|
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 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 |
$465.40 |
| Max. Negotiated Rate |
$1,345.83 |
| Rate for Payer: Aetna Commercial |
$1,140.49
|
| Rate for Payer: Aetna Medicare |
$868.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: ASR ASR |
$1,229.19
|
| Rate for Payer: ASR Commercial |
$1,229.19
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.72
|
| Rate for Payer: BCN Commercial |
$982.47
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| 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 |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$1,267.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,229.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$868.28
|
| Rate for Payer: Mclaren Commercial |
$1,140.49
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| 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 |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$955.11
|
| Rate for Payer: PHP Medicaid |
$465.40
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| 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 |
$868.28
|
| Rate for Payer: Priority Health Narrow Network |
$888.31
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,115.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,345.83
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP DNSP |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: VA VA |
$868.28
|
|
|
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 |
$465.40 |
| Max. Negotiated Rate |
$1,911.24 |
| Rate for Payer: Aetna Commercial |
$1,720.12
|
| Rate for Payer: Aetna Medicare |
$868.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: ASR ASR |
$1,853.90
|
| Rate for Payer: ASR Commercial |
$1,853.90
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,565.11
|
| Rate for Payer: BCN Commercial |
$1,481.78
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| 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 |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$1,911.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,853.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$868.28
|
| Rate for Payer: Mclaren Commercial |
$1,720.12
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| 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 |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$955.11
|
| Rate for Payer: PHP Medicaid |
$465.40
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,242.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,674.63
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,339.78
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,681.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,345.83
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP DNSP |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: VA VA |
$868.28
|
|
|
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 |
$465.40 |
| Max. Negotiated Rate |
$3,172.12 |
| Rate for Payer: Aetna Commercial |
$2,854.91
|
| Rate for Payer: Aetna Medicare |
$868.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: ASR ASR |
$3,076.96
|
| Rate for Payer: ASR Commercial |
$3,076.96
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,597.65
|
| Rate for Payer: BCN Commercial |
$2,459.34
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| 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 |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$3,172.12
|
| Rate for Payer: Healthscope Whirlpool |
$3,076.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$868.28
|
| Rate for Payer: Mclaren Commercial |
$2,854.91
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| 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 |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$955.11
|
| Rate for Payer: PHP Medicaid |
$465.40
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,779.41
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health Narrow Network |
$2,223.66
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,791.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,345.83
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP DNSP |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: VA VA |
$868.28
|
|
|
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 |
$362.01 |
| Max. Negotiated Rate |
$2,549.64 |
| Rate for Payer: Aetna Commercial |
$2,294.68
|
| Rate for Payer: Aetna Medicare |
$675.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: ASR ASR |
$2,473.15
|
| Rate for Payer: ASR Commercial |
$2,473.15
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,087.90
|
| Rate for Payer: BCN Commercial |
$1,976.74
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| 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 |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$2,549.64
|
| Rate for Payer: Healthscope Whirlpool |
$2,473.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$675.40
|
| Rate for Payer: Mclaren Commercial |
$2,294.68
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| 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 |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$742.94
|
| Rate for Payer: PHP Medicaid |
$362.01
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,657.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,233.99
|
| Rate for Payer: Priority Health Medicare |
$675.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,787.30
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,243.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Exchange |
$1,046.87
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP DNSP |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$362.01
|
| Rate for Payer: VA VA |
$675.40
|
|
|
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
|
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 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 |
$362.01 |
| Max. Negotiated Rate |
$1,046.87 |
| Rate for Payer: Aetna Commercial |
$877.91
|
| Rate for Payer: Aetna Medicare |
$675.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: ASR ASR |
$946.20
|
| Rate for Payer: ASR Commercial |
$946.20
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCBS Trust/PPO |
$798.80
|
| Rate for Payer: BCN Commercial |
$756.27
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| 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 |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$975.46
|
| Rate for Payer: Healthscope Whirlpool |
$946.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$675.40
|
| Rate for Payer: Mclaren Commercial |
$877.91
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.14
|
| Rate for Payer: Nomi Health Commercial |
$799.88
|
| Rate for Payer: PACE Medicare |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$742.94
|
| Rate for Payer: PHP Medicaid |
$362.01
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$854.70
|
| Rate for Payer: Priority Health Medicare |
$675.40
|
| Rate for Payer: Priority Health Narrow Network |
$683.80
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$858.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Exchange |
$1,046.87
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP DNSP |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$362.01
|
| Rate for Payer: VA VA |
$675.40
|
|
|
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 ANESTHETIC FEMORAL
|
Facility
|
OP
|
$1,534.27
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
36100391
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$362.01 |
| Max. Negotiated Rate |
$1,534.27 |
| Rate for Payer: Aetna Commercial |
$1,380.84
|
| Rate for Payer: Aetna Medicare |
$675.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: ASR ASR |
$1,488.24
|
| Rate for Payer: ASR Commercial |
$1,488.24
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,256.41
|
| Rate for Payer: BCN Commercial |
$1,189.52
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| 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 |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$1,534.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,488.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$675.40
|
| Rate for Payer: Mclaren Commercial |
$1,380.84
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| 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 |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$742.94
|
| Rate for Payer: PHP Medicaid |
$362.01
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,344.33
|
| Rate for Payer: Priority Health Medicare |
$675.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,075.52
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,350.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Exchange |
$1,046.87
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP DNSP |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$362.01
|
| Rate for Payer: VA VA |
$675.40
|
|
|
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 PERIPH NERVE
|
Facility
|
OP
|
$890.33
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
36100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.01 |
| Max. Negotiated Rate |
$1,046.87 |
| Rate for Payer: Aetna Commercial |
$801.30
|
| Rate for Payer: Aetna Medicare |
$675.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: ASR ASR |
$863.62
|
| Rate for Payer: ASR Commercial |
$863.62
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCBS Trust/PPO |
$729.09
|
| Rate for Payer: BCN Commercial |
$690.27
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| 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 |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$890.33
|
| Rate for Payer: Healthscope Whirlpool |
$863.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$675.40
|
| Rate for Payer: Mclaren Commercial |
$801.30
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$756.78
|
| Rate for Payer: Nomi Health Commercial |
$730.07
|
| Rate for Payer: PACE Medicare |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$742.94
|
| Rate for Payer: PHP Medicaid |
$362.01
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$780.11
|
| Rate for Payer: Priority Health Medicare |
$675.40
|
| Rate for Payer: Priority Health Narrow Network |
$624.12
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$783.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Exchange |
$1,046.87
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP DNSP |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$362.01
|
| Rate for Payer: VA VA |
$675.40
|
|
|
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 |
$465.40 |
| Max. Negotiated Rate |
$3,172.12 |
| Rate for Payer: Aetna Commercial |
$2,854.91
|
| Rate for Payer: Aetna Medicare |
$868.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: ASR ASR |
$3,076.96
|
| Rate for Payer: ASR Commercial |
$3,076.96
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,597.65
|
| Rate for Payer: BCN Commercial |
$2,459.34
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| 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 |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$3,172.12
|
| Rate for Payer: Healthscope Whirlpool |
$3,076.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$868.28
|
| Rate for Payer: Mclaren Commercial |
$2,854.91
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| 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 |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$955.11
|
| Rate for Payer: PHP Medicaid |
$465.40
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,779.41
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health Narrow Network |
$2,223.66
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,791.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,345.83
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP DNSP |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: VA VA |
$868.28
|
|
|
HC INJ ANESTH/STEROID BRACHIAL PLEXUS CONT
|
Facility
|
IP
|
$3,172.12
|
|
|
Service Code
|
CPT 64416
|
| Hospital Charge Code |
37100010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2,061.88 |
| Max. Negotiated Rate |
$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/STEROID SCIATIC NERVE CONT
|
Facility
|
IP
|
$3,180.56
|
|
|
Service Code
|
CPT 64446
|
| Hospital Charge Code |
37000020
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2,067.36 |
| Max. Negotiated Rate |
$3,180.56 |
| Rate for Payer: Aetna Commercial |
$2,862.50
|
| Rate for Payer: ASR ASR |
$3,085.14
|
| Rate for Payer: ASR Commercial |
$3,085.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,591.84
|
| Rate for Payer: BCN Commercial |
$2,465.89
|
| Rate for Payer: Cash Price |
$2,544.45
|
| Rate for Payer: Cofinity Commercial |
$2,989.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,544.45
|
| Rate for Payer: Healthscope Commercial |
$3,180.56
|
| Rate for Payer: Healthscope Whirlpool |
$3,085.14
|
| Rate for Payer: Mclaren Commercial |
$2,862.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,703.48
|
| Rate for Payer: Nomi Health Commercial |
$2,608.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,067.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,798.89
|
|
|
HC INJ ANESTH/STEROID SCIATIC NERVE CONT
|
Facility
|
OP
|
$3,180.56
|
|
|
Service Code
|
CPT 64446
|
| Hospital Charge Code |
37000020
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$3,180.56 |
| Rate for Payer: Aetna Commercial |
$2,862.50
|
| Rate for Payer: Aetna Medicare |
$868.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: ASR ASR |
$3,085.14
|
| Rate for Payer: ASR Commercial |
$3,085.14
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,604.56
|
| Rate for Payer: BCN Commercial |
$2,465.89
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$2,544.45
|
| Rate for Payer: Cash Price |
$2,544.45
|
| Rate for Payer: Cofinity Commercial |
$2,989.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,544.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$3,180.56
|
| Rate for Payer: Healthscope Whirlpool |
$3,085.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$868.28
|
| Rate for Payer: Mclaren Commercial |
$2,862.50
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,703.48
|
| Rate for Payer: Nomi Health Commercial |
$2,608.06
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$955.11
|
| Rate for Payer: PHP Medicaid |
$465.40
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,067.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,786.81
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health Narrow Network |
$2,229.57
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,798.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,345.83
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP DNSP |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: VA VA |
$868.28
|
|
|
HC INJ ANEST/STEROID ILIOING ILIOHYPOGAST NRV
|
Facility
|
IP
|
$975.46
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
76100270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$634.05 |
| Max. Negotiated Rate |
$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 ANEST/STEROID ILIOING ILIOHYPOGAST NRV
|
Facility
|
OP
|
$975.46
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
76100270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.01 |
| Max. Negotiated Rate |
$1,046.87 |
| Rate for Payer: Aetna Commercial |
$877.91
|
| Rate for Payer: Aetna Medicare |
$675.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: ASR ASR |
$946.20
|
| Rate for Payer: ASR Commercial |
$946.20
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCBS Trust/PPO |
$798.80
|
| Rate for Payer: BCN Commercial |
$756.27
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| 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 |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$975.46
|
| Rate for Payer: Healthscope Whirlpool |
$946.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$675.40
|
| Rate for Payer: Mclaren Commercial |
$877.91
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.14
|
| Rate for Payer: Nomi Health Commercial |
$799.88
|
| Rate for Payer: PACE Medicare |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$742.94
|
| Rate for Payer: PHP Medicaid |
$362.01
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$854.70
|
| Rate for Payer: Priority Health Medicare |
$675.40
|
| Rate for Payer: Priority Health Narrow Network |
$683.80
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$858.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Exchange |
$1,046.87
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP DNSP |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$362.01
|
| Rate for Payer: VA VA |
$675.40
|
|
|
HC INJ BEBTELOVIMAB
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
77100034
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$315.25 |
| Max. Negotiated Rate |
$485.00 |
| Rate for Payer: Aetna Commercial |
$436.50
|
| Rate for Payer: ASR ASR |
$470.45
|
| Rate for Payer: ASR Commercial |
$470.45
|
| Rate for Payer: BCBS Trust/PPO |
$395.23
|
| Rate for Payer: BCN Commercial |
$376.02
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$455.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.00
|
| Rate for Payer: Healthscope Commercial |
$485.00
|
| Rate for Payer: Healthscope Whirlpool |
$470.45
|
| Rate for Payer: Mclaren Commercial |
$436.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.25
|
| Rate for Payer: Nomi Health Commercial |
$397.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.80
|
|
|
HC INJ BEBTELOVIMAB
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
77100034
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$485.00 |
| Rate for Payer: Aetna Commercial |
$436.50
|
| Rate for Payer: Aetna Medicare |
$242.50
|
| Rate for Payer: ASR ASR |
$470.45
|
| Rate for Payer: ASR Commercial |
$470.45
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: BCBS Trust/PPO |
$397.17
|
| Rate for Payer: BCN Commercial |
$376.02
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$455.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.00
|
| Rate for Payer: Healthscope Commercial |
$485.00
|
| Rate for Payer: Healthscope Whirlpool |
$470.45
|
| Rate for Payer: Mclaren Commercial |
$436.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.25
|
| Rate for Payer: Nomi Health Commercial |
$397.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$424.96
|
| Rate for Payer: Priority Health Narrow Network |
$339.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.80
|
|
|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Narrow Network |
$14.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
OP
|
$1,103.46
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$1,345.83 |
| Rate for Payer: Aetna Commercial |
$993.11
|
| Rate for Payer: Aetna Medicare |
$868.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: ASR ASR |
$1,070.36
|
| Rate for Payer: ASR Commercial |
$1,070.36
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCBS Trust/PPO |
$903.62
|
| Rate for Payer: BCN Commercial |
$855.51
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$1,037.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$1,103.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,070.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$868.28
|
| Rate for Payer: Mclaren Commercial |
$993.11
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$904.84
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$955.11
|
| Rate for Payer: PHP Medicaid |
$465.40
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$966.85
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health Narrow Network |
$773.53
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$971.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,345.83
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP DNSP |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: VA VA |
$868.28
|
|
