|
HC INJECTION, CERTOLIZUMAB PEGOL, 1 MG
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.63
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.67
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.63
|
| Rate for Payer: Priority Health SBD |
$6.43
|
|
|
HC INJECTION, CERTOLIZUMAB PEGOL, 1 MG
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$13.40 |
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna Medicare |
$4.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.88
|
| Rate for Payer: BCBS Complete |
$2.19
|
| Rate for Payer: BCBS MAPPO |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$13.11
|
| Rate for Payer: BCN Commercial |
$13.11
|
| Rate for Payer: BCN Medicare Advantage |
$3.90
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.90
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Mclaren Medicaid |
$2.09
|
| Rate for Payer: Mclaren Medicare |
$3.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.10
|
| Rate for Payer: Meridian Medicaid |
$2.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.67
|
| Rate for Payer: Nomi Health Commercial |
$11.70
|
| Rate for Payer: PACE Medicare |
$3.70
|
| Rate for Payer: PACE SWMI |
$3.90
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: PHP Medicare Advantage |
$3.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.40
|
| Rate for Payer: Priority Health Medicare |
$3.90
|
| Rate for Payer: Priority Health Narrow Network |
$10.72
|
| Rate for Payer: Priority Health SBD |
$6.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.90
|
| Rate for Payer: UHC Medicare Advantage |
$3.90
|
| Rate for Payer: UHCCP Medicaid |
$2.20
|
| Rate for Payer: VA VA |
$3.90
|
|
|
HC INJECTION CERVICAL OR THORACIC
|
Facility
|
IP
|
$1,010.95
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
36100283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$636.90 |
| Max. Negotiated Rate |
$909.86 |
| Rate for Payer: Aetna Commercial |
$859.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.12
|
| Rate for Payer: Cash Price |
$808.76
|
| Rate for Payer: Cofinity Commercial |
$707.66
|
| Rate for Payer: Cofinity Commercial |
$869.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$707.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.76
|
| Rate for Payer: Healthscope Commercial |
$909.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.31
|
| Rate for Payer: PHP Commercial |
$859.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.12
|
| Rate for Payer: Priority Health SBD |
$636.90
|
|
|
HC INJECTION CERVICAL OR THORACIC
|
Facility
|
OP
|
$1,010.95
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
36100283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$150.06 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$859.31
|
| Rate for Payer: Aetna Medicare |
$505.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.12
|
| Rate for Payer: BCBS Complete |
$404.38
|
| Rate for Payer: BCBS Trust/PPO |
$682.33
|
| Rate for Payer: BCN Commercial |
$682.33
|
| Rate for Payer: Cash Price |
$808.76
|
| Rate for Payer: Cash Price |
$808.76
|
| Rate for Payer: Cash Price |
$808.76
|
| Rate for Payer: Cofinity Commercial |
$707.66
|
| Rate for Payer: Cofinity Commercial |
$869.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$707.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.76
|
| Rate for Payer: Healthscope Commercial |
$909.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.31
|
| Rate for Payer: PHP Commercial |
$859.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.12
|
| Rate for Payer: Priority Health SBD |
$636.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.06
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION CONTRAST FOR TUBE ASSESSMENT
|
Facility
|
IP
|
$1,018.86
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
36100223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$641.88 |
| Max. Negotiated Rate |
$916.97 |
| Rate for Payer: Aetna Commercial |
$866.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$662.26
|
| Rate for Payer: Cash Price |
$815.09
|
| Rate for Payer: Cofinity Commercial |
$713.20
|
| Rate for Payer: Cofinity Commercial |
$876.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$713.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$815.09
|
| Rate for Payer: Healthscope Commercial |
$916.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$866.03
|
| Rate for Payer: PHP Commercial |
$866.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$662.26
|
| Rate for Payer: Priority Health SBD |
$641.88
|
|
|
HC INJECTION CONTRAST FOR TUBE ASSESSMENT
|
Facility
|
OP
|
$1,018.86
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
36100223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.96 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$866.03
|
| Rate for Payer: Aetna Medicare |
$509.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$662.26
|
| Rate for Payer: BCBS Complete |
$407.54
|
| Rate for Payer: BCBS Trust/PPO |
$181.70
|
| Rate for Payer: BCN Commercial |
$181.70
|
| Rate for Payer: Cash Price |
$815.09
|
| Rate for Payer: Cash Price |
$815.09
|
| Rate for Payer: Cash Price |
$815.09
|
| Rate for Payer: Cofinity Commercial |
$713.20
|
| Rate for Payer: Cofinity Commercial |
$876.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$713.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$815.09
|
| Rate for Payer: Healthscope Commercial |
$916.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$866.03
|
| Rate for Payer: PHP Commercial |
$866.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$662.26
|
| Rate for Payer: Priority Health SBD |
$641.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.96
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION, DENOSUMAB, 1MG
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health SBD |
$16.06
|
|
|
HC INJECTION, DENOSUMAB, 1MG
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$82.98 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$28.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.58
|
| Rate for Payer: BCBS Complete |
$15.57
|
| Rate for Payer: BCBS MAPPO |
$27.66
|
| Rate for Payer: BCBS Trust/PPO |
$76.13
|
| Rate for Payer: BCN Commercial |
$76.13
|
| Rate for Payer: BCN Medicare Advantage |
$27.66
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.66
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$14.83
|
| Rate for Payer: Mclaren Medicare |
$27.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.04
|
| Rate for Payer: Meridian Medicaid |
$15.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$82.98
|
| Rate for Payer: PACE Medicare |
$26.28
|
| Rate for Payer: PACE SWMI |
$27.66
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$27.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.58
|
| Rate for Payer: Priority Health Medicare |
$27.66
|
| Rate for Payer: Priority Health Narrow Network |
$62.06
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: Railroad Medicare Medicare |
$27.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.66
|
| Rate for Payer: UHC Medicare Advantage |
$27.66
|
| Rate for Payer: UHCCP Medicaid |
$15.57
|
| Rate for Payer: VA VA |
$27.66
|
|
|
HC INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
|
Facility
|
IP
|
$14.57
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.47
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health SBD |
$9.18
|
|
|
HC INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
|
Facility
|
OP
|
$14.57
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$109.18 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna Medicare |
$7.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.47
|
| Rate for Payer: BCBS Complete |
$5.83
|
| Rate for Payer: BCBS Trust/PPO |
$109.18
|
| Rate for Payer: BCN Commercial |
$109.18
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health SBD |
$9.18
|
|
|
HC INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
|
Facility
|
IP
|
$2.08
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
63600167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health SBD |
$1.31
|
|
|
HC INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
|
Facility
|
OP
|
$2.08
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
63600167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.11 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna Medicare |
$1.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: BCBS Trust/PPO |
$2.11
|
| Rate for Payer: BCN Commercial |
$2.11
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health SBD |
$1.31
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
IP
|
$1,132.08
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$713.21 |
| Max. Negotiated Rate |
$1,018.87 |
| Rate for Payer: Aetna Commercial |
$962.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.85
|
| Rate for Payer: Cash Price |
$905.66
|
| Rate for Payer: Cofinity Commercial |
$792.46
|
| Rate for Payer: Cofinity Commercial |
$973.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$792.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$905.66
|
| Rate for Payer: Healthscope Commercial |
$1,018.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$962.27
|
| Rate for Payer: PHP Commercial |
$962.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$735.85
|
| Rate for Payer: Priority Health SBD |
$713.21
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
OP
|
$1,132.08
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$69.74 |
| Max. Negotiated Rate |
$1,018.87 |
| Rate for Payer: Aetna Commercial |
$962.27
|
| Rate for Payer: Aetna Medicare |
$566.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.85
|
| Rate for Payer: BCBS Complete |
$452.83
|
| Rate for Payer: BCBS Trust/PPO |
$247.39
|
| Rate for Payer: BCN Commercial |
$247.39
|
| Rate for Payer: Cash Price |
$905.66
|
| Rate for Payer: Cash Price |
$905.66
|
| Rate for Payer: Cash Price |
$905.66
|
| Rate for Payer: Cofinity Commercial |
$792.46
|
| Rate for Payer: Cofinity Commercial |
$973.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$792.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$905.66
|
| Rate for Payer: Healthscope Commercial |
$1,018.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$962.27
|
| Rate for Payer: PHP Commercial |
$962.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$735.85
|
| Rate for Payer: Priority Health SBD |
$713.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.74
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL
|
Facility
|
OP
|
$1,901.65
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.56 |
| Max. Negotiated Rate |
$2,741.59 |
| Rate for Payer: Aetna Commercial |
$1,616.40
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,236.07
|
| 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: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$815.61
|
| Rate for Payer: BCN Commercial |
$815.61
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$1,521.32
|
| Rate for Payer: Cash Price |
$1,521.32
|
| Rate for Payer: Cash Price |
$1,521.32
|
| Rate for Payer: Cofinity Commercial |
$1,331.16
|
| Rate for Payer: Cofinity Commercial |
$1,635.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,331.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,521.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,711.48
|
| 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 |
$1,616.40
|
| Rate for Payer: Nomi Health Commercial |
$1,831.81
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$1,616.40
|
| 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 |
$1,236.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,741.59
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,193.27
|
| Rate for Payer: Priority Health SBD |
$1,198.04
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.56
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$491.10
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL
|
Facility
|
IP
|
$1,901.65
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,198.04 |
| Max. Negotiated Rate |
$1,711.48 |
| Rate for Payer: Aetna Commercial |
$1,616.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,236.07
|
| Rate for Payer: Cash Price |
$1,521.32
|
| Rate for Payer: Cofinity Commercial |
$1,331.16
|
| Rate for Payer: Cofinity Commercial |
$1,635.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,331.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,521.32
|
| Rate for Payer: Healthscope Commercial |
$1,711.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,616.40
|
| Rate for Payer: PHP Commercial |
$1,616.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.07
|
| Rate for Payer: Priority Health SBD |
$1,198.04
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL
|
Facility
|
OP
|
$340.34
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100291
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.60 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$289.29
|
| Rate for Payer: Aetna Medicare |
$170.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.22
|
| Rate for Payer: BCBS Complete |
$136.14
|
| Rate for Payer: BCBS Trust/PPO |
$192.16
|
| Rate for Payer: BCN Commercial |
$192.16
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$238.24
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Healthscope Commercial |
$306.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: PHP Commercial |
$289.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health SBD |
$214.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.60
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL
|
Facility
|
IP
|
$340.34
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100291
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$214.41 |
| Max. Negotiated Rate |
$306.31 |
| Rate for Payer: Aetna Commercial |
$289.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.22
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$238.24
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Healthscope Commercial |
$306.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: PHP Commercial |
$289.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health SBD |
$214.41
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL
|
Facility
|
OP
|
$510.52
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.60 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$433.94
|
| Rate for Payer: Aetna Medicare |
$255.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.84
|
| Rate for Payer: BCBS Complete |
$204.21
|
| Rate for Payer: BCBS Trust/PPO |
$192.16
|
| Rate for Payer: BCN Commercial |
$192.16
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cofinity Commercial |
$357.36
|
| Rate for Payer: Cofinity Commercial |
$439.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.42
|
| Rate for Payer: Healthscope Commercial |
$459.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.94
|
| Rate for Payer: PHP Commercial |
$433.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.84
|
| Rate for Payer: Priority Health SBD |
$321.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.60
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL
|
Facility
|
IP
|
$510.52
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$321.63 |
| Max. Negotiated Rate |
$459.47 |
| Rate for Payer: Aetna Commercial |
$433.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.84
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cofinity Commercial |
$357.36
|
| Rate for Payer: Cofinity Commercial |
$439.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.42
|
| Rate for Payer: Healthscope Commercial |
$459.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.94
|
| Rate for Payer: PHP Commercial |
$433.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.84
|
| Rate for Payer: Priority Health SBD |
$321.63
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL
|
Facility
|
OP
|
$340.34
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100292
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.59 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$289.29
|
| Rate for Payer: Aetna Medicare |
$170.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.22
|
| Rate for Payer: BCBS Complete |
$136.14
|
| Rate for Payer: BCBS Trust/PPO |
$192.88
|
| Rate for Payer: BCN Commercial |
$192.88
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$238.24
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Healthscope Commercial |
$306.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: PHP Commercial |
$289.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health SBD |
$214.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.59
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL
|
Facility
|
IP
|
$340.34
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100292
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$214.41 |
| Max. Negotiated Rate |
$306.31 |
| Rate for Payer: Aetna Commercial |
$289.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.22
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$238.24
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Healthscope Commercial |
$306.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: PHP Commercial |
$289.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health SBD |
$214.41
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL BIL
|
Facility
|
IP
|
$510.52
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$321.63 |
| Max. Negotiated Rate |
$459.47 |
| Rate for Payer: Aetna Commercial |
$433.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.84
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cofinity Commercial |
$357.36
|
| Rate for Payer: Cofinity Commercial |
$439.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.42
|
| Rate for Payer: Healthscope Commercial |
$459.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.94
|
| Rate for Payer: PHP Commercial |
$433.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.84
|
| Rate for Payer: Priority Health SBD |
$321.63
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL BIL
|
Facility
|
OP
|
$510.52
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.59 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$433.94
|
| Rate for Payer: Aetna Medicare |
$255.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.84
|
| Rate for Payer: BCBS Complete |
$204.21
|
| Rate for Payer: BCBS Trust/PPO |
$192.88
|
| Rate for Payer: BCN Commercial |
$192.88
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cofinity Commercial |
$357.36
|
| Rate for Payer: Cofinity Commercial |
$439.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.42
|
| Rate for Payer: Healthscope Commercial |
$459.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.94
|
| Rate for Payer: PHP Commercial |
$433.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.84
|
| Rate for Payer: Priority Health SBD |
$321.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.59
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC INJECTION FACET JOINT L OR S 1ST LEVEL BIL
|
Facility
|
IP
|
$2,476.33
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,560.09 |
| Max. Negotiated Rate |
$2,228.70 |
| Rate for Payer: Aetna Commercial |
$2,104.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,609.61
|
| Rate for Payer: Cash Price |
$1,981.06
|
| Rate for Payer: Cofinity Commercial |
$1,733.43
|
| Rate for Payer: Cofinity Commercial |
$2,129.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,733.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,981.06
|
| Rate for Payer: Healthscope Commercial |
$2,228.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,104.88
|
| Rate for Payer: PHP Commercial |
$2,104.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,609.61
|
| Rate for Payer: Priority Health SBD |
$1,560.09
|
|
