|
| Rate for Payer: BCN Commercial |
$290.30
|
| Rate for Payer: BCN Medicare Advantage |
$93.34
|
| Rate for Payer: Cash Price |
$298.70
|
| Rate for Payer: Cofinity Commercial |
$321.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.34
|
| Rate for Payer: Healthscope Commercial |
$336.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.36
|
| Rate for Payer: Nomi Health Commercial |
$306.16
|
| Rate for Payer: PACE Senior Care Partners |
$88.68
|
| Rate for Payer: PACE SWMI |
$93.34
|
| Rate for Payer: PHP Commercial |
$317.36
|
| Rate for Payer: PHP Medicare Advantage |
$93.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.69
|
| Rate for Payer: Priority Health HMO/PPO |
$324.83
|
| Rate for Payer: Priority Health Medicare |
$94.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.16
|
| Rate for Payer: Railroad Medicare Medicare |
$93.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.57
|
| Rate for Payer: UHC Core |
$311.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.34
|
| Rate for Payer: UHC Exchange |
$93.34
|
| Rate for Payer: UHC Medicare Advantage |
$93.34
|
| Rate for Payer: VA VA |
$93.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.03
|
|
|
HC INJECT PORTAL VEIN
|
Facility
|
IP
|
$2,780.89
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
36100543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,807.58 |
| Max. Negotiated Rate |
$2,502.80 |
| Rate for Payer: Aetna Commercial |
$2,363.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,270.04
|
| Rate for Payer: BCN Commercial |
$2,149.07
|
| Rate for Payer: Cash Price |
$2,224.71
|
| Rate for Payer: Cofinity Commercial |
$2,391.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,224.71
|
| Rate for Payer: Healthscope Commercial |
$2,502.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,085.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.76
|
| Rate for Payer: Nomi Health Commercial |
$2,280.33
|
| Rate for Payer: PHP Commercial |
$2,363.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.58
|
| Rate for Payer: Priority Health HMO/PPO |
$2,419.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,863.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,447.18
|
| Rate for Payer: UHC Core |
$2,322.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,085.67
|
|
|
HC INJECT PORTAL VEIN
|
Facility
|
OP
|
$2,780.89
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
36100543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$660.46 |
| Max. Negotiated Rate |
$2,502.80 |
| Rate for Payer: Aetna Commercial |
$2,363.76
|
| Rate for Payer: Aetna Medicare |
$723.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$869.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$869.03
|
| Rate for Payer: BCBS Complete |
$1,112.36
|
| Rate for Payer: BCBS MAPPO |
$695.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,286.17
|
| Rate for Payer: BCN Commercial |
$2,162.14
|
| Rate for Payer: BCN Medicare Advantage |
$695.22
|
| Rate for Payer: Cash Price |
$2,224.71
|
| Rate for Payer: Cofinity Commercial |
$2,391.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,224.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.22
|
| Rate for Payer: Healthscope Commercial |
$2,502.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,085.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$799.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.76
|
| Rate for Payer: Nomi Health Commercial |
$2,280.33
|
| Rate for Payer: PACE Senior Care Partners |
$660.46
|
| Rate for Payer: PACE SWMI |
$695.22
|
| Rate for Payer: PHP Commercial |
$2,363.76
|
| Rate for Payer: PHP Medicare Advantage |
$695.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.58
|
| Rate for Payer: Priority Health HMO/PPO |
$2,419.37
|
| Rate for Payer: Priority Health Medicare |
$702.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,863.20
|
| Rate for Payer: Railroad Medicare Medicare |
$695.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,447.18
|
| Rate for Payer: UHC Core |
$2,322.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.22
|
| Rate for Payer: UHC Exchange |
$695.22
|
| Rate for Payer: UHC Medicare Advantage |
$695.22
|
| Rate for Payer: VA VA |
$695.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,085.67
|
|
|
HC INJECT PROC PENILE PLAQUE
|
Facility
|
OP
|
$361.15
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.77 |
| Max. Negotiated Rate |
$325.04 |
| Rate for Payer: Aetna Commercial |
$306.98
|
| Rate for Payer: Aetna Medicare |
$93.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.86
|
| Rate for Payer: BCBS Complete |
$184.65
|
| Rate for Payer: BCBS MAPPO |
$90.29
|
| Rate for Payer: BCBS Trust/PPO |
$296.90
|
| Rate for Payer: BCN Commercial |
$280.79
|
| Rate for Payer: BCN Medicare Advantage |
$90.29
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.29
|
| Rate for Payer: Healthscope Commercial |
$325.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.86
|
| Rate for Payer: Mclaren Medicaid |
$175.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.80
|
| Rate for Payer: Meridian Medicaid |
$184.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.98
|
| Rate for Payer: Nomi Health Commercial |
$296.14
|
| Rate for Payer: PACE Senior Care Partners |
$85.77
|
| Rate for Payer: PACE SWMI |
$90.29
|
| Rate for Payer: PHP Commercial |
$306.98
|
| Rate for Payer: PHP Medicare Advantage |
$90.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.75
|
| Rate for Payer: Priority Health HMO/PPO |
$314.20
|
| Rate for Payer: Priority Health Medicare |
$91.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.97
|
| Rate for Payer: Railroad Medicare Medicare |
$90.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.81
|
| Rate for Payer: UHC Core |
$301.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.29
|
| Rate for Payer: UHC Exchange |
$90.29
|
| Rate for Payer: UHC Medicare Advantage |
$90.29
|
| Rate for Payer: UHCCP Medicaid |
$175.84
|
| Rate for Payer: VA VA |
$90.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.86
|
|
|
HC INJECT PROC PENILE PLAQUE
|
Facility
|
IP
|
$361.15
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.75 |
| Max. Negotiated Rate |
$325.04 |
| Rate for Payer: Aetna Commercial |
$306.98
|
| Rate for Payer: BCBS Trust/PPO |
$294.81
|
| Rate for Payer: BCN Commercial |
$279.10
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.92
|
| Rate for Payer: Healthscope Commercial |
$325.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.98
|
| Rate for Payer: Nomi Health Commercial |
$296.14
|
| Rate for Payer: PHP Commercial |
$306.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.75
|
| Rate for Payer: Priority Health HMO/PPO |
$314.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.81
|
| Rate for Payer: UHC Core |
$301.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.86
|
|
