|
HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL
|
Facility
|
OP
|
$1,939.68
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$1,939.68 |
| Rate for Payer: Aetna Commercial |
$1,745.71
|
| Rate for Payer: Aetna Medicare |
$881.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: ASR ASR |
$1,881.49
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,599.27
|
| Rate for Payer: BCN Commercial |
$1,599.27
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$1,551.74
|
| Rate for Payer: Cash Price |
$1,551.74
|
| Rate for Payer: Cofinity Commercial |
$1,823.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,551.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,881.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,939.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$881.29
|
| Rate for Payer: Mclaren Commercial |
$1,745.71
|
| Rate for Payer: Mclaren Medicaid |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$484.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,648.73
|
| Rate for Payer: Nomi Health Commercial |
$1,590.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,454.76
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$969.42
|
| Rate for Payer: PHP Medicaid |
$472.37
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,699.55
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,359.72
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,706.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Exchange |
$1,366.00
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP DNSP |
$881.29
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL
|
Facility
|
OP
|
$347.15
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100291
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.45 |
| Max. Negotiated Rate |
$347.15 |
| Rate for Payer: Aetna Commercial |
$312.44
|
| Rate for Payer: Aetna Medicare |
$128.45
|
| Rate for Payer: ASR ASR |
$336.74
|
| Rate for Payer: BCBS Complete |
$138.86
|
| Rate for Payer: BCBS Trust/PPO |
$286.23
|
| Rate for Payer: BCN Commercial |
$286.23
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cofinity Commercial |
$326.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.72
|
| Rate for Payer: Healthscope Commercial |
$336.74
|
| Rate for Payer: Healthscope Whirlpool |
$347.15
|
| Rate for Payer: Mclaren Commercial |
$312.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$277.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.08
|
| Rate for Payer: Nomi Health Commercial |
$284.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$304.17
|
| Rate for Payer: Priority Health Narrow Network |
$243.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.49
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL
|
Facility
|
IP
|
$347.15
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100291
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$260.36 |
| Max. Negotiated Rate |
$347.15 |
| Rate for Payer: Aetna Commercial |
$312.44
|
| Rate for Payer: ASR ASR |
$336.74
|
| Rate for Payer: BCBS Trust/PPO |
$285.08
|
| Rate for Payer: BCN Commercial |
$285.08
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cofinity Commercial |
$326.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.72
|
| Rate for Payer: Healthscope Commercial |
$336.74
|
| Rate for Payer: Healthscope Whirlpool |
$347.15
|
| Rate for Payer: Mclaren Commercial |
$312.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.08
|
| Rate for Payer: Nomi Health Commercial |
$284.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.49
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL
|
Facility
|
OP
|
$520.73
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.67 |
| Max. Negotiated Rate |
$520.73 |
| Rate for Payer: Aetna Commercial |
$468.66
|
| Rate for Payer: Aetna Medicare |
$192.67
|
| Rate for Payer: ASR ASR |
$505.11
|
| Rate for Payer: BCBS Complete |
$208.29
|
| Rate for Payer: BCBS Trust/PPO |
$429.34
|
| Rate for Payer: BCN Commercial |
$429.34
|
| Rate for Payer: Cash Price |
$416.58
|
| Rate for Payer: Cofinity Commercial |
$489.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.58
|
| Rate for Payer: Healthscope Commercial |
$505.11
|
| Rate for Payer: Healthscope Whirlpool |
$520.73
|
| Rate for Payer: Mclaren Commercial |
$468.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.62
|
| Rate for Payer: Nomi Health Commercial |
$427.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$456.26
|
| Rate for Payer: Priority Health Narrow Network |
$365.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$458.24
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL
|
Facility
|
IP
|
$520.73
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$390.55 |
| Max. Negotiated Rate |
$520.73 |
| Rate for Payer: Aetna Commercial |
$468.66
|
| Rate for Payer: ASR ASR |
$505.11
|
| Rate for Payer: BCBS Trust/PPO |
$427.62
|
| Rate for Payer: BCN Commercial |
$427.62
|
| Rate for Payer: Cash Price |
$416.58
|
| Rate for Payer: Cofinity Commercial |
$489.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.58
|
| Rate for Payer: Healthscope Commercial |
$505.11
|
| Rate for Payer: Healthscope Whirlpool |
$520.73
|
| Rate for Payer: Mclaren Commercial |
$468.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.62
|
| Rate for Payer: Nomi Health Commercial |
$427.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$458.24
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL
|
Facility
|
OP
|
$347.15
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100292
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.45 |
| Max. Negotiated Rate |
$347.15 |
| Rate for Payer: Aetna Commercial |
$312.44
|
| Rate for Payer: Aetna Medicare |
$128.45
|
| Rate for Payer: ASR ASR |
$336.74
|
| Rate for Payer: BCBS Complete |
$138.86
|
| Rate for Payer: BCBS Trust/PPO |
$286.23
|
| Rate for Payer: BCN Commercial |
$286.23
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cofinity Commercial |
$326.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.72
|
| Rate for Payer: Healthscope Commercial |
$336.74
|
| Rate for Payer: Healthscope Whirlpool |
$347.15
|
| Rate for Payer: Mclaren Commercial |
$312.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$277.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.08
|
| Rate for Payer: Nomi Health Commercial |
$284.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$304.17
|
| Rate for Payer: Priority Health Narrow Network |
$243.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.49
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL
|
Facility
|
IP
|
$347.15
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100292
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$260.36 |
| Max. Negotiated Rate |
$347.15 |
| Rate for Payer: Aetna Commercial |
$312.44
|
| Rate for Payer: ASR ASR |
$336.74
|
| Rate for Payer: BCBS Trust/PPO |
$285.08
|
| Rate for Payer: BCN Commercial |
$285.08
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cofinity Commercial |
$326.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.72
|
| Rate for Payer: Healthscope Commercial |
$336.74
|
| Rate for Payer: Healthscope Whirlpool |
$347.15
|
| Rate for Payer: Mclaren Commercial |
$312.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.08
|
| Rate for Payer: Nomi Health Commercial |
$284.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.49
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL BIL
|
Facility
|
OP
|
$520.73
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.67 |
| Max. Negotiated Rate |
$520.73 |
| Rate for Payer: Aetna Commercial |
$468.66
|
| Rate for Payer: Aetna Medicare |
$192.67
|
| Rate for Payer: ASR ASR |
$505.11
|
| Rate for Payer: BCBS Complete |
$208.29
|
| Rate for Payer: BCBS Trust/PPO |
$429.34
|
| Rate for Payer: BCN Commercial |
$429.34
|
| Rate for Payer: Cash Price |
$416.58
|
| Rate for Payer: Cofinity Commercial |
$489.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.58
|
| Rate for Payer: Healthscope Commercial |
$505.11
|
| Rate for Payer: Healthscope Whirlpool |
$520.73
|
| Rate for Payer: Mclaren Commercial |
$468.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.62
|
| Rate for Payer: Nomi Health Commercial |
$427.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$456.26
|
| Rate for Payer: Priority Health Narrow Network |
$365.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$458.24
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL BIL
|
Facility
|
IP
|
$520.73
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$390.55 |
| Max. Negotiated Rate |
$520.73 |
| Rate for Payer: Aetna Commercial |
$468.66
|
| Rate for Payer: ASR ASR |
$505.11
|
| Rate for Payer: BCBS Trust/PPO |
$427.62
|
| Rate for Payer: BCN Commercial |
$427.62
|
| Rate for Payer: Cash Price |
$416.58
|
| Rate for Payer: Cofinity Commercial |
$489.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.58
|
| Rate for Payer: Healthscope Commercial |
$505.11
|
| Rate for Payer: Healthscope Whirlpool |
$520.73
|
| Rate for Payer: Mclaren Commercial |
$468.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.62
|
| Rate for Payer: Nomi Health Commercial |
$427.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$458.24
|
|
|
HC INJECTION FACET JOINT L OR S 1ST LEVEL BIL
|
Facility
|
OP
|
$2,525.86
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,525.86 |
| Rate for Payer: Aetna Commercial |
$2,273.27
|
| Rate for Payer: Aetna Medicare |
$881.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: ASR ASR |
$2,450.08
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,082.57
|
| Rate for Payer: BCN Commercial |
$2,082.57
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$2,020.69
|
| Rate for Payer: Cash Price |
$2,020.69
|
| Rate for Payer: Cofinity Commercial |
$2,374.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,020.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$2,450.08
|
| Rate for Payer: Healthscope Whirlpool |
$2,525.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$881.29
|
| Rate for Payer: Mclaren Commercial |
$2,273.27
|
| Rate for Payer: Mclaren Medicaid |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$484.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,146.98
|
| Rate for Payer: Nomi Health Commercial |
$2,071.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,894.39
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$969.42
|
| Rate for Payer: PHP Medicaid |
$472.37
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,213.16
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,770.63
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,222.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Exchange |
$1,366.00
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP DNSP |
$881.29
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
HC INJECTION FACET JOINT L OR S 1ST LEVEL BIL
|
Facility
|
IP
|
$2,525.86
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,894.39 |
| Max. Negotiated Rate |
$2,525.86 |
| Rate for Payer: Aetna Commercial |
$2,273.27
|
| Rate for Payer: ASR ASR |
$2,450.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,074.24
|
| Rate for Payer: BCN Commercial |
$2,074.24
|
| Rate for Payer: Cash Price |
$2,020.69
|
| Rate for Payer: Cofinity Commercial |
$2,374.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,020.69
|
| Rate for Payer: Healthscope Commercial |
$2,450.08
|
| Rate for Payer: Healthscope Whirlpool |
$2,525.86
|
| Rate for Payer: Mclaren Commercial |
$2,273.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,146.98
|
| Rate for Payer: Nomi Health Commercial |
$2,071.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,894.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,222.76
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL
|
Facility
|
IP
|
$420.05
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$315.04 |
| Max. Negotiated Rate |
$420.05 |
| Rate for Payer: Aetna Commercial |
$378.05
|
| Rate for Payer: ASR ASR |
$407.45
|
| Rate for Payer: BCBS Trust/PPO |
$344.95
|
| Rate for Payer: BCN Commercial |
$344.95
|
| Rate for Payer: Cash Price |
$336.04
|
| Rate for Payer: Cofinity Commercial |
$394.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.04
|
| Rate for Payer: Healthscope Commercial |
$407.45
|
| Rate for Payer: Healthscope Whirlpool |
$420.05
|
| Rate for Payer: Mclaren Commercial |
$378.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.04
|
| Rate for Payer: Nomi Health Commercial |
$344.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$369.64
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL
|
Facility
|
OP
|
$420.05
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.42 |
| Max. Negotiated Rate |
$420.05 |
| Rate for Payer: Aetna Commercial |
$378.05
|
| Rate for Payer: Aetna Medicare |
$155.42
|
| Rate for Payer: ASR ASR |
$407.45
|
| Rate for Payer: BCBS Complete |
$168.02
|
| Rate for Payer: BCBS Trust/PPO |
$346.33
|
| Rate for Payer: BCN Commercial |
$346.33
|
| Rate for Payer: Cash Price |
$336.04
|
| Rate for Payer: Cofinity Commercial |
$394.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.04
|
| Rate for Payer: Healthscope Commercial |
$407.45
|
| Rate for Payer: Healthscope Whirlpool |
$420.05
|
| Rate for Payer: Mclaren Commercial |
$378.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.04
|
| Rate for Payer: Nomi Health Commercial |
$344.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$368.05
|
| Rate for Payer: Priority Health Narrow Network |
$294.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$369.64
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL
|
Facility
|
OP
|
$630.06
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$233.12 |
| Max. Negotiated Rate |
$630.06 |
| Rate for Payer: Aetna Commercial |
$567.05
|
| Rate for Payer: Aetna Medicare |
$233.12
|
| Rate for Payer: ASR ASR |
$611.16
|
| Rate for Payer: BCBS Complete |
$252.02
|
| Rate for Payer: BCBS Trust/PPO |
$519.48
|
| Rate for Payer: BCN Commercial |
$519.48
|
| Rate for Payer: Cash Price |
$504.05
|
| Rate for Payer: Cofinity Commercial |
$592.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.05
|
| Rate for Payer: Healthscope Commercial |
$611.16
|
| Rate for Payer: Healthscope Whirlpool |
$630.06
|
| Rate for Payer: Mclaren Commercial |
$567.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$504.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.55
|
| Rate for Payer: Nomi Health Commercial |
$516.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$552.06
|
| Rate for Payer: Priority Health Narrow Network |
$441.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$554.45
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL
|
Facility
|
IP
|
$630.06
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.55 |
| Max. Negotiated Rate |
$630.06 |
| Rate for Payer: Aetna Commercial |
$567.05
|
| Rate for Payer: ASR ASR |
$611.16
|
| Rate for Payer: BCBS Trust/PPO |
$517.41
|
| Rate for Payer: BCN Commercial |
$517.41
|
| Rate for Payer: Cash Price |
$504.05
|
| Rate for Payer: Cofinity Commercial |
$592.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.05
|
| Rate for Payer: Healthscope Commercial |
$611.16
|
| Rate for Payer: Healthscope Whirlpool |
$630.06
|
| Rate for Payer: Mclaren Commercial |
$567.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.55
|
| Rate for Payer: Nomi Health Commercial |
$516.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$554.45
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LE
|
Facility
|
OP
|
$420.05
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100295
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.42 |
| Max. Negotiated Rate |
$420.05 |
| Rate for Payer: Aetna Commercial |
$378.05
|
| Rate for Payer: Aetna Medicare |
$155.42
|
| Rate for Payer: ASR ASR |
$407.45
|
| Rate for Payer: BCBS Complete |
$168.02
|
| Rate for Payer: BCBS Trust/PPO |
$346.33
|
| Rate for Payer: BCN Commercial |
$346.33
|
| Rate for Payer: Cash Price |
$336.04
|
| Rate for Payer: Cofinity Commercial |
$394.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.04
|
| Rate for Payer: Healthscope Commercial |
$407.45
|
| Rate for Payer: Healthscope Whirlpool |
$420.05
|
| Rate for Payer: Mclaren Commercial |
$378.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.04
|
| Rate for Payer: Nomi Health Commercial |
$344.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$368.05
|
| Rate for Payer: Priority Health Narrow Network |
$294.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$369.64
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LE
|
Facility
|
IP
|
$420.05
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100295
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$315.04 |
| Max. Negotiated Rate |
$420.05 |
| Rate for Payer: Aetna Commercial |
$378.05
|
| Rate for Payer: ASR ASR |
$407.45
|
| Rate for Payer: BCBS Trust/PPO |
$344.95
|
| Rate for Payer: BCN Commercial |
$344.95
|
| Rate for Payer: Cash Price |
$336.04
|
| Rate for Payer: Cofinity Commercial |
$394.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.04
|
| Rate for Payer: Healthscope Commercial |
$407.45
|
| Rate for Payer: Healthscope Whirlpool |
$420.05
|
| Rate for Payer: Mclaren Commercial |
$378.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.04
|
| Rate for Payer: Nomi Health Commercial |
$344.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$369.64
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL
|
Facility
|
OP
|
$630.06
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$233.12 |
| Max. Negotiated Rate |
$630.06 |
| Rate for Payer: Aetna Commercial |
$567.05
|
| Rate for Payer: Aetna Medicare |
$233.12
|
| Rate for Payer: ASR ASR |
$611.16
|
| Rate for Payer: BCBS Complete |
$252.02
|
| Rate for Payer: BCBS Trust/PPO |
$519.48
|
| Rate for Payer: BCN Commercial |
$519.48
|
| Rate for Payer: Cash Price |
$504.05
|
| Rate for Payer: Cofinity Commercial |
$592.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.05
|
| Rate for Payer: Healthscope Commercial |
$611.16
|
| Rate for Payer: Healthscope Whirlpool |
$630.06
|
| Rate for Payer: Mclaren Commercial |
$567.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$504.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.55
|
| Rate for Payer: Nomi Health Commercial |
$516.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$552.06
|
| Rate for Payer: Priority Health Narrow Network |
$441.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$554.45
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL
|
Facility
|
IP
|
$630.06
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.55 |
| Max. Negotiated Rate |
$630.06 |
| Rate for Payer: Aetna Commercial |
$567.05
|
| Rate for Payer: ASR ASR |
$611.16
|
| Rate for Payer: BCBS Trust/PPO |
$517.41
|
| Rate for Payer: BCN Commercial |
$517.41
|
| Rate for Payer: Cash Price |
$504.05
|
| Rate for Payer: Cofinity Commercial |
$592.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.05
|
| Rate for Payer: Healthscope Commercial |
$611.16
|
| Rate for Payer: Healthscope Whirlpool |
$630.06
|
| Rate for Payer: Mclaren Commercial |
$567.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.55
|
| Rate for Payer: Nomi Health Commercial |
$516.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$554.45
|
|
|
HC INJECTION FOR CEREBRAL SHUNT
|
Facility
|
OP
|
$842.88
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36100270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$1,090.18 |
| Rate for Payer: Aetna Commercial |
$758.59
|
| Rate for Payer: Aetna Medicare |
$703.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: ASR ASR |
$817.59
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$694.95
|
| Rate for Payer: BCN Commercial |
$694.95
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$674.30
|
| Rate for Payer: Cash Price |
$674.30
|
| Rate for Payer: Cofinity Commercial |
$792.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$674.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$817.59
|
| Rate for Payer: Healthscope Whirlpool |
$842.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$703.34
|
| Rate for Payer: Mclaren Commercial |
$758.59
|
| Rate for Payer: Mclaren Medicaid |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$386.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$716.45
|
| Rate for Payer: Nomi Health Commercial |
$691.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$632.16
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$773.67
|
| Rate for Payer: PHP Medicaid |
$376.99
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$738.53
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Narrow Network |
$590.86
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$741.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$1,090.18
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP DNSP |
$703.34
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC INJECTION FOR CEREBRAL SHUNT
|
Facility
|
IP
|
$842.88
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36100270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$632.16 |
| Max. Negotiated Rate |
$842.88 |
| Rate for Payer: Aetna Commercial |
$758.59
|
| Rate for Payer: ASR ASR |
$817.59
|
| Rate for Payer: BCBS Trust/PPO |
$692.17
|
| Rate for Payer: BCN Commercial |
$692.17
|
| Rate for Payer: Cash Price |
$674.30
|
| Rate for Payer: Cofinity Commercial |
$792.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$674.30
|
| Rate for Payer: Healthscope Commercial |
$817.59
|
| Rate for Payer: Healthscope Whirlpool |
$842.88
|
| Rate for Payer: Mclaren Commercial |
$758.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$716.45
|
| Rate for Payer: Nomi Health Commercial |
$691.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$632.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$741.73
|
|
|
HC INJECTION FOR HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$669.62
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
36100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.95 |
| Max. Negotiated Rate |
$669.62 |
| Rate for Payer: Aetna Commercial |
$602.66
|
| Rate for Payer: Aetna Medicare |
$247.76
|
| Rate for Payer: ASR ASR |
$649.53
|
| Rate for Payer: BCBS Complete |
$267.85
|
| Rate for Payer: BCBS Trust/PPO |
$552.10
|
| Rate for Payer: BCN Commercial |
$552.10
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Cofinity Commercial |
$629.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.70
|
| Rate for Payer: Healthscope Commercial |
$649.53
|
| Rate for Payer: Healthscope Whirlpool |
$669.62
|
| Rate for Payer: Mclaren Commercial |
$602.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$535.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.18
|
| Rate for Payer: Nomi Health Commercial |
$549.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$502.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$193.68
|
| Rate for Payer: Priority Health Narrow Network |
$154.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$589.27
|
|
|
HC INJECTION FOR HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$669.62
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
36100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$502.21 |
| Max. Negotiated Rate |
$669.62 |
| Rate for Payer: Aetna Commercial |
$602.66
|
| Rate for Payer: ASR ASR |
$649.53
|
| Rate for Payer: BCBS Trust/PPO |
$549.89
|
| Rate for Payer: BCN Commercial |
$549.89
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Cofinity Commercial |
$629.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.70
|
| Rate for Payer: Healthscope Commercial |
$649.53
|
| Rate for Payer: Healthscope Whirlpool |
$669.62
|
| Rate for Payer: Mclaren Commercial |
$602.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.18
|
| Rate for Payer: Nomi Health Commercial |
$549.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$502.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$589.27
|
|
|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
IP
|
$1,335.42
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,001.57 |
| Max. Negotiated Rate |
$1,335.42 |
| Rate for Payer: Aetna Commercial |
$1,201.88
|
| Rate for Payer: ASR ASR |
$1,295.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,096.65
|
| Rate for Payer: BCN Commercial |
$1,096.65
|
| Rate for Payer: Cash Price |
$1,068.34
|
| Rate for Payer: Cofinity Commercial |
$1,255.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,068.34
|
| Rate for Payer: Healthscope Commercial |
$1,295.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,335.42
|
| Rate for Payer: Mclaren Commercial |
$1,201.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,135.11
|
| Rate for Payer: Nomi Health Commercial |
$1,095.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,001.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,175.17
|
|
|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
OP
|
$1,335.42
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.38 |
| Max. Negotiated Rate |
$1,335.42 |
| Rate for Payer: Aetna Commercial |
$1,201.88
|
| Rate for Payer: Aetna Medicare |
$494.11
|
| Rate for Payer: ASR ASR |
$1,295.36
|
| Rate for Payer: BCBS Complete |
$534.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,101.05
|
| Rate for Payer: BCN Commercial |
$1,101.05
|
| Rate for Payer: Cash Price |
$1,068.34
|
| Rate for Payer: Cash Price |
$1,068.34
|
| Rate for Payer: Cofinity Commercial |
$1,255.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,068.34
|
| Rate for Payer: Healthscope Commercial |
$1,295.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,335.42
|
| Rate for Payer: Mclaren Commercial |
$1,201.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,068.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,135.11
|
| Rate for Payer: Nomi Health Commercial |
$1,095.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,001.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$311.72
|
| Rate for Payer: Priority Health Narrow Network |
$249.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,175.17
|
|
