|
HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL
|
Facility
|
OP
|
$520.73
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.67 |
| Max. Negotiated Rate |
$468.66 |
| Rate for Payer: Aetna American Axle |
$338.47
|
| Rate for Payer: Aetna Commercial |
$442.62
|
| Rate for Payer: Aetna Medicare |
$260.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.47
|
| Rate for Payer: BCBS Complete |
$208.29
|
| Rate for Payer: BCBS Trust/PPO |
$404.49
|
| Rate for Payer: BCN Commercial |
$404.49
|
| Rate for Payer: Cash Price |
$416.58
|
| Rate for Payer: Cash Price |
$416.58
|
| Rate for Payer: Cash Price |
$416.58
|
| Rate for Payer: Cofinity Advantage |
$364.51
|
| Rate for Payer: Cofinity Commercial |
$447.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.58
|
| Rate for Payer: Healthscope Commercial |
$468.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$364.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.55
|
| Rate for Payer: PHP Commercial |
$442.62
|
| Rate for Payer: Priority Health SBD |
$328.06
|
| Rate for Payer: UMR Bronson Commercial |
$192.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.55
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL
|
Facility
|
IP
|
$520.73
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$229.12 |
| Max. Negotiated Rate |
$468.66 |
| Rate for Payer: Aetna American Axle |
$338.47
|
| Rate for Payer: Aetna Commercial |
$442.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.47
|
| Rate for Payer: Cash Price |
$416.58
|
| Rate for Payer: Cofinity Advantage |
$364.51
|
| Rate for Payer: Cofinity Commercial |
$447.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.58
|
| Rate for Payer: Healthscope Commercial |
$468.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$364.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.55
|
| Rate for Payer: PHP Commercial |
$442.62
|
| Rate for Payer: Priority Health SBD |
$328.06
|
| Rate for Payer: UMR Bronson Commercial |
$229.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.55
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL
|
Facility
|
OP
|
$347.15
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100292
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.45 |
| Max. Negotiated Rate |
$406.03 |
| 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 |
$406.03
|
| Rate for Payer: BCN Commercial |
$406.03
|
| 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
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL
|
Facility
|
IP
|
$347.15
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100292
|
|
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 3RD + LEVEL BIL
|
Facility
|
OP
|
$520.73
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.67 |
| Max. Negotiated Rate |
$468.66 |
| Rate for Payer: Aetna American Axle |
$338.47
|
| Rate for Payer: Aetna Commercial |
$442.62
|
| Rate for Payer: Aetna Medicare |
$260.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.47
|
| Rate for Payer: BCBS Complete |
$208.29
|
| Rate for Payer: BCBS Trust/PPO |
$406.03
|
| Rate for Payer: BCN Commercial |
$406.03
|
| Rate for Payer: Cash Price |
$416.58
|
| Rate for Payer: Cash Price |
$416.58
|
| Rate for Payer: Cash Price |
$416.58
|
| Rate for Payer: Cofinity Advantage |
$364.51
|
| Rate for Payer: Cofinity Commercial |
$447.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.58
|
| Rate for Payer: Healthscope Commercial |
$468.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$364.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.55
|
| Rate for Payer: PHP Commercial |
$442.62
|
| Rate for Payer: Priority Health SBD |
$328.06
|
| Rate for Payer: UMR Bronson Commercial |
$192.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.55
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL BIL
|
Facility
|
IP
|
$520.73
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$229.12 |
| Max. Negotiated Rate |
$468.66 |
| Rate for Payer: Aetna American Axle |
$338.47
|
| Rate for Payer: Aetna Commercial |
$442.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.47
|
| Rate for Payer: Cash Price |
$416.58
|
| Rate for Payer: Cofinity Advantage |
$364.51
|
| Rate for Payer: Cofinity Commercial |
$447.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.58
|
| Rate for Payer: Healthscope Commercial |
$468.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$364.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.55
|
| Rate for Payer: PHP Commercial |
$442.62
|
| Rate for Payer: Priority Health SBD |
$328.06
|
| Rate for Payer: UMR Bronson Commercial |
$229.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.55
|
|
|
HC INJECTION FACET JOINT L OR S 1ST LEVEL BIL
|
Facility
|
OP
|
$2,525.86
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna American Axle |
$1,641.81
|
| Rate for Payer: Aetna Commercial |
$2,146.98
|
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,641.81
|
| 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 |
$1,235.94
|
| Rate for Payer: BCN Commercial |
$1,235.94
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Cash Price |
$2,020.69
|
| Rate for Payer: Cash Price |
$2,020.69
|
| Rate for Payer: Cash Price |
$2,020.69
|
| Rate for Payer: Cofinity Advantage |
$1,768.10
|
| Rate for Payer: Cofinity Commercial |
$2,172.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,020.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Healthscope Commercial |
$2,273.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,768.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,894.39
|
| 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 |
$2,146.98
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,894.39
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Commercial |
$2,146.98
|
| 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 |
$1,591.29
|
| 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 |
$934.57
|
| Rate for Payer: VA VA |
$881.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,894.39
|
|
|
HC INJECTION FACET JOINT L OR S 1ST LEVEL BIL
|
Facility
|
IP
|
$2,525.86
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,111.38 |
| Max. Negotiated Rate |
$2,273.27 |
| Rate for Payer: Aetna American Axle |
$1,641.81
|
| Rate for Payer: Aetna Commercial |
$2,146.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,641.81
|
| Rate for Payer: Cash Price |
$2,020.69
|
| Rate for Payer: Cofinity Advantage |
$1,768.10
|
| Rate for Payer: Cofinity Commercial |
$2,172.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,020.69
|
| Rate for Payer: Healthscope Commercial |
$2,273.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,768.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,894.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,146.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,894.39
|
| Rate for Payer: PHP Commercial |
$2,146.98
|
| Rate for Payer: Priority Health SBD |
$1,591.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,111.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,894.39
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL
|
Facility
|
OP
|
$420.05
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.42 |
| Max. Negotiated Rate |
$378.05 |
| Rate for Payer: Aetna American Axle |
$273.03
|
| Rate for Payer: Aetna Commercial |
$357.04
|
| Rate for Payer: Aetna Medicare |
$210.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.03
|
| Rate for Payer: BCBS Complete |
$168.02
|
| Rate for Payer: BCBS Trust/PPO |
$372.44
|
| Rate for Payer: BCN Commercial |
$372.44
|
| Rate for Payer: Cash Price |
$336.04
|
| Rate for Payer: Cash Price |
$336.04
|
| Rate for Payer: Cash Price |
$336.04
|
| Rate for Payer: Cofinity Advantage |
$294.04
|
| Rate for Payer: Cofinity Commercial |
$361.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.04
|
| Rate for Payer: Healthscope Commercial |
$378.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.04
|
| Rate for Payer: PHP Commercial |
$357.04
|
| Rate for Payer: Priority Health SBD |
$264.63
|
| Rate for Payer: UMR Bronson Commercial |
$155.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.04
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL
|
Facility
|
IP
|
$420.05
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$184.82 |
| Max. Negotiated Rate |
$378.05 |
| Rate for Payer: Aetna American Axle |
$273.03
|
| Rate for Payer: Aetna Commercial |
$357.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.03
|
| Rate for Payer: Cash Price |
$336.04
|
| Rate for Payer: Cofinity Advantage |
$294.04
|
| Rate for Payer: Cofinity Commercial |
$361.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.04
|
| Rate for Payer: Healthscope Commercial |
$378.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.04
|
| Rate for Payer: PHP Commercial |
$357.04
|
| Rate for Payer: Priority Health SBD |
$264.63
|
| Rate for Payer: UMR Bronson Commercial |
$184.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.04
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL
|
Facility
|
IP
|
$630.06
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$277.23 |
| Max. Negotiated Rate |
$567.05 |
| Rate for Payer: Aetna American Axle |
$409.54
|
| Rate for Payer: Aetna Commercial |
$535.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.54
|
| Rate for Payer: Cash Price |
$504.05
|
| Rate for Payer: Cofinity Advantage |
$441.04
|
| Rate for Payer: Cofinity Commercial |
$541.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.05
|
| Rate for Payer: Healthscope Commercial |
$567.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$441.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.55
|
| Rate for Payer: PHP Commercial |
$535.55
|
| Rate for Payer: Priority Health SBD |
$396.94
|
| Rate for Payer: UMR Bronson Commercial |
$277.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.55
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL
|
Facility
|
OP
|
$630.06
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$233.12 |
| Max. Negotiated Rate |
$567.05 |
| Rate for Payer: Aetna American Axle |
$409.54
|
| Rate for Payer: Aetna Commercial |
$535.55
|
| Rate for Payer: Aetna Medicare |
$315.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.54
|
| Rate for Payer: BCBS Complete |
$252.02
|
| Rate for Payer: BCBS Trust/PPO |
$372.44
|
| Rate for Payer: BCN Commercial |
$372.44
|
| Rate for Payer: Cash Price |
$504.05
|
| Rate for Payer: Cash Price |
$504.05
|
| Rate for Payer: Cash Price |
$504.05
|
| Rate for Payer: Cofinity Advantage |
$441.04
|
| Rate for Payer: Cofinity Commercial |
$541.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.05
|
| Rate for Payer: Healthscope Commercial |
$567.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$441.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$504.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.55
|
| Rate for Payer: PHP Commercial |
$535.55
|
| Rate for Payer: Priority Health SBD |
$396.94
|
| Rate for Payer: UMR Bronson Commercial |
$233.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.55
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LE
|
Facility
|
OP
|
$420.05
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100295
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.42 |
| Max. Negotiated Rate |
$378.05 |
| Rate for Payer: Aetna American Axle |
$273.03
|
| Rate for Payer: Aetna Commercial |
$357.04
|
| Rate for Payer: Aetna Medicare |
$210.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.03
|
| Rate for Payer: BCBS Complete |
$168.02
|
| Rate for Payer: BCBS Trust/PPO |
$373.95
|
| Rate for Payer: BCN Commercial |
$373.95
|
| Rate for Payer: Cash Price |
$336.04
|
| Rate for Payer: Cash Price |
$336.04
|
| Rate for Payer: Cash Price |
$336.04
|
| Rate for Payer: Cofinity Advantage |
$294.04
|
| Rate for Payer: Cofinity Commercial |
$361.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.04
|
| Rate for Payer: Healthscope Commercial |
$378.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.04
|
| Rate for Payer: PHP Commercial |
$357.04
|
| Rate for Payer: Priority Health SBD |
$264.63
|
| Rate for Payer: UMR Bronson Commercial |
$155.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.04
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LE
|
Facility
|
IP
|
$420.05
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100295
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$184.82 |
| Max. Negotiated Rate |
$378.05 |
| Rate for Payer: Aetna American Axle |
$273.03
|
| Rate for Payer: Aetna Commercial |
$357.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.03
|
| Rate for Payer: Cash Price |
$336.04
|
| Rate for Payer: Cofinity Advantage |
$294.04
|
| Rate for Payer: Cofinity Commercial |
$361.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.04
|
| Rate for Payer: Healthscope Commercial |
$378.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.04
|
| Rate for Payer: PHP Commercial |
$357.04
|
| Rate for Payer: Priority Health SBD |
$264.63
|
| Rate for Payer: UMR Bronson Commercial |
$184.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.04
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL
|
Facility
|
IP
|
$630.06
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$277.23 |
| Max. Negotiated Rate |
$567.05 |
| Rate for Payer: Aetna American Axle |
$409.54
|
| Rate for Payer: Aetna Commercial |
$535.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.54
|
| Rate for Payer: Cash Price |
$504.05
|
| Rate for Payer: Cofinity Advantage |
$441.04
|
| Rate for Payer: Cofinity Commercial |
$541.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.05
|
| Rate for Payer: Healthscope Commercial |
$567.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$441.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.55
|
| Rate for Payer: PHP Commercial |
$535.55
|
| Rate for Payer: Priority Health SBD |
$396.94
|
| Rate for Payer: UMR Bronson Commercial |
$277.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.55
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL
|
Facility
|
OP
|
$630.06
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$233.12 |
| Max. Negotiated Rate |
$567.05 |
| Rate for Payer: Aetna American Axle |
$409.54
|
| Rate for Payer: Aetna Commercial |
$535.55
|
| Rate for Payer: Aetna Medicare |
$315.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.54
|
| Rate for Payer: BCBS Complete |
$252.02
|
| Rate for Payer: BCBS Trust/PPO |
$373.95
|
| Rate for Payer: BCN Commercial |
$373.95
|
| Rate for Payer: Cash Price |
$504.05
|
| Rate for Payer: Cash Price |
$504.05
|
| Rate for Payer: Cash Price |
$504.05
|
| Rate for Payer: Cofinity Advantage |
$441.04
|
| Rate for Payer: Cofinity Commercial |
$541.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.05
|
| Rate for Payer: Healthscope Commercial |
$567.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$441.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$504.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.55
|
| Rate for Payer: PHP Commercial |
$535.55
|
| Rate for Payer: Priority Health SBD |
$396.94
|
| Rate for Payer: UMR Bronson Commercial |
$233.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.55
|
|
|
HC INJECTION FOR CEREBRAL SHUNT
|
Facility
|
OP
|
$842.88
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36100270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$311.87 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna American Axle |
$547.87
|
| Rate for Payer: Aetna Commercial |
$716.45
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$515.73
|
| Rate for Payer: BCN Commercial |
$515.73
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$674.30
|
| Rate for Payer: Cash Price |
$674.30
|
| Rate for Payer: Cash Price |
$674.30
|
| Rate for Payer: Cofinity Advantage |
$590.02
|
| Rate for Payer: Cofinity Commercial |
$724.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$674.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$758.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$590.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$632.16
|
| Rate for Payer: Mclaren Medicaid |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$716.45
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$632.16
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$716.45
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health SBD |
$531.01
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: UMR Bronson Commercial |
$311.87
|
| Rate for Payer: VA VA |
$703.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$632.16
|
|
|
HC INJECTION FOR CEREBRAL SHUNT
|
Facility
|
IP
|
$842.88
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36100270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$370.87 |
| Max. Negotiated Rate |
$758.59 |
| Rate for Payer: Aetna American Axle |
$547.87
|
| Rate for Payer: Aetna Commercial |
$716.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.87
|
| Rate for Payer: Cash Price |
$674.30
|
| Rate for Payer: Cofinity Advantage |
$590.02
|
| Rate for Payer: Cofinity Commercial |
$724.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$674.30
|
| Rate for Payer: Healthscope Commercial |
$758.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$590.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$632.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$716.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$632.16
|
| Rate for Payer: PHP Commercial |
$716.45
|
| Rate for Payer: Priority Health SBD |
$531.01
|
| Rate for Payer: UMR Bronson Commercial |
$370.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$632.16
|
|
|
HC INJECTION FOR HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$669.62
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
36100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.76 |
| Max. Negotiated Rate |
$602.66 |
| Rate for Payer: Aetna American Axle |
$435.25
|
| Rate for Payer: Aetna Commercial |
$569.18
|
| Rate for Payer: Aetna Medicare |
$334.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.25
|
| Rate for Payer: BCBS Complete |
$267.85
|
| Rate for Payer: BCBS Trust/PPO |
$374.35
|
| Rate for Payer: BCN Commercial |
$374.35
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Cofinity Advantage |
$468.73
|
| Rate for Payer: Cofinity Commercial |
$575.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.70
|
| Rate for Payer: Healthscope Commercial |
$602.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$535.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$502.21
|
| Rate for Payer: PHP Commercial |
$569.18
|
| Rate for Payer: Priority Health SBD |
$421.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.25
|
| Rate for Payer: UHC Core |
$348.87
|
| Rate for Payer: UHC Exchange |
$263.16
|
| Rate for Payer: UMR Bronson Commercial |
$247.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.21
|
|
|
HC INJECTION FOR HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$669.62
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
36100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.63 |
| Max. Negotiated Rate |
$602.66 |
| Rate for Payer: Aetna American Axle |
$435.25
|
| Rate for Payer: Aetna Commercial |
$569.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.25
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Cofinity Advantage |
$468.73
|
| Rate for Payer: Cofinity Commercial |
$575.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.70
|
| Rate for Payer: Healthscope Commercial |
$602.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$502.21
|
| Rate for Payer: PHP Commercial |
$569.18
|
| Rate for Payer: Priority Health SBD |
$421.86
|
| Rate for Payer: UMR Bronson Commercial |
$294.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.21
|
|
|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
OP
|
$1,335.42
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$494.11 |
| Max. Negotiated Rate |
$1,201.88 |
| Rate for Payer: Aetna American Axle |
$868.02
|
| Rate for Payer: Aetna Commercial |
$1,135.11
|
| Rate for Payer: Aetna Medicare |
$667.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$868.02
|
| Rate for Payer: BCBS Complete |
$534.17
|
| Rate for Payer: BCBS Trust/PPO |
$520.85
|
| Rate for Payer: BCN Commercial |
$520.85
|
| Rate for Payer: Cash Price |
$1,068.34
|
| Rate for Payer: Cash Price |
$1,068.34
|
| Rate for Payer: Cash Price |
$1,068.34
|
| Rate for Payer: Cofinity Advantage |
$934.79
|
| Rate for Payer: Cofinity Commercial |
$1,148.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,068.34
|
| Rate for Payer: Healthscope Commercial |
$1,201.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$934.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,001.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,068.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,135.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,001.57
|
| Rate for Payer: PHP Commercial |
$1,135.11
|
| Rate for Payer: Priority Health SBD |
$841.31
|
| Rate for Payer: UMR Bronson Commercial |
$494.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,001.57
|
|
|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
IP
|
$1,335.42
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$587.58 |
| Max. Negotiated Rate |
$1,201.88 |
| Rate for Payer: Aetna American Axle |
$868.02
|
| Rate for Payer: Aetna Commercial |
$1,135.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$868.02
|
| Rate for Payer: Cash Price |
$1,068.34
|
| Rate for Payer: Cofinity Advantage |
$934.79
|
| Rate for Payer: Cofinity Commercial |
$1,148.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,068.34
|
| Rate for Payer: Healthscope Commercial |
$1,201.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$934.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,001.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,135.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,001.57
|
| Rate for Payer: PHP Commercial |
$1,135.11
|
| Rate for Payer: Priority Health SBD |
$841.31
|
| Rate for Payer: UMR Bronson Commercial |
$587.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,001.57
|
|
|
HC INJECTION HIP ARTHROGRAM BIL
|
Facility
|
IP
|
$1,238.30
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$544.85 |
| Max. Negotiated Rate |
$1,114.47 |
| Rate for Payer: Aetna American Axle |
$804.89
|
| Rate for Payer: Aetna Commercial |
$1,052.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$804.89
|
| Rate for Payer: Cash Price |
$990.64
|
| Rate for Payer: Cofinity Advantage |
$866.81
|
| Rate for Payer: Cofinity Commercial |
$1,064.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.64
|
| Rate for Payer: Healthscope Commercial |
$1,114.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$866.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$928.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$928.73
|
| Rate for Payer: PHP Commercial |
$1,052.56
|
| Rate for Payer: Priority Health SBD |
$780.13
|
| Rate for Payer: UMR Bronson Commercial |
$544.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$928.73
|
|
|
HC INJECTION HIP ARTHROGRAM BIL
|
Facility
|
OP
|
$1,238.30
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$458.17 |
| Max. Negotiated Rate |
$1,114.47 |
| Rate for Payer: Aetna American Axle |
$804.89
|
| Rate for Payer: Aetna Commercial |
$1,052.56
|
| Rate for Payer: Aetna Medicare |
$619.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$804.89
|
| Rate for Payer: BCBS Complete |
$495.32
|
| Rate for Payer: BCBS Trust/PPO |
$520.85
|
| Rate for Payer: BCN Commercial |
$520.85
|
| Rate for Payer: Cash Price |
$990.64
|
| Rate for Payer: Cash Price |
$990.64
|
| Rate for Payer: Cash Price |
$990.64
|
| Rate for Payer: Cofinity Advantage |
$866.81
|
| Rate for Payer: Cofinity Commercial |
$1,064.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.64
|
| Rate for Payer: Healthscope Commercial |
$1,114.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$866.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$928.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$990.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$928.73
|
| Rate for Payer: PHP Commercial |
$1,052.56
|
| Rate for Payer: Priority Health SBD |
$780.13
|
| Rate for Payer: UMR Bronson Commercial |
$458.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$928.73
|
|
|
HC INJECTION INTRALESIONAL UP TO 7 LESIONS
|
Facility
|
IP
|
$150.05
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
76100134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.02 |
| Max. Negotiated Rate |
$135.04 |
| Rate for Payer: Aetna American Axle |
$97.53
|
| Rate for Payer: Aetna Commercial |
$127.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.53
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cofinity Advantage |
$105.03
|
| Rate for Payer: Cofinity Commercial |
$129.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.04
|
| Rate for Payer: Healthscope Commercial |
$135.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.54
|
| Rate for Payer: PHP Commercial |
$127.54
|
| Rate for Payer: Priority Health SBD |
$94.53
|
| Rate for Payer: UMR Bronson Commercial |
$66.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.54
|
|
