|
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 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 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 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
|
OP
|
$2,476.33
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$467.55 |
| Max. Negotiated Rate |
$2,476.33 |
| Rate for Payer: Aetna Commercial |
$2,228.70
|
| Rate for Payer: Aetna Medicare |
$872.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: ASR ASR |
$2,402.04
|
| Rate for Payer: ASR Commercial |
$2,402.04
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,027.87
|
| Rate for Payer: BCN Commercial |
$1,919.90
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| 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 |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$2,476.33
|
| Rate for Payer: Healthscope Whirlpool |
$2,402.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$872.29
|
| Rate for Payer: Mclaren Commercial |
$2,228.70
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,104.88
|
| Rate for Payer: Nomi Health Commercial |
$2,030.59
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$959.52
|
| Rate for Payer: PHP Medicaid |
$467.55
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,609.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,169.76
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,735.91
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,179.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,352.05
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP DNSP |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$467.55
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC INJECTION 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 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
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL
|
Facility
|
OP
|
$411.81
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$164.72 |
| Max. Negotiated Rate |
$411.81 |
| Rate for Payer: Aetna Commercial |
$370.63
|
| Rate for Payer: Aetna Medicare |
$205.90
|
| Rate for Payer: ASR ASR |
$399.46
|
| Rate for Payer: ASR Commercial |
$399.46
|
| Rate for Payer: BCBS Complete |
$164.72
|
| Rate for Payer: BCBS Trust/PPO |
$337.23
|
| 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: Priority Health HMO/PPO/Tiered Network |
$360.83
|
| Rate for Payer: Priority Health Narrow Network |
$288.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$362.39
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL
|
Facility
|
IP
|
$617.71
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$401.51 |
| Max. Negotiated Rate |
$617.71 |
| Rate for Payer: Aetna Commercial |
$555.94
|
| Rate for Payer: ASR ASR |
$599.18
|
| Rate for Payer: ASR Commercial |
$599.18
|
| Rate for Payer: BCBS Trust/PPO |
$503.37
|
| Rate for Payer: BCN Commercial |
$478.91
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$580.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.17
|
| Rate for Payer: Healthscope Commercial |
$617.71
|
| Rate for Payer: Healthscope Whirlpool |
$599.18
|
| Rate for Payer: Mclaren Commercial |
$555.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.05
|
| Rate for Payer: Nomi Health Commercial |
$506.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$543.58
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL
|
Facility
|
OP
|
$617.71
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$247.08 |
| Max. Negotiated Rate |
$617.71 |
| Rate for Payer: Aetna Commercial |
$555.94
|
| Rate for Payer: Aetna Medicare |
$308.86
|
| Rate for Payer: ASR ASR |
$599.18
|
| Rate for Payer: ASR Commercial |
$599.18
|
| Rate for Payer: BCBS Complete |
$247.08
|
| Rate for Payer: BCBS Trust/PPO |
$505.84
|
| Rate for Payer: BCN Commercial |
$478.91
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$580.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.17
|
| Rate for Payer: Healthscope Commercial |
$617.71
|
| Rate for Payer: Healthscope Whirlpool |
$599.18
|
| Rate for Payer: Mclaren Commercial |
$555.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.05
|
| Rate for Payer: Nomi Health Commercial |
$506.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.24
|
| Rate for Payer: Priority Health Narrow Network |
$433.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$543.58
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LE
|
Facility
|
OP
|
$411.81
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100295
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$164.72 |
| Max. Negotiated Rate |
$411.81 |
| Rate for Payer: Aetna Commercial |
$370.63
|
| Rate for Payer: Aetna Medicare |
$205.90
|
| Rate for Payer: ASR ASR |
$399.46
|
| Rate for Payer: ASR Commercial |
$399.46
|
| Rate for Payer: BCBS Complete |
$164.72
|
| Rate for Payer: BCBS Trust/PPO |
$337.23
|
| 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: Priority Health HMO/PPO/Tiered Network |
$360.83
|
| Rate for Payer: Priority Health Narrow Network |
$288.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$362.39
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LE
|
Facility
|
IP
|
$411.81
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100295
|
|
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
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL
|
Facility
|
IP
|
$617.71
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$401.51 |
| Max. Negotiated Rate |
$617.71 |
| Rate for Payer: Aetna Commercial |
$555.94
|
| Rate for Payer: ASR ASR |
$599.18
|
| Rate for Payer: ASR Commercial |
$599.18
|
| Rate for Payer: BCBS Trust/PPO |
$503.37
|
| Rate for Payer: BCN Commercial |
$478.91
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$580.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.17
|
| Rate for Payer: Healthscope Commercial |
$617.71
|
| Rate for Payer: Healthscope Whirlpool |
$599.18
|
| Rate for Payer: Mclaren Commercial |
$555.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.05
|
| Rate for Payer: Nomi Health Commercial |
$506.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$543.58
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL
|
Facility
|
OP
|
$617.71
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$247.08 |
| Max. Negotiated Rate |
$617.71 |
| Rate for Payer: Aetna Commercial |
$555.94
|
| Rate for Payer: Aetna Medicare |
$308.86
|
| Rate for Payer: ASR ASR |
$599.18
|
| Rate for Payer: ASR Commercial |
$599.18
|
| Rate for Payer: BCBS Complete |
$247.08
|
| Rate for Payer: BCBS Trust/PPO |
$505.84
|
| Rate for Payer: BCN Commercial |
$478.91
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$580.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.17
|
| Rate for Payer: Healthscope Commercial |
$617.71
|
| Rate for Payer: Healthscope Whirlpool |
$599.18
|
| Rate for Payer: Mclaren Commercial |
$555.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.05
|
| Rate for Payer: Nomi Health Commercial |
$506.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.24
|
| Rate for Payer: Priority Health Narrow Network |
$433.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$543.58
|
|
|
HC INJECTION FOR CEREBRAL SHUNT
|
Facility
|
IP
|
$826.35
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36100270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$537.13 |
| Max. Negotiated Rate |
$826.35 |
| Rate for Payer: Aetna Commercial |
$743.72
|
| Rate for Payer: ASR ASR |
$801.56
|
| Rate for Payer: ASR Commercial |
$801.56
|
| Rate for Payer: BCBS Trust/PPO |
$673.39
|
| Rate for Payer: BCN Commercial |
$640.67
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cofinity Commercial |
$776.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.08
|
| Rate for Payer: Healthscope Commercial |
$826.35
|
| Rate for Payer: Healthscope Whirlpool |
$801.56
|
| Rate for Payer: Mclaren Commercial |
$743.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$702.40
|
| Rate for Payer: Nomi Health Commercial |
$677.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$727.19
|
|
|
HC INJECTION FOR CEREBRAL SHUNT
|
Facility
|
OP
|
$826.35
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36100270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$363.69 |
| Max. Negotiated Rate |
$1,051.71 |
| Rate for Payer: Aetna Commercial |
$743.72
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$801.56
|
| Rate for Payer: ASR Commercial |
$801.56
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$676.70
|
| Rate for Payer: BCN Commercial |
$640.67
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cofinity Commercial |
$776.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$826.35
|
| Rate for Payer: Healthscope Whirlpool |
$801.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Commercial |
$743.72
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$702.40
|
| Rate for Payer: Nomi Health Commercial |
$677.61
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$724.05
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$579.27
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$727.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC INJECTION FOR HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$656.49
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
36100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$426.72 |
| Max. Negotiated Rate |
$656.49 |
| Rate for Payer: Aetna Commercial |
$590.84
|
| Rate for Payer: ASR ASR |
$636.80
|
| Rate for Payer: ASR Commercial |
$636.80
|
| Rate for Payer: BCBS Trust/PPO |
$534.97
|
| Rate for Payer: BCN Commercial |
$508.98
|
| Rate for Payer: Cash Price |
$525.19
|
| Rate for Payer: Cofinity Commercial |
$617.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.19
|
| Rate for Payer: Healthscope Commercial |
$656.49
|
| Rate for Payer: Healthscope Whirlpool |
$636.80
|
| Rate for Payer: Mclaren Commercial |
$590.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.02
|
| Rate for Payer: Nomi Health Commercial |
$538.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$577.71
|
|
|
HC INJECTION FOR HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$656.49
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
36100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.54 |
| Max. Negotiated Rate |
$656.49 |
| Rate for Payer: Aetna Commercial |
$590.84
|
| Rate for Payer: Aetna Medicare |
$328.24
|
| Rate for Payer: ASR ASR |
$636.80
|
| Rate for Payer: ASR Commercial |
$636.80
|
| Rate for Payer: BCBS Complete |
$262.60
|
| Rate for Payer: BCBS Trust/PPO |
$537.60
|
| Rate for Payer: BCN Commercial |
$508.98
|
| Rate for Payer: Cash Price |
$525.19
|
| Rate for Payer: Cash Price |
$525.19
|
| Rate for Payer: Cofinity Commercial |
$617.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.19
|
| Rate for Payer: Healthscope Commercial |
$656.49
|
| Rate for Payer: Healthscope Whirlpool |
$636.80
|
| Rate for Payer: Mclaren Commercial |
$590.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.02
|
| Rate for Payer: Nomi Health Commercial |
$538.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.68
|
| Rate for Payer: Priority Health Narrow Network |
$140.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$577.71
|
|
|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
OP
|
$1,309.24
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$1,309.24 |
| Rate for Payer: Aetna Commercial |
$1,178.32
|
| Rate for Payer: Aetna Medicare |
$654.62
|
| Rate for Payer: ASR ASR |
$1,269.96
|
| Rate for Payer: ASR Commercial |
$1,269.96
|
| Rate for Payer: BCBS Complete |
$523.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,072.14
|
| Rate for Payer: BCN Commercial |
$1,015.05
|
| Rate for Payer: Cash Price |
$1,047.39
|
| Rate for Payer: Cash Price |
$1,047.39
|
| Rate for Payer: Cofinity Commercial |
$1,230.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,047.39
|
| Rate for Payer: Healthscope Commercial |
$1,309.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,269.96
|
| Rate for Payer: Mclaren Commercial |
$1,178.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,112.85
|
| Rate for Payer: Nomi Health Commercial |
$1,073.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.74
|
| Rate for Payer: Priority Health Narrow Network |
$226.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,152.13
|
|
|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
IP
|
$1,309.24
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$851.01 |
| Max. Negotiated Rate |
$1,309.24 |
| Rate for Payer: Aetna Commercial |
$1,178.32
|
| Rate for Payer: ASR ASR |
$1,269.96
|
| Rate for Payer: ASR Commercial |
$1,269.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.90
|
| Rate for Payer: BCN Commercial |
$1,015.05
|
| Rate for Payer: Cash Price |
$1,047.39
|
| Rate for Payer: Cofinity Commercial |
$1,230.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,047.39
|
| Rate for Payer: Healthscope Commercial |
$1,309.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,269.96
|
| Rate for Payer: Mclaren Commercial |
$1,178.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,112.85
|
| Rate for Payer: Nomi Health Commercial |
$1,073.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,152.13
|
|
|
HC INJECTION HIP ARTHROGRAM BIL
|
Facility
|
OP
|
$1,214.02
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$1,214.02 |
| Rate for Payer: Aetna Commercial |
$1,092.62
|
| Rate for Payer: Aetna Medicare |
$607.01
|
| Rate for Payer: ASR ASR |
$1,177.60
|
| Rate for Payer: ASR Commercial |
$1,177.60
|
| Rate for Payer: BCBS Complete |
$485.61
|
| Rate for Payer: BCBS Trust/PPO |
$994.16
|
| Rate for Payer: BCN Commercial |
$941.23
|
| Rate for Payer: Cash Price |
$971.22
|
| Rate for Payer: Cash Price |
$971.22
|
| Rate for Payer: Cofinity Commercial |
$1,141.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$971.22
|
| Rate for Payer: Healthscope Commercial |
$1,214.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,177.60
|
| Rate for Payer: Mclaren Commercial |
$1,092.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,031.92
|
| Rate for Payer: Nomi Health Commercial |
$995.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.74
|
| Rate for Payer: Priority Health Narrow Network |
$226.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,068.34
|
|
|
HC INJECTION HIP ARTHROGRAM BIL
|
Facility
|
IP
|
$1,214.02
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$789.11 |
| Max. Negotiated Rate |
$1,214.02 |
| Rate for Payer: Aetna Commercial |
$1,092.62
|
| Rate for Payer: ASR ASR |
$1,177.60
|
| Rate for Payer: ASR Commercial |
$1,177.60
|
| Rate for Payer: BCBS Trust/PPO |
$989.30
|
| Rate for Payer: BCN Commercial |
$941.23
|
| Rate for Payer: Cash Price |
$971.22
|
| Rate for Payer: Cofinity Commercial |
$1,141.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$971.22
|
| Rate for Payer: Healthscope Commercial |
$1,214.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,177.60
|
| Rate for Payer: Mclaren Commercial |
$1,092.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,031.92
|
| Rate for Payer: Nomi Health Commercial |
$995.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,068.34
|
|
