|
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 |
$657.12 |
| Max. Negotiated Rate |
$1,010.95 |
| Rate for Payer: Aetna Commercial |
$909.86
|
| Rate for Payer: ASR ASR |
$980.62
|
| Rate for Payer: ASR Commercial |
$980.62
|
| Rate for Payer: BCBS Trust/PPO |
$823.82
|
| Rate for Payer: BCN Commercial |
$783.79
|
| Rate for Payer: Cash Price |
$808.76
|
| Rate for Payer: Cofinity Commercial |
$950.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.76
|
| Rate for Payer: Healthscope Commercial |
$1,010.95
|
| Rate for Payer: Healthscope Whirlpool |
$980.62
|
| Rate for Payer: Mclaren Commercial |
$909.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.31
|
| Rate for Payer: Nomi Health Commercial |
$828.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$889.64
|
|
|
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 |
$404.38 |
| Max. Negotiated Rate |
$1,010.95 |
| Rate for Payer: Aetna Commercial |
$909.86
|
| Rate for Payer: Aetna Medicare |
$505.48
|
| Rate for Payer: ASR ASR |
$980.62
|
| Rate for Payer: ASR Commercial |
$980.62
|
| Rate for Payer: BCBS Complete |
$404.38
|
| Rate for Payer: BCBS Trust/PPO |
$827.87
|
| Rate for Payer: BCN Commercial |
$783.79
|
| Rate for Payer: Cash Price |
$808.76
|
| Rate for Payer: Cofinity Commercial |
$950.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.76
|
| Rate for Payer: Healthscope Commercial |
$1,010.95
|
| Rate for Payer: Healthscope Whirlpool |
$980.62
|
| Rate for Payer: Mclaren Commercial |
$909.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.31
|
| Rate for Payer: Nomi Health Commercial |
$828.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$885.79
|
| Rate for Payer: Priority Health Narrow Network |
$708.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$889.64
|
|
|
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 |
$407.54 |
| Max. Negotiated Rate |
$1,018.86 |
| Rate for Payer: Aetna Commercial |
$916.97
|
| Rate for Payer: Aetna Medicare |
$509.43
|
| Rate for Payer: ASR ASR |
$988.29
|
| Rate for Payer: ASR Commercial |
$988.29
|
| Rate for Payer: BCBS Complete |
$407.54
|
| Rate for Payer: BCBS Trust/PPO |
$834.34
|
| Rate for Payer: BCN Commercial |
$789.92
|
| Rate for Payer: Cash Price |
$815.09
|
| Rate for Payer: Cofinity Commercial |
$957.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$815.09
|
| Rate for Payer: Healthscope Commercial |
$1,018.86
|
| Rate for Payer: Healthscope Whirlpool |
$988.29
|
| Rate for Payer: Mclaren Commercial |
$916.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$866.03
|
| Rate for Payer: Nomi Health Commercial |
$835.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$662.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$892.73
|
| Rate for Payer: Priority Health Narrow Network |
$714.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$896.60
|
|
|
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 |
$662.26 |
| Max. Negotiated Rate |
$1,018.86 |
| Rate for Payer: Aetna Commercial |
$916.97
|
| Rate for Payer: ASR ASR |
$988.29
|
| Rate for Payer: ASR Commercial |
$988.29
|
| Rate for Payer: BCBS Trust/PPO |
$830.27
|
| Rate for Payer: BCN Commercial |
$789.92
|
| Rate for Payer: Cash Price |
$815.09
|
| Rate for Payer: Cofinity Commercial |
$957.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$815.09
|
| Rate for Payer: Healthscope Commercial |
$1,018.86
|
| Rate for Payer: Healthscope Whirlpool |
$988.29
|
| Rate for Payer: Mclaren Commercial |
$916.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$866.03
|
| Rate for Payer: Nomi Health Commercial |
$835.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$662.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$896.60
|
|
|
HC INJECTION, DENOSUMAB, 1MG
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$45.54 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: Aetna Medicare |
$29.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.73
|
| Rate for Payer: ASR ASR |
$24.73
|
| Rate for Payer: ASR Commercial |
$24.73
|
| Rate for Payer: BCBS Complete |
$16.54
|
| Rate for Payer: BCBS MAPPO |
$29.38
|
| Rate for Payer: BCBS Trust/PPO |
$20.88
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: BCN Medicare Advantage |
$29.38
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$29.38
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$15.75
|
| Rate for Payer: Mclaren Medicare |
$29.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.85
|
| Rate for Payer: Meridian Medicaid |
$16.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: PACE Medicare |
$27.91
|
| Rate for Payer: PACE SWMI |
$29.38
|
| Rate for Payer: PHP Commercial |
$32.32
|
| Rate for Payer: PHP Medicaid |
$15.75
|
| Rate for Payer: PHP Medicare Advantage |
$29.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.34
|
| Rate for Payer: Priority Health Medicare |
$29.38
|
| Rate for Payer: Priority Health Narrow Network |
$17.88
|
| Rate for Payer: Railroad Medicare Medicare |
$29.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.38
|
| Rate for Payer: UHC Exchange |
$45.54
|
| Rate for Payer: UHC Medicare Advantage |
$29.38
|
| Rate for Payer: UHCCP DNSP |
$29.38
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: VA VA |
$29.38
|
|
|
HC INJECTION, DENOSUMAB, 1MG
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.57 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$22.95
|
| Rate for Payer: ASR ASR |
$24.73
|
| Rate for Payer: ASR Commercial |
$24.73
|
| Rate for Payer: BCBS Trust/PPO |
$20.78
|
| Rate for Payer: BCN Commercial |
$19.77
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$25.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.73
|
| Rate for Payer: Mclaren Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.44
|
|
|
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 |
$9.47 |
| Max. Negotiated Rate |
$14.57 |
| Rate for Payer: Aetna Commercial |
$13.11
|
| Rate for Payer: ASR ASR |
$14.13
|
| Rate for Payer: ASR Commercial |
$14.13
|
| Rate for Payer: BCBS Trust/PPO |
$11.87
|
| Rate for Payer: BCN Commercial |
$11.30
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$13.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$14.57
|
| Rate for Payer: Healthscope Whirlpool |
$14.13
|
| Rate for Payer: Mclaren Commercial |
$13.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.82
|
|
|
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 |
$14.57 |
| Rate for Payer: Aetna Commercial |
$13.11
|
| Rate for Payer: Aetna Medicare |
$7.29
|
| Rate for Payer: ASR ASR |
$14.13
|
| Rate for Payer: ASR Commercial |
$14.13
|
| Rate for Payer: BCBS Complete |
$5.83
|
| Rate for Payer: BCBS Trust/PPO |
$11.93
|
| Rate for Payer: BCN Commercial |
$11.30
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$13.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$14.57
|
| Rate for Payer: Healthscope Whirlpool |
$14.13
|
| Rate for Payer: Mclaren Commercial |
$13.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.77
|
| Rate for Payer: Priority Health Narrow Network |
$10.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.82
|
|
|
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 |
$1.35 |
| Max. Negotiated Rate |
$2.08 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: ASR ASR |
$2.02
|
| Rate for Payer: ASR Commercial |
$2.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$2.08
|
| Rate for Payer: Healthscope Whirlpool |
$2.02
|
| Rate for Payer: Mclaren Commercial |
$1.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Nomi Health Commercial |
$1.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.83
|
|
|
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 |
$2.08 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Medicare |
$1.04
|
| Rate for Payer: ASR ASR |
$2.02
|
| Rate for Payer: ASR Commercial |
$2.02
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: BCBS Trust/PPO |
$1.70
|
| Rate for Payer: BCN Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$2.08
|
| Rate for Payer: Healthscope Whirlpool |
$2.02
|
| Rate for Payer: Mclaren Commercial |
$1.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Nomi Health Commercial |
$1.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.82
|
| Rate for Payer: Priority Health Narrow Network |
$1.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.83
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
OP
|
$1,132.08
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$452.83 |
| Max. Negotiated Rate |
$1,132.08 |
| Rate for Payer: Aetna Commercial |
$1,018.87
|
| Rate for Payer: Aetna Medicare |
$566.04
|
| Rate for Payer: ASR ASR |
$1,098.12
|
| Rate for Payer: ASR Commercial |
$1,098.12
|
| Rate for Payer: BCBS Complete |
$452.83
|
| Rate for Payer: BCBS Trust/PPO |
$927.06
|
| Rate for Payer: BCN Commercial |
$877.70
|
| Rate for Payer: Cash Price |
$905.66
|
| Rate for Payer: Cofinity Commercial |
$1,064.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$905.66
|
| Rate for Payer: Healthscope Commercial |
$1,132.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,098.12
|
| Rate for Payer: Mclaren Commercial |
$1,018.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$962.27
|
| Rate for Payer: Nomi Health Commercial |
$928.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$735.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$991.93
|
| Rate for Payer: Priority Health Narrow Network |
$793.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$996.23
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
IP
|
$1,132.08
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$735.85 |
| Max. Negotiated Rate |
$1,132.08 |
| Rate for Payer: Aetna Commercial |
$1,018.87
|
| Rate for Payer: ASR ASR |
$1,098.12
|
| Rate for Payer: ASR Commercial |
$1,098.12
|
| Rate for Payer: BCBS Trust/PPO |
$922.53
|
| Rate for Payer: BCN Commercial |
$877.70
|
| Rate for Payer: Cash Price |
$905.66
|
| Rate for Payer: Cofinity Commercial |
$1,064.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$905.66
|
| Rate for Payer: Healthscope Commercial |
$1,132.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,098.12
|
| Rate for Payer: Mclaren Commercial |
$1,018.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$962.27
|
| Rate for Payer: Nomi Health Commercial |
$928.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$735.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$996.23
|
|
|
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 |
$1,236.07 |
| Max. Negotiated Rate |
$1,901.65 |
| Rate for Payer: Aetna Commercial |
$1,711.48
|
| Rate for Payer: ASR ASR |
$1,844.60
|
| Rate for Payer: ASR Commercial |
$1,844.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,549.65
|
| Rate for Payer: BCN Commercial |
$1,474.35
|
| Rate for Payer: Cash Price |
$1,521.32
|
| Rate for Payer: Cofinity Commercial |
$1,787.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,521.32
|
| Rate for Payer: Healthscope Commercial |
$1,901.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,844.60
|
| Rate for Payer: Mclaren Commercial |
$1,711.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,616.40
|
| Rate for Payer: Nomi Health Commercial |
$1,559.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,673.45
|
|
|
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 |
$465.40 |
| Max. Negotiated Rate |
$1,901.65 |
| Rate for Payer: Aetna Commercial |
$1,711.48
|
| Rate for Payer: Aetna Medicare |
$868.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: ASR ASR |
$1,844.60
|
| Rate for Payer: ASR Commercial |
$1,844.60
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,557.26
|
| Rate for Payer: BCN Commercial |
$1,474.35
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$1,521.32
|
| Rate for Payer: Cash Price |
$1,521.32
|
| Rate for Payer: Cofinity Commercial |
$1,787.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,521.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$1,901.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,844.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$868.28
|
| Rate for Payer: Mclaren Commercial |
$1,711.48
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,616.40
|
| Rate for Payer: Nomi Health Commercial |
$1,559.35
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$955.11
|
| Rate for Payer: PHP Medicaid |
$465.40
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,666.23
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,333.06
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,673.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,345.83
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP DNSP |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: VA VA |
$868.28
|
|
|
HC 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 |
$221.22 |
| Max. Negotiated Rate |
$340.34 |
| Rate for Payer: Aetna Commercial |
$306.31
|
| Rate for Payer: ASR ASR |
$330.13
|
| Rate for Payer: ASR Commercial |
$330.13
|
| Rate for Payer: BCBS Trust/PPO |
$277.34
|
| Rate for Payer: BCN Commercial |
$263.87
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$319.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Healthscope Commercial |
$340.34
|
| Rate for Payer: Healthscope Whirlpool |
$330.13
|
| Rate for Payer: Mclaren Commercial |
$306.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: Nomi Health Commercial |
$279.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.50
|
|
|
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 |
$136.14 |
| Max. Negotiated Rate |
$340.34 |
| Rate for Payer: Aetna Commercial |
$306.31
|
| Rate for Payer: Aetna Medicare |
$170.17
|
| Rate for Payer: ASR ASR |
$330.13
|
| Rate for Payer: ASR Commercial |
$330.13
|
| Rate for Payer: BCBS Complete |
$136.14
|
| Rate for Payer: BCBS Trust/PPO |
$278.70
|
| Rate for Payer: BCN Commercial |
$263.87
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$319.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Healthscope Commercial |
$340.34
|
| Rate for Payer: Healthscope Whirlpool |
$330.13
|
| Rate for Payer: Mclaren Commercial |
$306.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: Nomi Health Commercial |
$279.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.21
|
| Rate for Payer: Priority Health Narrow Network |
$238.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.50
|
|
|
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 |
$204.21 |
| Max. Negotiated Rate |
$510.52 |
| Rate for Payer: Aetna Commercial |
$459.47
|
| Rate for Payer: Aetna Medicare |
$255.26
|
| Rate for Payer: ASR ASR |
$495.20
|
| Rate for Payer: ASR Commercial |
$495.20
|
| Rate for Payer: BCBS Complete |
$204.21
|
| Rate for Payer: BCBS Trust/PPO |
$418.06
|
| Rate for Payer: BCN Commercial |
$395.81
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cofinity Commercial |
$479.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.42
|
| Rate for Payer: Healthscope Commercial |
$510.52
|
| Rate for Payer: Healthscope Whirlpool |
$495.20
|
| Rate for Payer: Mclaren Commercial |
$459.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.94
|
| Rate for Payer: Nomi Health Commercial |
$418.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$447.32
|
| Rate for Payer: Priority Health Narrow Network |
$357.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.26
|
|
|
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 |
$331.84 |
| Max. Negotiated Rate |
$510.52 |
| Rate for Payer: Aetna Commercial |
$459.47
|
| Rate for Payer: ASR ASR |
$495.20
|
| Rate for Payer: ASR Commercial |
$495.20
|
| Rate for Payer: BCBS Trust/PPO |
$416.02
|
| Rate for Payer: BCN Commercial |
$395.81
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cofinity Commercial |
$479.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.42
|
| Rate for Payer: Healthscope Commercial |
$510.52
|
| Rate for Payer: Healthscope Whirlpool |
$495.20
|
| Rate for Payer: Mclaren Commercial |
$459.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.94
|
| Rate for Payer: Nomi Health Commercial |
$418.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.26
|
|
|
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 |
$136.14 |
| Max. Negotiated Rate |
$340.34 |
| Rate for Payer: Aetna Commercial |
$306.31
|
| Rate for Payer: Aetna Medicare |
$170.17
|
| Rate for Payer: ASR ASR |
$330.13
|
| Rate for Payer: ASR Commercial |
$330.13
|
| Rate for Payer: BCBS Complete |
$136.14
|
| Rate for Payer: BCBS Trust/PPO |
$278.70
|
| Rate for Payer: BCN Commercial |
$263.87
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$319.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Healthscope Commercial |
$340.34
|
| Rate for Payer: Healthscope Whirlpool |
$330.13
|
| Rate for Payer: Mclaren Commercial |
$306.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: Nomi Health Commercial |
$279.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.21
|
| Rate for Payer: Priority Health Narrow Network |
$238.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.50
|
|
|
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 |
$221.22 |
| Max. Negotiated Rate |
$340.34 |
| Rate for Payer: Aetna Commercial |
$306.31
|
| Rate for Payer: ASR ASR |
$330.13
|
| Rate for Payer: ASR Commercial |
$330.13
|
| Rate for Payer: BCBS Trust/PPO |
$277.34
|
| Rate for Payer: BCN Commercial |
$263.87
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$319.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Healthscope Commercial |
$340.34
|
| Rate for Payer: Healthscope Whirlpool |
$330.13
|
| Rate for Payer: Mclaren Commercial |
$306.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: Nomi Health Commercial |
$279.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.50
|
|
|
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 |
$204.21 |
| Max. Negotiated Rate |
$510.52 |
| Rate for Payer: Aetna Commercial |
$459.47
|
| Rate for Payer: Aetna Medicare |
$255.26
|
| Rate for Payer: ASR ASR |
$495.20
|
| Rate for Payer: ASR Commercial |
$495.20
|
| Rate for Payer: BCBS Complete |
$204.21
|
| Rate for Payer: BCBS Trust/PPO |
$418.06
|
| Rate for Payer: BCN Commercial |
$395.81
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cofinity Commercial |
$479.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.42
|
| Rate for Payer: Healthscope Commercial |
$510.52
|
| Rate for Payer: Healthscope Whirlpool |
$495.20
|
| Rate for Payer: Mclaren Commercial |
$459.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.94
|
| Rate for Payer: Nomi Health Commercial |
$418.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$447.32
|
| Rate for Payer: Priority Health Narrow Network |
$357.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.26
|
|
|
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 |
$331.84 |
| Max. Negotiated Rate |
$510.52 |
| Rate for Payer: Aetna Commercial |
$459.47
|
| Rate for Payer: ASR ASR |
$495.20
|
| Rate for Payer: ASR Commercial |
$495.20
|
| Rate for Payer: BCBS Trust/PPO |
$416.02
|
| Rate for Payer: BCN Commercial |
$395.81
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cofinity Commercial |
$479.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.42
|
| Rate for Payer: Healthscope Commercial |
$510.52
|
| Rate for Payer: Healthscope Whirlpool |
$495.20
|
| Rate for Payer: Mclaren Commercial |
$459.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.94
|
| Rate for Payer: Nomi Health Commercial |
$418.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.26
|
|
|
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 |
$1,609.61 |
| Max. Negotiated Rate |
$2,476.33 |
| Rate for Payer: Aetna Commercial |
$2,228.70
|
| Rate for Payer: ASR ASR |
$2,402.04
|
| Rate for Payer: ASR Commercial |
$2,402.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,017.96
|
| Rate for Payer: BCN Commercial |
$1,919.90
|
| Rate for Payer: Cash Price |
$1,981.06
|
| Rate for Payer: Cofinity Commercial |
$2,327.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,981.06
|
| Rate for Payer: Healthscope Commercial |
$2,476.33
|
| Rate for Payer: Healthscope Whirlpool |
$2,402.04
|
| Rate for Payer: Mclaren Commercial |
$2,228.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,104.88
|
| Rate for Payer: Nomi Health Commercial |
$2,030.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,609.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,179.17
|
|
|
HC INJECTION FACET JOINT L OR S 1ST LEVEL BIL
|
Facility
|
OP
|
$2,476.33
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$2,476.33 |
| Rate for Payer: Aetna Commercial |
$2,228.70
|
| Rate for Payer: Aetna Medicare |
$868.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: ASR ASR |
$2,402.04
|
| Rate for Payer: ASR Commercial |
$2,402.04
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,027.87
|
| Rate for Payer: BCN Commercial |
$1,919.90
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$1,981.06
|
| Rate for Payer: Cash Price |
$1,981.06
|
| Rate for Payer: Cofinity Commercial |
$2,327.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,981.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$2,476.33
|
| Rate for Payer: Healthscope Whirlpool |
$2,402.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$868.28
|
| Rate for Payer: Mclaren Commercial |
$2,228.70
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,104.88
|
| Rate for Payer: Nomi Health Commercial |
$2,030.59
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$955.11
|
| Rate for Payer: PHP Medicaid |
$465.40
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,609.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,169.76
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,735.91
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,179.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,345.83
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP DNSP |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: VA VA |
$868.28
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL
|
Facility
|
IP
|
$411.81
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$267.68 |
| Max. Negotiated Rate |
$411.81 |
| Rate for Payer: Aetna Commercial |
$370.63
|
| Rate for Payer: ASR ASR |
$399.46
|
| Rate for Payer: ASR Commercial |
$399.46
|
| Rate for Payer: BCBS Trust/PPO |
$335.58
|
| Rate for Payer: BCN Commercial |
$319.28
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cofinity Commercial |
$387.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.45
|
| Rate for Payer: Healthscope Commercial |
$411.81
|
| Rate for Payer: Healthscope Whirlpool |
$399.46
|
| Rate for Payer: Mclaren Commercial |
$370.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.04
|
| Rate for Payer: Nomi Health Commercial |
$337.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$362.39
|
|
