|
HC INJECTION, CERTOLIZUMAB PEGOL, 1 MG
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna Medicare |
$2.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.25
|
| Rate for Payer: BCBS Complete |
$1.93
|
| Rate for Payer: BCBS MAPPO |
$2.60
|
| Rate for Payer: BCBS Trust/PPO |
$8.55
|
| Rate for Payer: BCN Commercial |
$8.55
|
| Rate for Payer: BCN Medicare Advantage |
$2.60
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Mclaren Medicaid |
$1.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.73
|
| Rate for Payer: Meridian Medicaid |
$1.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.80
|
| Rate for Payer: PACE Senior Care Partners |
$2.47
|
| Rate for Payer: PACE SWMI |
$2.60
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: PHP Medicare Advantage |
$2.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.05
|
| Rate for Payer: Priority Health Medicare |
$2.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.24
|
| Rate for Payer: Railroad Medicare Medicare |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.15
|
| Rate for Payer: UHC Core |
$8.68
|
| Rate for Payer: UHC Exchange |
$2.60
|
| Rate for Payer: UHC Medicaid |
$1.83
|
| Rate for Payer: UHC Medicare Advantage |
$2.60
|
| Rate for Payer: UHCCP Medicaid |
$1.83
|
| Rate for Payer: VA VA |
$2.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
|
HC INJECTION, CERTOLIZUMAB PEGOL, 1 MG
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: BCBS Trust/PPO |
$8.59
|
| Rate for Payer: BCN Commercial |
$8.59
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.80
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.15
|
| Rate for Payer: UHC Core |
$8.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
|
HC INJECTION CERVICAL OR THORACIC
|
Facility
|
OP
|
$1,031.17
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
36100283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$181.80 |
| Max. Negotiated Rate |
$928.05 |
| Rate for Payer: Aetna Commercial |
$876.49
|
| Rate for Payer: Aetna Medicare |
$268.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$322.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$322.24
|
| Rate for Payer: BCBS Complete |
$190.87
|
| Rate for Payer: BCBS MAPPO |
$257.79
|
| Rate for Payer: BCBS Trust/PPO |
$847.72
|
| Rate for Payer: BCN Commercial |
$847.72
|
| Rate for Payer: BCN Medicare Advantage |
$257.79
|
| Rate for Payer: Cash Price |
$824.94
|
| Rate for Payer: Cofinity Commercial |
$886.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$824.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.79
|
| Rate for Payer: Healthscope Commercial |
$928.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$773.38
|
| Rate for Payer: Mclaren Medicaid |
$181.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.68
|
| Rate for Payer: Meridian Medicaid |
$190.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$283.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.49
|
| Rate for Payer: Nomi Health Commercial |
$845.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$773.38
|
| Rate for Payer: PACE Senior Care Partners |
$244.90
|
| Rate for Payer: PACE SWMI |
$257.79
|
| Rate for Payer: PHP Commercial |
$876.49
|
| Rate for Payer: PHP Medicare Advantage |
$257.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$897.12
|
| Rate for Payer: Priority Health Medicare |
$260.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$717.69
|
| Rate for Payer: Railroad Medicare Medicare |
$257.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$907.43
|
| Rate for Payer: UHC Core |
$861.03
|
| Rate for Payer: UHC Exchange |
$257.79
|
| Rate for Payer: UHC Medicaid |
$181.80
|
| Rate for Payer: UHC Medicare Advantage |
$257.79
|
| Rate for Payer: UHCCP Medicaid |
$181.80
|
| Rate for Payer: VA VA |
$257.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$773.38
|
|
|
HC INJECTION CERVICAL OR THORACIC
|
Facility
|
IP
|
$1,031.17
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
36100283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$717.69 |
| Max. Negotiated Rate |
$928.05 |
| Rate for Payer: Aetna Commercial |
$876.49
|
| Rate for Payer: BCBS Trust/PPO |
$851.64
|
| Rate for Payer: BCN Commercial |
$851.64
|
| Rate for Payer: Cash Price |
$824.94
|
| Rate for Payer: Cofinity Commercial |
$886.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$824.94
|
| Rate for Payer: Healthscope Commercial |
$928.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$773.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.49
|
| Rate for Payer: Nomi Health Commercial |
$845.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$773.38
|
| Rate for Payer: PHP Commercial |
$876.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$897.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$717.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$907.43
|
| Rate for Payer: UHC Core |
$861.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$773.38
|
|
|
HC INJECTION CONTRAST FOR TUBE ASSESSMENT
|
Facility
|
IP
|
$1,039.24
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
36100223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$723.31 |
| Max. Negotiated Rate |
$935.32 |
| Rate for Payer: Aetna Commercial |
$883.35
|
| Rate for Payer: BCBS Trust/PPO |
$858.31
|
| Rate for Payer: BCN Commercial |
$858.31
|
| Rate for Payer: Cash Price |
$831.39
|
| Rate for Payer: Cofinity Commercial |
$893.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$831.39
|
| Rate for Payer: Healthscope Commercial |
$935.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$779.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$883.35
|
| Rate for Payer: Nomi Health Commercial |
$852.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$779.43
|
| Rate for Payer: PHP Commercial |
$883.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$904.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$723.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$914.53
|
| Rate for Payer: UHC Core |
$867.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$779.43
|
|
|
HC INJECTION CONTRAST FOR TUBE ASSESSMENT
|
Facility
|
OP
|
$1,039.24
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
36100223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$183.22 |
| Max. Negotiated Rate |
$935.32 |
| Rate for Payer: Aetna Commercial |
$883.35
|
| Rate for Payer: Aetna Medicare |
$270.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$324.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$324.76
|
| Rate for Payer: BCBS Complete |
$192.36
|
| Rate for Payer: BCBS MAPPO |
$259.81
|
| Rate for Payer: BCBS Trust/PPO |
$854.36
|
| Rate for Payer: BCN Commercial |
$854.36
|
| Rate for Payer: BCN Medicare Advantage |
$259.81
|
| Rate for Payer: Cash Price |
$831.39
|
| Rate for Payer: Cofinity Commercial |
$893.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$831.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.81
|
| Rate for Payer: Healthscope Commercial |
$935.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$779.43
|
| Rate for Payer: Mclaren Medicaid |
$183.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$272.80
|
| Rate for Payer: Meridian Medicaid |
$192.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$298.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$285.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$883.35
|
| Rate for Payer: Nomi Health Commercial |
$852.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$779.43
|
| Rate for Payer: PACE Senior Care Partners |
$246.82
|
| Rate for Payer: PACE SWMI |
$259.81
|
| Rate for Payer: PHP Commercial |
$883.35
|
| Rate for Payer: PHP Medicare Advantage |
$259.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$904.14
|
| Rate for Payer: Priority Health Medicare |
$262.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$723.31
|
| Rate for Payer: Railroad Medicare Medicare |
$259.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$914.53
|
| Rate for Payer: UHC Core |
$867.77
|
| Rate for Payer: UHC Exchange |
$259.81
|
| Rate for Payer: UHC Medicaid |
$183.22
|
| Rate for Payer: UHC Medicare Advantage |
$259.81
|
| Rate for Payer: UHCCP Medicaid |
$183.22
|
| Rate for Payer: VA VA |
$259.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$779.43
|
|
|
HC INJECTION, DENOSUMAB, 1MG
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.48
|
| Rate for Payer: BCN Commercial |
$21.48
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.51
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC INJECTION, DENOSUMAB, 1MG
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.13
|
| Rate for Payer: BCBS Complete |
$4.81
|
| Rate for Payer: BCBS MAPPO |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCN Commercial |
$21.38
|
| Rate for Payer: BCN Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Mclaren Medicaid |
$4.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.83
|
| Rate for Payer: Meridian Medicaid |
$4.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.51
|
| Rate for Payer: PACE Senior Care Partners |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.50
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Medicare |
$6.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.10
|
| Rate for Payer: Railroad Medicare Medicare |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: UHC Exchange |
$6.50
|
| Rate for Payer: UHC Medicaid |
$4.59
|
| Rate for Payer: UHC Medicare Advantage |
$6.50
|
| Rate for Payer: UHCCP Medicaid |
$4.59
|
| Rate for Payer: VA VA |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
|
Facility
|
OP
|
$14.86
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$13.37 |
| Rate for Payer: Aetna Commercial |
$12.63
|
| Rate for Payer: Aetna Medicare |
$3.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.64
|
| Rate for Payer: BCBS Complete |
$2.75
|
| Rate for Payer: BCBS MAPPO |
$3.71
|
| Rate for Payer: BCBS Trust/PPO |
$12.22
|
| Rate for Payer: BCN Commercial |
$12.22
|
| Rate for Payer: BCN Medicare Advantage |
$3.71
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$12.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$13.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.14
|
| Rate for Payer: Mclaren Medicaid |
$2.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.90
|
| Rate for Payer: Meridian Medicaid |
$2.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: PACE Senior Care Partners |
$3.53
|
| Rate for Payer: PACE SWMI |
$3.71
|
| Rate for Payer: PHP Commercial |
$12.63
|
| Rate for Payer: PHP Medicare Advantage |
$3.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.93
|
| Rate for Payer: Priority Health Medicare |
$3.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.34
|
| Rate for Payer: Railroad Medicare Medicare |
$3.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.08
|
| Rate for Payer: UHC Core |
$12.41
|
| Rate for Payer: UHC Exchange |
$3.71
|
| Rate for Payer: UHC Medicaid |
$2.62
|
| Rate for Payer: UHC Medicare Advantage |
$3.71
|
| Rate for Payer: UHCCP Medicaid |
$2.62
|
| Rate for Payer: VA VA |
$3.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.14
|
|
|
HC INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
|
Facility
|
IP
|
$14.86
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$13.37 |
| Rate for Payer: Aetna Commercial |
$12.63
|
| Rate for Payer: BCBS Trust/PPO |
$12.27
|
| Rate for Payer: BCN Commercial |
$12.27
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$12.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$13.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: PHP Commercial |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.08
|
| Rate for Payer: UHC Core |
$12.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.14
|
|
|
HC INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
|
Facility
|
OP
|
$2.12
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
63600167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Medicare |
$0.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.66
|
| Rate for Payer: BCBS Complete |
$0.39
|
| Rate for Payer: BCBS MAPPO |
$0.53
|
| Rate for Payer: BCBS Trust/PPO |
$1.74
|
| Rate for Payer: BCN Commercial |
$1.74
|
| Rate for Payer: BCN Medicare Advantage |
$0.53
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.53
|
| Rate for Payer: Healthscope Commercial |
$1.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.59
|
| Rate for Payer: Mclaren Medicaid |
$0.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.56
|
| Rate for Payer: Meridian Medicaid |
$0.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.80
|
| Rate for Payer: Nomi Health Commercial |
$1.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.59
|
| Rate for Payer: PACE Senior Care Partners |
$0.50
|
| Rate for Payer: PACE SWMI |
$0.53
|
| Rate for Payer: PHP Commercial |
$1.80
|
| Rate for Payer: PHP Medicare Advantage |
$0.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.84
|
| Rate for Payer: Priority Health Medicare |
$0.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.48
|
| Rate for Payer: Railroad Medicare Medicare |
$0.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.87
|
| Rate for Payer: UHC Core |
$1.77
|
| Rate for Payer: UHC Exchange |
$0.53
|
| Rate for Payer: UHC Medicaid |
$0.37
|
| Rate for Payer: UHC Medicare Advantage |
$0.53
|
| Rate for Payer: UHCCP Medicaid |
$0.37
|
| Rate for Payer: VA VA |
$0.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.59
|
|
|
HC INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
|
Facility
|
IP
|
$2.12
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
63600167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: BCBS Trust/PPO |
$1.75
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.70
|
| Rate for Payer: Healthscope Commercial |
$1.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.80
|
| Rate for Payer: Nomi Health Commercial |
$1.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.59
|
| Rate for Payer: PHP Commercial |
$1.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.87
|
| Rate for Payer: UHC Core |
$1.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.59
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
IP
|
$1,154.72
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$803.69 |
| Max. Negotiated Rate |
$1,039.25 |
| Rate for Payer: Aetna Commercial |
$981.51
|
| Rate for Payer: BCBS Trust/PPO |
$953.68
|
| Rate for Payer: BCN Commercial |
$953.68
|
| Rate for Payer: Cash Price |
$923.78
|
| Rate for Payer: Cofinity Commercial |
$993.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$923.78
|
| Rate for Payer: Healthscope Commercial |
$1,039.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$866.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$981.51
|
| Rate for Payer: Nomi Health Commercial |
$946.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$866.04
|
| Rate for Payer: PHP Commercial |
$981.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,004.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$803.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,016.15
|
| Rate for Payer: UHC Core |
$964.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$866.04
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
OP
|
$1,154.72
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.58 |
| Max. Negotiated Rate |
$1,039.25 |
| Rate for Payer: Aetna Commercial |
$981.51
|
| Rate for Payer: Aetna Medicare |
$300.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$360.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$360.85
|
| Rate for Payer: BCBS Complete |
$213.74
|
| Rate for Payer: BCBS MAPPO |
$288.68
|
| Rate for Payer: BCBS Trust/PPO |
$949.30
|
| Rate for Payer: BCN Commercial |
$949.30
|
| Rate for Payer: BCN Medicare Advantage |
$288.68
|
| Rate for Payer: Cash Price |
$923.78
|
| Rate for Payer: Cofinity Commercial |
$993.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$923.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$288.68
|
| Rate for Payer: Healthscope Commercial |
$1,039.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$866.04
|
| Rate for Payer: Mclaren Medicaid |
$203.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.11
|
| Rate for Payer: Meridian Medicaid |
$213.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$317.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$981.51
|
| Rate for Payer: Nomi Health Commercial |
$946.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$866.04
|
| Rate for Payer: PACE Senior Care Partners |
$274.25
|
| Rate for Payer: PACE SWMI |
$288.68
|
| Rate for Payer: PHP Commercial |
$981.51
|
| Rate for Payer: PHP Medicare Advantage |
$288.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$203.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,004.61
|
| Rate for Payer: Priority Health Medicare |
$291.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$803.69
|
| Rate for Payer: Railroad Medicare Medicare |
$288.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,016.15
|
| Rate for Payer: UHC Core |
$964.19
|
| Rate for Payer: UHC Exchange |
$288.68
|
| Rate for Payer: UHC Medicaid |
$203.58
|
| Rate for Payer: UHC Medicare Advantage |
$288.68
|
| Rate for Payer: UHCCP Medicaid |
$203.58
|
| Rate for Payer: VA VA |
$288.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$866.04
|
|
|
HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL
|
Facility
|
IP
|
$1,939.68
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,350.02 |
| Max. Negotiated Rate |
$1,745.71 |
| Rate for Payer: Aetna Commercial |
$1,648.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,601.98
|
| Rate for Payer: BCN Commercial |
$1,601.98
|
| Rate for Payer: Cash Price |
$1,551.74
|
| Rate for Payer: Cofinity Commercial |
$1,668.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,551.74
|
| Rate for Payer: Healthscope Commercial |
$1,745.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,454.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,648.73
|
| Rate for Payer: Nomi Health Commercial |
$1,590.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,454.76
|
| Rate for Payer: PHP Commercial |
$1,648.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,687.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,350.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,706.92
|
| Rate for Payer: UHC Core |
$1,619.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,454.76
|
|
|
HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL
|
Facility
|
OP
|
$1,939.68
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$341.97 |
| Max. Negotiated Rate |
$1,745.71 |
| Rate for Payer: Aetna Commercial |
$1,648.73
|
| Rate for Payer: Aetna Medicare |
$504.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$606.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$606.15
|
| Rate for Payer: BCBS Complete |
$359.03
|
| Rate for Payer: BCBS MAPPO |
$484.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,594.61
|
| Rate for Payer: BCN Commercial |
$1,594.61
|
| Rate for Payer: BCN Medicare Advantage |
$484.92
|
| Rate for Payer: Cash Price |
$1,551.74
|
| Rate for Payer: Cofinity Commercial |
$1,668.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,551.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$484.92
|
| Rate for Payer: Healthscope Commercial |
$1,745.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,454.76
|
| Rate for Payer: Mclaren Medicaid |
$341.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$509.17
|
| Rate for Payer: Meridian Medicaid |
$359.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$557.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$533.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,648.73
|
| Rate for Payer: Nomi Health Commercial |
$1,590.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,454.76
|
| Rate for Payer: PACE Senior Care Partners |
$460.67
|
| Rate for Payer: PACE SWMI |
$484.92
|
| Rate for Payer: PHP Commercial |
$1,648.73
|
| Rate for Payer: PHP Medicare Advantage |
$484.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$341.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,687.52
|
| Rate for Payer: Priority Health Medicare |
$489.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,350.02
|
| Rate for Payer: Railroad Medicare Medicare |
$484.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,706.92
|
| Rate for Payer: UHC Core |
$1,619.63
|
| Rate for Payer: UHC Exchange |
$484.92
|
| Rate for Payer: UHC Medicaid |
$341.97
|
| Rate for Payer: UHC Medicare Advantage |
$484.92
|
| Rate for Payer: UHCCP Medicaid |
$341.97
|
| Rate for Payer: VA VA |
$484.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,454.76
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL
|
Facility
|
OP
|
$347.15
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100291
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$312.44 |
| Rate for Payer: Aetna Commercial |
$295.08
|
| Rate for Payer: Aetna Medicare |
$90.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.48
|
| Rate for Payer: BCBS Complete |
$64.26
|
| Rate for Payer: BCBS MAPPO |
$86.79
|
| Rate for Payer: BCBS Trust/PPO |
$285.39
|
| Rate for Payer: BCN Commercial |
$285.39
|
| Rate for Payer: BCN Medicare Advantage |
$86.79
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cofinity Commercial |
$298.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.79
|
| Rate for Payer: Healthscope Commercial |
$312.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.36
|
| Rate for Payer: Mclaren Medicaid |
$61.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.13
|
| Rate for Payer: Meridian Medicaid |
$64.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.08
|
| Rate for Payer: Nomi Health Commercial |
$284.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.36
|
| Rate for Payer: PACE Senior Care Partners |
$82.45
|
| Rate for Payer: PACE SWMI |
$86.79
|
| Rate for Payer: PHP Commercial |
$295.08
|
| Rate for Payer: PHP Medicare Advantage |
$86.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$302.02
|
| Rate for Payer: Priority Health Medicare |
$87.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.62
|
| Rate for Payer: Railroad Medicare Medicare |
$86.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.49
|
| Rate for Payer: UHC Core |
$289.87
|
| Rate for Payer: UHC Exchange |
$86.79
|
| Rate for Payer: UHC Medicaid |
$61.20
|
| Rate for Payer: UHC Medicare Advantage |
$86.79
|
| Rate for Payer: UHCCP Medicaid |
$61.20
|
| Rate for Payer: VA VA |
$86.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.36
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL
|
Facility
|
IP
|
$347.15
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100291
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.62 |
| Max. Negotiated Rate |
$312.44 |
| Rate for Payer: Aetna Commercial |
$295.08
|
| Rate for Payer: BCBS Trust/PPO |
$286.71
|
| Rate for Payer: BCN Commercial |
$286.71
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cofinity Commercial |
$298.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.72
|
| Rate for Payer: Healthscope Commercial |
$312.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.08
|
| Rate for Payer: Nomi Health Commercial |
$284.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.36
|
| Rate for Payer: PHP Commercial |
$295.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$302.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.49
|
| Rate for Payer: UHC Core |
$289.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.36
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL
|
Facility
|
OP
|
$520.73
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$468.66 |
| Rate for Payer: Aetna Commercial |
$442.62
|
| Rate for Payer: Aetna Medicare |
$135.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.73
|
| Rate for Payer: BCBS Complete |
$96.39
|
| Rate for Payer: BCBS MAPPO |
$130.18
|
| Rate for Payer: BCBS Trust/PPO |
$428.09
|
| Rate for Payer: BCN Commercial |
$428.09
|
| Rate for Payer: BCN Medicare Advantage |
$130.18
|
| Rate for Payer: Cash Price |
$416.58
|
| Rate for Payer: Cofinity Commercial |
$447.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.18
|
| Rate for Payer: Healthscope Commercial |
$468.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.55
|
| Rate for Payer: Mclaren Medicaid |
$91.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.69
|
| Rate for Payer: Meridian Medicaid |
$96.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$143.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.62
|
| Rate for Payer: Nomi Health Commercial |
$427.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.55
|
| Rate for Payer: PACE Senior Care Partners |
$123.67
|
| Rate for Payer: PACE SWMI |
$130.18
|
| Rate for Payer: PHP Commercial |
$442.62
|
| Rate for Payer: PHP Medicare Advantage |
$130.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$453.04
|
| Rate for Payer: Priority Health Medicare |
$131.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.43
|
| Rate for Payer: Railroad Medicare Medicare |
$130.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.24
|
| Rate for Payer: UHC Core |
$434.81
|
| Rate for Payer: UHC Exchange |
$130.18
|
| Rate for Payer: UHC Medicaid |
$91.80
|
| Rate for Payer: UHC Medicare Advantage |
$130.18
|
| Rate for Payer: UHCCP Medicaid |
$91.80
|
| Rate for Payer: VA VA |
$130.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.55
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL
|
Facility
|
IP
|
$520.73
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$362.43 |
| Max. Negotiated Rate |
$468.66 |
| Rate for Payer: Aetna Commercial |
$442.62
|
| Rate for Payer: BCBS Trust/PPO |
$430.07
|
| Rate for Payer: BCN Commercial |
$430.07
|
| Rate for Payer: Cash Price |
$416.58
|
| Rate for Payer: Cofinity Commercial |
$447.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.58
|
| Rate for Payer: Healthscope Commercial |
$468.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.62
|
| Rate for Payer: Nomi Health Commercial |
$427.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.55
|
| Rate for Payer: PHP Commercial |
$442.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$453.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.24
|
| Rate for Payer: UHC Core |
$434.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.55
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL
|
Facility
|
IP
|
$347.15
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100292
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.62 |
| Max. Negotiated Rate |
$312.44 |
| Rate for Payer: Aetna Commercial |
$295.08
|
| Rate for Payer: BCBS Trust/PPO |
$286.71
|
| Rate for Payer: BCN Commercial |
$286.71
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cofinity Commercial |
$298.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.72
|
| Rate for Payer: Healthscope Commercial |
$312.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.08
|
| Rate for Payer: Nomi Health Commercial |
$284.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.36
|
| Rate for Payer: PHP Commercial |
$295.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$302.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.49
|
| Rate for Payer: UHC Core |
$289.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.36
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL
|
Facility
|
OP
|
$347.15
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100292
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$312.44 |
| Rate for Payer: Aetna Commercial |
$295.08
|
| Rate for Payer: Aetna Medicare |
$90.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.48
|
| Rate for Payer: BCBS Complete |
$64.26
|
| Rate for Payer: BCBS MAPPO |
$86.79
|
| Rate for Payer: BCBS Trust/PPO |
$285.39
|
| Rate for Payer: BCN Commercial |
$285.39
|
| Rate for Payer: BCN Medicare Advantage |
$86.79
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cofinity Commercial |
$298.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.79
|
| Rate for Payer: Healthscope Commercial |
$312.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.36
|
| Rate for Payer: Mclaren Medicaid |
$61.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.13
|
| Rate for Payer: Meridian Medicaid |
$64.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.08
|
| Rate for Payer: Nomi Health Commercial |
$284.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.36
|
| Rate for Payer: PACE Senior Care Partners |
$82.45
|
| Rate for Payer: PACE SWMI |
$86.79
|
| Rate for Payer: PHP Commercial |
$295.08
|
| Rate for Payer: PHP Medicare Advantage |
$86.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$302.02
|
| Rate for Payer: Priority Health Medicare |
$87.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.62
|
| Rate for Payer: Railroad Medicare Medicare |
$86.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.49
|
| Rate for Payer: UHC Core |
$289.87
|
| Rate for Payer: UHC Exchange |
$86.79
|
| Rate for Payer: UHC Medicaid |
$61.20
|
| Rate for Payer: UHC Medicare Advantage |
$86.79
|
| Rate for Payer: UHCCP Medicaid |
$61.20
|
| Rate for Payer: VA VA |
$86.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.36
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL BIL
|
Facility
|
OP
|
$520.73
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$468.66 |
| Rate for Payer: Aetna Commercial |
$442.62
|
| Rate for Payer: Aetna Medicare |
$135.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.73
|
| Rate for Payer: BCBS Complete |
$96.39
|
| Rate for Payer: BCBS MAPPO |
$130.18
|
| Rate for Payer: BCBS Trust/PPO |
$428.09
|
| Rate for Payer: BCN Commercial |
$428.09
|
| Rate for Payer: BCN Medicare Advantage |
$130.18
|
| Rate for Payer: Cash Price |
$416.58
|
| Rate for Payer: Cofinity Commercial |
$447.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.18
|
| Rate for Payer: Healthscope Commercial |
$468.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.55
|
| Rate for Payer: Mclaren Medicaid |
$91.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.69
|
| Rate for Payer: Meridian Medicaid |
$96.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$143.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.62
|
| Rate for Payer: Nomi Health Commercial |
$427.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.55
|
| Rate for Payer: PACE Senior Care Partners |
$123.67
|
| Rate for Payer: PACE SWMI |
$130.18
|
| Rate for Payer: PHP Commercial |
$442.62
|
| Rate for Payer: PHP Medicare Advantage |
$130.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$453.04
|
| Rate for Payer: Priority Health Medicare |
$131.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.43
|
| Rate for Payer: Railroad Medicare Medicare |
$130.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.24
|
| Rate for Payer: UHC Core |
$434.81
|
| Rate for Payer: UHC Exchange |
$130.18
|
| Rate for Payer: UHC Medicaid |
$91.80
|
| Rate for Payer: UHC Medicare Advantage |
$130.18
|
| Rate for Payer: UHCCP Medicaid |
$91.80
|
| Rate for Payer: VA VA |
$130.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.55
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL BIL
|
Facility
|
IP
|
$520.73
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$362.43 |
| Max. Negotiated Rate |
$468.66 |
| Rate for Payer: Aetna Commercial |
$442.62
|
| Rate for Payer: BCBS Trust/PPO |
$430.07
|
| Rate for Payer: BCN Commercial |
$430.07
|
| Rate for Payer: Cash Price |
$416.58
|
| Rate for Payer: Cofinity Commercial |
$447.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.58
|
| Rate for Payer: Healthscope Commercial |
$468.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.62
|
| Rate for Payer: Nomi Health Commercial |
$427.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.55
|
| Rate for Payer: PHP Commercial |
$442.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$453.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.24
|
| Rate for Payer: UHC Core |
$434.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.55
|
|
|
HC INJECTION FACET JOINT L OR S 1ST LEVEL BIL
|
Facility
|
IP
|
$2,525.86
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,758.00 |
| Max. Negotiated Rate |
$2,273.27 |
| Rate for Payer: Aetna Commercial |
$2,146.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,086.11
|
| Rate for Payer: BCN Commercial |
$2,086.11
|
| Rate for Payer: Cash Price |
$2,020.69
|
| Rate for Payer: Cofinity Commercial |
$2,172.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,020.69
|
| Rate for Payer: Healthscope Commercial |
$2,273.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,894.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,146.98
|
| Rate for Payer: Nomi Health Commercial |
$2,071.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,894.39
|
| Rate for Payer: PHP Commercial |
$2,146.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,197.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,758.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,222.76
|
| Rate for Payer: UHC Core |
$2,109.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,894.39
|
|
