|
HC INJECTION, CERTOLIZUMAB PEGOL, 1 MG
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: BCBS Trust/PPO |
$7.73
|
| Rate for Payer: BCN Commercial |
$7.73
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.50
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.80
|
| Rate for Payer: UHC Core |
$8.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.50
|
|
|
HC INJECTION, CERTOLIZUMAB PEGOL, 1 MG
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: Aetna Medicare |
$2.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.12
|
| Rate for Payer: BCBS Complete |
$3.73
|
| Rate for Payer: BCBS MAPPO |
$2.50
|
| Rate for Payer: BCBS Trust/PPO |
$7.78
|
| Rate for Payer: BCN Commercial |
$7.78
|
| Rate for Payer: BCN Medicare Advantage |
$2.50
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.50
|
| Rate for Payer: Mclaren Medicaid |
$3.55
|
| Rate for Payer: Meridian Medicaid |
$3.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.50
|
| Rate for Payer: PACE Senior Care Partners |
$2.38
|
| Rate for Payer: PACE SWMI |
$2.50
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: PHP Medicare Advantage |
$2.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.70
|
| Rate for Payer: Priority Health Medicare |
$2.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.10
|
| Rate for Payer: Railroad Medicare Medicare |
$2.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.80
|
| Rate for Payer: UHC Core |
$8.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.50
|
| Rate for Payer: UHC Medicare Advantage |
$2.58
|
| Rate for Payer: VA VA |
$2.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.50
|
|
|
HC INJECTION CERVICAL OR THORACIC
|
Facility
|
OP
|
$991.13
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
36100283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$235.39 |
| Max. Negotiated Rate |
$892.02 |
| Rate for Payer: Aetna Commercial |
$842.46
|
| Rate for Payer: Aetna Medicare |
$257.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$309.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$309.73
|
| Rate for Payer: BCBS Complete |
$396.45
|
| Rate for Payer: BCBS MAPPO |
$247.78
|
| Rate for Payer: BCBS Trust/PPO |
$770.60
|
| Rate for Payer: BCN Commercial |
$770.60
|
| Rate for Payer: BCN Medicare Advantage |
$247.78
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cofinity Commercial |
$852.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$247.78
|
| Rate for Payer: Healthscope Commercial |
$892.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$260.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$284.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$842.46
|
| Rate for Payer: PACE Senior Care Partners |
$235.39
|
| Rate for Payer: PACE SWMI |
$247.78
|
| Rate for Payer: PHP Commercial |
$842.46
|
| Rate for Payer: PHP Medicare Advantage |
$247.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$862.28
|
| Rate for Payer: Priority Health Medicare |
$247.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$604.49
|
| Rate for Payer: Railroad Medicare Medicare |
$247.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$872.19
|
| Rate for Payer: UHC Core |
$827.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$247.78
|
| Rate for Payer: UHC Medicare Advantage |
$255.22
|
| Rate for Payer: VA VA |
$247.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.35
|
|
|
HC INJECTION CERVICAL OR THORACIC
|
Facility
|
IP
|
$991.13
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
36100283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$604.49 |
| Max. Negotiated Rate |
$892.02 |
| Rate for Payer: Aetna Commercial |
$842.46
|
| Rate for Payer: BCBS Trust/PPO |
$765.95
|
| Rate for Payer: BCN Commercial |
$765.95
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cofinity Commercial |
$852.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.90
|
| Rate for Payer: Healthscope Commercial |
$892.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$842.46
|
| Rate for Payer: PHP Commercial |
$842.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$862.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$604.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$872.19
|
| Rate for Payer: UHC Core |
$827.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.35
|
|
|
HC INJECTION CONTRAST FOR TUBE ASSESSMENT
|
Facility
|
IP
|
$998.88
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
36100223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$609.22 |
| Max. Negotiated Rate |
$898.99 |
| Rate for Payer: Aetna Commercial |
$849.05
|
| Rate for Payer: BCBS Trust/PPO |
$771.93
|
| Rate for Payer: BCN Commercial |
$771.93
|
| Rate for Payer: Cash Price |
$799.10
|
| Rate for Payer: Cofinity Commercial |
$859.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$799.10
|
| Rate for Payer: Healthscope Commercial |
$898.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$749.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$849.05
|
| Rate for Payer: PHP Commercial |
$849.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$699.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$869.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$609.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$879.01
|
| Rate for Payer: UHC Core |
$834.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$749.16
|
|
|
HC INJECTION CONTRAST FOR TUBE ASSESSMENT
|
Facility
|
OP
|
$998.88
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
36100223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$237.23 |
| Max. Negotiated Rate |
$898.99 |
| Rate for Payer: Aetna Commercial |
$849.05
|
| Rate for Payer: Aetna Medicare |
$259.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$312.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$312.15
|
| Rate for Payer: BCBS Complete |
$399.55
|
| Rate for Payer: BCBS MAPPO |
$249.72
|
| Rate for Payer: BCBS Trust/PPO |
$776.63
|
| Rate for Payer: BCN Commercial |
$776.63
|
| Rate for Payer: BCN Medicare Advantage |
$249.72
|
| Rate for Payer: Cash Price |
$799.10
|
| Rate for Payer: Cofinity Commercial |
$859.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$799.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$249.72
|
| Rate for Payer: Healthscope Commercial |
$898.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$749.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$262.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$849.05
|
| Rate for Payer: PACE Senior Care Partners |
$237.23
|
| Rate for Payer: PACE SWMI |
$249.72
|
| Rate for Payer: PHP Commercial |
$849.05
|
| Rate for Payer: PHP Medicare Advantage |
$249.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$699.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$869.03
|
| Rate for Payer: Priority Health Medicare |
$249.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$609.22
|
| Rate for Payer: Railroad Medicare Medicare |
$249.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$879.01
|
| Rate for Payer: UHC Core |
$834.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$249.72
|
| Rate for Payer: UHC Medicare Advantage |
$257.21
|
| Rate for Payer: VA VA |
$249.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$749.16
|
|
|
HC INJECTION, DENOSUMAB, 1MG
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.81
|
| Rate for Payer: BCBS Complete |
$19.53
|
| Rate for Payer: BCBS MAPPO |
$6.25
|
| Rate for Payer: BCBS Trust/PPO |
$19.44
|
| Rate for Payer: BCN Commercial |
$19.44
|
| Rate for Payer: BCN Medicare Advantage |
$6.25
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.25
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.75
|
| Rate for Payer: Mclaren Medicaid |
$18.60
|
| Rate for Payer: Meridian Medicaid |
$19.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: PACE Senior Care Partners |
$5.94
|
| Rate for Payer: PACE SWMI |
$6.25
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: PHP Medicare Advantage |
$6.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.75
|
| Rate for Payer: Priority Health Medicare |
$6.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.25
|
| Rate for Payer: Railroad Medicare Medicare |
$6.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.00
|
| Rate for Payer: UHC Core |
$20.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.25
|
| Rate for Payer: UHC Medicare Advantage |
$6.44
|
| Rate for Payer: VA VA |
$6.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.75
|
|
|
HC INJECTION, DENOSUMAB, 1MG
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: BCBS Trust/PPO |
$19.32
|
| Rate for Payer: BCN Commercial |
$19.32
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.00
|
| Rate for Payer: UHC Core |
$20.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.75
|
|
|
HC INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
|
Facility
|
IP
|
$14.28
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: BCN Commercial |
$11.04
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.14
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.57
|
| Rate for Payer: UHC Core |
$11.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
|
|
HC INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
|
Facility
|
OP
|
$14.28
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna Medicare |
$3.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.46
|
| Rate for Payer: BCBS Complete |
$5.71
|
| Rate for Payer: BCBS MAPPO |
$3.57
|
| Rate for Payer: BCBS Trust/PPO |
$11.10
|
| Rate for Payer: BCN Commercial |
$11.10
|
| Rate for Payer: BCN Medicare Advantage |
$3.57
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.14
|
| Rate for Payer: PACE Senior Care Partners |
$3.39
|
| Rate for Payer: PACE SWMI |
$3.57
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: PHP Medicare Advantage |
$3.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.42
|
| Rate for Payer: Priority Health Medicare |
$3.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.57
|
| Rate for Payer: UHC Core |
$11.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.57
|
| Rate for Payer: UHC Medicare Advantage |
$3.68
|
| Rate for Payer: VA VA |
$3.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
|
|
HC INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
|
Facility
|
IP
|
$2.04
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
63600167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna Commercial |
$1.73
|
| Rate for Payer: BCBS Trust/PPO |
$1.58
|
| Rate for Payer: BCN Commercial |
$1.58
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.63
|
| Rate for Payer: Healthscope Commercial |
$1.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.73
|
| Rate for Payer: PHP Commercial |
$1.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC Core |
$1.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.53
|
|
|
HC INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
|
Facility
|
OP
|
$2.04
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
63600167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna Commercial |
$1.73
|
| Rate for Payer: Aetna Medicare |
$0.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.64
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: BCBS MAPPO |
$0.51
|
| Rate for Payer: BCBS Trust/PPO |
$1.59
|
| Rate for Payer: BCN Commercial |
$1.59
|
| Rate for Payer: BCN Medicare Advantage |
$0.51
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.51
|
| Rate for Payer: Healthscope Commercial |
$1.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.73
|
| Rate for Payer: PACE Senior Care Partners |
$0.48
|
| Rate for Payer: PACE SWMI |
$0.51
|
| Rate for Payer: PHP Commercial |
$1.73
|
| Rate for Payer: PHP Medicare Advantage |
$0.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.77
|
| Rate for Payer: Priority Health Medicare |
$0.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.24
|
| Rate for Payer: Railroad Medicare Medicare |
$0.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC Core |
$1.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.51
|
| Rate for Payer: UHC Medicare Advantage |
$0.53
|
| Rate for Payer: VA VA |
$0.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.53
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
IP
|
$1,109.88
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$676.92 |
| Max. Negotiated Rate |
$998.89 |
| Rate for Payer: Aetna Commercial |
$943.40
|
| Rate for Payer: BCBS Trust/PPO |
$857.72
|
| Rate for Payer: BCN Commercial |
$857.72
|
| Rate for Payer: Cash Price |
$887.90
|
| Rate for Payer: Cofinity Commercial |
$954.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$887.90
|
| Rate for Payer: Healthscope Commercial |
$998.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$832.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$943.40
|
| Rate for Payer: PHP Commercial |
$943.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$776.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$965.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$676.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$976.69
|
| Rate for Payer: UHC Core |
$926.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$832.41
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
OP
|
$1,109.88
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$263.60 |
| Max. Negotiated Rate |
$998.89 |
| Rate for Payer: Aetna Commercial |
$943.40
|
| Rate for Payer: Aetna Medicare |
$288.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$346.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$346.84
|
| Rate for Payer: BCBS Complete |
$443.95
|
| Rate for Payer: BCBS MAPPO |
$277.47
|
| Rate for Payer: BCBS Trust/PPO |
$862.93
|
| Rate for Payer: BCN Commercial |
$862.93
|
| Rate for Payer: BCN Medicare Advantage |
$277.47
|
| Rate for Payer: Cash Price |
$887.90
|
| Rate for Payer: Cofinity Commercial |
$954.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$887.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$277.47
|
| Rate for Payer: Healthscope Commercial |
$998.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$832.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$291.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$319.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$943.40
|
| Rate for Payer: PACE Senior Care Partners |
$263.60
|
| Rate for Payer: PACE SWMI |
$277.47
|
| Rate for Payer: PHP Commercial |
$943.40
|
| Rate for Payer: PHP Medicare Advantage |
$277.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$776.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$965.60
|
| Rate for Payer: Priority Health Medicare |
$277.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$676.92
|
| Rate for Payer: Railroad Medicare Medicare |
$277.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$976.69
|
| Rate for Payer: UHC Core |
$926.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$277.47
|
| Rate for Payer: UHC Medicare Advantage |
$285.79
|
| Rate for Payer: VA VA |
$277.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$832.41
|
|
|
HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL
|
Facility
|
OP
|
$1,864.36
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$442.79 |
| Max. Negotiated Rate |
$1,677.92 |
| Rate for Payer: Aetna Commercial |
$1,584.71
|
| Rate for Payer: Aetna Medicare |
$484.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$582.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$582.61
|
| Rate for Payer: BCBS Complete |
$627.82
|
| Rate for Payer: BCBS MAPPO |
$466.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,449.54
|
| Rate for Payer: BCN Commercial |
$1,449.54
|
| Rate for Payer: BCN Medicare Advantage |
$466.09
|
| Rate for Payer: Cash Price |
$1,491.49
|
| Rate for Payer: Cash Price |
$1,491.49
|
| Rate for Payer: Cofinity Commercial |
$1,603.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,491.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$466.09
|
| Rate for Payer: Healthscope Commercial |
$1,677.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,398.27
|
| Rate for Payer: Mclaren Medicaid |
$597.92
|
| Rate for Payer: Meridian Medicaid |
$627.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$489.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$536.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,584.71
|
| Rate for Payer: PACE Senior Care Partners |
$442.79
|
| Rate for Payer: PACE SWMI |
$466.09
|
| Rate for Payer: PHP Commercial |
$1,584.71
|
| Rate for Payer: PHP Medicare Advantage |
$466.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,621.99
|
| Rate for Payer: Priority Health Medicare |
$466.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,137.07
|
| Rate for Payer: Railroad Medicare Medicare |
$466.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,640.64
|
| Rate for Payer: UHC Core |
$1,556.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$466.09
|
| Rate for Payer: UHC Medicare Advantage |
$480.07
|
| Rate for Payer: VA VA |
$466.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,398.27
|
|
|
HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL
|
Facility
|
IP
|
$1,864.36
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,137.07 |
| Max. Negotiated Rate |
$1,677.92 |
| Rate for Payer: Aetna Commercial |
$1,584.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,440.78
|
| Rate for Payer: BCN Commercial |
$1,440.78
|
| Rate for Payer: Cash Price |
$1,491.49
|
| Rate for Payer: Cofinity Commercial |
$1,603.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,491.49
|
| Rate for Payer: Healthscope Commercial |
$1,677.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,398.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,584.71
|
| Rate for Payer: PHP Commercial |
$1,584.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,621.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,137.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,640.64
|
| Rate for Payer: UHC Core |
$1,556.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,398.27
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL
|
Facility
|
OP
|
$333.67
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100291
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$300.30 |
| Rate for Payer: Aetna Commercial |
$283.62
|
| Rate for Payer: Aetna Medicare |
$86.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.27
|
| Rate for Payer: BCBS Complete |
$133.47
|
| Rate for Payer: BCBS MAPPO |
$83.42
|
| Rate for Payer: BCBS Trust/PPO |
$259.43
|
| Rate for Payer: BCN Commercial |
$259.43
|
| Rate for Payer: BCN Medicare Advantage |
$83.42
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.42
|
| Rate for Payer: Healthscope Commercial |
$300.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: PACE Senior Care Partners |
$79.25
|
| Rate for Payer: PACE SWMI |
$83.42
|
| Rate for Payer: PHP Commercial |
$283.62
|
| Rate for Payer: PHP Medicare Advantage |
$83.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.29
|
| Rate for Payer: Priority Health Medicare |
$83.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.51
|
| Rate for Payer: Railroad Medicare Medicare |
$83.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.63
|
| Rate for Payer: UHC Core |
$278.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.42
|
| Rate for Payer: UHC Medicare Advantage |
$85.92
|
| Rate for Payer: VA VA |
$83.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.25
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL
|
Facility
|
IP
|
$333.67
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100291
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.51 |
| Max. Negotiated Rate |
$300.30 |
| Rate for Payer: Aetna Commercial |
$283.62
|
| Rate for Payer: BCBS Trust/PPO |
$257.86
|
| Rate for Payer: BCN Commercial |
$257.86
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.94
|
| Rate for Payer: Healthscope Commercial |
$300.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: PHP Commercial |
$283.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.63
|
| Rate for Payer: UHC Core |
$278.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.25
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL
|
Facility
|
IP
|
$500.51
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$305.26 |
| Max. Negotiated Rate |
$450.46 |
| Rate for Payer: Aetna Commercial |
$425.43
|
| Rate for Payer: BCBS Trust/PPO |
$386.79
|
| Rate for Payer: BCN Commercial |
$386.79
|
| Rate for Payer: Cash Price |
$400.41
|
| Rate for Payer: Cofinity Commercial |
$430.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.41
|
| Rate for Payer: Healthscope Commercial |
$450.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.43
|
| Rate for Payer: PHP Commercial |
$425.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$305.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.45
|
| Rate for Payer: UHC Core |
$417.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.38
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL
|
Facility
|
OP
|
$500.51
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.87 |
| Max. Negotiated Rate |
$450.46 |
| Rate for Payer: Aetna Commercial |
$425.43
|
| Rate for Payer: Aetna Medicare |
$130.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.41
|
| Rate for Payer: BCBS Complete |
$200.20
|
| Rate for Payer: BCBS MAPPO |
$125.13
|
| Rate for Payer: BCBS Trust/PPO |
$389.15
|
| Rate for Payer: BCN Commercial |
$389.15
|
| Rate for Payer: BCN Medicare Advantage |
$125.13
|
| Rate for Payer: Cash Price |
$400.41
|
| Rate for Payer: Cofinity Commercial |
$430.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.13
|
| Rate for Payer: Healthscope Commercial |
$450.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$131.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.43
|
| Rate for Payer: PACE Senior Care Partners |
$118.87
|
| Rate for Payer: PACE SWMI |
$125.13
|
| Rate for Payer: PHP Commercial |
$425.43
|
| Rate for Payer: PHP Medicare Advantage |
$125.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.44
|
| Rate for Payer: Priority Health Medicare |
$125.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$305.26
|
| Rate for Payer: Railroad Medicare Medicare |
$125.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.45
|
| Rate for Payer: UHC Core |
$417.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.13
|
| Rate for Payer: UHC Medicare Advantage |
$128.88
|
| Rate for Payer: VA VA |
$125.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.38
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL
|
Facility
|
OP
|
$333.67
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100292
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$300.30 |
| Rate for Payer: Aetna Commercial |
$283.62
|
| Rate for Payer: Aetna Medicare |
$86.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.27
|
| Rate for Payer: BCBS Complete |
$133.47
|
| Rate for Payer: BCBS MAPPO |
$83.42
|
| Rate for Payer: BCBS Trust/PPO |
$259.43
|
| Rate for Payer: BCN Commercial |
$259.43
|
| Rate for Payer: BCN Medicare Advantage |
$83.42
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.42
|
| Rate for Payer: Healthscope Commercial |
$300.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: PACE Senior Care Partners |
$79.25
|
| Rate for Payer: PACE SWMI |
$83.42
|
| Rate for Payer: PHP Commercial |
$283.62
|
| Rate for Payer: PHP Medicare Advantage |
$83.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.29
|
| Rate for Payer: Priority Health Medicare |
$83.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.51
|
| Rate for Payer: Railroad Medicare Medicare |
$83.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.63
|
| Rate for Payer: UHC Core |
$278.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.42
|
| Rate for Payer: UHC Medicare Advantage |
$85.92
|
| Rate for Payer: VA VA |
$83.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.25
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL
|
Facility
|
IP
|
$333.67
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100292
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.51 |
| Max. Negotiated Rate |
$300.30 |
| Rate for Payer: Aetna Commercial |
$283.62
|
| Rate for Payer: BCBS Trust/PPO |
$257.86
|
| Rate for Payer: BCN Commercial |
$257.86
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.94
|
| Rate for Payer: Healthscope Commercial |
$300.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: PHP Commercial |
$283.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.63
|
| Rate for Payer: UHC Core |
$278.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.25
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL BIL
|
Facility
|
IP
|
$500.51
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$305.26 |
| Max. Negotiated Rate |
$450.46 |
| Rate for Payer: Aetna Commercial |
$425.43
|
| Rate for Payer: BCBS Trust/PPO |
$386.79
|
| Rate for Payer: BCN Commercial |
$386.79
|
| Rate for Payer: Cash Price |
$400.41
|
| Rate for Payer: Cofinity Commercial |
$430.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.41
|
| Rate for Payer: Healthscope Commercial |
$450.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.43
|
| Rate for Payer: PHP Commercial |
$425.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$305.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.45
|
| Rate for Payer: UHC Core |
$417.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.38
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL BIL
|
Facility
|
OP
|
$500.51
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.87 |
| Max. Negotiated Rate |
$450.46 |
| Rate for Payer: Aetna Commercial |
$425.43
|
| Rate for Payer: Aetna Medicare |
$130.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.41
|
| Rate for Payer: BCBS Complete |
$200.20
|
| Rate for Payer: BCBS MAPPO |
$125.13
|
| Rate for Payer: BCBS Trust/PPO |
$389.15
|
| Rate for Payer: BCN Commercial |
$389.15
|
| Rate for Payer: BCN Medicare Advantage |
$125.13
|
| Rate for Payer: Cash Price |
$400.41
|
| Rate for Payer: Cofinity Commercial |
$430.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.13
|
| Rate for Payer: Healthscope Commercial |
$450.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$131.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.43
|
| Rate for Payer: PACE Senior Care Partners |
$118.87
|
| Rate for Payer: PACE SWMI |
$125.13
|
| Rate for Payer: PHP Commercial |
$425.43
|
| Rate for Payer: PHP Medicare Advantage |
$125.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.44
|
| Rate for Payer: Priority Health Medicare |
$125.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$305.26
|
| Rate for Payer: Railroad Medicare Medicare |
$125.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.45
|
| Rate for Payer: UHC Core |
$417.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.13
|
| Rate for Payer: UHC Medicare Advantage |
$128.88
|
| Rate for Payer: VA VA |
$125.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.38
|
|
|
HC INJECTION FACET JOINT L OR S 1ST LEVEL BIL
|
Facility
|
OP
|
$2,427.77
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$576.60 |
| Max. Negotiated Rate |
$2,184.99 |
| Rate for Payer: Aetna Commercial |
$2,063.60
|
| Rate for Payer: Aetna Medicare |
$631.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$758.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$758.68
|
| Rate for Payer: BCBS Complete |
$627.82
|
| Rate for Payer: BCBS MAPPO |
$606.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,887.59
|
| Rate for Payer: BCN Commercial |
$1,887.59
|
| Rate for Payer: BCN Medicare Advantage |
$606.94
|
| Rate for Payer: Cash Price |
$1,942.22
|
| Rate for Payer: Cash Price |
$1,942.22
|
| Rate for Payer: Cofinity Commercial |
$2,087.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,942.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$606.94
|
| Rate for Payer: Healthscope Commercial |
$2,184.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,820.83
|
| Rate for Payer: Mclaren Medicaid |
$597.92
|
| Rate for Payer: Meridian Medicaid |
$627.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$637.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$697.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,063.60
|
| Rate for Payer: PACE Senior Care Partners |
$576.60
|
| Rate for Payer: PACE SWMI |
$606.94
|
| Rate for Payer: PHP Commercial |
$2,063.60
|
| Rate for Payer: PHP Medicare Advantage |
$606.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,699.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,112.16
|
| Rate for Payer: Priority Health Medicare |
$606.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,480.70
|
| Rate for Payer: Railroad Medicare Medicare |
$606.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,136.44
|
| Rate for Payer: UHC Core |
$2,027.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$606.94
|
| Rate for Payer: UHC Medicare Advantage |
$625.15
|
| Rate for Payer: VA VA |
$606.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,820.83
|
|
