|
HC INJECTION SI JOINT BIL ANESTHESIA/STEROID
|
Facility
|
OP
|
$1,047.85
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$419.14 |
| Max. Negotiated Rate |
$1,147.41 |
| Rate for Payer: Aetna Commercial |
$943.06
|
| Rate for Payer: Aetna Medicare |
$523.92
|
| Rate for Payer: ASR ASR |
$1,016.41
|
| Rate for Payer: ASR Commercial |
$1,016.41
|
| Rate for Payer: BCBS Complete |
$419.14
|
| Rate for Payer: BCBS Trust/PPO |
$858.08
|
| Rate for Payer: BCN Commercial |
$812.40
|
| Rate for Payer: Cash Price |
$838.28
|
| Rate for Payer: Cash Price |
$838.28
|
| Rate for Payer: Cofinity Commercial |
$984.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.28
|
| Rate for Payer: Healthscope Commercial |
$1,047.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,016.41
|
| Rate for Payer: Mclaren Commercial |
$943.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.67
|
| Rate for Payer: Nomi Health Commercial |
$859.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$681.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,147.41
|
| Rate for Payer: Priority Health Narrow Network |
$917.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$922.11
|
|
|
HC INJECTION SI JOINT BIL ANESTHESIA/STEROID
|
Facility
|
IP
|
$1,047.85
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$681.10 |
| Max. Negotiated Rate |
$1,047.85 |
| Rate for Payer: Aetna Commercial |
$943.06
|
| Rate for Payer: ASR ASR |
$1,016.41
|
| Rate for Payer: ASR Commercial |
$1,016.41
|
| Rate for Payer: BCBS Trust/PPO |
$853.89
|
| Rate for Payer: BCN Commercial |
$812.40
|
| Rate for Payer: Cash Price |
$838.28
|
| Rate for Payer: Cofinity Commercial |
$984.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.28
|
| Rate for Payer: Healthscope Commercial |
$1,047.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,016.41
|
| Rate for Payer: Mclaren Commercial |
$943.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.67
|
| Rate for Payer: Nomi Health Commercial |
$859.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$681.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$922.11
|
|
|
HC INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$279.36
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
36100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.58 |
| Max. Negotiated Rate |
$279.36 |
| Rate for Payer: Aetna Commercial |
$251.42
|
| Rate for Payer: ASR ASR |
$270.98
|
| Rate for Payer: ASR Commercial |
$270.98
|
| Rate for Payer: BCBS Trust/PPO |
$227.65
|
| Rate for Payer: BCN Commercial |
$216.59
|
| Rate for Payer: Cash Price |
$223.49
|
| Rate for Payer: Cofinity Commercial |
$262.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.49
|
| Rate for Payer: Healthscope Commercial |
$279.36
|
| Rate for Payer: Healthscope Whirlpool |
$270.98
|
| Rate for Payer: Mclaren Commercial |
$251.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.46
|
| Rate for Payer: Nomi Health Commercial |
$229.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.84
|
|
|
HC INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$279.36
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
36100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.02 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Aetna Commercial |
$251.42
|
| Rate for Payer: Aetna Medicare |
$289.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: ASR ASR |
$270.98
|
| Rate for Payer: ASR Commercial |
$270.98
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$228.77
|
| Rate for Payer: BCN Commercial |
$216.59
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$223.49
|
| Rate for Payer: Cash Price |
$223.49
|
| Rate for Payer: Cofinity Commercial |
$262.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$279.36
|
| Rate for Payer: Healthscope Whirlpool |
$270.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$289.22
|
| Rate for Payer: Mclaren Commercial |
$251.42
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.46
|
| Rate for Payer: Nomi Health Commercial |
$229.08
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$318.14
|
| Rate for Payer: PHP Medicaid |
$155.02
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.78
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$195.83
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$448.29
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP DNSP |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: VA VA |
$289.22
|
|
|
HC INJECTION SPLENOPOTOGRAM SPLENOPORTOG
|
Facility
|
IP
|
$437.63
|
|
|
Service Code
|
CPT 38200
|
| Hospital Charge Code |
36100183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$284.46 |
| Max. Negotiated Rate |
$437.63 |
| Rate for Payer: Aetna Commercial |
$393.87
|
| Rate for Payer: ASR ASR |
$424.50
|
| Rate for Payer: ASR Commercial |
$424.50
|
| Rate for Payer: BCBS Trust/PPO |
$356.62
|
| Rate for Payer: BCN Commercial |
$339.29
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$411.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Healthscope Commercial |
$437.63
|
| Rate for Payer: Healthscope Whirlpool |
$424.50
|
| Rate for Payer: Mclaren Commercial |
$393.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: Nomi Health Commercial |
$358.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.11
|
|
|
HC INJECTION SPLENOPOTOGRAM SPLENOPORTOG
|
Facility
|
OP
|
$437.63
|
|
|
Service Code
|
CPT 38200
|
| Hospital Charge Code |
36100183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$175.05 |
| Max. Negotiated Rate |
$437.63 |
| Rate for Payer: Aetna Commercial |
$393.87
|
| Rate for Payer: Aetna Medicare |
$218.82
|
| Rate for Payer: ASR ASR |
$424.50
|
| Rate for Payer: ASR Commercial |
$424.50
|
| Rate for Payer: BCBS Complete |
$175.05
|
| Rate for Payer: BCBS Trust/PPO |
$358.38
|
| Rate for Payer: BCN Commercial |
$339.29
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$411.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Healthscope Commercial |
$437.63
|
| Rate for Payer: Healthscope Whirlpool |
$424.50
|
| Rate for Payer: Mclaren Commercial |
$393.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: Nomi Health Commercial |
$358.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$383.45
|
| Rate for Payer: Priority Health Narrow Network |
$306.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.11
|
|
|
HC INJECTIONS SCLEROSANT FOR SPIDER VEINS /TRNK
|
Facility
|
IP
|
$1,085.28
|
|
|
Service Code
|
CPT 36468
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$705.43 |
| Max. Negotiated Rate |
$1,085.28 |
| Rate for Payer: Aetna Commercial |
$976.75
|
| Rate for Payer: ASR ASR |
$1,052.72
|
| Rate for Payer: ASR Commercial |
$1,052.72
|
| Rate for Payer: BCBS Trust/PPO |
$884.39
|
| Rate for Payer: BCN Commercial |
$841.42
|
| Rate for Payer: Cash Price |
$868.22
|
| Rate for Payer: Cofinity Commercial |
$1,020.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$868.22
|
| Rate for Payer: Healthscope Commercial |
$1,085.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,052.72
|
| Rate for Payer: Mclaren Commercial |
$976.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$922.49
|
| Rate for Payer: Nomi Health Commercial |
$889.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$955.05
|
|
|
HC INJECTIONS SCLEROSANT FOR SPIDER VEINS /TRNK
|
Facility
|
OP
|
$1,085.28
|
|
|
Service Code
|
CPT 36468
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$1,085.28 |
| Rate for Payer: Aetna Commercial |
$976.75
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$1,052.72
|
| Rate for Payer: ASR Commercial |
$1,052.72
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$888.74
|
| Rate for Payer: BCN Commercial |
$841.42
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$868.22
|
| Rate for Payer: Cash Price |
$868.22
|
| Rate for Payer: Cofinity Commercial |
$1,020.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$868.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$1,085.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,052.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$976.75
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$922.49
|
| Rate for Payer: Nomi Health Commercial |
$889.93
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$950.92
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$760.78
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$955.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
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 |
$0.08
|
| Rate for Payer: ASR ASR |
$0.16
|
| Rate for Payer: ASR Commercial |
$0.16
|
| Rate for Payer: BCBS Complete |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.12
|
| 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: Multiplan/Beech St/PHCS Commercial |
$0.14
|
| Rate for Payer: Nomi Health Commercial |
$0.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.10
|
| Rate for Payer: 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 |
$0.10 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: ASR ASR |
$0.16
|
| Rate for Payer: ASR Commercial |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cofinity Commercial |
$0.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.13
|
| Rate for Payer: Healthscope Commercial |
$0.16
|
| Rate for Payer: Healthscope Whirlpool |
$0.16
|
| Rate for Payer: Mclaren Commercial |
$0.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.14
|
| Rate for Payer: Nomi Health Commercial |
$0.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.14
|
|
|
HC INJECTION THERAPEUTIC SINUS TRACT
|
Facility
|
IP
|
$923.66
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
36100020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$600.38 |
| Max. Negotiated Rate |
$923.66 |
| Rate for Payer: Aetna Commercial |
$831.29
|
| Rate for Payer: ASR ASR |
$895.95
|
| Rate for Payer: ASR Commercial |
$895.95
|
| Rate for Payer: BCBS Trust/PPO |
$752.69
|
| Rate for Payer: BCN Commercial |
$716.11
|
| Rate for Payer: Cash Price |
$738.93
|
| Rate for Payer: Cofinity Commercial |
$868.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$738.93
|
| Rate for Payer: Healthscope Commercial |
$923.66
|
| Rate for Payer: Healthscope Whirlpool |
$895.95
|
| Rate for Payer: Mclaren Commercial |
$831.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.11
|
| Rate for Payer: Nomi Health Commercial |
$757.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$812.82
|
|
|
HC INJECTION THERAPEUTIC SINUS TRACT
|
Facility
|
OP
|
$923.66
|
|
|
Service Code
|
CPT 20500
|
| Hospital Charge Code |
36100020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$600.38 |
| Max. Negotiated Rate |
$2,249.56 |
| Rate for Payer: Aetna Commercial |
$831.29
|
| Rate for Payer: Aetna Medicare |
$1,451.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,814.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,814.16
|
| Rate for Payer: ASR ASR |
$895.95
|
| Rate for Payer: ASR Commercial |
$895.95
|
| Rate for Payer: BCBS Complete |
$816.81
|
| Rate for Payer: BCBS MAPPO |
$1,451.33
|
| Rate for Payer: BCBS Trust/PPO |
$756.39
|
| Rate for Payer: BCN Commercial |
$716.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.33
|
| Rate for Payer: Cash Price |
$738.93
|
| Rate for Payer: Cash Price |
$738.93
|
| Rate for Payer: Cofinity Commercial |
$868.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$738.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.33
|
| Rate for Payer: Healthscope Commercial |
$923.66
|
| Rate for Payer: Healthscope Whirlpool |
$895.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,451.33
|
| Rate for Payer: Mclaren Commercial |
$831.29
|
| Rate for Payer: Mclaren Medicaid |
$777.91
|
| Rate for Payer: Mclaren Medicare |
$1,451.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,523.90
|
| Rate for Payer: Meridian Medicaid |
$816.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,669.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.11
|
| Rate for Payer: Nomi Health Commercial |
$757.40
|
| Rate for Payer: PACE Medicare |
$1,378.76
|
| Rate for Payer: PACE SWMI |
$1,451.33
|
| Rate for Payer: PHP Commercial |
$1,596.46
|
| Rate for Payer: PHP Medicaid |
$777.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$777.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$809.31
|
| Rate for Payer: Priority Health Medicare |
$1,451.33
|
| Rate for Payer: Priority Health Narrow Network |
$647.49
|
| Rate for Payer: Railroad Medicare Medicare |
$1,451.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$812.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,451.33
|
| Rate for Payer: UHC Exchange |
$2,249.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,451.33
|
| Rate for Payer: UHCCP DNSP |
$1,451.33
|
| Rate for Payer: UHCCP Medicaid |
$777.91
|
| Rate for Payer: VA VA |
$1,451.33
|
|
|
HC INJECTION TRANSFORAMINAL CERVICAL OR THORACIC
|
Facility
|
IP
|
$1,724.42
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,120.87 |
| Max. Negotiated Rate |
$1,724.42 |
| Rate for Payer: Aetna Commercial |
$1,551.98
|
| Rate for Payer: ASR ASR |
$1,672.69
|
| Rate for Payer: ASR Commercial |
$1,672.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,405.23
|
| Rate for Payer: BCN Commercial |
$1,336.94
|
| Rate for Payer: Cash Price |
$1,379.54
|
| Rate for Payer: Cofinity Commercial |
$1,620.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,379.54
|
| Rate for Payer: Healthscope Commercial |
$1,724.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,672.69
|
| Rate for Payer: Mclaren Commercial |
$1,551.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,465.76
|
| Rate for Payer: Nomi Health Commercial |
$1,414.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,120.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,517.49
|
|
|
HC INJECTION TRANSFORAMINAL CERVICAL OR THORACIC
|
Facility
|
OP
|
$1,724.42
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$467.55 |
| Max. Negotiated Rate |
$1,724.42 |
| Rate for Payer: Aetna Commercial |
$1,551.98
|
| 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 |
$1,672.69
|
| Rate for Payer: ASR Commercial |
$1,672.69
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,412.13
|
| Rate for Payer: BCN Commercial |
$1,336.94
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$1,379.54
|
| Rate for Payer: Cash Price |
$1,379.54
|
| Rate for Payer: Cofinity Commercial |
$1,620.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,379.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,724.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,672.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$872.29
|
| Rate for Payer: Mclaren Commercial |
$1,551.98
|
| 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 |
$1,465.76
|
| Rate for Payer: Nomi Health Commercial |
$1,414.02
|
| 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 |
$1,120.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,510.94
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,208.82
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,517.49
|
| 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 INJECTION TRANSFORAMIN CERVICAL OR THORACIC BIL
|
Facility
|
IP
|
$2,586.63
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100623
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,681.31 |
| Max. Negotiated Rate |
$2,586.63 |
| Rate for Payer: Aetna Commercial |
$2,327.97
|
| Rate for Payer: ASR ASR |
$2,509.03
|
| Rate for Payer: ASR Commercial |
$2,509.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,107.84
|
| Rate for Payer: BCN Commercial |
$2,005.41
|
| Rate for Payer: Cash Price |
$2,069.30
|
| Rate for Payer: Cofinity Commercial |
$2,431.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,069.30
|
| Rate for Payer: Healthscope Commercial |
$2,586.63
|
| Rate for Payer: Healthscope Whirlpool |
$2,509.03
|
| Rate for Payer: Mclaren Commercial |
$2,327.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,198.64
|
| Rate for Payer: Nomi Health Commercial |
$2,121.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,681.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,276.23
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC BIL
|
Facility
|
OP
|
$2,586.63
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
36100623
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$467.55 |
| Max. Negotiated Rate |
$2,586.63 |
| Rate for Payer: Aetna Commercial |
$2,327.97
|
| 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 |
$2,509.03
|
| Rate for Payer: ASR Commercial |
$2,509.03
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,118.19
|
| Rate for Payer: BCN Commercial |
$2,005.41
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$2,069.30
|
| Rate for Payer: Cash Price |
$2,069.30
|
| Rate for Payer: Cofinity Commercial |
$2,431.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,069.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$2,586.63
|
| Rate for Payer: Healthscope Whirlpool |
$2,509.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$872.29
|
| Rate for Payer: Mclaren Commercial |
$2,327.97
|
| 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 |
$2,198.64
|
| Rate for Payer: Nomi Health Commercial |
$2,121.04
|
| 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 |
$1,681.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,266.41
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,813.23
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,276.23
|
| 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 INJECTION TRANSFORAMIN CERVICAL OR THORACIC EA ADD
|
Facility
|
OP
|
$911.49
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$364.60 |
| Max. Negotiated Rate |
$911.49 |
| Rate for Payer: Aetna Commercial |
$820.34
|
| Rate for Payer: Aetna Medicare |
$455.74
|
| Rate for Payer: ASR ASR |
$884.15
|
| Rate for Payer: ASR Commercial |
$884.15
|
| Rate for Payer: BCBS Complete |
$364.60
|
| Rate for Payer: BCBS Trust/PPO |
$746.42
|
| Rate for Payer: BCN Commercial |
$706.68
|
| Rate for Payer: Cash Price |
$729.19
|
| Rate for Payer: Cofinity Commercial |
$856.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.19
|
| Rate for Payer: Healthscope Commercial |
$911.49
|
| Rate for Payer: Healthscope Whirlpool |
$884.15
|
| Rate for Payer: Mclaren Commercial |
$820.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.77
|
| Rate for Payer: Nomi Health Commercial |
$747.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$798.65
|
| Rate for Payer: Priority Health Narrow Network |
$638.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$802.11
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EA ADD
|
Facility
|
IP
|
$911.49
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$592.47 |
| Max. Negotiated Rate |
$911.49 |
| Rate for Payer: Aetna Commercial |
$820.34
|
| Rate for Payer: ASR ASR |
$884.15
|
| Rate for Payer: ASR Commercial |
$884.15
|
| Rate for Payer: BCBS Trust/PPO |
$742.77
|
| Rate for Payer: BCN Commercial |
$706.68
|
| Rate for Payer: Cash Price |
$729.19
|
| Rate for Payer: Cofinity Commercial |
$856.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.19
|
| Rate for Payer: Healthscope Commercial |
$911.49
|
| Rate for Payer: Healthscope Whirlpool |
$884.15
|
| Rate for Payer: Mclaren Commercial |
$820.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$774.77
|
| Rate for Payer: Nomi Health Commercial |
$747.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$802.11
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL
|
Facility
|
OP
|
$1,367.24
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$546.90 |
| Max. Negotiated Rate |
$1,367.24 |
| Rate for Payer: Aetna Commercial |
$1,230.52
|
| Rate for Payer: Aetna Medicare |
$683.62
|
| Rate for Payer: ASR ASR |
$1,326.22
|
| Rate for Payer: ASR Commercial |
$1,326.22
|
| Rate for Payer: BCBS Complete |
$546.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,119.63
|
| Rate for Payer: BCN Commercial |
$1,060.02
|
| Rate for Payer: Cash Price |
$1,093.79
|
| Rate for Payer: Cofinity Commercial |
$1,285.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,093.79
|
| Rate for Payer: Healthscope Commercial |
$1,367.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,326.22
|
| Rate for Payer: Mclaren Commercial |
$1,230.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,162.15
|
| Rate for Payer: Nomi Health Commercial |
$1,121.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$888.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,197.98
|
| Rate for Payer: Priority Health Narrow Network |
$958.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,203.17
|
|
|
HC INJECTION TRANSFORAMIN CERVICAL OR THORACIC EACH ADDL BIL
|
Facility
|
IP
|
$1,367.24
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
36100624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$888.71 |
| Max. Negotiated Rate |
$1,367.24 |
| Rate for Payer: Aetna Commercial |
$1,230.52
|
| Rate for Payer: ASR ASR |
$1,326.22
|
| Rate for Payer: ASR Commercial |
$1,326.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,114.16
|
| Rate for Payer: BCN Commercial |
$1,060.02
|
| Rate for Payer: Cash Price |
$1,093.79
|
| Rate for Payer: Cofinity Commercial |
$1,285.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,093.79
|
| Rate for Payer: Healthscope Commercial |
$1,367.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,326.22
|
| Rate for Payer: Mclaren Commercial |
$1,230.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,162.15
|
| Rate for Payer: Nomi Health Commercial |
$1,121.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$888.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,203.17
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL
|
Facility
|
OP
|
$972.13
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$388.85 |
| Max. Negotiated Rate |
$972.13 |
| Rate for Payer: Aetna Commercial |
$874.92
|
| Rate for Payer: Aetna Medicare |
$486.06
|
| Rate for Payer: ASR ASR |
$942.97
|
| Rate for Payer: ASR Commercial |
$942.97
|
| Rate for Payer: BCBS Complete |
$388.85
|
| Rate for Payer: BCBS Trust/PPO |
$796.08
|
| Rate for Payer: BCN Commercial |
$753.69
|
| Rate for Payer: Cash Price |
$777.70
|
| Rate for Payer: Cofinity Commercial |
$913.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.70
|
| Rate for Payer: Healthscope Commercial |
$972.13
|
| Rate for Payer: Healthscope Whirlpool |
$942.97
|
| Rate for Payer: Mclaren Commercial |
$874.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$826.31
|
| Rate for Payer: Nomi Health Commercial |
$797.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$851.78
|
| Rate for Payer: Priority Health Narrow Network |
$681.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$855.47
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL
|
Facility
|
IP
|
$972.13
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100289
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$631.88 |
| Max. Negotiated Rate |
$972.13 |
| Rate for Payer: Aetna Commercial |
$874.92
|
| Rate for Payer: ASR ASR |
$942.97
|
| Rate for Payer: ASR Commercial |
$942.97
|
| Rate for Payer: BCBS Trust/PPO |
$792.19
|
| Rate for Payer: BCN Commercial |
$753.69
|
| Rate for Payer: Cash Price |
$777.70
|
| Rate for Payer: Cofinity Commercial |
$913.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.70
|
| Rate for Payer: Healthscope Commercial |
$972.13
|
| Rate for Payer: Healthscope Whirlpool |
$942.97
|
| Rate for Payer: Mclaren Commercial |
$874.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$826.31
|
| Rate for Payer: Nomi Health Commercial |
$797.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$855.47
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL
|
Facility
|
IP
|
$1,458.19
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$947.82 |
| Max. Negotiated Rate |
$1,458.19 |
| Rate for Payer: Aetna Commercial |
$1,312.37
|
| Rate for Payer: ASR ASR |
$1,414.44
|
| Rate for Payer: ASR Commercial |
$1,414.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,188.28
|
| Rate for Payer: BCN Commercial |
$1,130.53
|
| Rate for Payer: Cash Price |
$1,166.55
|
| Rate for Payer: Cofinity Commercial |
$1,370.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.55
|
| Rate for Payer: Healthscope Commercial |
$1,458.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,414.44
|
| Rate for Payer: Mclaren Commercial |
$1,312.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.46
|
| Rate for Payer: Nomi Health Commercial |
$1,195.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,283.21
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR EA ADD LEVEL BIL
|
Facility
|
OP
|
$1,458.19
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
36100625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$583.28 |
| Max. Negotiated Rate |
$1,458.19 |
| Rate for Payer: Aetna Commercial |
$1,312.37
|
| Rate for Payer: Aetna Medicare |
$729.10
|
| Rate for Payer: ASR ASR |
$1,414.44
|
| Rate for Payer: ASR Commercial |
$1,414.44
|
| Rate for Payer: BCBS Complete |
$583.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,194.11
|
| Rate for Payer: BCN Commercial |
$1,130.53
|
| Rate for Payer: Cash Price |
$1,166.55
|
| Rate for Payer: Cofinity Commercial |
$1,370.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.55
|
| Rate for Payer: Healthscope Commercial |
$1,458.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,414.44
|
| Rate for Payer: Mclaren Commercial |
$1,312.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.46
|
| Rate for Payer: Nomi Health Commercial |
$1,195.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,277.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,022.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,283.21
|
|
|
HC INJECTION TRANSFORAMIN LUMB OR SACR SINGLE LEVEL
|
Facility
|
IP
|
$1,536.98
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
36100288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$999.04 |
| Max. Negotiated Rate |
$1,536.98 |
| Rate for Payer: Aetna Commercial |
$1,383.28
|
| Rate for Payer: ASR ASR |
$1,490.87
|
| Rate for Payer: ASR Commercial |
$1,490.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,252.49
|
| Rate for Payer: BCN Commercial |
$1,191.62
|
| Rate for Payer: Cash Price |
$1,229.58
|
| Rate for Payer: Cofinity Commercial |
$1,444.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.58
|
| Rate for Payer: Healthscope Commercial |
$1,536.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,490.87
|
| Rate for Payer: Mclaren Commercial |
$1,383.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,306.43
|
| Rate for Payer: Nomi Health Commercial |
$1,260.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$999.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,352.54
|
|
