|
HC INITIAT MED TX IN ER
|
Facility
|
OP
|
$158.10
|
|
|
Service Code
|
HCPCS G2213
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$63.24 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Aetna Commercial |
$142.29
|
| Rate for Payer: Aetna Medicare |
$79.05
|
| Rate for Payer: ASR ASR |
$153.36
|
| Rate for Payer: ASR Commercial |
$153.36
|
| Rate for Payer: BCBS Complete |
$63.24
|
| Rate for Payer: BCBS Trust/PPO |
$129.47
|
| Rate for Payer: BCN Commercial |
$122.57
|
| Rate for Payer: Cash Price |
$126.48
|
| Rate for Payer: Cofinity Commercial |
$148.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.48
|
| Rate for Payer: Healthscope Commercial |
$158.10
|
| Rate for Payer: Healthscope Whirlpool |
$153.36
|
| Rate for Payer: Mclaren Commercial |
$142.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.38
|
| Rate for Payer: Nomi Health Commercial |
$129.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.53
|
| Rate for Payer: Priority Health Narrow Network |
$110.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.13
|
|
|
HC INITIAT MED TX IN ER
|
Facility
|
IP
|
$158.10
|
|
|
Service Code
|
HCPCS G2213
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.76 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Aetna Commercial |
$142.29
|
| Rate for Payer: ASR ASR |
$153.36
|
| Rate for Payer: ASR Commercial |
$153.36
|
| Rate for Payer: BCBS Trust/PPO |
$128.84
|
| Rate for Payer: BCN Commercial |
$122.57
|
| Rate for Payer: Cash Price |
$126.48
|
| Rate for Payer: Cofinity Commercial |
$148.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.48
|
| Rate for Payer: Healthscope Commercial |
$158.10
|
| Rate for Payer: Healthscope Whirlpool |
$153.36
|
| Rate for Payer: Mclaren Commercial |
$142.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.38
|
| Rate for Payer: Nomi Health Commercial |
$129.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.13
|
|
|
HC INIT SUB PSYCH 1ST 30 MIN
|
Facility
|
IP
|
$126.93
|
|
|
Service Code
|
HCPCS G2214
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$126.93 |
| Rate for Payer: Aetna Commercial |
$114.24
|
| Rate for Payer: ASR ASR |
$123.12
|
| Rate for Payer: ASR Commercial |
$123.12
|
| Rate for Payer: BCBS Trust/PPO |
$103.44
|
| Rate for Payer: BCN Commercial |
$98.41
|
| Rate for Payer: Cash Price |
$101.54
|
| Rate for Payer: Cofinity Commercial |
$119.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.54
|
| Rate for Payer: Healthscope Commercial |
$126.93
|
| Rate for Payer: Healthscope Whirlpool |
$123.12
|
| Rate for Payer: Mclaren Commercial |
$114.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.89
|
| Rate for Payer: Nomi Health Commercial |
$104.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.70
|
|
|
HC INIT SUB PSYCH 1ST 30 MIN
|
Facility
|
OP
|
$126.93
|
|
|
Service Code
|
HCPCS G2214
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.58 |
| Max. Negotiated Rate |
$140.48 |
| Rate for Payer: Aetna Commercial |
$114.24
|
| Rate for Payer: Aetna Medicare |
$90.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.29
|
| Rate for Payer: ASR ASR |
$123.12
|
| Rate for Payer: ASR Commercial |
$123.12
|
| Rate for Payer: BCBS Complete |
$51.01
|
| Rate for Payer: BCBS MAPPO |
$90.63
|
| Rate for Payer: BCBS Trust/PPO |
$103.94
|
| Rate for Payer: BCN Commercial |
$98.41
|
| Rate for Payer: BCN Medicare Advantage |
$90.63
|
| Rate for Payer: Cash Price |
$101.54
|
| Rate for Payer: Cash Price |
$101.54
|
| Rate for Payer: Cofinity Commercial |
$119.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.63
|
| Rate for Payer: Healthscope Commercial |
$126.93
|
| Rate for Payer: Healthscope Whirlpool |
$123.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$90.63
|
| Rate for Payer: Mclaren Commercial |
$114.24
|
| Rate for Payer: Mclaren Medicaid |
$48.58
|
| Rate for Payer: Mclaren Medicare |
$90.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.16
|
| Rate for Payer: Meridian Medicaid |
$51.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.89
|
| Rate for Payer: Nomi Health Commercial |
$104.08
|
| Rate for Payer: PACE Medicare |
$86.10
|
| Rate for Payer: PACE SWMI |
$90.63
|
| Rate for Payer: PHP Commercial |
$99.69
|
| Rate for Payer: PHP Medicaid |
$48.58
|
| Rate for Payer: PHP Medicare Advantage |
$90.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.22
|
| Rate for Payer: Priority Health Medicare |
$90.63
|
| Rate for Payer: Priority Health Narrow Network |
$88.98
|
| Rate for Payer: Railroad Medicare Medicare |
$90.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.63
|
| Rate for Payer: UHC Exchange |
$140.48
|
| Rate for Payer: UHC Medicare Advantage |
$90.63
|
| Rate for Payer: UHCCP DNSP |
$90.63
|
| Rate for Payer: UHCCP Medicaid |
$48.58
|
| Rate for Payer: VA VA |
$90.63
|
|
|
HC INJ AIR CONTRAST PERITONEAL CAVITY
|
Facility
|
OP
|
$964.47
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
36100446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$385.79 |
| Max. Negotiated Rate |
$964.47 |
| Rate for Payer: Aetna Commercial |
$868.02
|
| Rate for Payer: Aetna Medicare |
$482.24
|
| Rate for Payer: ASR ASR |
$935.54
|
| Rate for Payer: ASR Commercial |
$935.54
|
| Rate for Payer: BCBS Complete |
$385.79
|
| Rate for Payer: BCBS Trust/PPO |
$789.80
|
| Rate for Payer: BCN Commercial |
$747.75
|
| Rate for Payer: Cash Price |
$771.58
|
| Rate for Payer: Cofinity Commercial |
$906.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.58
|
| Rate for Payer: Healthscope Commercial |
$964.47
|
| Rate for Payer: Healthscope Whirlpool |
$935.54
|
| Rate for Payer: Mclaren Commercial |
$868.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.80
|
| Rate for Payer: Nomi Health Commercial |
$790.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.07
|
| Rate for Payer: Priority Health Narrow Network |
$676.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$848.73
|
|
|
HC INJ AIR CONTRAST PERITONEAL CAVITY
|
Facility
|
IP
|
$964.47
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
36100446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$626.91 |
| Max. Negotiated Rate |
$964.47 |
| Rate for Payer: Aetna Commercial |
$868.02
|
| Rate for Payer: ASR ASR |
$935.54
|
| Rate for Payer: ASR Commercial |
$935.54
|
| Rate for Payer: BCBS Trust/PPO |
$785.95
|
| Rate for Payer: BCN Commercial |
$747.75
|
| Rate for Payer: Cash Price |
$771.58
|
| Rate for Payer: Cofinity Commercial |
$906.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.58
|
| Rate for Payer: Healthscope Commercial |
$964.47
|
| Rate for Payer: Healthscope Whirlpool |
$935.54
|
| Rate for Payer: Mclaren Commercial |
$868.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.80
|
| Rate for Payer: Nomi Health Commercial |
$790.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$848.73
|
|
|
HC INJ ANES CELIAC PLEXUS
|
Facility
|
IP
|
$1,267.21
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
36100605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$823.69 |
| Max. Negotiated Rate |
$1,267.21 |
| Rate for Payer: Aetna Commercial |
$1,140.49
|
| Rate for Payer: ASR ASR |
$1,229.19
|
| Rate for Payer: ASR Commercial |
$1,229.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,032.65
|
| Rate for Payer: BCN Commercial |
$982.47
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cofinity Commercial |
$1,191.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.77
|
| Rate for Payer: Healthscope Commercial |
$1,267.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,229.19
|
| Rate for Payer: Mclaren Commercial |
$1,140.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.13
|
| Rate for Payer: Nomi Health Commercial |
$1,039.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,115.14
|
|
|
HC INJ ANES CELIAC PLEXUS
|
Facility
|
OP
|
$1,267.21
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
36100605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$467.55 |
| Max. Negotiated Rate |
$1,352.05 |
| Rate for Payer: Aetna Commercial |
$1,140.49
|
| Rate for Payer: Aetna Medicare |
$872.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: ASR ASR |
$1,229.19
|
| Rate for Payer: ASR Commercial |
$1,229.19
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.72
|
| Rate for Payer: BCN Commercial |
$982.47
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cofinity Commercial |
$1,191.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,267.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,229.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$872.29
|
| Rate for Payer: Mclaren Commercial |
$1,140.49
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.13
|
| Rate for Payer: Nomi Health Commercial |
$1,039.11
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$959.52
|
| Rate for Payer: PHP Medicaid |
$467.55
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,110.33
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$888.31
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,115.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,352.05
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP DNSP |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$467.55
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJ ANES FEMORAL CONT
|
Facility
|
OP
|
$1,855.22
|
|
|
Service Code
|
CPT 64448
|
| Hospital Charge Code |
36100395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$467.55 |
| Max. Negotiated Rate |
$1,855.22 |
| Rate for Payer: Aetna Commercial |
$1,669.70
|
| Rate for Payer: Aetna Medicare |
$872.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: ASR ASR |
$1,799.56
|
| Rate for Payer: ASR Commercial |
$1,799.56
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,519.24
|
| Rate for Payer: BCN Commercial |
$1,438.35
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$1,484.18
|
| Rate for Payer: Cash Price |
$1,484.18
|
| Rate for Payer: Cofinity Commercial |
$1,743.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,484.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,855.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,799.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$872.29
|
| Rate for Payer: Mclaren Commercial |
$1,669.70
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,576.94
|
| Rate for Payer: Nomi Health Commercial |
$1,521.28
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$959.52
|
| Rate for Payer: PHP Medicaid |
$467.55
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,147.41
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$917.93
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,632.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,352.05
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP DNSP |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$467.55
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJ ANES FEMORAL CONT
|
Facility
|
IP
|
$1,855.22
|
|
|
Service Code
|
CPT 64448
|
| Hospital Charge Code |
36100395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,205.89 |
| Max. Negotiated Rate |
$1,855.22 |
| Rate for Payer: Aetna Commercial |
$1,669.70
|
| Rate for Payer: ASR ASR |
$1,799.56
|
| Rate for Payer: ASR Commercial |
$1,799.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,511.82
|
| Rate for Payer: BCN Commercial |
$1,438.35
|
| Rate for Payer: Cash Price |
$1,484.18
|
| Rate for Payer: Cofinity Commercial |
$1,743.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,484.18
|
| Rate for Payer: Healthscope Commercial |
$1,855.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,799.56
|
| Rate for Payer: Mclaren Commercial |
$1,669.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,576.94
|
| Rate for Payer: Nomi Health Commercial |
$1,521.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,632.59
|
|
|
HC INJ ANES MIDDLE OR LOWER SPINE SYMPATHETIC NERVES
|
Facility
|
OP
|
$1,267.21
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
36100604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$467.55 |
| Max. Negotiated Rate |
$1,352.05 |
| Rate for Payer: Aetna Commercial |
$1,140.49
|
| Rate for Payer: Aetna Medicare |
$872.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: ASR ASR |
$1,229.19
|
| Rate for Payer: ASR Commercial |
$1,229.19
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.72
|
| Rate for Payer: BCN Commercial |
$982.47
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cofinity Commercial |
$1,191.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,267.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,229.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$872.29
|
| Rate for Payer: Mclaren Commercial |
$1,140.49
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.13
|
| Rate for Payer: Nomi Health Commercial |
$1,039.11
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$959.52
|
| Rate for Payer: PHP Medicaid |
$467.55
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,110.33
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$888.31
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,115.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,352.05
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP DNSP |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$467.55
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJ ANES MIDDLE OR LOWER SPINE SYMPATHETIC NERVES
|
Facility
|
IP
|
$1,267.21
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
36100604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$823.69 |
| Max. Negotiated Rate |
$1,267.21 |
| Rate for Payer: Aetna Commercial |
$1,140.49
|
| Rate for Payer: ASR ASR |
$1,229.19
|
| Rate for Payer: ASR Commercial |
$1,229.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,032.65
|
| Rate for Payer: BCN Commercial |
$982.47
|
| Rate for Payer: Cash Price |
$1,013.77
|
| Rate for Payer: Cofinity Commercial |
$1,191.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.77
|
| Rate for Payer: Healthscope Commercial |
$1,267.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,229.19
|
| Rate for Payer: Mclaren Commercial |
$1,140.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.13
|
| Rate for Payer: Nomi Health Commercial |
$1,039.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,115.14
|
|
|
HC INJ ANESTH AND/OR STEROID AXILLARY NERVE
|
Facility
|
IP
|
$1,911.24
|
|
|
Service Code
|
CPT 64417
|
| Hospital Charge Code |
36100599
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,242.31 |
| Max. Negotiated Rate |
$1,911.24 |
| Rate for Payer: Aetna Commercial |
$1,720.12
|
| Rate for Payer: ASR ASR |
$1,853.90
|
| Rate for Payer: ASR Commercial |
$1,853.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,557.47
|
| Rate for Payer: BCN Commercial |
$1,481.78
|
| Rate for Payer: Cash Price |
$1,528.99
|
| Rate for Payer: Cofinity Commercial |
$1,796.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,528.99
|
| Rate for Payer: Healthscope Commercial |
$1,911.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,853.90
|
| Rate for Payer: Mclaren Commercial |
$1,720.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,624.55
|
| Rate for Payer: Nomi Health Commercial |
$1,567.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,242.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,681.89
|
|
|
HC INJ ANESTH AND/OR STEROID AXILLARY NERVE
|
Facility
|
OP
|
$1,911.24
|
|
|
Service Code
|
CPT 64417
|
| Hospital Charge Code |
36100599
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$467.55 |
| Max. Negotiated Rate |
$1,911.24 |
| Rate for Payer: Aetna Commercial |
$1,720.12
|
| Rate for Payer: Aetna Medicare |
$872.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: ASR ASR |
$1,853.90
|
| Rate for Payer: ASR Commercial |
$1,853.90
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,565.11
|
| Rate for Payer: BCN Commercial |
$1,481.78
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$1,528.99
|
| Rate for Payer: Cash Price |
$1,528.99
|
| Rate for Payer: Cofinity Commercial |
$1,796.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,528.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,911.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,853.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$872.29
|
| Rate for Payer: Mclaren Commercial |
$1,720.12
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,624.55
|
| Rate for Payer: Nomi Health Commercial |
$1,567.22
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$959.52
|
| Rate for Payer: PHP Medicaid |
$467.55
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,242.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$675.28
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$540.22
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,681.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,352.05
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP DNSP |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$467.55
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJ ANESTH AND/OR STEROID BRACHIAL PLEXUS
|
Facility
|
OP
|
$3,172.12
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
37100005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$467.55 |
| Max. Negotiated Rate |
$3,172.12 |
| Rate for Payer: Aetna Commercial |
$2,854.91
|
| Rate for Payer: Aetna Medicare |
$872.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: ASR ASR |
$3,076.96
|
| Rate for Payer: ASR Commercial |
$3,076.96
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,597.65
|
| Rate for Payer: BCN Commercial |
$2,459.34
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cofinity Commercial |
$2,981.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,537.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$3,172.12
|
| Rate for Payer: Healthscope Whirlpool |
$3,076.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$872.29
|
| Rate for Payer: Mclaren Commercial |
$2,854.91
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,696.30
|
| Rate for Payer: Nomi Health Commercial |
$2,601.14
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$959.52
|
| Rate for Payer: PHP Medicaid |
$467.55
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$596.21
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$476.97
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,791.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,352.05
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP DNSP |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$467.55
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJ ANESTH AND/OR STEROID BRACHIAL PLEXUS
|
Facility
|
IP
|
$3,172.12
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
37100005
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2,061.88 |
| Max. Negotiated Rate |
$3,172.12 |
| Rate for Payer: Aetna Commercial |
$2,854.91
|
| Rate for Payer: ASR ASR |
$3,076.96
|
| Rate for Payer: ASR Commercial |
$3,076.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,584.96
|
| Rate for Payer: BCN Commercial |
$2,459.34
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cofinity Commercial |
$2,981.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,537.70
|
| Rate for Payer: Healthscope Commercial |
$3,172.12
|
| Rate for Payer: Healthscope Whirlpool |
$3,076.96
|
| Rate for Payer: Mclaren Commercial |
$2,854.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,696.30
|
| Rate for Payer: Nomi Health Commercial |
$2,601.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,791.47
|
|
|
HC INJ ANESTH AND/OR STEROID SCIATIC NERVE
|
Facility
|
OP
|
$2,549.64
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
37100008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$363.69 |
| Max. Negotiated Rate |
$2,549.64 |
| Rate for Payer: Aetna Commercial |
$2,294.68
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$2,473.15
|
| Rate for Payer: ASR Commercial |
$2,473.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$2,087.90
|
| Rate for Payer: BCN Commercial |
$1,976.74
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$2,039.71
|
| Rate for Payer: Cash Price |
$2,039.71
|
| Rate for Payer: Cofinity Commercial |
$2,396.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,039.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$2,549.64
|
| Rate for Payer: Healthscope Whirlpool |
$2,473.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Commercial |
$2,294.68
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,167.19
|
| Rate for Payer: Nomi Health Commercial |
$2,090.70
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,147.41
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$917.93
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,243.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC INJ ANESTH AND/OR STEROID SCIATIC NERVE
|
Facility
|
IP
|
$2,549.64
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
37100008
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,657.27 |
| Max. Negotiated Rate |
$2,549.64 |
| Rate for Payer: Aetna Commercial |
$2,294.68
|
| Rate for Payer: ASR ASR |
$2,473.15
|
| Rate for Payer: ASR Commercial |
$2,473.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,077.70
|
| Rate for Payer: BCN Commercial |
$1,976.74
|
| Rate for Payer: Cash Price |
$2,039.71
|
| Rate for Payer: Cofinity Commercial |
$2,396.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,039.71
|
| Rate for Payer: Healthscope Commercial |
$2,549.64
|
| Rate for Payer: Healthscope Whirlpool |
$2,473.15
|
| Rate for Payer: Mclaren Commercial |
$2,294.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,167.19
|
| Rate for Payer: Nomi Health Commercial |
$2,090.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,243.68
|
|
|
HC INJ ANESTH AND/OR STEROID SUPRASCAPULAR NERVE
|
Facility
|
OP
|
$975.46
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
36100600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$363.69 |
| Max. Negotiated Rate |
$1,051.71 |
| Rate for Payer: Aetna Commercial |
$877.91
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$946.20
|
| Rate for Payer: ASR Commercial |
$946.20
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$798.80
|
| Rate for Payer: BCN Commercial |
$756.27
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cofinity Commercial |
$916.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$975.46
|
| Rate for Payer: Healthscope Whirlpool |
$946.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Commercial |
$877.91
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.14
|
| Rate for Payer: Nomi Health Commercial |
$799.88
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$587.44
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$469.95
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$858.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC INJ ANESTH AND/OR STEROID SUPRASCAPULAR NERVE
|
Facility
|
IP
|
$975.46
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
36100600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$634.05 |
| Max. Negotiated Rate |
$975.46 |
| Rate for Payer: Aetna Commercial |
$877.91
|
| Rate for Payer: ASR ASR |
$946.20
|
| Rate for Payer: ASR Commercial |
$946.20
|
| Rate for Payer: BCBS Trust/PPO |
$794.90
|
| Rate for Payer: BCN Commercial |
$756.27
|
| Rate for Payer: Cash Price |
$780.37
|
| Rate for Payer: Cofinity Commercial |
$916.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.37
|
| Rate for Payer: Healthscope Commercial |
$975.46
|
| Rate for Payer: Healthscope Whirlpool |
$946.20
|
| Rate for Payer: Mclaren Commercial |
$877.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.14
|
| Rate for Payer: Nomi Health Commercial |
$799.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$858.40
|
|
|
HC INJ ANESTHETIC FEMORAL
|
Facility
|
OP
|
$1,534.27
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
36100391
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$363.69 |
| Max. Negotiated Rate |
$1,534.27 |
| Rate for Payer: Aetna Commercial |
$1,380.84
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$1,488.24
|
| Rate for Payer: ASR Commercial |
$1,488.24
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,256.41
|
| Rate for Payer: BCN Commercial |
$1,189.52
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$1,227.42
|
| Rate for Payer: Cash Price |
$1,227.42
|
| Rate for Payer: Cofinity Commercial |
$1,442.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,227.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$1,534.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,488.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Commercial |
$1,380.84
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,304.13
|
| Rate for Payer: Nomi Health Commercial |
$1,258.10
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$596.21
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$476.97
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,350.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC INJ ANESTHETIC FEMORAL
|
Facility
|
IP
|
$1,534.27
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
36100391
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$997.28 |
| Max. Negotiated Rate |
$1,534.27 |
| Rate for Payer: Aetna Commercial |
$1,380.84
|
| Rate for Payer: ASR ASR |
$1,488.24
|
| Rate for Payer: ASR Commercial |
$1,488.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,250.28
|
| Rate for Payer: BCN Commercial |
$1,189.52
|
| Rate for Payer: Cash Price |
$1,227.42
|
| Rate for Payer: Cofinity Commercial |
$1,442.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,227.42
|
| Rate for Payer: Healthscope Commercial |
$1,534.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,488.24
|
| Rate for Payer: Mclaren Commercial |
$1,380.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,304.13
|
| Rate for Payer: Nomi Health Commercial |
$1,258.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,350.16
|
|
|
HC INJ ANESTH PERIPH NERVE
|
Facility
|
OP
|
$890.33
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
36100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.69 |
| Max. Negotiated Rate |
$1,051.71 |
| Rate for Payer: Aetna Commercial |
$801.30
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$863.62
|
| Rate for Payer: ASR Commercial |
$863.62
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$729.09
|
| Rate for Payer: BCN Commercial |
$690.27
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$712.26
|
| Rate for Payer: Cash Price |
$712.26
|
| Rate for Payer: Cofinity Commercial |
$836.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$712.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$890.33
|
| Rate for Payer: Healthscope Whirlpool |
$863.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Commercial |
$801.30
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$756.78
|
| Rate for Payer: Nomi Health Commercial |
$730.07
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$596.21
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$476.97
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$783.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC INJ ANESTH PERIPH NERVE
|
Facility
|
IP
|
$890.33
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
36100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$578.71 |
| Max. Negotiated Rate |
$890.33 |
| Rate for Payer: Aetna Commercial |
$801.30
|
| Rate for Payer: ASR ASR |
$863.62
|
| Rate for Payer: ASR Commercial |
$863.62
|
| Rate for Payer: BCBS Trust/PPO |
$725.53
|
| Rate for Payer: BCN Commercial |
$690.27
|
| Rate for Payer: Cash Price |
$712.26
|
| Rate for Payer: Cofinity Commercial |
$836.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$712.26
|
| Rate for Payer: Healthscope Commercial |
$890.33
|
| Rate for Payer: Healthscope Whirlpool |
$863.62
|
| Rate for Payer: Mclaren Commercial |
$801.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$756.78
|
| Rate for Payer: Nomi Health Commercial |
$730.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$783.49
|
|
|
HC INJ ANESTH/STEROID BRACHIAL PLEXUS CONT
|
Facility
|
OP
|
$3,172.12
|
|
|
Service Code
|
CPT 64416
|
| Hospital Charge Code |
37100010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$467.55 |
| Max. Negotiated Rate |
$3,172.12 |
| Rate for Payer: Aetna Commercial |
$2,854.91
|
| Rate for Payer: Aetna Medicare |
$872.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: ASR ASR |
$3,076.96
|
| Rate for Payer: ASR Commercial |
$3,076.96
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,597.65
|
| Rate for Payer: BCN Commercial |
$2,459.34
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cash Price |
$2,537.70
|
| Rate for Payer: Cofinity Commercial |
$2,981.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,537.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$3,172.12
|
| Rate for Payer: Healthscope Whirlpool |
$3,076.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$872.29
|
| Rate for Payer: Mclaren Commercial |
$2,854.91
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,696.30
|
| Rate for Payer: Nomi Health Commercial |
$2,601.14
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$959.52
|
| Rate for Payer: PHP Medicaid |
$467.55
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,147.41
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$917.93
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,791.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,352.05
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP DNSP |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$467.55
|
| Rate for Payer: VA VA |
$872.29
|
|
