|
HC INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
|
Facility
|
IP
|
$2.04
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
63600167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna American Axle |
$1.33
|
| Rate for Payer: Aetna Commercial |
$1.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.33
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Cofinity Commercial |
$1.43
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.63
|
| Rate for Payer: Healthscope Commercial |
$1.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.73
|
| Rate for Payer: PHP Commercial |
$1.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.43
|
| Rate for Payer: Priority Health SBD |
$1.29
|
| Rate for Payer: UMR Bronson Commercial |
$0.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.53
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
IP
|
$1,109.88
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$488.35 |
| Max. Negotiated Rate |
$998.89 |
| Rate for Payer: Aetna American Axle |
$721.42
|
| Rate for Payer: Aetna Commercial |
$943.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$721.42
|
| Rate for Payer: Cash Price |
$887.90
|
| Rate for Payer: Cofinity Commercial |
$776.92
|
| Rate for Payer: Cofinity Commercial |
$954.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$887.90
|
| Rate for Payer: Healthscope Commercial |
$998.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$776.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$832.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$943.40
|
| Rate for Payer: PHP Commercial |
$943.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$776.92
|
| Rate for Payer: Priority Health SBD |
$699.22
|
| Rate for Payer: UMR Bronson Commercial |
$488.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$832.41
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
OP
|
$1,109.88
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$998.89 |
| Rate for Payer: Aetna American Axle |
$721.42
|
| Rate for Payer: Aetna Commercial |
$943.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$721.42
|
| Rate for Payer: BCBS Complete |
$443.95
|
| Rate for Payer: BCBS Trust/PPO |
$410.99
|
| Rate for Payer: Cash Price |
$887.90
|
| Rate for Payer: Cash Price |
$887.90
|
| Rate for Payer: Cofinity Commercial |
$776.92
|
| Rate for Payer: Cofinity Commercial |
$954.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$887.90
|
| Rate for Payer: Healthscope Commercial |
$998.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$776.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$832.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$943.40
|
| Rate for Payer: PHP Commercial |
$943.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$776.92
|
| Rate for Payer: Priority Health SBD |
$699.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.60
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$64.18
|
| Rate for Payer: UMR Bronson Commercial |
$410.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$832.41
|
|
|
HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL
|
Facility
|
IP
|
$1,864.36
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$820.32 |
| Max. Negotiated Rate |
$1,677.92 |
| Rate for Payer: Aetna American Axle |
$1,211.83
|
| Rate for Payer: Aetna Commercial |
$1,584.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,211.83
|
| Rate for Payer: Cash Price |
$1,491.49
|
| Rate for Payer: Cofinity Commercial |
$1,305.05
|
| Rate for Payer: Cofinity Commercial |
$1,603.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,491.49
|
| Rate for Payer: Healthscope Commercial |
$1,677.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,305.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,398.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,584.71
|
| Rate for Payer: PHP Commercial |
$1,584.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.05
|
| Rate for Payer: Priority Health SBD |
$1,174.55
|
| Rate for Payer: UMR Bronson Commercial |
$820.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,398.27
|
|
|
HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL
|
Facility
|
OP
|
$1,864.36
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$102.82 |
| Max. Negotiated Rate |
$2,550.52 |
| Rate for Payer: Aetna American Axle |
$1,211.83
|
| Rate for Payer: Aetna Commercial |
$1,584.71
|
| Rate for Payer: Aetna Medicare |
$842.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,211.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,012.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,012.74
|
| Rate for Payer: BCBS Complete |
$465.37
|
| Rate for Payer: BCBS MAPPO |
$810.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,355.00
|
| Rate for Payer: BCN Medicare Advantage |
$810.19
|
| Rate for Payer: Cash Price |
$1,491.49
|
| Rate for Payer: Cash Price |
$1,491.49
|
| Rate for Payer: Cofinity Commercial |
$1,603.35
|
| Rate for Payer: Cofinity Commercial |
$1,305.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,491.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.19
|
| Rate for Payer: Healthscope Commercial |
$1,677.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,305.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,398.27
|
| Rate for Payer: Mclaren Medicaid |
$443.17
|
| Rate for Payer: Mclaren Medicare |
$810.19
|
| Rate for Payer: Meridian Medicaid |
$465.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$850.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$931.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,584.71
|
| Rate for Payer: PACE Medicare |
$769.68
|
| Rate for Payer: PACE SWMI |
$810.19
|
| Rate for Payer: PHP Commercial |
$1,584.71
|
| Rate for Payer: PHP Medicare Advantage |
$810.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,550.52
|
| Rate for Payer: Priority Health Medicare |
$810.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,040.42
|
| Rate for Payer: Priority Health SBD |
$1,174.55
|
| Rate for Payer: Railroad Medicare Medicare |
$810.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.10
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$810.19
|
| Rate for Payer: UHC Exchange |
$102.82
|
| Rate for Payer: UHC Medicare Advantage |
$834.50
|
| Rate for Payer: UMR Bronson Commercial |
$689.81
|
| Rate for Payer: VA VA |
$810.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,398.27
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL
|
Facility
|
OP
|
$333.67
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100291
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.63 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$216.89
|
| Rate for Payer: Aetna Commercial |
$283.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.89
|
| Rate for Payer: BCBS Complete |
$133.47
|
| Rate for Payer: BCBS Trust/PPO |
$319.24
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$233.57
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.94
|
| Rate for Payer: Healthscope Commercial |
$300.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: PHP Commercial |
$283.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health SBD |
$210.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.39
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$57.63
|
| Rate for Payer: UMR Bronson Commercial |
$123.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.25
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL
|
Facility
|
IP
|
$333.67
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100291
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$146.81 |
| Max. Negotiated Rate |
$300.30 |
| Rate for Payer: Aetna American Axle |
$216.89
|
| Rate for Payer: Aetna Commercial |
$283.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.89
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$233.57
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.94
|
| Rate for Payer: Healthscope Commercial |
$300.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: PHP Commercial |
$283.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health SBD |
$210.21
|
| Rate for Payer: UMR Bronson Commercial |
$146.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.25
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL
|
Facility
|
OP
|
$500.51
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.63 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$325.33
|
| Rate for Payer: Aetna Commercial |
$425.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.33
|
| Rate for Payer: BCBS Complete |
$200.20
|
| Rate for Payer: BCBS Trust/PPO |
$319.24
|
| Rate for Payer: Cash Price |
$400.41
|
| Rate for Payer: Cash Price |
$400.41
|
| Rate for Payer: Cofinity Commercial |
$430.44
|
| Rate for Payer: Cofinity Commercial |
$350.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.41
|
| Rate for Payer: Healthscope Commercial |
$450.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$350.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.43
|
| Rate for Payer: PHP Commercial |
$425.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.36
|
| Rate for Payer: Priority Health SBD |
$315.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.39
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$57.63
|
| Rate for Payer: UMR Bronson Commercial |
$185.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.38
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL
|
Facility
|
IP
|
$500.51
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$220.22 |
| Max. Negotiated Rate |
$450.46 |
| Rate for Payer: Aetna American Axle |
$325.33
|
| Rate for Payer: Aetna Commercial |
$425.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.33
|
| Rate for Payer: Cash Price |
$400.41
|
| Rate for Payer: Cofinity Commercial |
$350.36
|
| Rate for Payer: Cofinity Commercial |
$430.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.41
|
| Rate for Payer: Healthscope Commercial |
$450.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$350.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.43
|
| Rate for Payer: PHP Commercial |
$425.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.36
|
| Rate for Payer: Priority Health SBD |
$315.32
|
| Rate for Payer: UMR Bronson Commercial |
$220.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.38
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL
|
Facility
|
OP
|
$333.67
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100292
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$58.61 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$216.89
|
| Rate for Payer: Aetna Commercial |
$283.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.89
|
| Rate for Payer: BCBS Complete |
$133.47
|
| Rate for Payer: BCBS Trust/PPO |
$320.45
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| Rate for Payer: Cofinity Commercial |
$233.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.94
|
| Rate for Payer: Healthscope Commercial |
$300.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: PHP Commercial |
$283.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health SBD |
$210.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.47
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$58.61
|
| Rate for Payer: UMR Bronson Commercial |
$123.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.25
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL
|
Facility
|
IP
|
$333.67
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100292
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$146.81 |
| Max. Negotiated Rate |
$300.30 |
| Rate for Payer: Aetna American Axle |
$216.89
|
| Rate for Payer: Aetna Commercial |
$283.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.89
|
| Rate for Payer: Cash Price |
$266.94
|
| Rate for Payer: Cofinity Commercial |
$233.57
|
| Rate for Payer: Cofinity Commercial |
$286.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.94
|
| Rate for Payer: Healthscope Commercial |
$300.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.62
|
| Rate for Payer: PHP Commercial |
$283.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.57
|
| Rate for Payer: Priority Health SBD |
$210.21
|
| Rate for Payer: UMR Bronson Commercial |
$146.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.25
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL BIL
|
Facility
|
OP
|
$500.51
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$58.61 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$325.33
|
| Rate for Payer: Aetna Commercial |
$425.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.33
|
| Rate for Payer: BCBS Complete |
$200.20
|
| Rate for Payer: BCBS Trust/PPO |
$320.45
|
| Rate for Payer: Cash Price |
$400.41
|
| Rate for Payer: Cash Price |
$400.41
|
| Rate for Payer: Cofinity Commercial |
$430.44
|
| Rate for Payer: Cofinity Commercial |
$350.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.41
|
| Rate for Payer: Healthscope Commercial |
$450.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$350.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.43
|
| Rate for Payer: PHP Commercial |
$425.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.36
|
| Rate for Payer: Priority Health SBD |
$315.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.47
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$58.61
|
| Rate for Payer: UMR Bronson Commercial |
$185.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.38
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL BIL
|
Facility
|
IP
|
$500.51
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$220.22 |
| Max. Negotiated Rate |
$450.46 |
| Rate for Payer: Aetna American Axle |
$325.33
|
| Rate for Payer: Aetna Commercial |
$425.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.33
|
| Rate for Payer: Cash Price |
$400.41
|
| Rate for Payer: Cofinity Commercial |
$350.36
|
| Rate for Payer: Cofinity Commercial |
$430.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.41
|
| Rate for Payer: Healthscope Commercial |
$450.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$350.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.43
|
| Rate for Payer: PHP Commercial |
$425.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.36
|
| Rate for Payer: Priority Health SBD |
$315.32
|
| Rate for Payer: UMR Bronson Commercial |
$220.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.38
|
|
|
HC INJECTION FACET JOINT L OR S 1ST LEVEL BIL
|
Facility
|
OP
|
$2,427.77
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$88.41 |
| Max. Negotiated Rate |
$2,550.52 |
| Rate for Payer: Aetna American Axle |
$1,578.05
|
| Rate for Payer: Aetna Commercial |
$2,063.60
|
| Rate for Payer: Aetna Medicare |
$842.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,578.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,012.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,012.74
|
| Rate for Payer: BCBS Complete |
$465.37
|
| Rate for Payer: BCBS MAPPO |
$810.19
|
| Rate for Payer: BCBS Trust/PPO |
$975.43
|
| Rate for Payer: BCN Medicare Advantage |
$810.19
|
| Rate for Payer: Cash Price |
$1,942.22
|
| Rate for Payer: Cash Price |
$1,942.22
|
| Rate for Payer: Cofinity Commercial |
$2,087.88
|
| Rate for Payer: Cofinity Commercial |
$1,699.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,942.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.19
|
| Rate for Payer: Healthscope Commercial |
$2,184.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,699.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,820.83
|
| Rate for Payer: Mclaren Medicaid |
$443.17
|
| Rate for Payer: Mclaren Medicare |
$810.19
|
| Rate for Payer: Meridian Medicaid |
$465.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$850.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$931.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,063.60
|
| Rate for Payer: PACE Medicare |
$769.68
|
| Rate for Payer: PACE SWMI |
$810.19
|
| Rate for Payer: PHP Commercial |
$2,063.60
|
| Rate for Payer: PHP Medicare Advantage |
$810.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,699.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,550.52
|
| Rate for Payer: Priority Health Medicare |
$810.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,040.42
|
| Rate for Payer: Priority Health SBD |
$1,529.50
|
| Rate for Payer: Railroad Medicare Medicare |
$810.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.25
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$810.19
|
| Rate for Payer: UHC Exchange |
$88.41
|
| Rate for Payer: UHC Medicare Advantage |
$834.50
|
| Rate for Payer: UMR Bronson Commercial |
$898.27
|
| Rate for Payer: VA VA |
$810.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,820.83
|
|
|
HC INJECTION FACET JOINT L OR S 1ST LEVEL BIL
|
Facility
|
IP
|
$2,427.77
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,068.22 |
| Max. Negotiated Rate |
$2,184.99 |
| Rate for Payer: Aetna American Axle |
$1,578.05
|
| Rate for Payer: Aetna Commercial |
$2,063.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,578.05
|
| Rate for Payer: Cash Price |
$1,942.22
|
| Rate for Payer: Cofinity Commercial |
$1,699.44
|
| Rate for Payer: Cofinity Commercial |
$2,087.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,942.22
|
| Rate for Payer: Healthscope Commercial |
$2,184.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,699.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,820.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,063.60
|
| Rate for Payer: PHP Commercial |
$2,063.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,699.44
|
| Rate for Payer: Priority Health SBD |
$1,529.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,068.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,820.83
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL
|
Facility
|
OP
|
$403.74
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$49.44 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$262.43
|
| Rate for Payer: Aetna Commercial |
$343.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.43
|
| Rate for Payer: BCBS Complete |
$161.50
|
| Rate for Payer: BCBS Trust/PPO |
$293.94
|
| Rate for Payer: Cash Price |
$322.99
|
| Rate for Payer: Cash Price |
$322.99
|
| Rate for Payer: Cofinity Commercial |
$282.62
|
| Rate for Payer: Cofinity Commercial |
$347.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.99
|
| Rate for Payer: Healthscope Commercial |
$363.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$302.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.18
|
| Rate for Payer: PHP Commercial |
$343.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.62
|
| Rate for Payer: Priority Health SBD |
$254.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.38
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$49.44
|
| Rate for Payer: UMR Bronson Commercial |
$149.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$302.80
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL
|
Facility
|
IP
|
$403.74
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$177.65 |
| Max. Negotiated Rate |
$363.37 |
| Rate for Payer: Aetna American Axle |
$262.43
|
| Rate for Payer: Aetna Commercial |
$343.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.43
|
| Rate for Payer: Cash Price |
$322.99
|
| Rate for Payer: Cofinity Commercial |
$282.62
|
| Rate for Payer: Cofinity Commercial |
$347.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.99
|
| Rate for Payer: Healthscope Commercial |
$363.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$302.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.18
|
| Rate for Payer: PHP Commercial |
$343.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.62
|
| Rate for Payer: Priority Health SBD |
$254.36
|
| Rate for Payer: UMR Bronson Commercial |
$177.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$302.80
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL
|
Facility
|
IP
|
$605.60
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.46 |
| Max. Negotiated Rate |
$545.04 |
| Rate for Payer: Aetna American Axle |
$393.64
|
| Rate for Payer: Aetna Commercial |
$514.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$393.64
|
| Rate for Payer: Cash Price |
$484.48
|
| Rate for Payer: Cofinity Commercial |
$423.92
|
| Rate for Payer: Cofinity Commercial |
$520.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$484.48
|
| Rate for Payer: Healthscope Commercial |
$545.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$423.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$454.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$514.76
|
| Rate for Payer: PHP Commercial |
$514.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.92
|
| Rate for Payer: Priority Health SBD |
$381.53
|
| Rate for Payer: UMR Bronson Commercial |
$266.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$454.20
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL
|
Facility
|
OP
|
$605.60
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$49.44 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$393.64
|
| Rate for Payer: Aetna Commercial |
$514.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$393.64
|
| Rate for Payer: BCBS Complete |
$242.24
|
| Rate for Payer: BCBS Trust/PPO |
$293.94
|
| Rate for Payer: Cash Price |
$484.48
|
| Rate for Payer: Cash Price |
$484.48
|
| Rate for Payer: Cofinity Commercial |
$520.82
|
| Rate for Payer: Cofinity Commercial |
$423.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$484.48
|
| Rate for Payer: Healthscope Commercial |
$545.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$423.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$454.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$514.76
|
| Rate for Payer: PHP Commercial |
$514.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.92
|
| Rate for Payer: Priority Health SBD |
$381.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.38
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$49.44
|
| Rate for Payer: UMR Bronson Commercial |
$224.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$454.20
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LE
|
Facility
|
IP
|
$403.74
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100295
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$177.65 |
| Max. Negotiated Rate |
$363.37 |
| Rate for Payer: Aetna American Axle |
$262.43
|
| Rate for Payer: Aetna Commercial |
$343.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.43
|
| Rate for Payer: Cash Price |
$322.99
|
| Rate for Payer: Cofinity Commercial |
$282.62
|
| Rate for Payer: Cofinity Commercial |
$347.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.99
|
| Rate for Payer: Healthscope Commercial |
$363.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$302.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.18
|
| Rate for Payer: PHP Commercial |
$343.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.62
|
| Rate for Payer: Priority Health SBD |
$254.36
|
| Rate for Payer: UMR Bronson Commercial |
$177.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$302.80
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LE
|
Facility
|
OP
|
$403.74
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100295
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$262.43
|
| Rate for Payer: Aetna Commercial |
$343.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.43
|
| Rate for Payer: BCBS Complete |
$161.50
|
| Rate for Payer: BCBS Trust/PPO |
$295.13
|
| Rate for Payer: Cash Price |
$322.99
|
| Rate for Payer: Cash Price |
$322.99
|
| Rate for Payer: Cofinity Commercial |
$347.22
|
| Rate for Payer: Cofinity Commercial |
$282.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.99
|
| Rate for Payer: Healthscope Commercial |
$363.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$302.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.18
|
| Rate for Payer: PHP Commercial |
$343.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.62
|
| Rate for Payer: Priority Health SBD |
$254.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.47
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$50.43
|
| Rate for Payer: UMR Bronson Commercial |
$149.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$302.80
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL
|
Facility
|
OP
|
$605.60
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$393.64
|
| Rate for Payer: Aetna Commercial |
$514.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$393.64
|
| Rate for Payer: BCBS Complete |
$242.24
|
| Rate for Payer: BCBS Trust/PPO |
$295.13
|
| Rate for Payer: Cash Price |
$484.48
|
| Rate for Payer: Cash Price |
$484.48
|
| Rate for Payer: Cofinity Commercial |
$520.82
|
| Rate for Payer: Cofinity Commercial |
$423.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$484.48
|
| Rate for Payer: Healthscope Commercial |
$545.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$423.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$454.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$514.76
|
| Rate for Payer: PHP Commercial |
$514.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.92
|
| Rate for Payer: Priority Health SBD |
$381.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.47
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$50.43
|
| Rate for Payer: UMR Bronson Commercial |
$224.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$454.20
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL
|
Facility
|
IP
|
$605.60
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.46 |
| Max. Negotiated Rate |
$545.04 |
| Rate for Payer: Aetna American Axle |
$393.64
|
| Rate for Payer: Aetna Commercial |
$514.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$393.64
|
| Rate for Payer: Cash Price |
$484.48
|
| Rate for Payer: Cofinity Commercial |
$423.92
|
| Rate for Payer: Cofinity Commercial |
$520.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$484.48
|
| Rate for Payer: Healthscope Commercial |
$545.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$423.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$454.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$514.76
|
| Rate for Payer: PHP Commercial |
$514.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.92
|
| Rate for Payer: Priority Health SBD |
$381.53
|
| Rate for Payer: UMR Bronson Commercial |
$266.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$454.20
|
|
|
HC INJECTION FOR CEREBRAL SHUNT
|
Facility
|
OP
|
$810.15
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36100270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$55.01 |
| Max. Negotiated Rate |
$1,935.09 |
| Rate for Payer: Aetna American Axle |
$526.60
|
| Rate for Payer: Aetna Commercial |
$688.63
|
| Rate for Payer: Aetna Medicare |
$639.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.38
|
| Rate for Payer: BCBS Complete |
$353.08
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCBS Trust/PPO |
$407.02
|
| Rate for Payer: BCN Medicare Advantage |
$614.70
|
| Rate for Payer: Cash Price |
$648.12
|
| Rate for Payer: Cash Price |
$648.12
|
| Rate for Payer: Cofinity Commercial |
$567.10
|
| Rate for Payer: Cofinity Commercial |
$696.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.70
|
| Rate for Payer: Healthscope Commercial |
$729.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$567.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$607.61
|
| Rate for Payer: Mclaren Medicaid |
$336.24
|
| Rate for Payer: Mclaren Medicare |
$614.70
|
| Rate for Payer: Meridian Medicaid |
$353.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$645.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$706.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$688.63
|
| Rate for Payer: PACE Medicare |
$583.96
|
| Rate for Payer: PACE SWMI |
$614.70
|
| Rate for Payer: PHP Commercial |
$688.63
|
| Rate for Payer: PHP Medicare Advantage |
$614.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,935.09
|
| Rate for Payer: Priority Health Medicare |
$614.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,548.07
|
| Rate for Payer: Priority Health SBD |
$510.39
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.51
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$614.70
|
| Rate for Payer: UHC Exchange |
$55.01
|
| Rate for Payer: UHC Medicare Advantage |
$633.14
|
| Rate for Payer: UMR Bronson Commercial |
$299.76
|
| Rate for Payer: VA VA |
$614.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$607.61
|
|
|
HC INJECTION FOR CEREBRAL SHUNT
|
Facility
|
IP
|
$810.15
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36100270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$356.47 |
| Max. Negotiated Rate |
$729.14 |
| Rate for Payer: Aetna American Axle |
$526.60
|
| Rate for Payer: Aetna Commercial |
$688.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.60
|
| Rate for Payer: Cash Price |
$648.12
|
| Rate for Payer: Cofinity Commercial |
$567.10
|
| Rate for Payer: Cofinity Commercial |
$696.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.12
|
| Rate for Payer: Healthscope Commercial |
$729.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$567.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$607.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$688.63
|
| Rate for Payer: PHP Commercial |
$688.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.10
|
| Rate for Payer: Priority Health SBD |
$510.39
|
| Rate for Payer: UMR Bronson Commercial |
$356.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$607.61
|
|
