|
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 |
$459.47 |
| Rate for Payer: Aetna Commercial |
$433.94
|
| Rate for Payer: BCBS Trust/PPO |
$416.74
|
| Rate for Payer: BCN Commercial |
$394.53
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cofinity Commercial |
$439.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.42
|
| Rate for Payer: Healthscope Commercial |
$459.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.94
|
| Rate for Payer: Nomi Health Commercial |
$418.63
|
| Rate for Payer: PHP Commercial |
$433.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.84
|
| Rate for Payer: Priority Health HMO/PPO |
$444.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$342.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.26
|
| Rate for Payer: UHC Core |
$426.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.89
|
|
|
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 |
$2,228.70 |
| Rate for Payer: Aetna Commercial |
$2,104.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,021.43
|
| Rate for Payer: BCN Commercial |
$1,913.71
|
| Rate for Payer: Cash Price |
$1,981.06
|
| Rate for Payer: Cofinity Commercial |
$2,129.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,981.06
|
| Rate for Payer: Healthscope Commercial |
$2,228.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,857.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,104.88
|
| Rate for Payer: Nomi Health Commercial |
$2,030.59
|
| Rate for Payer: PHP Commercial |
$2,104.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,609.61
|
| Rate for Payer: Priority Health HMO/PPO |
$2,154.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,659.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,179.17
|
| Rate for Payer: UHC Core |
$2,067.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,857.25
|
|
|
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 |
$588.13 |
| Max. Negotiated Rate |
$2,228.70 |
| Rate for Payer: Aetna Commercial |
$2,104.88
|
| Rate for Payer: Aetna Medicare |
$643.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$773.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$773.85
|
| Rate for Payer: BCBS Complete |
$662.24
|
| Rate for Payer: BCBS MAPPO |
$619.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,035.79
|
| Rate for Payer: BCN Commercial |
$1,925.35
|
| Rate for Payer: BCN Medicare Advantage |
$619.08
|
| Rate for Payer: Cash Price |
$1,981.06
|
| Rate for Payer: Cash Price |
$1,981.06
|
| Rate for Payer: Cofinity Commercial |
$2,129.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,981.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$619.08
|
| Rate for Payer: Healthscope Commercial |
$2,228.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,857.25
|
| Rate for Payer: Mclaren Medicaid |
$630.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$650.04
|
| Rate for Payer: Meridian Medicaid |
$662.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$711.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,104.88
|
| Rate for Payer: Nomi Health Commercial |
$2,030.59
|
| Rate for Payer: PACE Senior Care Partners |
$588.13
|
| Rate for Payer: PACE SWMI |
$619.08
|
| Rate for Payer: PHP Commercial |
$2,104.88
|
| Rate for Payer: PHP Medicare Advantage |
$619.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$630.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,609.61
|
| Rate for Payer: Priority Health HMO/PPO |
$2,154.41
|
| Rate for Payer: Priority Health Medicare |
$625.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,659.14
|
| Rate for Payer: Railroad Medicare Medicare |
$619.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,179.17
|
| Rate for Payer: UHC Core |
$2,067.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$619.08
|
| Rate for Payer: UHC Exchange |
$619.08
|
| Rate for Payer: UHC Medicare Advantage |
$619.08
|
| Rate for Payer: UHCCP Medicaid |
$630.67
|
| Rate for Payer: VA VA |
$619.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,857.25
|
|
|
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 |
$97.80 |
| Max. Negotiated Rate |
$370.63 |
| Rate for Payer: Aetna Commercial |
$350.04
|
| Rate for Payer: Aetna Medicare |
$107.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$128.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$128.69
|
| Rate for Payer: BCBS Complete |
$164.72
|
| Rate for Payer: BCBS MAPPO |
$102.95
|
| Rate for Payer: BCBS Trust/PPO |
$338.55
|
| Rate for Payer: BCN Commercial |
$320.18
|
| Rate for Payer: BCN Medicare Advantage |
$102.95
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cofinity Commercial |
$354.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.95
|
| Rate for Payer: Healthscope Commercial |
$370.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.04
|
| Rate for Payer: Nomi Health Commercial |
$337.68
|
| Rate for Payer: PACE Senior Care Partners |
$97.80
|
| Rate for Payer: PACE SWMI |
$102.95
|
| Rate for Payer: PHP Commercial |
$350.04
|
| Rate for Payer: PHP Medicare Advantage |
$102.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.68
|
| Rate for Payer: Priority Health HMO/PPO |
$358.27
|
| Rate for Payer: Priority Health Medicare |
$103.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.91
|
| Rate for Payer: Railroad Medicare Medicare |
$102.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$362.39
|
| Rate for Payer: UHC Core |
$343.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.95
|
| Rate for Payer: UHC Exchange |
$102.95
|
| Rate for Payer: UHC Medicare Advantage |
$102.95
|
| Rate for Payer: VA VA |
$102.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.86
|
|
|
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 |
$370.63 |
| Rate for Payer: Aetna Commercial |
$350.04
|
| Rate for Payer: BCBS Trust/PPO |
$336.16
|
| Rate for Payer: BCN Commercial |
$318.25
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cofinity Commercial |
$354.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.45
|
| Rate for Payer: Healthscope Commercial |
$370.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.04
|
| Rate for Payer: Nomi Health Commercial |
$337.68
|
| Rate for Payer: PHP Commercial |
$350.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.68
|
| Rate for Payer: Priority Health HMO/PPO |
$358.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$362.39
|
| Rate for Payer: UHC Core |
$343.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.86
|
|
|
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 |
$146.71 |
| Max. Negotiated Rate |
$555.94 |
| Rate for Payer: Aetna Commercial |
$525.05
|
| Rate for Payer: Aetna Medicare |
$160.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$193.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$193.03
|
| Rate for Payer: BCBS Complete |
$247.08
|
| Rate for Payer: BCBS MAPPO |
$154.43
|
| Rate for Payer: BCBS Trust/PPO |
$507.82
|
| Rate for Payer: BCN Commercial |
$480.27
|
| Rate for Payer: BCN Medicare Advantage |
$154.43
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$531.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.43
|
| Rate for Payer: Healthscope Commercial |
$555.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.05
|
| Rate for Payer: Nomi Health Commercial |
$506.52
|
| Rate for Payer: PACE Senior Care Partners |
$146.71
|
| Rate for Payer: PACE SWMI |
$154.43
|
| Rate for Payer: PHP Commercial |
$525.05
|
| Rate for Payer: PHP Medicare Advantage |
$154.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.51
|
| Rate for Payer: Priority Health HMO/PPO |
$537.41
|
| Rate for Payer: Priority Health Medicare |
$155.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.87
|
| Rate for Payer: Railroad Medicare Medicare |
$154.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.58
|
| Rate for Payer: UHC Core |
$515.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.43
|
| Rate for Payer: UHC Exchange |
$154.43
|
| Rate for Payer: UHC Medicare Advantage |
$154.43
|
| Rate for Payer: VA VA |
$154.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.28
|
|
|
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 |
$555.94 |
| Rate for Payer: Aetna Commercial |
$525.05
|
| Rate for Payer: BCBS Trust/PPO |
$504.24
|
| Rate for Payer: BCN Commercial |
$477.37
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$531.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.17
|
| Rate for Payer: Healthscope Commercial |
$555.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.05
|
| Rate for Payer: Nomi Health Commercial |
$506.52
|
| Rate for Payer: PHP Commercial |
$525.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.51
|
| Rate for Payer: Priority Health HMO/PPO |
$537.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.58
|
| Rate for Payer: UHC Core |
$515.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.28
|
|
|
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 |
$370.63 |
| Rate for Payer: Aetna Commercial |
$350.04
|
| Rate for Payer: BCBS Trust/PPO |
$336.16
|
| Rate for Payer: BCN Commercial |
$318.25
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cofinity Commercial |
$354.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.45
|
| Rate for Payer: Healthscope Commercial |
$370.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.04
|
| Rate for Payer: Nomi Health Commercial |
$337.68
|
| Rate for Payer: PHP Commercial |
$350.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.68
|
| Rate for Payer: Priority Health HMO/PPO |
$358.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$362.39
|
| Rate for Payer: UHC Core |
$343.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.86
|
|
|
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 |
$97.80 |
| Max. Negotiated Rate |
$370.63 |
| Rate for Payer: Aetna Commercial |
$350.04
|
| Rate for Payer: Aetna Medicare |
$107.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$128.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$128.69
|
| Rate for Payer: BCBS Complete |
$164.72
|
| Rate for Payer: BCBS MAPPO |
$102.95
|
| Rate for Payer: BCBS Trust/PPO |
$338.55
|
| Rate for Payer: BCN Commercial |
$320.18
|
| Rate for Payer: BCN Medicare Advantage |
$102.95
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cofinity Commercial |
$354.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.95
|
| Rate for Payer: Healthscope Commercial |
$370.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.04
|
| Rate for Payer: Nomi Health Commercial |
$337.68
|
| Rate for Payer: PACE Senior Care Partners |
$97.80
|
| Rate for Payer: PACE SWMI |
$102.95
|
| Rate for Payer: PHP Commercial |
$350.04
|
| Rate for Payer: PHP Medicare Advantage |
$102.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.68
|
| Rate for Payer: Priority Health HMO/PPO |
$358.27
|
| Rate for Payer: Priority Health Medicare |
$103.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.91
|
| Rate for Payer: Railroad Medicare Medicare |
$102.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$362.39
|
| Rate for Payer: UHC Core |
$343.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.95
|
| Rate for Payer: UHC Exchange |
$102.95
|
| Rate for Payer: UHC Medicare Advantage |
$102.95
|
| Rate for Payer: VA VA |
$102.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.86
|
|
|
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 |
$146.71 |
| Max. Negotiated Rate |
$555.94 |
| Rate for Payer: Aetna Commercial |
$525.05
|
| Rate for Payer: Aetna Medicare |
$160.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$193.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$193.03
|
| Rate for Payer: BCBS Complete |
$247.08
|
| Rate for Payer: BCBS MAPPO |
$154.43
|
| Rate for Payer: BCBS Trust/PPO |
$507.82
|
| Rate for Payer: BCN Commercial |
$480.27
|
| Rate for Payer: BCN Medicare Advantage |
$154.43
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$531.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.43
|
| Rate for Payer: Healthscope Commercial |
$555.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.05
|
| Rate for Payer: Nomi Health Commercial |
$506.52
|
| Rate for Payer: PACE Senior Care Partners |
$146.71
|
| Rate for Payer: PACE SWMI |
$154.43
|
| Rate for Payer: PHP Commercial |
$525.05
|
| Rate for Payer: PHP Medicare Advantage |
$154.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.51
|
| Rate for Payer: Priority Health HMO/PPO |
$537.41
|
| Rate for Payer: Priority Health Medicare |
$155.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.87
|
| Rate for Payer: Railroad Medicare Medicare |
$154.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.58
|
| Rate for Payer: UHC Core |
$515.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.43
|
| Rate for Payer: UHC Exchange |
$154.43
|
| Rate for Payer: UHC Medicare Advantage |
$154.43
|
| Rate for Payer: VA VA |
$154.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.28
|
|
|
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 |
$555.94 |
| Rate for Payer: Aetna Commercial |
$525.05
|
| Rate for Payer: BCBS Trust/PPO |
$504.24
|
| Rate for Payer: BCN Commercial |
$477.37
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$531.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.17
|
| Rate for Payer: Healthscope Commercial |
$555.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.05
|
| Rate for Payer: Nomi Health Commercial |
$506.52
|
| Rate for Payer: PHP Commercial |
$525.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.51
|
| Rate for Payer: Priority Health HMO/PPO |
$537.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.58
|
| Rate for Payer: UHC Core |
$515.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.28
|
|
|
HC INJECTION FOR CEREBRAL SHUNT
|
Facility
|
OP
|
$826.35
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36100270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$196.26 |
| Max. Negotiated Rate |
$743.72 |
| Rate for Payer: Aetna Commercial |
$702.40
|
| Rate for Payer: Aetna Medicare |
$214.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$258.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$258.23
|
| Rate for Payer: BCBS Complete |
$515.13
|
| Rate for Payer: BCBS MAPPO |
$206.59
|
| Rate for Payer: BCBS Trust/PPO |
$679.34
|
| Rate for Payer: BCN Commercial |
$642.49
|
| Rate for Payer: BCN Medicare Advantage |
$206.59
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cofinity Commercial |
$710.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.59
|
| Rate for Payer: Healthscope Commercial |
$743.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$619.76
|
| Rate for Payer: Mclaren Medicaid |
$490.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.92
|
| Rate for Payer: Meridian Medicaid |
$515.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$702.40
|
| Rate for Payer: Nomi Health Commercial |
$677.61
|
| Rate for Payer: PACE Senior Care Partners |
$196.26
|
| Rate for Payer: PACE SWMI |
$206.59
|
| Rate for Payer: PHP Commercial |
$702.40
|
| Rate for Payer: PHP Medicare Advantage |
$206.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.13
|
| Rate for Payer: Priority Health HMO/PPO |
$718.92
|
| Rate for Payer: Priority Health Medicare |
$208.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$553.65
|
| Rate for Payer: Railroad Medicare Medicare |
$206.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.19
|
| Rate for Payer: UHC Core |
$690.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.59
|
| Rate for Payer: UHC Exchange |
$206.59
|
| Rate for Payer: UHC Medicare Advantage |
$206.59
|
| Rate for Payer: UHCCP Medicaid |
$490.57
|
| Rate for Payer: VA VA |
$206.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$619.76
|
|
|
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 |
$743.72 |
| Rate for Payer: Aetna Commercial |
$702.40
|
| Rate for Payer: BCBS Trust/PPO |
$674.55
|
| Rate for Payer: BCN Commercial |
$638.60
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cofinity Commercial |
$710.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.08
|
| Rate for Payer: Healthscope Commercial |
$743.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$619.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$702.40
|
| Rate for Payer: Nomi Health Commercial |
$677.61
|
| Rate for Payer: PHP Commercial |
$702.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.13
|
| Rate for Payer: Priority Health HMO/PPO |
$718.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$553.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.19
|
| Rate for Payer: UHC Core |
$690.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$619.76
|
|
|
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 |
$590.84 |
| Rate for Payer: Aetna Commercial |
$558.02
|
| Rate for Payer: BCBS Trust/PPO |
$535.89
|
| Rate for Payer: BCN Commercial |
$507.34
|
| Rate for Payer: Cash Price |
$525.19
|
| Rate for Payer: Cofinity Commercial |
$564.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.19
|
| Rate for Payer: Healthscope Commercial |
$590.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$492.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.02
|
| Rate for Payer: Nomi Health Commercial |
$538.32
|
| Rate for Payer: PHP Commercial |
$558.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.72
|
| Rate for Payer: Priority Health HMO/PPO |
$571.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$439.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$577.71
|
| Rate for Payer: UHC Core |
$548.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$492.37
|
|
|
HC INJECTION FOR HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$656.49
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
36100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.92 |
| Max. Negotiated Rate |
$590.84 |
| Rate for Payer: Aetna Commercial |
$558.02
|
| Rate for Payer: Aetna Medicare |
$170.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$205.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$205.15
|
| Rate for Payer: BCBS Complete |
$262.60
|
| Rate for Payer: BCBS MAPPO |
$164.12
|
| Rate for Payer: BCBS Trust/PPO |
$539.70
|
| Rate for Payer: BCN Commercial |
$510.42
|
| Rate for Payer: BCN Medicare Advantage |
$164.12
|
| Rate for Payer: Cash Price |
$525.19
|
| Rate for Payer: Cofinity Commercial |
$564.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.12
|
| Rate for Payer: Healthscope Commercial |
$590.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$492.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.02
|
| Rate for Payer: Nomi Health Commercial |
$538.32
|
| Rate for Payer: PACE Senior Care Partners |
$155.92
|
| Rate for Payer: PACE SWMI |
$164.12
|
| Rate for Payer: PHP Commercial |
$558.02
|
| Rate for Payer: PHP Medicare Advantage |
$164.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.72
|
| Rate for Payer: Priority Health HMO/PPO |
$571.15
|
| Rate for Payer: Priority Health Medicare |
$165.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$439.85
|
| Rate for Payer: Railroad Medicare Medicare |
$164.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$577.71
|
| Rate for Payer: UHC Core |
$548.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.12
|
| Rate for Payer: UHC Exchange |
$164.12
|
| Rate for Payer: UHC Medicare Advantage |
$164.12
|
| Rate for Payer: VA VA |
$164.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$492.37
|
|
|
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 |
$1,178.32 |
| Rate for Payer: Aetna Commercial |
$1,112.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,068.73
|
| Rate for Payer: BCN Commercial |
$1,011.78
|
| Rate for Payer: Cash Price |
$1,047.39
|
| Rate for Payer: Cofinity Commercial |
$1,125.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,047.39
|
| Rate for Payer: Healthscope Commercial |
$1,178.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$981.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,112.85
|
| Rate for Payer: Nomi Health Commercial |
$1,073.58
|
| Rate for Payer: PHP Commercial |
$1,112.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.01
|
| Rate for Payer: Priority Health HMO/PPO |
$1,139.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$877.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,152.13
|
| Rate for Payer: UHC Core |
$1,093.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$981.93
|
|
|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
OP
|
$1,309.24
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$310.94 |
| Max. Negotiated Rate |
$1,178.32 |
| Rate for Payer: Aetna Commercial |
$1,112.85
|
| Rate for Payer: Aetna Medicare |
$340.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$409.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$409.14
|
| Rate for Payer: BCBS Complete |
$523.70
|
| Rate for Payer: BCBS MAPPO |
$327.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,076.33
|
| Rate for Payer: BCN Commercial |
$1,017.93
|
| Rate for Payer: BCN Medicare Advantage |
$327.31
|
| Rate for Payer: Cash Price |
$1,047.39
|
| Rate for Payer: Cofinity Commercial |
$1,125.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,047.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.31
|
| Rate for Payer: Healthscope Commercial |
$1,178.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$981.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,112.85
|
| Rate for Payer: Nomi Health Commercial |
$1,073.58
|
| Rate for Payer: PACE Senior Care Partners |
$310.94
|
| Rate for Payer: PACE SWMI |
$327.31
|
| Rate for Payer: PHP Commercial |
$1,112.85
|
| Rate for Payer: PHP Medicare Advantage |
$327.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.01
|
| Rate for Payer: Priority Health HMO/PPO |
$1,139.04
|
| Rate for Payer: Priority Health Medicare |
$330.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$877.19
|
| Rate for Payer: Railroad Medicare Medicare |
$327.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,152.13
|
| Rate for Payer: UHC Core |
$1,093.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.31
|
| Rate for Payer: UHC Exchange |
$327.31
|
| Rate for Payer: UHC Medicare Advantage |
$327.31
|
| Rate for Payer: VA VA |
$327.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$981.93
|
|
|
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 |
$288.33 |
| Max. Negotiated Rate |
$1,092.62 |
| Rate for Payer: Aetna Commercial |
$1,031.92
|
| Rate for Payer: Aetna Medicare |
$315.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.38
|
| Rate for Payer: BCBS Complete |
$485.61
|
| Rate for Payer: BCBS MAPPO |
$303.50
|
| Rate for Payer: BCBS Trust/PPO |
$998.05
|
| Rate for Payer: BCN Commercial |
$943.90
|
| Rate for Payer: BCN Medicare Advantage |
$303.50
|
| Rate for Payer: Cash Price |
$971.22
|
| Rate for Payer: Cofinity Commercial |
$1,044.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$971.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.50
|
| Rate for Payer: Healthscope Commercial |
$1,092.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,031.92
|
| Rate for Payer: Nomi Health Commercial |
$995.50
|
| Rate for Payer: PACE Senior Care Partners |
$288.33
|
| Rate for Payer: PACE SWMI |
$303.50
|
| Rate for Payer: PHP Commercial |
$1,031.92
|
| Rate for Payer: PHP Medicare Advantage |
$303.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.11
|
| Rate for Payer: Priority Health HMO/PPO |
$1,056.20
|
| Rate for Payer: Priority Health Medicare |
$306.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$813.39
|
| Rate for Payer: Railroad Medicare Medicare |
$303.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,068.34
|
| Rate for Payer: UHC Core |
$1,013.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.50
|
| Rate for Payer: UHC Exchange |
$303.50
|
| Rate for Payer: UHC Medicare Advantage |
$303.50
|
| Rate for Payer: VA VA |
$303.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.52
|
|
|
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 |
$1,092.62 |
| Rate for Payer: Aetna Commercial |
$1,031.92
|
| Rate for Payer: BCBS Trust/PPO |
$991.00
|
| Rate for Payer: BCN Commercial |
$938.19
|
| Rate for Payer: Cash Price |
$971.22
|
| Rate for Payer: Cofinity Commercial |
$1,044.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$971.22
|
| Rate for Payer: Healthscope Commercial |
$1,092.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,031.92
|
| Rate for Payer: Nomi Health Commercial |
$995.50
|
| Rate for Payer: PHP Commercial |
$1,031.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.11
|
| Rate for Payer: Priority Health HMO/PPO |
$1,056.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$813.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,068.34
|
| Rate for Payer: UHC Core |
$1,013.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.52
|
|
|
HC INJECTION INTRALESIONAL UP TO 7 LESIONS
|
Facility
|
IP
|
$147.11
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
76100134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.62 |
| Max. Negotiated Rate |
$132.40 |
| Rate for Payer: Aetna Commercial |
$125.04
|
| Rate for Payer: BCBS Trust/PPO |
$120.09
|
| Rate for Payer: BCN Commercial |
$113.69
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$126.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Healthscope Commercial |
$132.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: Nomi Health Commercial |
$120.63
|
| Rate for Payer: PHP Commercial |
$125.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: Priority Health HMO/PPO |
$127.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.46
|
| Rate for Payer: UHC Core |
$122.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.33
|
|
|
HC INJECTION INTRALESIONAL UP TO 7 LESIONS
|
Facility
|
OP
|
$147.11
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
76100134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$147.80 |
| Rate for Payer: Aetna Commercial |
$125.04
|
| Rate for Payer: Aetna Medicare |
$38.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.97
|
| Rate for Payer: BCBS Complete |
$147.80
|
| Rate for Payer: BCBS MAPPO |
$36.78
|
| Rate for Payer: BCBS Trust/PPO |
$120.94
|
| Rate for Payer: BCN Commercial |
$114.38
|
| Rate for Payer: BCN Medicare Advantage |
$36.78
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$126.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.78
|
| Rate for Payer: Healthscope Commercial |
$132.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.33
|
| Rate for Payer: Mclaren Medicaid |
$140.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.62
|
| Rate for Payer: Meridian Medicaid |
$147.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: Nomi Health Commercial |
$120.63
|
| Rate for Payer: PACE Senior Care Partners |
$34.94
|
| Rate for Payer: PACE SWMI |
$36.78
|
| Rate for Payer: PHP Commercial |
$125.04
|
| Rate for Payer: PHP Medicare Advantage |
$36.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: Priority Health HMO/PPO |
$127.99
|
| Rate for Payer: Priority Health Medicare |
$37.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.56
|
| Rate for Payer: Railroad Medicare Medicare |
$36.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.46
|
| Rate for Payer: UHC Core |
$122.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.78
|
| Rate for Payer: UHC Exchange |
$36.78
|
| Rate for Payer: UHC Medicare Advantage |
$36.78
|
| Rate for Payer: UHCCP Medicaid |
$140.75
|
| Rate for Payer: VA VA |
$36.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.33
|
|
|
HC INJECTION, IRON DEXTRAN, 50 MG
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT J1750
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: BCBS Trust/PPO |
$50.95
|
| Rate for Payer: BCN Commercial |
$48.24
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO |
$54.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.93
|
| Rate for Payer: UHC Core |
$52.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.82
|
|
|
HC INJECTION, IRON DEXTRAN, 50 MG
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT J1750
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$16.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.51
|
| Rate for Payer: BCBS Complete |
$13.21
|
| Rate for Payer: BCBS MAPPO |
$15.60
|
| Rate for Payer: BCBS Trust/PPO |
$51.32
|
| Rate for Payer: BCN Commercial |
$48.53
|
| Rate for Payer: BCN Medicare Advantage |
$15.60
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.60
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$12.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.39
|
| Rate for Payer: Meridian Medicaid |
$13.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PACE Senior Care Partners |
$14.82
|
| Rate for Payer: PACE SWMI |
$15.60
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$15.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO |
$54.31
|
| Rate for Payer: Priority Health Medicare |
$15.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.82
|
| Rate for Payer: Railroad Medicare Medicare |
$15.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.93
|
| Rate for Payer: UHC Core |
$52.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.60
|
| Rate for Payer: UHC Exchange |
$15.60
|
| Rate for Payer: UHC Medicare Advantage |
$15.60
|
| Rate for Payer: UHCCP Medicaid |
$12.58
|
| Rate for Payer: VA VA |
$15.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.82
|
|
|
HC INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
63600098
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$0.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.20
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
63600098
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
