|
HC INJECTION, DENOSUMAB, 1MG
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.57 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$20.82
|
| Rate for Payer: BCN Commercial |
$19.71
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health HMO/PPO |
$22.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
|
Facility
|
IP
|
$14.57
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: BCBS Trust/PPO |
$11.89
|
| Rate for Payer: BCN Commercial |
$11.26
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO |
$12.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.82
|
| Rate for Payer: UHC Core |
$12.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.93
|
|
|
HC INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
|
Facility
|
OP
|
$14.57
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna Medicare |
$3.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.55
|
| Rate for Payer: BCBS Complete |
$5.83
|
| Rate for Payer: BCBS MAPPO |
$3.64
|
| Rate for Payer: BCBS Trust/PPO |
$11.98
|
| Rate for Payer: BCN Commercial |
$11.33
|
| Rate for Payer: BCN Medicare Advantage |
$3.64
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.64
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: PACE Senior Care Partners |
$3.46
|
| Rate for Payer: PACE SWMI |
$3.64
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: PHP Medicare Advantage |
$3.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO |
$12.68
|
| Rate for Payer: Priority Health Medicare |
$3.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.76
|
| Rate for Payer: Railroad Medicare Medicare |
$3.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.82
|
| Rate for Payer: UHC Core |
$12.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.64
|
| Rate for Payer: UHC Exchange |
$3.64
|
| Rate for Payer: UHC Medicare Advantage |
$3.64
|
| Rate for Payer: VA VA |
$3.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.93
|
|
|
HC INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
|
Facility
|
IP
|
$2.08
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
63600167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: BCBS Trust/PPO |
$1.70
|
| Rate for Payer: BCN Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Nomi Health Commercial |
$1.71
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health HMO/PPO |
$1.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.83
|
| Rate for Payer: UHC Core |
$1.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.56
|
|
|
HC INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
|
Facility
|
OP
|
$2.08
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
63600167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.65
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: BCBS MAPPO |
$0.52
|
| Rate for Payer: BCBS Trust/PPO |
$1.71
|
| Rate for Payer: BCN Commercial |
$1.62
|
| Rate for Payer: BCN Medicare Advantage |
$0.52
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.52
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Nomi Health Commercial |
$1.71
|
| Rate for Payer: PACE Senior Care Partners |
$0.49
|
| Rate for Payer: PACE SWMI |
$0.52
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: PHP Medicare Advantage |
$0.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health HMO/PPO |
$1.81
|
| Rate for Payer: Priority Health Medicare |
$0.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.39
|
| Rate for Payer: Railroad Medicare Medicare |
$0.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.83
|
| Rate for Payer: UHC Core |
$1.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.52
|
| Rate for Payer: UHC Exchange |
$0.52
|
| Rate for Payer: UHC Medicare Advantage |
$0.52
|
| Rate for Payer: VA VA |
$0.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.56
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
OP
|
$1,132.08
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$268.87 |
| Max. Negotiated Rate |
$1,018.87 |
| Rate for Payer: Aetna Commercial |
$962.27
|
| Rate for Payer: Aetna Medicare |
$294.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$353.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$353.77
|
| Rate for Payer: BCBS Complete |
$452.83
|
| Rate for Payer: BCBS MAPPO |
$283.02
|
| Rate for Payer: BCBS Trust/PPO |
$930.68
|
| Rate for Payer: BCN Commercial |
$880.19
|
| Rate for Payer: BCN Medicare Advantage |
$283.02
|
| Rate for Payer: Cash Price |
$905.66
|
| Rate for Payer: Cofinity Commercial |
$973.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$905.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$283.02
|
| Rate for Payer: Healthscope Commercial |
$1,018.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$849.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$297.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$325.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$962.27
|
| Rate for Payer: Nomi Health Commercial |
$928.31
|
| Rate for Payer: PACE Senior Care Partners |
$268.87
|
| Rate for Payer: PACE SWMI |
$283.02
|
| Rate for Payer: PHP Commercial |
$962.27
|
| Rate for Payer: PHP Medicare Advantage |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$735.85
|
| Rate for Payer: Priority Health HMO/PPO |
$984.91
|
| Rate for Payer: Priority Health Medicare |
$285.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$758.49
|
| Rate for Payer: Railroad Medicare Medicare |
$283.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$996.23
|
| Rate for Payer: UHC Core |
$945.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$283.02
|
| Rate for Payer: UHC Exchange |
$283.02
|
| Rate for Payer: UHC Medicare Advantage |
$283.02
|
| Rate for Payer: VA VA |
$283.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$849.06
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
IP
|
$1,132.08
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$735.85 |
| Max. Negotiated Rate |
$1,018.87 |
| Rate for Payer: Aetna Commercial |
$962.27
|
| Rate for Payer: BCBS Trust/PPO |
$924.12
|
| Rate for Payer: BCN Commercial |
$874.87
|
| Rate for Payer: Cash Price |
$905.66
|
| Rate for Payer: Cofinity Commercial |
$973.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$905.66
|
| Rate for Payer: Healthscope Commercial |
$1,018.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$849.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$962.27
|
| Rate for Payer: Nomi Health Commercial |
$928.31
|
| Rate for Payer: PHP Commercial |
$962.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$735.85
|
| Rate for Payer: Priority Health HMO/PPO |
$984.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$758.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$996.23
|
| Rate for Payer: UHC Core |
$945.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$849.06
|
|
|
HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL
|
Facility
|
IP
|
$1,901.65
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,236.07 |
| Max. Negotiated Rate |
$1,711.48 |
| Rate for Payer: Aetna Commercial |
$1,616.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,552.32
|
| Rate for Payer: BCN Commercial |
$1,469.60
|
| Rate for Payer: Cash Price |
$1,521.32
|
| Rate for Payer: Cofinity Commercial |
$1,635.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,521.32
|
| Rate for Payer: Healthscope Commercial |
$1,711.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,426.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,616.40
|
| Rate for Payer: Nomi Health Commercial |
$1,559.35
|
| Rate for Payer: PHP Commercial |
$1,616.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.07
|
| Rate for Payer: Priority Health HMO/PPO |
$1,654.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,274.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,673.45
|
| Rate for Payer: UHC Core |
$1,587.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,426.24
|
|
|
HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL
|
Facility
|
OP
|
$1,901.65
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$451.64 |
| Max. Negotiated Rate |
$1,711.48 |
| Rate for Payer: Aetna Commercial |
$1,616.40
|
| Rate for Payer: Aetna Medicare |
$494.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$594.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$594.27
|
| Rate for Payer: BCBS Complete |
$675.91
|
| Rate for Payer: BCBS MAPPO |
$475.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,563.35
|
| Rate for Payer: BCN Commercial |
$1,478.53
|
| Rate for Payer: BCN Medicare Advantage |
$475.41
|
| Rate for Payer: Cash Price |
$1,521.32
|
| Rate for Payer: Cash Price |
$1,521.32
|
| Rate for Payer: Cofinity Commercial |
$1,635.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,521.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$475.41
|
| Rate for Payer: Healthscope Commercial |
$1,711.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,426.24
|
| Rate for Payer: Mclaren Medicaid |
$643.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$499.18
|
| Rate for Payer: Meridian Medicaid |
$675.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$546.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,616.40
|
| Rate for Payer: Nomi Health Commercial |
$1,559.35
|
| Rate for Payer: PACE Senior Care Partners |
$451.64
|
| Rate for Payer: PACE SWMI |
$475.41
|
| Rate for Payer: PHP Commercial |
$1,616.40
|
| Rate for Payer: PHP Medicare Advantage |
$475.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.07
|
| Rate for Payer: Priority Health HMO/PPO |
$1,654.44
|
| Rate for Payer: Priority Health Medicare |
$480.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,274.11
|
| Rate for Payer: Railroad Medicare Medicare |
$475.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,673.45
|
| Rate for Payer: UHC Core |
$1,587.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$475.41
|
| Rate for Payer: UHC Exchange |
$475.41
|
| Rate for Payer: UHC Medicare Advantage |
$475.41
|
| Rate for Payer: UHCCP Medicaid |
$643.68
|
| Rate for Payer: VA VA |
$475.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,426.24
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL
|
Facility
|
OP
|
$340.34
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100291
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$80.83 |
| Max. Negotiated Rate |
$306.31 |
| Rate for Payer: Aetna Commercial |
$289.29
|
| Rate for Payer: Aetna Medicare |
$88.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.36
|
| Rate for Payer: BCBS Complete |
$136.14
|
| Rate for Payer: BCBS MAPPO |
$85.08
|
| Rate for Payer: BCBS Trust/PPO |
$279.79
|
| Rate for Payer: BCN Commercial |
$264.61
|
| Rate for Payer: BCN Medicare Advantage |
$85.08
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.08
|
| Rate for Payer: Healthscope Commercial |
$306.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: Nomi Health Commercial |
$279.08
|
| Rate for Payer: PACE Senior Care Partners |
$80.83
|
| Rate for Payer: PACE SWMI |
$85.08
|
| Rate for Payer: PHP Commercial |
$289.29
|
| Rate for Payer: PHP Medicare Advantage |
$85.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health HMO/PPO |
$296.10
|
| Rate for Payer: Priority Health Medicare |
$85.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.03
|
| Rate for Payer: Railroad Medicare Medicare |
$85.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.50
|
| Rate for Payer: UHC Core |
$284.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.08
|
| Rate for Payer: UHC Exchange |
$85.08
|
| Rate for Payer: UHC Medicare Advantage |
$85.08
|
| Rate for Payer: VA VA |
$85.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.25
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL
|
Facility
|
IP
|
$340.34
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100291
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$221.22 |
| Max. Negotiated Rate |
$306.31 |
| Rate for Payer: Aetna Commercial |
$289.29
|
| Rate for Payer: BCBS Trust/PPO |
$277.82
|
| Rate for Payer: BCN Commercial |
$263.01
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Healthscope Commercial |
$306.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: Nomi Health Commercial |
$279.08
|
| Rate for Payer: PHP Commercial |
$289.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health HMO/PPO |
$296.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.50
|
| Rate for Payer: UHC Core |
$284.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.25
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL
|
Facility
|
OP
|
$510.52
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$121.25 |
| Max. Negotiated Rate |
$459.47 |
| Rate for Payer: Aetna Commercial |
$433.94
|
| Rate for Payer: Aetna Medicare |
$132.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.54
|
| Rate for Payer: BCBS Complete |
$204.21
|
| Rate for Payer: BCBS MAPPO |
$127.63
|
| Rate for Payer: BCBS Trust/PPO |
$419.70
|
| Rate for Payer: BCN Commercial |
$396.93
|
| Rate for Payer: BCN Medicare Advantage |
$127.63
|
| 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: Health Alliance Plan Medicare Advantage |
$127.63
|
| Rate for Payer: Healthscope Commercial |
$459.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.94
|
| Rate for Payer: Nomi Health Commercial |
$418.63
|
| Rate for Payer: PACE Senior Care Partners |
$121.25
|
| Rate for Payer: PACE SWMI |
$127.63
|
| Rate for Payer: PHP Commercial |
$433.94
|
| Rate for Payer: PHP Medicare Advantage |
$127.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.84
|
| Rate for Payer: Priority Health HMO/PPO |
$444.15
|
| Rate for Payer: Priority Health Medicare |
$128.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$342.05
|
| Rate for Payer: Railroad Medicare Medicare |
$127.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.26
|
| Rate for Payer: UHC Core |
$426.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.63
|
| Rate for Payer: UHC Exchange |
$127.63
|
| Rate for Payer: UHC Medicare Advantage |
$127.63
|
| Rate for Payer: VA VA |
$127.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.89
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL
|
Facility
|
IP
|
$510.52
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$331.84 |
| Max. Negotiated Rate |
$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 C OR T 3RD + LEVEL
|
Facility
|
OP
|
$340.34
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100292
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$80.83 |
| Max. Negotiated Rate |
$306.31 |
| Rate for Payer: Aetna Commercial |
$289.29
|
| Rate for Payer: Aetna Medicare |
$88.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.36
|
| Rate for Payer: BCBS Complete |
$136.14
|
| Rate for Payer: BCBS MAPPO |
$85.08
|
| Rate for Payer: BCBS Trust/PPO |
$279.79
|
| Rate for Payer: BCN Commercial |
$264.61
|
| Rate for Payer: BCN Medicare Advantage |
$85.08
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.08
|
| Rate for Payer: Healthscope Commercial |
$306.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: Nomi Health Commercial |
$279.08
|
| Rate for Payer: PACE Senior Care Partners |
$80.83
|
| Rate for Payer: PACE SWMI |
$85.08
|
| Rate for Payer: PHP Commercial |
$289.29
|
| Rate for Payer: PHP Medicare Advantage |
$85.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health HMO/PPO |
$296.10
|
| Rate for Payer: Priority Health Medicare |
$85.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.03
|
| Rate for Payer: Railroad Medicare Medicare |
$85.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.50
|
| Rate for Payer: UHC Core |
$284.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.08
|
| Rate for Payer: UHC Exchange |
$85.08
|
| Rate for Payer: UHC Medicare Advantage |
$85.08
|
| Rate for Payer: VA VA |
$85.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.25
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL
|
Facility
|
IP
|
$340.34
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100292
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$221.22 |
| Max. Negotiated Rate |
$306.31 |
| Rate for Payer: Aetna Commercial |
$289.29
|
| Rate for Payer: BCBS Trust/PPO |
$277.82
|
| Rate for Payer: BCN Commercial |
$263.01
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Healthscope Commercial |
$306.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: Nomi Health Commercial |
$279.08
|
| Rate for Payer: PHP Commercial |
$289.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health HMO/PPO |
$296.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.50
|
| Rate for Payer: UHC Core |
$284.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.25
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL BIL
|
Facility
|
OP
|
$510.52
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$121.25 |
| Max. Negotiated Rate |
$459.47 |
| Rate for Payer: Aetna Commercial |
$433.94
|
| Rate for Payer: Aetna Medicare |
$132.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.54
|
| Rate for Payer: BCBS Complete |
$204.21
|
| Rate for Payer: BCBS MAPPO |
$127.63
|
| Rate for Payer: BCBS Trust/PPO |
$419.70
|
| Rate for Payer: BCN Commercial |
$396.93
|
| Rate for Payer: BCN Medicare Advantage |
$127.63
|
| 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: Health Alliance Plan Medicare Advantage |
$127.63
|
| Rate for Payer: Healthscope Commercial |
$459.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.94
|
| Rate for Payer: Nomi Health Commercial |
$418.63
|
| Rate for Payer: PACE Senior Care Partners |
$121.25
|
| Rate for Payer: PACE SWMI |
$127.63
|
| Rate for Payer: PHP Commercial |
$433.94
|
| Rate for Payer: PHP Medicare Advantage |
$127.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.84
|
| Rate for Payer: Priority Health HMO/PPO |
$444.15
|
| Rate for Payer: Priority Health Medicare |
$128.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$342.05
|
| Rate for Payer: Railroad Medicare Medicare |
$127.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.26
|
| Rate for Payer: UHC Core |
$426.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.63
|
| Rate for Payer: UHC Exchange |
$127.63
|
| Rate for Payer: UHC Medicare Advantage |
$127.63
|
| Rate for Payer: VA VA |
$127.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.89
|
|
|
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
|
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 |
$675.91
|
| 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 |
$643.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$650.04
|
| Rate for Payer: Meridian Medicaid |
$675.91
|
| 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 |
$643.68
|
| 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 |
$643.68
|
| 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 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 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
|
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 + 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
|
|
