|
HC INJECTION SI JOINT ANESTHESIA/STEROID
|
Facility
|
IP
|
$1,031.48
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$773.61 |
| Max. Negotiated Rate |
$1,031.48 |
| Rate for Payer: Aetna Commercial |
$928.33
|
| Rate for Payer: ASR ASR |
$1,000.54
|
| Rate for Payer: BCBS Trust/PPO |
$847.05
|
| Rate for Payer: BCN Commercial |
$847.05
|
| Rate for Payer: Cash Price |
$825.18
|
| Rate for Payer: Cofinity Commercial |
$969.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.18
|
| Rate for Payer: Healthscope Commercial |
$1,000.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,031.48
|
| Rate for Payer: Mclaren Commercial |
$928.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.76
|
| Rate for Payer: Nomi Health Commercial |
$845.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$773.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$907.70
|
|
|
HC INJECTION SI JOINT ANESTHESIA/STEROID
|
Facility
|
OP
|
$1,031.48
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$381.65 |
| Max. Negotiated Rate |
$1,265.02 |
| Rate for Payer: Aetna Commercial |
$928.33
|
| Rate for Payer: Aetna Medicare |
$381.65
|
| Rate for Payer: ASR ASR |
$1,000.54
|
| Rate for Payer: BCBS Complete |
$412.59
|
| Rate for Payer: BCBS Trust/PPO |
$850.46
|
| Rate for Payer: BCN Commercial |
$850.46
|
| Rate for Payer: Cash Price |
$825.18
|
| Rate for Payer: Cash Price |
$825.18
|
| Rate for Payer: Cofinity Commercial |
$969.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.18
|
| Rate for Payer: Healthscope Commercial |
$1,000.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,031.48
|
| Rate for Payer: Mclaren Commercial |
$928.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$825.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.76
|
| Rate for Payer: Nomi Health Commercial |
$845.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$773.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,265.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,012.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$907.70
|
|
|
HC INJECTION SI JOINT BIL ANESTHESIA/STEROID
|
Facility
|
IP
|
$1,068.81
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$801.61 |
| Max. Negotiated Rate |
$1,068.81 |
| Rate for Payer: Aetna Commercial |
$961.93
|
| Rate for Payer: ASR ASR |
$1,036.75
|
| Rate for Payer: BCBS Trust/PPO |
$877.71
|
| Rate for Payer: BCN Commercial |
$877.71
|
| Rate for Payer: Cash Price |
$855.05
|
| Rate for Payer: Cofinity Commercial |
$1,004.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$855.05
|
| Rate for Payer: Healthscope Commercial |
$1,036.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,068.81
|
| Rate for Payer: Mclaren Commercial |
$961.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$908.49
|
| Rate for Payer: Nomi Health Commercial |
$876.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$801.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$940.55
|
|
|
HC INJECTION SI JOINT BIL ANESTHESIA/STEROID
|
Facility
|
OP
|
$1,068.81
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$395.46 |
| Max. Negotiated Rate |
$1,265.02 |
| Rate for Payer: Aetna Commercial |
$961.93
|
| Rate for Payer: Aetna Medicare |
$395.46
|
| Rate for Payer: ASR ASR |
$1,036.75
|
| Rate for Payer: BCBS Complete |
$427.52
|
| Rate for Payer: BCBS Trust/PPO |
$881.23
|
| Rate for Payer: BCN Commercial |
$881.23
|
| Rate for Payer: Cash Price |
$855.05
|
| Rate for Payer: Cash Price |
$855.05
|
| Rate for Payer: Cofinity Commercial |
$1,004.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$855.05
|
| Rate for Payer: Healthscope Commercial |
$1,036.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,068.81
|
| Rate for Payer: Mclaren Commercial |
$961.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$855.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$908.49
|
| Rate for Payer: Nomi Health Commercial |
$876.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$801.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,265.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,012.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$940.55
|
|
|
HC INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$284.95
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
36100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.71 |
| Max. Negotiated Rate |
$284.95 |
| Rate for Payer: Aetna Commercial |
$256.45
|
| Rate for Payer: ASR ASR |
$276.40
|
| Rate for Payer: BCBS Trust/PPO |
$234.00
|
| Rate for Payer: BCN Commercial |
$234.00
|
| Rate for Payer: Cash Price |
$227.96
|
| Rate for Payer: Cofinity Commercial |
$267.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.96
|
| Rate for Payer: Healthscope Commercial |
$276.40
|
| Rate for Payer: Healthscope Whirlpool |
$284.95
|
| Rate for Payer: Mclaren Commercial |
$256.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.21
|
| Rate for Payer: Nomi Health Commercial |
$233.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.76
|
|
|
HC INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$284.95
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
36100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$474.07 |
| Rate for Payer: Aetna Commercial |
$256.45
|
| Rate for Payer: Aetna Medicare |
$305.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: ASR ASR |
$276.40
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$234.94
|
| Rate for Payer: BCN Commercial |
$234.94
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$227.96
|
| Rate for Payer: Cash Price |
$227.96
|
| Rate for Payer: Cofinity Commercial |
$267.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$276.40
|
| Rate for Payer: Healthscope Whirlpool |
$284.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$256.45
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$167.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.21
|
| Rate for Payer: Nomi Health Commercial |
$233.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.71
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$336.44
|
| Rate for Payer: PHP Medicaid |
$163.94
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$249.67
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$199.75
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$474.07
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP DNSP |
$305.85
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC INJECTION SPLENOPOTOGRAM SPLENOPORTOG
|
Facility
|
OP
|
$446.38
|
|
|
Service Code
|
CPT 38200
|
| Hospital Charge Code |
36100183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$165.16 |
| Max. Negotiated Rate |
$446.38 |
| Rate for Payer: Aetna Commercial |
$401.74
|
| Rate for Payer: Aetna Medicare |
$165.16
|
| Rate for Payer: ASR ASR |
$432.99
|
| Rate for Payer: BCBS Complete |
$178.55
|
| Rate for Payer: BCBS Trust/PPO |
$368.04
|
| Rate for Payer: BCN Commercial |
$368.04
|
| Rate for Payer: Cash Price |
$357.10
|
| Rate for Payer: Cofinity Commercial |
$419.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.10
|
| Rate for Payer: Healthscope Commercial |
$432.99
|
| Rate for Payer: Healthscope Whirlpool |
$446.38
|
| Rate for Payer: Mclaren Commercial |
$401.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$357.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.42
|
| Rate for Payer: Nomi Health Commercial |
$366.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$391.12
|
| Rate for Payer: Priority Health Narrow Network |
$312.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$392.81
|
|
|
HC INJECTION SPLENOPOTOGRAM SPLENOPORTOG
|
Facility
|
IP
|
$446.38
|
|
|
Service Code
|
CPT 38200
|
| Hospital Charge Code |
36100183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$334.79 |
| Max. Negotiated Rate |
$446.38 |
| Rate for Payer: Aetna Commercial |
$401.74
|
| Rate for Payer: ASR ASR |
$432.99
|
| Rate for Payer: BCBS Trust/PPO |
$366.57
|
| Rate for Payer: BCN Commercial |
$366.57
|
| Rate for Payer: Cash Price |
$357.10
|
| Rate for Payer: Cofinity Commercial |
$419.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.10
|
| Rate for Payer: Healthscope Commercial |
$432.99
|
| Rate for Payer: Healthscope Whirlpool |
$446.38
|
| Rate for Payer: Mclaren Commercial |
$401.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.42
|
| Rate for Payer: Nomi Health Commercial |
$366.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$392.81
|
|
|
HC INJECTIONS SCLEROSANT FOR SPIDER VEINS /TRNK
|
Facility
|
OP
|
$1,106.99
|
|
|
Service Code
|
CPT 36468
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,106.99 |
| Rate for Payer: Aetna Commercial |
$996.29
|
| Rate for Payer: Aetna Medicare |
$405.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: ASR ASR |
$1,073.78
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$912.71
|
| Rate for Payer: BCN Commercial |
$912.71
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$885.59
|
| Rate for Payer: Cash Price |
$885.59
|
| Rate for Payer: Cofinity Commercial |
$1,040.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$1,073.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,106.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$405.05
|
| Rate for Payer: Mclaren Commercial |
$996.29
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$222.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$940.94
|
| Rate for Payer: Nomi Health Commercial |
$907.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$830.24
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$445.56
|
| Rate for Payer: PHP Medicaid |
$217.11
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$969.94
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Narrow Network |
$776.00
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$974.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$627.83
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP DNSP |
$405.05
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC INJECTIONS SCLEROSANT FOR SPIDER VEINS /TRNK
|
Facility
|
IP
|
$1,106.99
|
|
|
Service Code
|
CPT 36468
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$830.24 |
| Max. Negotiated Rate |
$1,106.99 |
| Rate for Payer: Aetna Commercial |
$996.29
|
| Rate for Payer: ASR ASR |
$1,073.78
|
| Rate for Payer: BCBS Trust/PPO |
$909.06
|
| Rate for Payer: BCN Commercial |
$909.06
|
| Rate for Payer: Cash Price |
$885.59
|
| Rate for Payer: Cofinity Commercial |
$1,040.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.59
|
| Rate for Payer: Healthscope Commercial |
$1,073.78
|
| Rate for Payer: Healthscope Whirlpool |
$1,106.99
|
| Rate for Payer: Mclaren Commercial |
$996.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$940.94
|
| Rate for Payer: Nomi Health Commercial |
$907.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$830.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$974.15
|
|
|
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 |
$0.02 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Aetna Medicare |
$0.06
|
| Rate for Payer: ASR ASR |
$0.16
|
| Rate for Payer: BCBS Complete |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: 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: MI Amish Medical Board Commercial |
$0.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.14
|
| Rate for Payer: Nomi Health Commercial |
$0.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.14
|
|
|
HC INJECTION, TESTOSTERONE CYPIONATE, 1 MG
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
CPT J1071
|
| Hospital Charge Code |
63600109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: ASR ASR |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cofinity Commercial |
$0.15
|
| 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 Commercial |
$0.14
|
| Rate for Payer: Nomi Health Commercial |
$0.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.14
|
|
|
HC INJECTION THERAPEUTIC SINUS TRACT
|
Facility
|
IP
|
$942.13
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
36100020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$706.60 |
| Max. Negotiated Rate |
$942.13 |
| Rate for Payer: Aetna Commercial |
$847.92
|
| Rate for Payer: ASR ASR |
$913.87
|
| Rate for Payer: BCBS Trust/PPO |
$773.68
|
| Rate for Payer: BCN Commercial |
$773.68
|
| Rate for Payer: Cash Price |
$753.70
|
| Rate for Payer: Cofinity Commercial |
$885.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$753.70
|
| Rate for Payer: Healthscope Commercial |
$913.87
|
| Rate for Payer: Healthscope Whirlpool |
$942.13
|
| Rate for Payer: Mclaren Commercial |
$847.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$800.81
|
| Rate for Payer: Nomi Health Commercial |
$772.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$706.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$829.07
|
|
|
HC INJECTION THERAPEUTIC SINUS TRACT
|
Facility
|
OP
|
$942.13
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
36100020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$660.43 |
| Max. Negotiated Rate |
$2,396.30 |
| Rate for Payer: Aetna Commercial |
$847.92
|
| Rate for Payer: Aetna Medicare |
$1,546.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,932.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,932.50
|
| Rate for Payer: ASR ASR |
$913.87
|
| Rate for Payer: BCBS Complete |
$849.06
|
| Rate for Payer: BCBS MAPPO |
$1,546.00
|
| Rate for Payer: BCBS Trust/PPO |
$776.79
|
| Rate for Payer: BCN Commercial |
$776.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,546.00
|
| Rate for Payer: Cash Price |
$753.70
|
| Rate for Payer: Cash Price |
$753.70
|
| Rate for Payer: Cofinity Commercial |
$885.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$753.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,546.00
|
| Rate for Payer: Healthscope Commercial |
$913.87
|
| Rate for Payer: Healthscope Whirlpool |
$942.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,546.00
|
| Rate for Payer: Mclaren Commercial |
$847.92
|
| Rate for Payer: Mclaren Medicaid |
$1,546.00
|
| Rate for Payer: Mclaren Medicare |
$1,546.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,623.30
|
| Rate for Payer: Meridian Medicaid |
$849.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,777.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,700.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$800.81
|
| Rate for Payer: Nomi Health Commercial |
$772.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$706.60
|
| Rate for Payer: PACE Medicare |
$1,468.70
|
| Rate for Payer: PACE SWMI |
$1,546.00
|
| Rate for Payer: PHP Commercial |
$1,700.60
|
| Rate for Payer: PHP Medicaid |
$828.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,546.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$825.49
|
| Rate for Payer: Priority Health Medicare |
$1,546.00
|
| Rate for Payer: Priority Health Narrow Network |
$660.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1,546.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$829.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,546.00
|
| Rate for Payer: UHC Exchange |
$2,396.30
|
| Rate for Payer: UHC Medicaid |
$808.56
|
| Rate for Payer: UHCCP DNSP |
$1,546.00
|
| Rate for Payer: UHCCP Medicaid |
$808.56
|
| Rate for Payer: VA VA |
$1,546.00
|
|
|
HC INJECTION TRANSFORAMINAL CERVICAL OR THORACIC
|
Facility
|
IP
|
$1,758.91
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,319.18 |
| Max. Negotiated Rate |
$1,758.91 |
| Rate for Payer: Aetna Commercial |
$1,583.02
|
| Rate for Payer: ASR ASR |
$1,706.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,444.42
|
| Rate for Payer: BCN Commercial |
$1,444.42
|
| Rate for Payer: Cash Price |
$1,407.13
|
| Rate for Payer: Cofinity Commercial |
$1,653.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,407.13
|
| Rate for Payer: Healthscope Commercial |
$1,706.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,758.91
|
| Rate for Payer: Mclaren Commercial |
$1,583.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,495.07
|
| Rate for Payer: Nomi Health Commercial |
$1,442.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,319.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,547.84
|
|
|
HC INJECTION TRANSFORAMINAL CERVICAL OR THORACIC
|
Facility
|
OP
|
$1,758.91
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$1,758.91 |
| Rate for Payer: Aetna Commercial |
$1,583.02
|
| Rate for Payer: Aetna Medicare |
$881.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: ASR ASR |
$1,706.14
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,450.22
|
| Rate for Payer: BCN Commercial |
$1,450.22
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$1,407.13
|
| Rate for Payer: Cash Price |
$1,407.13
|
| Rate for Payer: Cofinity Commercial |
$1,653.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,407.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,706.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,758.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$881.29
|
| Rate for Payer: Mclaren Commercial |
$1,583.02
|
| Rate for Payer: Mclaren Medicaid |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$484.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,495.07
|
| Rate for Payer: Nomi Health Commercial |
$1,442.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,319.18
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$969.42
|
| Rate for Payer: PHP Medicaid |
$472.37
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,541.16
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,233.00
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,547.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Exchange |
$1,366.00
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP DNSP |
$881.29
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC BIL
|
Facility
|
OP
|
$2,638.36
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100623
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,638.36 |
| Rate for Payer: Aetna Commercial |
$2,374.52
|
| Rate for Payer: Aetna Medicare |
$881.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: ASR ASR |
$2,559.21
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,175.33
|
| Rate for Payer: BCN Commercial |
$2,175.33
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$2,110.69
|
| Rate for Payer: Cash Price |
$2,110.69
|
| Rate for Payer: Cofinity Commercial |
$2,480.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,110.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$2,559.21
|
| Rate for Payer: Healthscope Whirlpool |
$2,638.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$881.29
|
| Rate for Payer: Mclaren Commercial |
$2,374.52
|
| Rate for Payer: Mclaren Medicaid |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$484.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,242.61
|
| Rate for Payer: Nomi Health Commercial |
$2,163.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,978.77
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$969.42
|
| Rate for Payer: PHP Medicaid |
$472.37
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,311.73
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,849.49
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,321.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Exchange |
$1,366.00
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP DNSP |
$881.29
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC BIL
|
Facility
|
IP
|
$2,638.36
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100623
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,978.77 |
| Max. Negotiated Rate |
$2,638.36 |
| Rate for Payer: Aetna Commercial |
$2,374.52
|
| Rate for Payer: ASR ASR |
$2,559.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,166.62
|
| Rate for Payer: BCN Commercial |
$2,166.62
|
| Rate for Payer: Cash Price |
$2,110.69
|
| Rate for Payer: Cofinity Commercial |
$2,480.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,110.69
|
| Rate for Payer: Healthscope Commercial |
$2,559.21
|
| Rate for Payer: Healthscope Whirlpool |
$2,638.36
|
| Rate for Payer: Mclaren Commercial |
$2,374.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,242.61
|
| Rate for Payer: Nomi Health Commercial |
$2,163.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,978.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,321.76
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EA ADD
|
Facility
|
IP
|
$929.72
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$697.29 |
| Max. Negotiated Rate |
$929.72 |
| Rate for Payer: Aetna Commercial |
$836.75
|
| Rate for Payer: ASR ASR |
$901.83
|
| Rate for Payer: BCBS Trust/PPO |
$763.49
|
| Rate for Payer: BCN Commercial |
$763.49
|
| Rate for Payer: Cash Price |
$743.78
|
| Rate for Payer: Cofinity Commercial |
$873.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$743.78
|
| Rate for Payer: Healthscope Commercial |
$901.83
|
| Rate for Payer: Healthscope Whirlpool |
$929.72
|
| Rate for Payer: Mclaren Commercial |
$836.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$790.26
|
| Rate for Payer: Nomi Health Commercial |
$762.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$697.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$818.15
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EA ADD
|
Facility
|
OP
|
$929.72
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$344.00 |
| Max. Negotiated Rate |
$929.72 |
| Rate for Payer: Aetna Commercial |
$836.75
|
| Rate for Payer: Aetna Medicare |
$344.00
|
| Rate for Payer: ASR ASR |
$901.83
|
| Rate for Payer: BCBS Complete |
$371.89
|
| Rate for Payer: BCBS Trust/PPO |
$766.55
|
| Rate for Payer: BCN Commercial |
$766.55
|
| Rate for Payer: Cash Price |
$743.78
|
| Rate for Payer: Cofinity Commercial |
$873.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$743.78
|
| Rate for Payer: Healthscope Commercial |
$901.83
|
| Rate for Payer: Healthscope Whirlpool |
$929.72
|
| Rate for Payer: Mclaren Commercial |
$836.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$743.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$790.26
|
| Rate for Payer: Nomi Health Commercial |
$762.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$697.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$814.62
|
| Rate for Payer: Priority Health Narrow Network |
$651.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$818.15
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL
|
Facility
|
OP
|
$1,394.58
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$515.99 |
| Max. Negotiated Rate |
$1,394.58 |
| Rate for Payer: Aetna Commercial |
$1,255.12
|
| Rate for Payer: Aetna Medicare |
$515.99
|
| Rate for Payer: ASR ASR |
$1,352.74
|
| Rate for Payer: BCBS Complete |
$557.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,149.83
|
| Rate for Payer: BCN Commercial |
$1,149.83
|
| Rate for Payer: Cash Price |
$1,115.66
|
| Rate for Payer: Cofinity Commercial |
$1,310.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,115.66
|
| Rate for Payer: Healthscope Commercial |
$1,352.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,394.58
|
| Rate for Payer: Mclaren Commercial |
$1,255.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,115.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,185.39
|
| Rate for Payer: Nomi Health Commercial |
$1,143.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,045.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,221.93
|
| Rate for Payer: Priority Health Narrow Network |
$977.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,227.23
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL
|
Facility
|
IP
|
$1,394.58
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,045.93 |
| Max. Negotiated Rate |
$1,394.58 |
| Rate for Payer: Aetna Commercial |
$1,255.12
|
| Rate for Payer: ASR ASR |
$1,352.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,145.23
|
| Rate for Payer: BCN Commercial |
$1,145.23
|
| Rate for Payer: Cash Price |
$1,115.66
|
| Rate for Payer: Cofinity Commercial |
$1,310.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,115.66
|
| Rate for Payer: Healthscope Commercial |
$1,352.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,394.58
|
| Rate for Payer: Mclaren Commercial |
$1,255.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,185.39
|
| Rate for Payer: Nomi Health Commercial |
$1,143.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,045.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,227.23
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL
|
Facility
|
IP
|
$991.57
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$743.68 |
| Max. Negotiated Rate |
$991.57 |
| Rate for Payer: Aetna Commercial |
$892.41
|
| Rate for Payer: ASR ASR |
$961.82
|
| Rate for Payer: BCBS Trust/PPO |
$814.28
|
| Rate for Payer: BCN Commercial |
$814.28
|
| Rate for Payer: Cash Price |
$793.26
|
| Rate for Payer: Cofinity Commercial |
$932.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.26
|
| Rate for Payer: Healthscope Commercial |
$961.82
|
| Rate for Payer: Healthscope Whirlpool |
$991.57
|
| Rate for Payer: Mclaren Commercial |
$892.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.83
|
| Rate for Payer: Nomi Health Commercial |
$813.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$743.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.58
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL
|
Facility
|
OP
|
$991.57
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$366.88 |
| Max. Negotiated Rate |
$991.57 |
| Rate for Payer: Aetna Commercial |
$892.41
|
| Rate for Payer: Aetna Medicare |
$366.88
|
| Rate for Payer: ASR ASR |
$961.82
|
| Rate for Payer: BCBS Complete |
$396.63
|
| Rate for Payer: BCBS Trust/PPO |
$817.55
|
| Rate for Payer: BCN Commercial |
$817.55
|
| Rate for Payer: Cash Price |
$793.26
|
| Rate for Payer: Cofinity Commercial |
$932.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.26
|
| Rate for Payer: Healthscope Commercial |
$961.82
|
| Rate for Payer: Healthscope Whirlpool |
$991.57
|
| Rate for Payer: Mclaren Commercial |
$892.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$793.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.83
|
| Rate for Payer: Nomi Health Commercial |
$813.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$743.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$868.81
|
| Rate for Payer: Priority Health Narrow Network |
$695.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.58
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL
|
Facility
|
OP
|
$1,487.35
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$550.32 |
| Max. Negotiated Rate |
$1,487.35 |
| Rate for Payer: Aetna Commercial |
$1,338.62
|
| Rate for Payer: Aetna Medicare |
$550.32
|
| Rate for Payer: ASR ASR |
$1,442.73
|
| Rate for Payer: BCBS Complete |
$594.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,226.32
|
| Rate for Payer: BCN Commercial |
$1,226.32
|
| Rate for Payer: Cash Price |
$1,189.88
|
| Rate for Payer: Cofinity Commercial |
$1,398.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,189.88
|
| Rate for Payer: Healthscope Commercial |
$1,442.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,487.35
|
| Rate for Payer: Mclaren Commercial |
$1,338.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,189.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.25
|
| Rate for Payer: Nomi Health Commercial |
$1,219.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,115.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,303.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,042.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,308.87
|
|
