|
HC INJECT CARPAL TUNNEL
|
Facility
|
IP
|
$393.93
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.33 |
| Max. Negotiated Rate |
$354.54 |
| Rate for Payer: Aetna American Axle |
$256.05
|
| Rate for Payer: Aetna Commercial |
$334.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.05
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cofinity Advantage |
$275.75
|
| Rate for Payer: Cofinity Commercial |
$338.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.14
|
| Rate for Payer: Healthscope Commercial |
$354.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.45
|
| Rate for Payer: PHP Commercial |
$334.84
|
| Rate for Payer: Priority Health SBD |
$248.18
|
| Rate for Payer: UMR Bronson Commercial |
$173.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.45
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
OP
|
$1,186.06
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.90 |
| Max. Negotiated Rate |
$1,067.45 |
| Rate for Payer: Aetna American Axle |
$770.94
|
| Rate for Payer: Aetna American Axle |
$513.96
|
| Rate for Payer: Aetna Commercial |
$1,008.15
|
| Rate for Payer: Aetna Commercial |
$672.10
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$770.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$157.90
|
| Rate for Payer: BCBS Trust/PPO |
$157.90
|
| Rate for Payer: BCN Commercial |
$157.90
|
| Rate for Payer: BCN Commercial |
$157.90
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$632.56
|
| Rate for Payer: Cash Price |
$948.85
|
| Rate for Payer: Cash Price |
$632.56
|
| Rate for Payer: Cash Price |
$948.85
|
| Rate for Payer: Cash Price |
$948.85
|
| Rate for Payer: Cash Price |
$632.56
|
| Rate for Payer: Cofinity Advantage |
$830.24
|
| Rate for Payer: Cofinity Advantage |
$553.49
|
| Rate for Payer: Cofinity Commercial |
$680.00
|
| Rate for Payer: Cofinity Commercial |
$1,020.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$711.63
|
| Rate for Payer: Healthscope Commercial |
$1,067.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$553.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$830.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$889.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$593.02
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,008.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.10
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$889.54
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$672.10
|
| Rate for Payer: PHP Commercial |
$1,008.15
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health SBD |
$498.14
|
| Rate for Payer: Priority Health SBD |
$747.22
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$513.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$770.94
|
| Rate for Payer: UHC Core |
$411.95
|
| Rate for Payer: UHC Core |
$617.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$310.75
|
| Rate for Payer: UHC Exchange |
$466.12
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: UMR Bronson Commercial |
$438.84
|
| Rate for Payer: UMR Bronson Commercial |
$292.56
|
| Rate for Payer: VA VA |
$305.85
|
| Rate for Payer: VA VA |
$305.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$593.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$889.54
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
IP
|
$1,186.06
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$521.87 |
| Max. Negotiated Rate |
$1,067.45 |
| Rate for Payer: Aetna American Axle |
$770.94
|
| Rate for Payer: Aetna American Axle |
$513.96
|
| Rate for Payer: Aetna Commercial |
$1,008.15
|
| Rate for Payer: Aetna Commercial |
$672.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$770.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.96
|
| Rate for Payer: Cash Price |
$948.85
|
| Rate for Payer: Cash Price |
$632.56
|
| Rate for Payer: Cofinity Advantage |
$553.49
|
| Rate for Payer: Cofinity Advantage |
$830.24
|
| Rate for Payer: Cofinity Commercial |
$680.00
|
| Rate for Payer: Cofinity Commercial |
$1,020.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.56
|
| Rate for Payer: Healthscope Commercial |
$1,067.45
|
| Rate for Payer: Healthscope Commercial |
$711.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$553.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$830.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$889.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$593.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,008.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$889.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.02
|
| Rate for Payer: PHP Commercial |
$1,008.15
|
| Rate for Payer: PHP Commercial |
$672.10
|
| Rate for Payer: Priority Health SBD |
$498.14
|
| Rate for Payer: Priority Health SBD |
$747.22
|
| Rate for Payer: UMR Bronson Commercial |
$521.87
|
| Rate for Payer: UMR Bronson Commercial |
$347.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$889.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$593.02
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
IP
|
$3,183.62
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,400.79 |
| Max. Negotiated Rate |
$2,865.26 |
| Rate for Payer: Aetna American Axle |
$2,069.35
|
| Rate for Payer: Aetna Commercial |
$2,706.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,069.35
|
| Rate for Payer: Cash Price |
$2,546.90
|
| Rate for Payer: Cofinity Advantage |
$2,228.53
|
| Rate for Payer: Cofinity Commercial |
$2,737.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,546.90
|
| Rate for Payer: Healthscope Commercial |
$2,865.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,228.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,387.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,706.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,387.72
|
| Rate for Payer: PHP Commercial |
$2,706.08
|
| Rate for Payer: Priority Health SBD |
$2,005.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,400.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,387.72
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
OP
|
$3,183.62
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.39 |
| Max. Negotiated Rate |
$2,865.26 |
| Rate for Payer: Aetna American Axle |
$2,069.35
|
| Rate for Payer: Aetna Commercial |
$2,706.08
|
| Rate for Payer: Aetna Medicare |
$46.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,069.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.90
|
| Rate for Payer: BCBS Complete |
$24.56
|
| Rate for Payer: BCBS MAPPO |
$44.72
|
| Rate for Payer: BCBS Trust/PPO |
$186.28
|
| Rate for Payer: BCN Commercial |
$186.28
|
| Rate for Payer: BCN Medicare Advantage |
$44.72
|
| Rate for Payer: Cash Price |
$2,546.90
|
| Rate for Payer: Cash Price |
$2,546.90
|
| Rate for Payer: Cofinity Advantage |
$2,228.53
|
| Rate for Payer: Cofinity Commercial |
$2,737.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,546.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.72
|
| Rate for Payer: Healthscope Commercial |
$2,865.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,228.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,387.72
|
| Rate for Payer: Mclaren Medicaid |
$44.72
|
| Rate for Payer: Mclaren Medicare |
$44.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.96
|
| Rate for Payer: Meridian Medicaid |
$46.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,706.08
|
| Rate for Payer: Nomi Health Commercial |
$134.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,387.72
|
| Rate for Payer: PACE Medicare |
$42.48
|
| Rate for Payer: PACE SWMI |
$44.72
|
| Rate for Payer: PHP Commercial |
$2,706.08
|
| Rate for Payer: PHP Medicare Advantage |
$44.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$139.11
|
| Rate for Payer: Priority Health Medicare |
$44.72
|
| Rate for Payer: Priority Health SBD |
$2,005.68
|
| Rate for Payer: Priority Health Tiered Network |
$111.29
|
| Rate for Payer: Railroad Medicare Medicare |
$44.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.87
|
| Rate for Payer: UHC Core |
$73.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44.72
|
| Rate for Payer: UHC Exchange |
$73.87
|
| Rate for Payer: UHC Medicaid |
$23.39
|
| Rate for Payer: UHCCP Medicaid |
$23.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,177.94
|
| Rate for Payer: VA VA |
$44.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,387.72
|
|
|
HC INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
OP
|
$63.67
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna American Axle |
$41.39
|
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna Medicare |
$31.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.39
|
| Rate for Payer: BCBS Complete |
$25.47
|
| Rate for Payer: BCBS Trust/PPO |
$1.50
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Advantage |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: Priority Health SBD |
$40.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.76
|
| Rate for Payer: UHC Core |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UMR Bronson Commercial |
$23.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.75
|
|
|
HC INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
IP
|
$63.67
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.01 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna American Axle |
$41.39
|
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.39
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Advantage |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: Priority Health SBD |
$40.11
|
| Rate for Payer: UMR Bronson Commercial |
$28.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.75
|
|
|
HC INJECTION, CERTOLIZUMAB PEGOL, 1 MG
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna American Axle |
$6.76
|
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.76
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Advantage |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.80
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: Priority Health SBD |
$6.55
|
| Rate for Payer: UMR Bronson Commercial |
$4.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
|
HC INJECTION, CERTOLIZUMAB PEGOL, 1 MG
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$12.51 |
| Rate for Payer: Aetna American Axle |
$6.76
|
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.74
|
| Rate for Payer: BCBS Complete |
$2.08
|
| Rate for Payer: BCBS MAPPO |
$3.79
|
| Rate for Payer: BCBS Trust/PPO |
$12.51
|
| Rate for Payer: BCN Commercial |
$12.51
|
| Rate for Payer: BCN Medicare Advantage |
$3.79
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Advantage |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.79
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Mclaren Medicaid |
$3.79
|
| Rate for Payer: Mclaren Medicare |
$3.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.98
|
| Rate for Payer: Meridian Medicaid |
$3.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$11.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.80
|
| Rate for Payer: PACE Medicare |
$3.60
|
| Rate for Payer: PACE SWMI |
$3.79
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: PHP Medicare Advantage |
$3.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.34
|
| Rate for Payer: Priority Health Medicare |
$3.79
|
| Rate for Payer: Priority Health SBD |
$6.55
|
| Rate for Payer: Priority Health Tiered Network |
$9.87
|
| Rate for Payer: Railroad Medicare Medicare |
$3.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.39
|
| Rate for Payer: UHC Core |
$6.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.79
|
| Rate for Payer: UHC Exchange |
$6.39
|
| Rate for Payer: UHC Medicaid |
$1.98
|
| Rate for Payer: UHCCP Medicaid |
$1.98
|
| Rate for Payer: UMR Bronson Commercial |
$3.85
|
| Rate for Payer: VA VA |
$3.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
|
HC INJECTION CERVICAL OR THORACIC
|
Facility
|
IP
|
$1,031.17
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
36100283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$453.71 |
| Max. Negotiated Rate |
$928.05 |
| Rate for Payer: Aetna American Axle |
$670.26
|
| Rate for Payer: Aetna Commercial |
$876.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.26
|
| Rate for Payer: Cash Price |
$824.94
|
| Rate for Payer: Cofinity Advantage |
$721.82
|
| Rate for Payer: Cofinity Commercial |
$886.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$824.94
|
| Rate for Payer: Healthscope Commercial |
$928.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$721.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$773.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$773.38
|
| Rate for Payer: PHP Commercial |
$876.49
|
| Rate for Payer: Priority Health SBD |
$649.64
|
| Rate for Payer: UMR Bronson Commercial |
$453.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$773.38
|
|
|
HC INJECTION CERVICAL OR THORACIC
|
Facility
|
OP
|
$1,031.17
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
36100283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$381.53 |
| Max. Negotiated Rate |
$1,436.33 |
| Rate for Payer: Aetna American Axle |
$670.26
|
| Rate for Payer: Aetna Commercial |
$876.49
|
| Rate for Payer: Aetna Medicare |
$515.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.26
|
| Rate for Payer: BCBS Complete |
$412.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,436.33
|
| Rate for Payer: BCN Commercial |
$1,436.33
|
| Rate for Payer: Cash Price |
$824.94
|
| Rate for Payer: Cash Price |
$824.94
|
| Rate for Payer: Cash Price |
$824.94
|
| Rate for Payer: Cofinity Advantage |
$721.82
|
| Rate for Payer: Cofinity Commercial |
$886.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$824.94
|
| Rate for Payer: Healthscope Commercial |
$928.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$721.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$773.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$824.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$773.38
|
| Rate for Payer: PHP Commercial |
$876.49
|
| Rate for Payer: Priority Health SBD |
$649.64
|
| Rate for Payer: UMR Bronson Commercial |
$381.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$773.38
|
|
|
HC INJECTION CONTRAST FOR TUBE ASSESSMENT
|
Facility
|
IP
|
$1,039.24
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
36100223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$457.27 |
| Max. Negotiated Rate |
$935.32 |
| Rate for Payer: Aetna American Axle |
$675.51
|
| Rate for Payer: Aetna Commercial |
$883.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$675.51
|
| Rate for Payer: Cash Price |
$831.39
|
| Rate for Payer: Cofinity Advantage |
$727.47
|
| Rate for Payer: Cofinity Commercial |
$893.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$831.39
|
| Rate for Payer: Healthscope Commercial |
$935.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$727.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$779.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$883.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$779.43
|
| Rate for Payer: PHP Commercial |
$883.35
|
| Rate for Payer: Priority Health SBD |
$654.72
|
| Rate for Payer: UMR Bronson Commercial |
$457.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$779.43
|
|
|
HC INJECTION CONTRAST FOR TUBE ASSESSMENT
|
Facility
|
OP
|
$1,039.24
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
36100223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$382.48 |
| Max. Negotiated Rate |
$935.32 |
| Rate for Payer: Aetna American Axle |
$675.51
|
| Rate for Payer: Aetna Commercial |
$883.35
|
| Rate for Payer: Aetna Medicare |
$519.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$675.51
|
| Rate for Payer: BCBS Complete |
$415.70
|
| Rate for Payer: BCBS Trust/PPO |
$382.48
|
| Rate for Payer: BCN Commercial |
$382.48
|
| Rate for Payer: Cash Price |
$831.39
|
| Rate for Payer: Cash Price |
$831.39
|
| Rate for Payer: Cash Price |
$831.39
|
| Rate for Payer: Cofinity Advantage |
$727.47
|
| Rate for Payer: Cofinity Commercial |
$893.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$831.39
|
| Rate for Payer: Healthscope Commercial |
$935.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$727.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$779.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$831.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$883.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$779.43
|
| Rate for Payer: PHP Commercial |
$883.35
|
| Rate for Payer: Priority Health SBD |
$654.72
|
| Rate for Payer: UMR Bronson Commercial |
$384.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$779.43
|
|
|
HC INJECTION, DENOSUMAB, 1MG
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna American Axle |
$16.91
|
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Advantage |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.51
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: UMR Bronson Commercial |
$11.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC INJECTION, DENOSUMAB, 1MG
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna American Axle |
$16.91
|
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$30.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.89
|
| Rate for Payer: BCBS Complete |
$16.21
|
| Rate for Payer: BCBS MAPPO |
$29.51
|
| Rate for Payer: BCBS Trust/PPO |
$95.51
|
| Rate for Payer: BCN Commercial |
$95.51
|
| Rate for Payer: BCN Medicare Advantage |
$29.51
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Advantage |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.51
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Mclaren Medicaid |
$29.51
|
| Rate for Payer: Mclaren Medicare |
$29.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.99
|
| Rate for Payer: Meridian Medicaid |
$30.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$88.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.51
|
| Rate for Payer: PACE Medicare |
$28.03
|
| Rate for Payer: PACE SWMI |
$29.51
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$29.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$92.67
|
| Rate for Payer: Priority Health Medicare |
$29.51
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: Priority Health Tiered Network |
$74.14
|
| Rate for Payer: Railroad Medicare Medicare |
$29.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.61
|
| Rate for Payer: UHC Core |
$48.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.51
|
| Rate for Payer: UHC Exchange |
$48.61
|
| Rate for Payer: UHC Medicaid |
$15.43
|
| Rate for Payer: UHCCP Medicaid |
$15.43
|
| Rate for Payer: UMR Bronson Commercial |
$9.62
|
| Rate for Payer: VA VA |
$29.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
|
Facility
|
IP
|
$14.86
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$13.37 |
| Rate for Payer: Aetna American Axle |
$9.66
|
| Rate for Payer: Aetna Commercial |
$12.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.66
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Advantage |
$10.40
|
| Rate for Payer: Cofinity Commercial |
$12.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$13.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: PHP Commercial |
$12.63
|
| Rate for Payer: Priority Health SBD |
$9.36
|
| Rate for Payer: UMR Bronson Commercial |
$6.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.14
|
|
|
HC INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
|
Facility
|
OP
|
$14.86
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$168.01 |
| Rate for Payer: Aetna American Axle |
$9.66
|
| Rate for Payer: Aetna Commercial |
$12.63
|
| Rate for Payer: Aetna Medicare |
$7.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.66
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: BCBS Trust/PPO |
$168.01
|
| Rate for Payer: BCN Commercial |
$168.01
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Advantage |
$10.40
|
| Rate for Payer: Cofinity Commercial |
$12.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$13.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: PHP Commercial |
$12.63
|
| Rate for Payer: Priority Health SBD |
$9.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.50
|
| Rate for Payer: UHC Core |
$85.50
|
| Rate for Payer: UHC Exchange |
$85.50
|
| Rate for Payer: UMR Bronson Commercial |
$5.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.14
|
|
|
HC INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
|
Facility
|
IP
|
$2.12
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
63600167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna American Axle |
$1.38
|
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.38
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cofinity Advantage |
$1.48
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.70
|
| Rate for Payer: Healthscope Commercial |
$1.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.59
|
| Rate for Payer: PHP Commercial |
$1.80
|
| Rate for Payer: Priority Health SBD |
$1.34
|
| Rate for Payer: UMR Bronson Commercial |
$0.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.59
|
|
|
HC INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
|
Facility
|
OP
|
$2.12
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
63600167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna American Axle |
$1.38
|
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.38
|
| Rate for Payer: BCBS Complete |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$2.29
|
| Rate for Payer: BCN Commercial |
$2.29
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cofinity Advantage |
$1.48
|
| Rate for Payer: Cofinity Commercial |
$1.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.70
|
| Rate for Payer: Healthscope Commercial |
$1.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.59
|
| Rate for Payer: PHP Commercial |
$1.80
|
| Rate for Payer: Priority Health SBD |
$1.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.17
|
| Rate for Payer: UHC Core |
$1.17
|
| Rate for Payer: UHC Exchange |
$1.17
|
| Rate for Payer: UMR Bronson Commercial |
$0.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.59
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
OP
|
$1,154.72
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$427.25 |
| Max. Negotiated Rate |
$1,039.25 |
| Rate for Payer: Aetna American Axle |
$750.57
|
| Rate for Payer: Aetna Commercial |
$981.51
|
| Rate for Payer: Aetna Medicare |
$577.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.57
|
| Rate for Payer: BCBS Complete |
$461.89
|
| Rate for Payer: BCBS Trust/PPO |
$520.75
|
| Rate for Payer: BCN Commercial |
$520.75
|
| Rate for Payer: Cash Price |
$923.78
|
| Rate for Payer: Cash Price |
$923.78
|
| Rate for Payer: Cash Price |
$923.78
|
| Rate for Payer: Cofinity Advantage |
$808.30
|
| Rate for Payer: Cofinity Commercial |
$993.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$923.78
|
| Rate for Payer: Healthscope Commercial |
$1,039.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$808.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$866.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$923.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$981.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$866.04
|
| Rate for Payer: PHP Commercial |
$981.51
|
| Rate for Payer: Priority Health SBD |
$727.47
|
| Rate for Payer: UMR Bronson Commercial |
$427.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$866.04
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
IP
|
$1,154.72
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.08 |
| Max. Negotiated Rate |
$1,039.25 |
| Rate for Payer: Aetna American Axle |
$750.57
|
| Rate for Payer: Aetna Commercial |
$981.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.57
|
| Rate for Payer: Cash Price |
$923.78
|
| Rate for Payer: Cofinity Advantage |
$808.30
|
| Rate for Payer: Cofinity Commercial |
$993.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$923.78
|
| Rate for Payer: Healthscope Commercial |
$1,039.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$808.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$866.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$981.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$866.04
|
| Rate for Payer: PHP Commercial |
$981.51
|
| Rate for Payer: Priority Health SBD |
$727.47
|
| Rate for Payer: UMR Bronson Commercial |
$508.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$866.04
|
|
|
HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL
|
Facility
|
OP
|
$1,939.68
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna American Axle |
$1,260.79
|
| Rate for Payer: Aetna Commercial |
$1,648.73
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,260.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,716.88
|
| Rate for Payer: BCN Commercial |
$1,716.88
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$1,551.74
|
| Rate for Payer: Cash Price |
$1,551.74
|
| Rate for Payer: Cash Price |
$1,551.74
|
| Rate for Payer: Cofinity Advantage |
$1,357.78
|
| Rate for Payer: Cofinity Commercial |
$1,668.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,551.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$1,745.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,357.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,454.76
|
| Rate for Payer: Mclaren Medicaid |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,648.73
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,454.76
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$1,648.73
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health SBD |
$1,222.00
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: UMR Bronson Commercial |
$717.68
|
| Rate for Payer: VA VA |
$881.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,454.76
|
|
|
HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL
|
Facility
|
IP
|
$1,939.68
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$853.46 |
| Max. Negotiated Rate |
$1,745.71 |
| Rate for Payer: Aetna American Axle |
$1,260.79
|
| Rate for Payer: Aetna Commercial |
$1,648.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,260.79
|
| Rate for Payer: Cash Price |
$1,551.74
|
| Rate for Payer: Cofinity Advantage |
$1,357.78
|
| Rate for Payer: Cofinity Commercial |
$1,668.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,551.74
|
| Rate for Payer: Healthscope Commercial |
$1,745.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,357.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,454.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,648.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,454.76
|
| Rate for Payer: PHP Commercial |
$1,648.73
|
| Rate for Payer: Priority Health SBD |
$1,222.00
|
| Rate for Payer: UMR Bronson Commercial |
$853.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,454.76
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL
|
Facility
|
IP
|
$347.15
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100291
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.75 |
| Max. Negotiated Rate |
$312.44 |
| Rate for Payer: Aetna American Axle |
$225.65
|
| Rate for Payer: Aetna Commercial |
$295.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.65
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cofinity Advantage |
$243.00
|
| Rate for Payer: Cofinity Commercial |
$298.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.72
|
| Rate for Payer: Healthscope Commercial |
$312.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$243.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.36
|
| Rate for Payer: PHP Commercial |
$295.08
|
| Rate for Payer: Priority Health SBD |
$218.70
|
| Rate for Payer: UMR Bronson Commercial |
$152.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.36
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL
|
Facility
|
OP
|
$347.15
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100291
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.45 |
| Max. Negotiated Rate |
$404.49 |
| Rate for Payer: Aetna American Axle |
$225.65
|
| Rate for Payer: Aetna Commercial |
$295.08
|
| Rate for Payer: Aetna Medicare |
$173.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.65
|
| Rate for Payer: BCBS Complete |
$138.86
|
| Rate for Payer: BCBS Trust/PPO |
$404.49
|
| Rate for Payer: BCN Commercial |
$404.49
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cash Price |
$277.72
|
| Rate for Payer: Cofinity Advantage |
$243.00
|
| Rate for Payer: Cofinity Commercial |
$298.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.72
|
| Rate for Payer: Healthscope Commercial |
$312.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$243.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$277.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.36
|
| Rate for Payer: PHP Commercial |
$295.08
|
| Rate for Payer: Priority Health SBD |
$218.70
|
| Rate for Payer: UMR Bronson Commercial |
$128.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.36
|
|
