|
HC INJECTION, TESTOSTERONE CYPIONATE, 1 MG
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
CPT J1071
|
| Hospital Charge Code |
63600109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: ASR ASR |
$0.16
|
| Rate for Payer: BCBS Complete |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cofinity Commercial |
$0.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.13
|
| Rate for Payer: Healthscope Commercial |
$0.16
|
| Rate for Payer: Healthscope Whirlpool |
$0.16
|
| Rate for Payer: Mclaren Commercial |
$0.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.15
|
| Rate for Payer: Priority Health Narrow Network |
$0.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.14
|
|
|
HC INJECTION THERAPEUTIC SINUS TRACT
|
Facility
|
OP
|
$905.55
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
36100020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$633.88 |
| Max. Negotiated Rate |
$1,694.48 |
| Rate for Payer: Aetna Commercial |
$815.00
|
| Rate for Payer: Aetna Medicare |
$1,355.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,694.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,694.48
|
| Rate for Payer: ASR ASR |
$878.38
|
| Rate for Payer: BCBS Complete |
$778.65
|
| Rate for Payer: BCBS MAPPO |
$1,355.58
|
| Rate for Payer: BCBS Trust/PPO |
$702.07
|
| Rate for Payer: BCN Commercial |
$702.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,355.58
|
| Rate for Payer: Cash Price |
$724.44
|
| Rate for Payer: Cash Price |
$724.44
|
| Rate for Payer: Cofinity Commercial |
$851.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,355.58
|
| Rate for Payer: Healthscope Commercial |
$905.55
|
| Rate for Payer: Healthscope Whirlpool |
$878.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,355.58
|
| Rate for Payer: Mclaren Commercial |
$815.00
|
| Rate for Payer: Mclaren Medicaid |
$741.50
|
| Rate for Payer: Mclaren Medicare |
$1,355.58
|
| Rate for Payer: Meridian Medicaid |
$778.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,423.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,558.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$769.72
|
| Rate for Payer: PACE Medicare |
$1,287.80
|
| Rate for Payer: PACE SWMI |
$1,355.58
|
| Rate for Payer: PHP Commercial |
$1,491.14
|
| Rate for Payer: PHP Medicaid |
$741.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,355.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$741.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$824.05
|
| Rate for Payer: Priority Health Medicare |
$1,355.58
|
| Rate for Payer: Priority Health Narrow Network |
$642.94
|
| Rate for Payer: Railroad Medicare Medicare |
$1,355.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$796.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,396.25
|
| Rate for Payer: VA VA |
$1,355.58
|
|
|
HC INJECTION THERAPEUTIC SINUS TRACT
|
Facility
|
IP
|
$905.55
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
36100020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$633.88 |
| Max. Negotiated Rate |
$905.55 |
| Rate for Payer: Aetna Commercial |
$815.00
|
| Rate for Payer: ASR ASR |
$878.38
|
| Rate for Payer: BCBS Trust/PPO |
$702.07
|
| Rate for Payer: BCN Commercial |
$702.07
|
| Rate for Payer: Cash Price |
$724.44
|
| Rate for Payer: Cofinity Commercial |
$851.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.44
|
| Rate for Payer: Healthscope Commercial |
$905.55
|
| Rate for Payer: Healthscope Whirlpool |
$878.38
|
| Rate for Payer: Mclaren Commercial |
$815.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$769.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$796.88
|
|
|
HC INJECTION TRANSFORAMINAL CERVICAL OR THORACIC
|
Facility
|
OP
|
$1,690.61
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$443.17 |
| Max. Negotiated Rate |
$1,690.61 |
| Rate for Payer: Aetna Commercial |
$1,521.55
|
| Rate for Payer: Aetna Medicare |
$810.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,012.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,012.74
|
| Rate for Payer: ASR ASR |
$1,639.89
|
| Rate for Payer: BCBS Complete |
$465.37
|
| Rate for Payer: BCBS MAPPO |
$810.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,310.73
|
| Rate for Payer: BCN Commercial |
$1,310.73
|
| Rate for Payer: BCN Medicare Advantage |
$810.19
|
| Rate for Payer: Cash Price |
$1,352.49
|
| Rate for Payer: Cash Price |
$1,352.49
|
| Rate for Payer: Cofinity Commercial |
$1,589.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,352.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.19
|
| Rate for Payer: Healthscope Commercial |
$1,690.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,639.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$810.19
|
| Rate for Payer: Mclaren Commercial |
$1,521.55
|
| Rate for Payer: Mclaren Medicaid |
$443.17
|
| Rate for Payer: Mclaren Medicare |
$810.19
|
| Rate for Payer: Meridian Medicaid |
$465.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$850.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$931.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,437.02
|
| Rate for Payer: PACE Medicare |
$769.68
|
| Rate for Payer: PACE SWMI |
$810.19
|
| Rate for Payer: PHP Commercial |
$891.21
|
| Rate for Payer: PHP Medicaid |
$443.17
|
| Rate for Payer: PHP Medicare Advantage |
$810.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,183.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,538.46
|
| Rate for Payer: Priority Health Medicare |
$810.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,200.33
|
| Rate for Payer: Railroad Medicare Medicare |
$810.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,487.74
|
| Rate for Payer: UHC Medicare Advantage |
$834.50
|
| Rate for Payer: VA VA |
$810.19
|
|
|
HC INJECTION TRANSFORAMINAL CERVICAL OR THORACIC
|
Facility
|
IP
|
$1,690.61
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,183.43 |
| Max. Negotiated Rate |
$1,690.61 |
| Rate for Payer: Aetna Commercial |
$1,521.55
|
| Rate for Payer: ASR ASR |
$1,639.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,310.73
|
| Rate for Payer: BCN Commercial |
$1,310.73
|
| Rate for Payer: Cash Price |
$1,352.49
|
| Rate for Payer: Cofinity Commercial |
$1,589.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,352.49
|
| Rate for Payer: Healthscope Commercial |
$1,690.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,639.89
|
| Rate for Payer: Mclaren Commercial |
$1,521.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,437.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,183.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,487.74
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC BIL
|
Facility
|
OP
|
$2,535.91
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100623
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$443.17 |
| Max. Negotiated Rate |
$2,535.91 |
| Rate for Payer: Aetna Commercial |
$2,282.32
|
| Rate for Payer: Aetna Medicare |
$810.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,012.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,012.74
|
| Rate for Payer: ASR ASR |
$2,459.83
|
| Rate for Payer: BCBS Complete |
$465.37
|
| Rate for Payer: BCBS MAPPO |
$810.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,966.09
|
| Rate for Payer: BCN Commercial |
$1,966.09
|
| Rate for Payer: BCN Medicare Advantage |
$810.19
|
| Rate for Payer: Cash Price |
$2,028.73
|
| Rate for Payer: Cash Price |
$2,028.73
|
| Rate for Payer: Cofinity Commercial |
$2,383.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,028.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.19
|
| Rate for Payer: Healthscope Commercial |
$2,535.91
|
| Rate for Payer: Healthscope Whirlpool |
$2,459.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$810.19
|
| Rate for Payer: Mclaren Commercial |
$2,282.32
|
| Rate for Payer: Mclaren Medicaid |
$443.17
|
| Rate for Payer: Mclaren Medicare |
$810.19
|
| Rate for Payer: Meridian Medicaid |
$465.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$850.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$931.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,155.52
|
| Rate for Payer: PACE Medicare |
$769.68
|
| Rate for Payer: PACE SWMI |
$810.19
|
| Rate for Payer: PHP Commercial |
$891.21
|
| Rate for Payer: PHP Medicaid |
$443.17
|
| Rate for Payer: PHP Medicare Advantage |
$810.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,775.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,307.68
|
| Rate for Payer: Priority Health Medicare |
$810.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,800.50
|
| Rate for Payer: Railroad Medicare Medicare |
$810.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,231.60
|
| Rate for Payer: UHC Medicare Advantage |
$834.50
|
| Rate for Payer: VA VA |
$810.19
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC BIL
|
Facility
|
IP
|
$2,535.91
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100623
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,775.14 |
| Max. Negotiated Rate |
$2,535.91 |
| Rate for Payer: Aetna Commercial |
$2,282.32
|
| Rate for Payer: ASR ASR |
$2,459.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,966.09
|
| Rate for Payer: BCN Commercial |
$1,966.09
|
| Rate for Payer: Cash Price |
$2,028.73
|
| Rate for Payer: Cofinity Commercial |
$2,383.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,028.73
|
| Rate for Payer: Healthscope Commercial |
$2,535.91
|
| Rate for Payer: Healthscope Whirlpool |
$2,459.83
|
| Rate for Payer: Mclaren Commercial |
$2,282.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,155.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,775.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,231.60
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EA ADD
|
Facility
|
OP
|
$893.62
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$357.45 |
| Max. Negotiated Rate |
$893.62 |
| Rate for Payer: Aetna Commercial |
$804.26
|
| Rate for Payer: ASR ASR |
$866.81
|
| Rate for Payer: BCBS Complete |
$357.45
|
| Rate for Payer: BCBS Trust/PPO |
$692.82
|
| Rate for Payer: BCN Commercial |
$692.82
|
| Rate for Payer: Cash Price |
$714.90
|
| Rate for Payer: Cofinity Commercial |
$840.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$714.90
|
| Rate for Payer: Healthscope Commercial |
$893.62
|
| Rate for Payer: Healthscope Whirlpool |
$866.81
|
| Rate for Payer: Mclaren Commercial |
$804.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$759.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$625.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.19
|
| Rate for Payer: Priority Health Narrow Network |
$634.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$786.39
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EA ADD
|
Facility
|
IP
|
$893.62
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$625.53 |
| Max. Negotiated Rate |
$893.62 |
| Rate for Payer: Aetna Commercial |
$804.26
|
| Rate for Payer: ASR ASR |
$866.81
|
| Rate for Payer: BCBS Trust/PPO |
$692.82
|
| Rate for Payer: BCN Commercial |
$692.82
|
| Rate for Payer: Cash Price |
$714.90
|
| Rate for Payer: Cofinity Commercial |
$840.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$714.90
|
| Rate for Payer: Healthscope Commercial |
$893.62
|
| Rate for Payer: Healthscope Whirlpool |
$866.81
|
| Rate for Payer: Mclaren Commercial |
$804.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$759.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$625.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$786.39
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL
|
Facility
|
OP
|
$1,340.43
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$536.17 |
| Max. Negotiated Rate |
$1,340.43 |
| Rate for Payer: Aetna Commercial |
$1,206.39
|
| Rate for Payer: ASR ASR |
$1,300.22
|
| Rate for Payer: BCBS Complete |
$536.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,039.24
|
| Rate for Payer: BCN Commercial |
$1,039.24
|
| Rate for Payer: Cash Price |
$1,072.34
|
| Rate for Payer: Cofinity Commercial |
$1,260.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,072.34
|
| Rate for Payer: Healthscope Commercial |
$1,340.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,300.22
|
| Rate for Payer: Mclaren Commercial |
$1,206.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,139.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$938.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,219.79
|
| Rate for Payer: Priority Health Narrow Network |
$951.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,179.58
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL
|
Facility
|
IP
|
$1,340.43
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$938.30 |
| Max. Negotiated Rate |
$1,340.43 |
| Rate for Payer: Aetna Commercial |
$1,206.39
|
| Rate for Payer: ASR ASR |
$1,300.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,039.24
|
| Rate for Payer: BCN Commercial |
$1,039.24
|
| Rate for Payer: Cash Price |
$1,072.34
|
| Rate for Payer: Cofinity Commercial |
$1,260.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,072.34
|
| Rate for Payer: Healthscope Commercial |
$1,340.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,300.22
|
| Rate for Payer: Mclaren Commercial |
$1,206.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,139.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$938.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,179.58
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL
|
Facility
|
IP
|
$953.07
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$667.15 |
| Max. Negotiated Rate |
$953.07 |
| Rate for Payer: Aetna Commercial |
$857.76
|
| Rate for Payer: ASR ASR |
$924.48
|
| Rate for Payer: BCBS Trust/PPO |
$738.92
|
| Rate for Payer: BCN Commercial |
$738.92
|
| Rate for Payer: Cash Price |
$762.46
|
| Rate for Payer: Cofinity Commercial |
$895.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$762.46
|
| Rate for Payer: Healthscope Commercial |
$953.07
|
| Rate for Payer: Healthscope Whirlpool |
$924.48
|
| Rate for Payer: Mclaren Commercial |
$857.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$810.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$667.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$838.70
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL
|
Facility
|
OP
|
$953.07
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$381.23 |
| Max. Negotiated Rate |
$953.07 |
| Rate for Payer: Aetna Commercial |
$857.76
|
| Rate for Payer: ASR ASR |
$924.48
|
| Rate for Payer: BCBS Complete |
$381.23
|
| Rate for Payer: BCBS Trust/PPO |
$738.92
|
| Rate for Payer: BCN Commercial |
$738.92
|
| Rate for Payer: Cash Price |
$762.46
|
| Rate for Payer: Cofinity Commercial |
$895.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$762.46
|
| Rate for Payer: Healthscope Commercial |
$953.07
|
| Rate for Payer: Healthscope Whirlpool |
$924.48
|
| Rate for Payer: Mclaren Commercial |
$857.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$810.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$667.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$867.29
|
| Rate for Payer: Priority Health Narrow Network |
$676.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$838.70
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL
|
Facility
|
OP
|
$1,429.60
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$571.84 |
| Max. Negotiated Rate |
$1,429.60 |
| Rate for Payer: Aetna Commercial |
$1,286.64
|
| Rate for Payer: ASR ASR |
$1,386.71
|
| Rate for Payer: BCBS Complete |
$571.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,108.37
|
| Rate for Payer: BCN Commercial |
$1,108.37
|
| Rate for Payer: Cash Price |
$1,143.68
|
| Rate for Payer: Cofinity Commercial |
$1,343.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.68
|
| Rate for Payer: Healthscope Commercial |
$1,429.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,386.71
|
| Rate for Payer: Mclaren Commercial |
$1,286.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,215.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,000.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,300.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,015.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,258.05
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL
|
Facility
|
IP
|
$1,429.60
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,000.72 |
| Max. Negotiated Rate |
$1,429.60 |
| Rate for Payer: Aetna Commercial |
$1,286.64
|
| Rate for Payer: ASR ASR |
$1,386.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,108.37
|
| Rate for Payer: BCN Commercial |
$1,108.37
|
| Rate for Payer: Cash Price |
$1,143.68
|
| Rate for Payer: Cofinity Commercial |
$1,343.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.68
|
| Rate for Payer: Healthscope Commercial |
$1,429.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,386.71
|
| Rate for Payer: Mclaren Commercial |
$1,286.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,215.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,000.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,258.05
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR SINGLE LEVEL
|
Facility
|
IP
|
$1,475.91
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,033.14 |
| Max. Negotiated Rate |
$1,475.91 |
| Rate for Payer: Aetna Commercial |
$1,328.32
|
| Rate for Payer: ASR ASR |
$1,431.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,144.27
|
| Rate for Payer: BCN Commercial |
$1,144.27
|
| Rate for Payer: Cash Price |
$1,180.73
|
| Rate for Payer: Cofinity Commercial |
$1,387.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,180.73
|
| Rate for Payer: Healthscope Commercial |
$1,475.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,431.63
|
| Rate for Payer: Mclaren Commercial |
$1,328.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,254.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,298.80
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR SINGLE LEVEL
|
Facility
|
OP
|
$1,475.91
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$443.17 |
| Max. Negotiated Rate |
$1,475.91 |
| Rate for Payer: Aetna Commercial |
$1,328.32
|
| Rate for Payer: Aetna Medicare |
$810.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,012.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,012.74
|
| Rate for Payer: ASR ASR |
$1,431.63
|
| Rate for Payer: BCBS Complete |
$465.37
|
| Rate for Payer: BCBS MAPPO |
$810.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,144.27
|
| Rate for Payer: BCN Commercial |
$1,144.27
|
| Rate for Payer: BCN Medicare Advantage |
$810.19
|
| Rate for Payer: Cash Price |
$1,180.73
|
| Rate for Payer: Cash Price |
$1,180.73
|
| Rate for Payer: Cofinity Commercial |
$1,387.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,180.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.19
|
| Rate for Payer: Healthscope Commercial |
$1,475.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,431.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$810.19
|
| Rate for Payer: Mclaren Commercial |
$1,328.32
|
| Rate for Payer: Mclaren Medicaid |
$443.17
|
| Rate for Payer: Mclaren Medicare |
$810.19
|
| Rate for Payer: Meridian Medicaid |
$465.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$850.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$931.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,254.52
|
| Rate for Payer: PACE Medicare |
$769.68
|
| Rate for Payer: PACE SWMI |
$810.19
|
| Rate for Payer: PHP Commercial |
$891.21
|
| Rate for Payer: PHP Medicaid |
$443.17
|
| Rate for Payer: PHP Medicare Advantage |
$810.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,343.08
|
| Rate for Payer: Priority Health Medicare |
$810.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,047.90
|
| Rate for Payer: Railroad Medicare Medicare |
$810.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,298.80
|
| Rate for Payer: UHC Medicare Advantage |
$834.50
|
| Rate for Payer: VA VA |
$810.19
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SAC SINGLE LEVEL BIL
|
Facility
|
OP
|
$1,162.01
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$443.17 |
| Max. Negotiated Rate |
$1,162.01 |
| Rate for Payer: Aetna Commercial |
$1,045.81
|
| Rate for Payer: Aetna Medicare |
$810.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,012.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,012.74
|
| Rate for Payer: ASR ASR |
$1,127.15
|
| Rate for Payer: BCBS Complete |
$465.37
|
| Rate for Payer: BCBS MAPPO |
$810.19
|
| Rate for Payer: BCBS Trust/PPO |
$900.91
|
| Rate for Payer: BCN Commercial |
$900.91
|
| Rate for Payer: BCN Medicare Advantage |
$810.19
|
| Rate for Payer: Cash Price |
$929.61
|
| Rate for Payer: Cash Price |
$929.61
|
| Rate for Payer: Cofinity Commercial |
$1,092.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.19
|
| Rate for Payer: Healthscope Commercial |
$1,162.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,127.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$810.19
|
| Rate for Payer: Mclaren Commercial |
$1,045.81
|
| Rate for Payer: Mclaren Medicaid |
$443.17
|
| Rate for Payer: Mclaren Medicare |
$810.19
|
| Rate for Payer: Meridian Medicaid |
$465.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$850.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$931.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$987.71
|
| Rate for Payer: PACE Medicare |
$769.68
|
| Rate for Payer: PACE SWMI |
$810.19
|
| Rate for Payer: PHP Commercial |
$891.21
|
| Rate for Payer: PHP Medicaid |
$443.17
|
| Rate for Payer: PHP Medicare Advantage |
$810.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,057.43
|
| Rate for Payer: Priority Health Medicare |
$810.19
|
| Rate for Payer: Priority Health Narrow Network |
$825.03
|
| Rate for Payer: Railroad Medicare Medicare |
$810.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,022.57
|
| Rate for Payer: UHC Medicare Advantage |
$834.50
|
| Rate for Payer: VA VA |
$810.19
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SAC SINGLE LEVEL BIL
|
Facility
|
IP
|
$1,162.01
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$813.41 |
| Max. Negotiated Rate |
$1,162.01 |
| Rate for Payer: Aetna Commercial |
$1,045.81
|
| Rate for Payer: ASR ASR |
$1,127.15
|
| Rate for Payer: BCBS Trust/PPO |
$900.91
|
| Rate for Payer: BCN Commercial |
$900.91
|
| Rate for Payer: Cash Price |
$929.61
|
| Rate for Payer: Cofinity Commercial |
$1,092.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.61
|
| Rate for Payer: Healthscope Commercial |
$1,162.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,127.15
|
| Rate for Payer: Mclaren Commercial |
$1,045.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$987.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$813.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,022.57
|
|
|
HC INJECTION TURBINATE THERAPEUTIC
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT 30200
|
| Hospital Charge Code |
76100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.52 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$1,215.00
|
| Rate for Payer: Aetna Medicare |
$489.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$611.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$611.32
|
| Rate for Payer: ASR ASR |
$1,309.50
|
| Rate for Payer: BCBS Complete |
$280.92
|
| Rate for Payer: BCBS MAPPO |
$489.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,046.66
|
| Rate for Payer: BCN Commercial |
$1,046.66
|
| Rate for Payer: BCN Medicare Advantage |
$489.06
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cofinity Commercial |
$1,269.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,080.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.06
|
| Rate for Payer: Healthscope Commercial |
$1,350.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,309.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$489.06
|
| Rate for Payer: Mclaren Commercial |
$1,215.00
|
| Rate for Payer: Mclaren Medicaid |
$267.52
|
| Rate for Payer: Mclaren Medicare |
$489.06
|
| Rate for Payer: Meridian Medicaid |
$280.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$513.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$562.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.50
|
| Rate for Payer: PACE Medicare |
$464.61
|
| Rate for Payer: PACE SWMI |
$489.06
|
| Rate for Payer: PHP Commercial |
$537.97
|
| Rate for Payer: PHP Medicaid |
$267.52
|
| Rate for Payer: PHP Medicare Advantage |
$489.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,228.50
|
| Rate for Payer: Priority Health Medicare |
$489.06
|
| Rate for Payer: Priority Health Narrow Network |
$958.50
|
| Rate for Payer: Railroad Medicare Medicare |
$489.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,188.00
|
| Rate for Payer: UHC Medicare Advantage |
$503.73
|
| Rate for Payer: VA VA |
$489.06
|
|
|
HC INJECTION TURBINATE THERAPEUTIC
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT 30200
|
| Hospital Charge Code |
76100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$945.00 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$1,215.00
|
| Rate for Payer: ASR ASR |
$1,309.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,046.66
|
| Rate for Payer: BCN Commercial |
$1,046.66
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cofinity Commercial |
$1,269.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,080.00
|
| Rate for Payer: Healthscope Commercial |
$1,350.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,309.50
|
| Rate for Payer: Mclaren Commercial |
$1,215.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,188.00
|
|
|
HC INJECTION VENOGRAM
|
Facility
|
IP
|
$555.85
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
36100095
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$389.10 |
| Max. Negotiated Rate |
$555.85 |
| Rate for Payer: Aetna Commercial |
$500.26
|
| Rate for Payer: ASR ASR |
$539.17
|
| Rate for Payer: BCBS Trust/PPO |
$430.95
|
| Rate for Payer: BCN Commercial |
$430.95
|
| Rate for Payer: Cash Price |
$444.68
|
| Rate for Payer: Cofinity Commercial |
$522.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.68
|
| Rate for Payer: Healthscope Commercial |
$555.85
|
| Rate for Payer: Healthscope Whirlpool |
$539.17
|
| Rate for Payer: Mclaren Commercial |
$500.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$472.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$489.15
|
|
|
HC INJECTION VENOGRAM
|
Facility
|
OP
|
$555.85
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
36100095
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$222.34 |
| Max. Negotiated Rate |
$555.85 |
| Rate for Payer: Aetna Commercial |
$500.26
|
| Rate for Payer: ASR ASR |
$539.17
|
| Rate for Payer: BCBS Complete |
$222.34
|
| Rate for Payer: BCBS Trust/PPO |
$430.95
|
| Rate for Payer: BCN Commercial |
$430.95
|
| Rate for Payer: Cash Price |
$444.68
|
| Rate for Payer: Cofinity Commercial |
$522.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$444.68
|
| Rate for Payer: Healthscope Commercial |
$555.85
|
| Rate for Payer: Healthscope Whirlpool |
$539.17
|
| Rate for Payer: Mclaren Commercial |
$500.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$472.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$505.82
|
| Rate for Payer: Priority Health Narrow Network |
$394.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$489.15
|
|
|
HC INJECTION WRIST ARTHROGRAM
|
Facility
|
IP
|
$1,129.61
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
36100039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$790.73 |
| Max. Negotiated Rate |
$1,129.61 |
| Rate for Payer: Aetna Commercial |
$1,016.65
|
| Rate for Payer: ASR ASR |
$1,095.72
|
| Rate for Payer: BCBS Trust/PPO |
$875.79
|
| Rate for Payer: BCN Commercial |
$875.79
|
| Rate for Payer: Cash Price |
$903.69
|
| Rate for Payer: Cofinity Commercial |
$1,061.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.69
|
| Rate for Payer: Healthscope Commercial |
$1,129.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,095.72
|
| Rate for Payer: Mclaren Commercial |
$1,016.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$960.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$790.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$994.06
|
|
|
HC INJECTION WRIST ARTHROGRAM
|
Facility
|
OP
|
$1,129.61
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
36100039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$451.84 |
| Max. Negotiated Rate |
$1,129.61 |
| Rate for Payer: Aetna Commercial |
$1,016.65
|
| Rate for Payer: ASR ASR |
$1,095.72
|
| Rate for Payer: BCBS Complete |
$451.84
|
| Rate for Payer: BCBS Trust/PPO |
$875.79
|
| Rate for Payer: BCN Commercial |
$875.79
|
| Rate for Payer: Cash Price |
$903.69
|
| Rate for Payer: Cofinity Commercial |
$1,061.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.69
|
| Rate for Payer: Healthscope Commercial |
$1,129.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,095.72
|
| Rate for Payer: Mclaren Commercial |
$1,016.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$960.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$790.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,027.95
|
| Rate for Payer: Priority Health Narrow Network |
$802.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$994.06
|
|
