|
HC ABDOMINAL HYSTERECT (OB SURGER
|
Facility
|
OP
|
$2,565.37
|
|
| Hospital Charge Code |
36000002
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$949.19 |
| Max. Negotiated Rate |
$2,308.83 |
| Rate for Payer: Aetna American Axle |
$1,667.49
|
| Rate for Payer: Aetna Commercial |
$2,180.56
|
| Rate for Payer: Aetna Medicare |
$1,282.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,667.49
|
| Rate for Payer: BCBS Complete |
$1,026.15
|
| Rate for Payer: Cash Price |
$2,052.30
|
| Rate for Payer: Cofinity Commercial |
$1,795.76
|
| Rate for Payer: Cofinity Commercial |
$2,206.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,795.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,052.30
|
| Rate for Payer: Healthscope Commercial |
$2,308.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,795.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,924.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,180.56
|
| Rate for Payer: PHP Commercial |
$2,180.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,667.49
|
| Rate for Payer: Priority Health SBD |
$1,616.18
|
| Rate for Payer: UMR Bronson Commercial |
$949.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,924.03
|
|
|
HC ABDOMINAL HYSTERECT (OB SURGER
|
Facility
|
IP
|
$2,565.37
|
|
| Hospital Charge Code |
36000002
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,128.76 |
| Max. Negotiated Rate |
$2,308.83 |
| Rate for Payer: Aetna American Axle |
$1,667.49
|
| Rate for Payer: Aetna Commercial |
$2,180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,667.49
|
| Rate for Payer: Cash Price |
$2,052.30
|
| Rate for Payer: Cofinity Commercial |
$1,795.76
|
| Rate for Payer: Cofinity Commercial |
$2,206.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,795.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,052.30
|
| Rate for Payer: Healthscope Commercial |
$2,308.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,795.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,924.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,180.56
|
| Rate for Payer: PHP Commercial |
$2,180.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,667.49
|
| Rate for Payer: Priority Health SBD |
$1,616.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,128.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,924.03
|
|
|
HC ABDOMINAL STERILIZE (OB SURGER
|
Facility
|
OP
|
$1,576.94
|
|
| Hospital Charge Code |
36000003
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$583.47 |
| Max. Negotiated Rate |
$1,419.25 |
| Rate for Payer: Aetna American Axle |
$1,025.01
|
| Rate for Payer: Aetna Commercial |
$1,340.40
|
| Rate for Payer: Aetna Medicare |
$788.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,025.01
|
| Rate for Payer: BCBS Complete |
$630.78
|
| Rate for Payer: Cash Price |
$1,261.55
|
| Rate for Payer: Cofinity Commercial |
$1,103.86
|
| Rate for Payer: Cofinity Commercial |
$1,356.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,103.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.55
|
| Rate for Payer: Healthscope Commercial |
$1,419.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,103.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,182.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.40
|
| Rate for Payer: PHP Commercial |
$1,340.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.01
|
| Rate for Payer: Priority Health SBD |
$993.47
|
| Rate for Payer: UMR Bronson Commercial |
$583.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,182.70
|
|
|
HC ABDOMINAL STERILIZE (OB SURGER
|
Facility
|
IP
|
$1,576.94
|
|
| Hospital Charge Code |
36000003
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$693.85 |
| Max. Negotiated Rate |
$1,419.25 |
| Rate for Payer: Aetna American Axle |
$1,025.01
|
| Rate for Payer: Aetna Commercial |
$1,340.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,025.01
|
| Rate for Payer: Cash Price |
$1,261.55
|
| Rate for Payer: Cofinity Commercial |
$1,103.86
|
| Rate for Payer: Cofinity Commercial |
$1,356.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,103.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.55
|
| Rate for Payer: Healthscope Commercial |
$1,419.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,103.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,182.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.40
|
| Rate for Payer: PHP Commercial |
$1,340.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.01
|
| Rate for Payer: Priority Health SBD |
$993.47
|
| Rate for Payer: UMR Bronson Commercial |
$693.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,182.70
|
|
|
HC ABLAT BY NEUROLYTIC AGENT GENICULAR NRV BIL KNEE 3 OR MORE NRVS
|
Facility
|
IP
|
$4,024.27
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
36100603
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,770.68 |
| Max. Negotiated Rate |
$3,621.84 |
| Rate for Payer: Aetna American Axle |
$2,615.78
|
| Rate for Payer: Aetna Commercial |
$3,420.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,615.78
|
| Rate for Payer: Cash Price |
$3,219.42
|
| Rate for Payer: Cofinity Commercial |
$2,816.99
|
| Rate for Payer: Cofinity Commercial |
$3,460.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,816.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,219.42
|
| Rate for Payer: Healthscope Commercial |
$3,621.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,816.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,018.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,420.63
|
| Rate for Payer: PHP Commercial |
$3,420.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,615.78
|
| Rate for Payer: Priority Health SBD |
$2,535.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,770.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,018.20
|
|
|
HC ABLAT BY NEUROLYTIC AGENT GENICULAR NRV BIL KNEE 3 OR MORE NRVS
|
Facility
|
OP
|
$4,024.27
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
36100603
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna American Axle |
$2,615.78
|
| Rate for Payer: Aetna Commercial |
$3,420.63
|
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,615.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Cash Price |
$3,219.42
|
| Rate for Payer: Cash Price |
$3,219.42
|
| Rate for Payer: Cofinity Commercial |
$3,460.87
|
| Rate for Payer: Cofinity Commercial |
$2,816.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,816.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,219.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Healthscope Commercial |
$3,621.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,816.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,018.20
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,420.63
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Commercial |
$3,420.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,615.78
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Priority Health SBD |
$2,535.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$3,639.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.81
|
| Rate for Payer: UMR Bronson Commercial |
$1,488.98
|
| Rate for Payer: VA VA |
$1,904.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,018.20
|
|
|
HC ABLAT BY NEUROLYTIC AGENT GENICULAR NRV KNEE 3 OR MORE NRVS
|
Facility
|
IP
|
$2,683.19
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
36100601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,180.60 |
| Max. Negotiated Rate |
$2,414.87 |
| Rate for Payer: Aetna American Axle |
$1,744.07
|
| Rate for Payer: Aetna Commercial |
$2,280.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,744.07
|
| Rate for Payer: Cash Price |
$2,146.55
|
| Rate for Payer: Cofinity Commercial |
$1,878.23
|
| Rate for Payer: Cofinity Commercial |
$2,307.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,878.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,146.55
|
| Rate for Payer: Healthscope Commercial |
$2,414.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,878.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,012.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,280.71
|
| Rate for Payer: PHP Commercial |
$2,280.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,744.07
|
| Rate for Payer: Priority Health SBD |
$1,690.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,180.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,012.39
|
|
|
HC ABLAT BY NEUROLYTIC AGENT GENICULAR NRV KNEE 3 OR MORE NRVS
|
Facility
|
OP
|
$2,683.19
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
36100601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$992.78 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna American Axle |
$1,744.07
|
| Rate for Payer: Aetna Commercial |
$2,280.71
|
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,744.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Cash Price |
$2,146.55
|
| Rate for Payer: Cash Price |
$2,146.55
|
| Rate for Payer: Cofinity Commercial |
$2,307.54
|
| Rate for Payer: Cofinity Commercial |
$1,878.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,878.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,146.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Healthscope Commercial |
$2,414.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,878.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,012.39
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,280.71
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Commercial |
$2,280.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,744.07
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Priority Health SBD |
$1,690.41
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$3,639.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.81
|
| Rate for Payer: UMR Bronson Commercial |
$992.78
|
| Rate for Payer: VA VA |
$1,904.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,012.39
|
|
|
HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NR OR BRANCH SHOULDER EA ADDL NRV
|
Facility
|
OP
|
$1,267.29
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
36100596
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$2,444.12 |
| Rate for Payer: Aetna American Axle |
$823.74
|
| Rate for Payer: Aetna Commercial |
$1,077.20
|
| Rate for Payer: Aetna Medicare |
$903.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$1,013.83
|
| Rate for Payer: Cash Price |
$1,013.83
|
| Rate for Payer: Cofinity Commercial |
$887.10
|
| Rate for Payer: Cofinity Commercial |
$1,089.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$887.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$1,140.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$887.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$950.47
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.20
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$1,077.20
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.74
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health SBD |
$798.39
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,444.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,659.37
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: UMR Bronson Commercial |
$468.90
|
| Rate for Payer: VA VA |
$868.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$950.47
|
|
|
HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NR OR BRANCH SHOULDER EA ADDL NRV
|
Facility
|
IP
|
$1,267.29
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
36100596
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$557.61 |
| Max. Negotiated Rate |
$1,140.56 |
| Rate for Payer: Aetna American Axle |
$823.74
|
| Rate for Payer: Aetna Commercial |
$1,077.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.74
|
| Rate for Payer: Cash Price |
$1,013.83
|
| Rate for Payer: Cofinity Commercial |
$1,089.87
|
| Rate for Payer: Cofinity Commercial |
$887.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$887.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.83
|
| Rate for Payer: Healthscope Commercial |
$1,140.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$887.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$950.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.20
|
| Rate for Payer: PHP Commercial |
$1,077.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.74
|
| Rate for Payer: Priority Health SBD |
$798.39
|
| Rate for Payer: UMR Bronson Commercial |
$557.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$950.47
|
|
|
HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NRV OR BRANCH HIP EA ADDL NRV
|
Facility
|
IP
|
$1,267.29
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
36100598
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$557.61 |
| Max. Negotiated Rate |
$1,140.56 |
| Rate for Payer: Aetna American Axle |
$823.74
|
| Rate for Payer: Aetna Commercial |
$1,077.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.74
|
| Rate for Payer: Cash Price |
$1,013.83
|
| Rate for Payer: Cofinity Commercial |
$1,089.87
|
| Rate for Payer: Cofinity Commercial |
$887.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$887.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.83
|
| Rate for Payer: Healthscope Commercial |
$1,140.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$887.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$950.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.20
|
| Rate for Payer: PHP Commercial |
$1,077.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.74
|
| Rate for Payer: Priority Health SBD |
$798.39
|
| Rate for Payer: UMR Bronson Commercial |
$557.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$950.47
|
|
|
HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NRV OR BRANCH HIP EA ADDL NRV
|
Facility
|
OP
|
$1,267.29
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
36100598
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$2,444.12 |
| Rate for Payer: Aetna American Axle |
$823.74
|
| Rate for Payer: Aetna Commercial |
$1,077.20
|
| Rate for Payer: Aetna Medicare |
$903.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$1,013.83
|
| Rate for Payer: Cash Price |
$1,013.83
|
| Rate for Payer: Cofinity Commercial |
$887.10
|
| Rate for Payer: Cofinity Commercial |
$1,089.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$887.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$1,140.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$887.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$950.47
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.20
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$1,077.20
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.74
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health SBD |
$798.39
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,444.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,659.37
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: UMR Bronson Commercial |
$468.90
|
| Rate for Payer: VA VA |
$868.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$950.47
|
|
|
HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NRV OR BRANCH HIP SNG NRV
|
Facility
|
OP
|
$1,267.29
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
36100597
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$2,444.12 |
| Rate for Payer: Aetna American Axle |
$823.74
|
| Rate for Payer: Aetna Commercial |
$1,077.20
|
| Rate for Payer: Aetna Medicare |
$903.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$1,013.83
|
| Rate for Payer: Cash Price |
$1,013.83
|
| Rate for Payer: Cofinity Commercial |
$887.10
|
| Rate for Payer: Cofinity Commercial |
$1,089.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$887.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$1,140.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$887.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$950.47
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.20
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$1,077.20
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.74
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health SBD |
$798.39
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,444.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,659.37
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: UMR Bronson Commercial |
$468.90
|
| Rate for Payer: VA VA |
$868.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$950.47
|
|
|
HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NRV OR BRANCH HIP SNG NRV
|
Facility
|
IP
|
$1,267.29
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
36100597
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$557.61 |
| Max. Negotiated Rate |
$1,140.56 |
| Rate for Payer: Aetna American Axle |
$823.74
|
| Rate for Payer: Aetna Commercial |
$1,077.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.74
|
| Rate for Payer: Cash Price |
$1,013.83
|
| Rate for Payer: Cofinity Commercial |
$1,089.87
|
| Rate for Payer: Cofinity Commercial |
$887.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$887.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.83
|
| Rate for Payer: Healthscope Commercial |
$1,140.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$887.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$950.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.20
|
| Rate for Payer: PHP Commercial |
$1,077.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.74
|
| Rate for Payer: Priority Health SBD |
$798.39
|
| Rate for Payer: UMR Bronson Commercial |
$557.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$950.47
|
|
|
HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NRV OR BRANCH SHOULDER SNG NRV
|
Facility
|
IP
|
$1,267.29
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
36100595
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$557.61 |
| Max. Negotiated Rate |
$1,140.56 |
| Rate for Payer: Aetna American Axle |
$823.74
|
| Rate for Payer: Aetna Commercial |
$1,077.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.74
|
| Rate for Payer: Cash Price |
$1,013.83
|
| Rate for Payer: Cofinity Commercial |
$1,089.87
|
| Rate for Payer: Cofinity Commercial |
$887.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$887.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.83
|
| Rate for Payer: Healthscope Commercial |
$1,140.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$887.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$950.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.20
|
| Rate for Payer: PHP Commercial |
$1,077.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.74
|
| Rate for Payer: Priority Health SBD |
$798.39
|
| Rate for Payer: UMR Bronson Commercial |
$557.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$950.47
|
|
|
HC ABLAT BY NEUROLYTIC AGENT OTHER PERIPH NRV OR BRANCH SHOULDER SNG NRV
|
Facility
|
OP
|
$1,267.29
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
36100595
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$2,444.12 |
| Rate for Payer: Aetna American Axle |
$823.74
|
| Rate for Payer: Aetna Commercial |
$1,077.20
|
| Rate for Payer: Aetna Medicare |
$903.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$1,013.83
|
| Rate for Payer: Cash Price |
$1,013.83
|
| Rate for Payer: Cofinity Commercial |
$887.10
|
| Rate for Payer: Cofinity Commercial |
$1,089.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$887.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$1,140.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$887.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$950.47
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.20
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$1,077.20
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.74
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health SBD |
$798.39
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,444.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,659.37
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: UMR Bronson Commercial |
$468.90
|
| Rate for Payer: VA VA |
$868.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$950.47
|
|
|
HC ABLATION AV NODE
|
Facility
|
IP
|
$8,558.71
|
|
|
Service Code
|
CPT 93650
|
| Hospital Charge Code |
48100044
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,765.83 |
| Max. Negotiated Rate |
$7,702.84 |
| Rate for Payer: Aetna American Axle |
$5,563.16
|
| Rate for Payer: Aetna Commercial |
$7,274.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,563.16
|
| Rate for Payer: Cash Price |
$6,846.97
|
| Rate for Payer: Cofinity Commercial |
$5,991.10
|
| Rate for Payer: Cofinity Commercial |
$7,360.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,991.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,846.97
|
| Rate for Payer: Healthscope Commercial |
$7,702.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,991.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,419.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,274.90
|
| Rate for Payer: PHP Commercial |
$7,274.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,563.16
|
| Rate for Payer: Priority Health SBD |
$5,391.99
|
| Rate for Payer: UMR Bronson Commercial |
$3,765.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,419.03
|
|
|
HC ABLATION AV NODE
|
Facility
|
OP
|
$8,558.71
|
|
|
Service Code
|
CPT 93650
|
| Hospital Charge Code |
48100044
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,166.72 |
| Max. Negotiated Rate |
$20,831.72 |
| Rate for Payer: Aetna American Axle |
$5,563.16
|
| Rate for Payer: Aetna Commercial |
$7,274.90
|
| Rate for Payer: Aetna Medicare |
$7,696.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,563.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,250.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,250.65
|
| Rate for Payer: BCBS Complete |
$4,165.01
|
| Rate for Payer: BCBS MAPPO |
$7,400.52
|
| Rate for Payer: BCN Medicare Advantage |
$7,400.52
|
| Rate for Payer: Cash Price |
$6,846.97
|
| Rate for Payer: Cash Price |
$6,846.97
|
| Rate for Payer: Cofinity Commercial |
$7,360.49
|
| Rate for Payer: Cofinity Commercial |
$5,991.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,991.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,846.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,400.52
|
| Rate for Payer: Healthscope Commercial |
$7,702.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,991.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,419.03
|
| Rate for Payer: Mclaren Medicaid |
$3,966.68
|
| Rate for Payer: Mclaren Medicare |
$7,400.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,770.55
|
| Rate for Payer: Meridian Medicaid |
$4,165.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,510.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,274.90
|
| Rate for Payer: PACE Medicare |
$7,030.49
|
| Rate for Payer: PACE SWMI |
$7,400.52
|
| Rate for Payer: PHP Commercial |
$7,274.90
|
| Rate for Payer: PHP Medicare Advantage |
$7,400.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,966.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,563.16
|
| Rate for Payer: Priority Health Medicare |
$7,400.52
|
| Rate for Payer: Priority Health SBD |
$5,391.99
|
| Rate for Payer: Railroad Medicare Medicare |
$7,400.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,831.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,400.52
|
| Rate for Payer: UHC Exchange |
$14,143.13
|
| Rate for Payer: UHC Medicare Advantage |
$7,400.52
|
| Rate for Payer: UHCCP Medicaid |
$3,966.68
|
| Rate for Payer: UMR Bronson Commercial |
$3,166.72
|
| Rate for Payer: VA VA |
$7,400.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,419.03
|
|
|
HC ABLATION BONE
|
Facility
|
IP
|
$6,775.93
|
|
|
Service Code
|
CPT 20982
|
| Hospital Charge Code |
36100480
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,981.41 |
| Max. Negotiated Rate |
$6,098.34 |
| Rate for Payer: Aetna American Axle |
$4,404.35
|
| Rate for Payer: Aetna Commercial |
$5,759.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,404.35
|
| Rate for Payer: Cash Price |
$5,420.74
|
| Rate for Payer: Cofinity Commercial |
$4,743.15
|
| Rate for Payer: Cofinity Commercial |
$5,827.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,743.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,420.74
|
| Rate for Payer: Healthscope Commercial |
$6,098.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,743.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,081.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,759.54
|
| Rate for Payer: PHP Commercial |
$5,759.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,404.35
|
| Rate for Payer: Priority Health SBD |
$4,268.84
|
| Rate for Payer: UMR Bronson Commercial |
$2,981.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,081.95
|
|
|
HC ABLATION BONE
|
Facility
|
OP
|
$6,775.93
|
|
|
Service Code
|
CPT 20982
|
| Hospital Charge Code |
36100480
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,507.09 |
| Max. Negotiated Rate |
$35,323.48 |
| Rate for Payer: Aetna American Axle |
$4,404.35
|
| Rate for Payer: Aetna Commercial |
$5,759.54
|
| Rate for Payer: Aetna Medicare |
$13,050.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,404.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,685.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,685.94
|
| Rate for Payer: BCBS Complete |
$7,062.44
|
| Rate for Payer: BCBS MAPPO |
$12,548.75
|
| Rate for Payer: BCN Medicare Advantage |
$12,548.75
|
| Rate for Payer: Cash Price |
$5,420.74
|
| Rate for Payer: Cash Price |
$5,420.74
|
| Rate for Payer: Cofinity Commercial |
$5,827.30
|
| Rate for Payer: Cofinity Commercial |
$4,743.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,743.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,420.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,548.75
|
| Rate for Payer: Healthscope Commercial |
$6,098.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,743.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,081.95
|
| Rate for Payer: Mclaren Medicaid |
$6,726.13
|
| Rate for Payer: Mclaren Medicare |
$12,548.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,176.19
|
| Rate for Payer: Meridian Medicaid |
$7,062.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,431.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,759.54
|
| Rate for Payer: PACE Medicare |
$11,921.31
|
| Rate for Payer: PACE SWMI |
$12,548.75
|
| Rate for Payer: PHP Commercial |
$5,759.54
|
| Rate for Payer: PHP Medicare Advantage |
$12,548.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,726.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,404.35
|
| Rate for Payer: Priority Health Medicare |
$12,548.75
|
| Rate for Payer: Priority Health SBD |
$4,268.84
|
| Rate for Payer: Railroad Medicare Medicare |
$12,548.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,323.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,548.75
|
| Rate for Payer: UHC Exchange |
$23,981.92
|
| Rate for Payer: UHC Medicare Advantage |
$12,548.75
|
| Rate for Payer: UHCCP Medicaid |
$6,726.13
|
| Rate for Payer: UMR Bronson Commercial |
$2,507.09
|
| Rate for Payer: VA VA |
$12,548.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,081.95
|
|
|
HC ABLATION BY NEUROLYTIC AGENT FACET JT C OR T EA ADDL JOINT
|
Facility
|
OP
|
$1,092.42
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
36100591
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$404.20 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna American Axle |
$710.07
|
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna Medicare |
$546.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.07
|
| Rate for Payer: BCBS Complete |
$436.97
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$764.69
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$764.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$764.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$819.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.07
|
| Rate for Payer: Priority Health SBD |
$688.22
|
| Rate for Payer: UMR Bronson Commercial |
$404.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$819.32
|
|
|
HC ABLATION BY NEUROLYTIC AGENT FACET JT C OR T EA ADDL JOINT
|
Facility
|
IP
|
$1,092.42
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
36100591
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$480.66 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna American Axle |
$710.07
|
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.07
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$764.69
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$764.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$764.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$819.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.07
|
| Rate for Payer: Priority Health SBD |
$688.22
|
| Rate for Payer: UMR Bronson Commercial |
$480.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$819.32
|
|
|
HC ABLATION BY NEUROLYTIC AGENT FACET JT C OR T SNG LVL
|
Facility
|
OP
|
$2,683.22
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
36100590
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$992.79 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna American Axle |
$1,744.09
|
| Rate for Payer: Aetna Commercial |
$2,280.74
|
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,744.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Cash Price |
$2,146.58
|
| Rate for Payer: Cash Price |
$2,146.58
|
| Rate for Payer: Cofinity Commercial |
$2,307.57
|
| Rate for Payer: Cofinity Commercial |
$1,878.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,878.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,146.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Healthscope Commercial |
$2,414.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,878.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,012.41
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,280.74
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Commercial |
$2,280.74
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,744.09
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Priority Health SBD |
$1,690.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$3,639.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.81
|
| Rate for Payer: UMR Bronson Commercial |
$992.79
|
| Rate for Payer: VA VA |
$1,904.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,012.41
|
|
|
HC ABLATION BY NEUROLYTIC AGENT FACET JT C OR T SNG LVL
|
Facility
|
IP
|
$2,683.22
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
36100590
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,180.62 |
| Max. Negotiated Rate |
$2,414.90 |
| Rate for Payer: Aetna American Axle |
$1,744.09
|
| Rate for Payer: Aetna Commercial |
$2,280.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,744.09
|
| Rate for Payer: Cash Price |
$2,146.58
|
| Rate for Payer: Cofinity Commercial |
$1,878.25
|
| Rate for Payer: Cofinity Commercial |
$2,307.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,878.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,146.58
|
| Rate for Payer: Healthscope Commercial |
$2,414.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,878.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,012.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,280.74
|
| Rate for Payer: PHP Commercial |
$2,280.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,744.09
|
| Rate for Payer: Priority Health SBD |
$1,690.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,180.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,012.41
|
|
|
HC ABLATION BY NEUROLYTIC AGENT FACET JT L OR S EA ADDL JOINT
|
Facility
|
OP
|
$1,092.42
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
36100593
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$404.20 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna American Axle |
$710.07
|
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna Medicare |
$546.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.07
|
| Rate for Payer: BCBS Complete |
$436.97
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$764.69
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$764.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$764.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$819.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.07
|
| Rate for Payer: Priority Health SBD |
$688.22
|
| Rate for Payer: UMR Bronson Commercial |
$404.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$819.32
|
|
