|
HC INJECTION CERVICAL OR THORACIC
|
Facility
|
OP
|
$1,010.95
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
36100283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$374.05 |
| Max. Negotiated Rate |
$909.86 |
| Rate for Payer: Aetna American Axle |
$657.12
|
| Rate for Payer: Aetna Commercial |
$859.31
|
| Rate for Payer: Aetna Medicare |
$505.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.12
|
| Rate for Payer: BCBS Complete |
$404.38
|
| Rate for Payer: Cash Price |
$808.76
|
| Rate for Payer: Cofinity Commercial |
$707.66
|
| Rate for Payer: Cofinity Commercial |
$869.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$707.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.76
|
| Rate for Payer: Healthscope Commercial |
$909.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$707.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$758.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.31
|
| Rate for Payer: PHP Commercial |
$859.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.12
|
| Rate for Payer: Priority Health SBD |
$636.90
|
| Rate for Payer: UMR Bronson Commercial |
$374.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$758.21
|
|
|
HC INJECTION CERVICAL OR THORACIC
|
Facility
|
IP
|
$1,010.95
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
36100283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$444.82 |
| Max. Negotiated Rate |
$909.86 |
| Rate for Payer: Aetna American Axle |
$657.12
|
| Rate for Payer: Aetna Commercial |
$859.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.12
|
| Rate for Payer: Cash Price |
$808.76
|
| Rate for Payer: Cofinity Commercial |
$707.66
|
| Rate for Payer: Cofinity Commercial |
$869.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$707.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.76
|
| Rate for Payer: Healthscope Commercial |
$909.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$707.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$758.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.31
|
| Rate for Payer: PHP Commercial |
$859.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.12
|
| Rate for Payer: Priority Health SBD |
$636.90
|
| Rate for Payer: UMR Bronson Commercial |
$444.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$758.21
|
|
|
HC INJECTION CONTRAST FOR TUBE ASSESSMENT
|
Facility
|
IP
|
$1,018.86
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
36100223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$448.30 |
| Max. Negotiated Rate |
$916.97 |
| Rate for Payer: Aetna American Axle |
$662.26
|
| Rate for Payer: Aetna Commercial |
$866.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$662.26
|
| Rate for Payer: Cash Price |
$815.09
|
| Rate for Payer: Cofinity Commercial |
$713.20
|
| Rate for Payer: Cofinity Commercial |
$876.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$713.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$815.09
|
| Rate for Payer: Healthscope Commercial |
$916.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$713.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$764.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$866.03
|
| Rate for Payer: PHP Commercial |
$866.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$662.26
|
| Rate for Payer: Priority Health SBD |
$641.88
|
| Rate for Payer: UMR Bronson Commercial |
$448.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$764.14
|
|
|
HC INJECTION CONTRAST FOR TUBE ASSESSMENT
|
Facility
|
OP
|
$1,018.86
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
36100223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$376.98 |
| Max. Negotiated Rate |
$916.97 |
| Rate for Payer: Aetna American Axle |
$662.26
|
| Rate for Payer: Aetna Commercial |
$866.03
|
| Rate for Payer: Aetna Medicare |
$509.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$662.26
|
| Rate for Payer: BCBS Complete |
$407.54
|
| Rate for Payer: Cash Price |
$815.09
|
| Rate for Payer: Cofinity Commercial |
$713.20
|
| Rate for Payer: Cofinity Commercial |
$876.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$713.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$815.09
|
| Rate for Payer: Healthscope Commercial |
$916.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$713.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$764.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$866.03
|
| Rate for Payer: PHP Commercial |
$866.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$662.26
|
| Rate for Payer: Priority Health SBD |
$641.88
|
| Rate for Payer: UMR Bronson Commercial |
$376.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$764.14
|
|
|
HC INJECTION, DENOSUMAB, 1MG
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$82.70 |
| Rate for Payer: Aetna American Axle |
$16.57
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$30.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.73
|
| Rate for Payer: BCBS Complete |
$16.54
|
| Rate for Payer: BCBS MAPPO |
$29.38
|
| Rate for Payer: BCN Medicare Advantage |
$29.38
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Mclaren Medicaid |
$15.75
|
| Rate for Payer: Mclaren Medicare |
$29.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.85
|
| Rate for Payer: Meridian Medicaid |
$16.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: PACE Medicare |
$27.91
|
| Rate for Payer: PACE SWMI |
$29.38
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$29.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health Medicare |
$29.38
|
| Rate for Payer: Priority Health SBD |
$16.07
|
| Rate for Payer: Railroad Medicare Medicare |
$29.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.38
|
| Rate for Payer: UHC Exchange |
$56.15
|
| Rate for Payer: UHC Medicare Advantage |
$29.38
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: UMR Bronson Commercial |
$9.44
|
| Rate for Payer: VA VA |
$29.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INJECTION, DENOSUMAB, 1MG
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna American Axle |
$16.57
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health SBD |
$16.07
|
| Rate for Payer: UMR Bronson Commercial |
$11.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
|
Facility
|
OP
|
$14.57
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna American Axle |
$9.47
|
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna Medicare |
$7.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.47
|
| Rate for Payer: BCBS Complete |
$5.83
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health SBD |
$9.18
|
| Rate for Payer: UMR Bronson Commercial |
$5.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.93
|
|
|
HC INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
|
Facility
|
IP
|
$14.57
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna American Axle |
$9.47
|
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.47
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health SBD |
$9.18
|
| Rate for Payer: UMR Bronson Commercial |
$6.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.93
|
|
|
HC INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
|
Facility
|
IP
|
$2.08
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
63600167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna American Axle |
$1.35
|
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health SBD |
$1.31
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.56
|
|
|
HC INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
|
Facility
|
OP
|
$2.08
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
63600167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna American Axle |
$1.35
|
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna Medicare |
$1.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health SBD |
$1.31
|
| Rate for Payer: UMR Bronson Commercial |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.56
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
OP
|
$1,132.08
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$418.87 |
| Max. Negotiated Rate |
$1,018.87 |
| Rate for Payer: Aetna American Axle |
$735.85
|
| Rate for Payer: Aetna Commercial |
$962.27
|
| Rate for Payer: Aetna Medicare |
$566.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.85
|
| Rate for Payer: BCBS Complete |
$452.83
|
| Rate for Payer: Cash Price |
$905.66
|
| Rate for Payer: Cofinity Commercial |
$792.46
|
| Rate for Payer: Cofinity Commercial |
$973.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$792.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$905.66
|
| Rate for Payer: Healthscope Commercial |
$1,018.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$792.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$849.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$962.27
|
| Rate for Payer: PHP Commercial |
$962.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$735.85
|
| Rate for Payer: Priority Health SBD |
$713.21
|
| Rate for Payer: UMR Bronson Commercial |
$418.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$849.06
|
|
|
HC INJECTION ELBOW ARTHROGRAM
|
Facility
|
IP
|
$1,132.08
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
36100038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$498.12 |
| Max. Negotiated Rate |
$1,018.87 |
| Rate for Payer: Aetna American Axle |
$735.85
|
| Rate for Payer: Aetna Commercial |
$962.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.85
|
| Rate for Payer: Cash Price |
$905.66
|
| Rate for Payer: Cofinity Commercial |
$792.46
|
| Rate for Payer: Cofinity Commercial |
$973.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$792.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$905.66
|
| Rate for Payer: Healthscope Commercial |
$1,018.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$792.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$849.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$962.27
|
| Rate for Payer: PHP Commercial |
$962.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$735.85
|
| Rate for Payer: Priority Health SBD |
$713.21
|
| Rate for Payer: UMR Bronson Commercial |
$498.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$849.06
|
|
|
HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL
|
Facility
|
IP
|
$1,901.65
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$836.73 |
| Max. Negotiated Rate |
$1,711.48 |
| Rate for Payer: Aetna American Axle |
$1,236.07
|
| Rate for Payer: Aetna Commercial |
$1,616.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,236.07
|
| Rate for Payer: Cash Price |
$1,521.32
|
| Rate for Payer: Cofinity Commercial |
$1,331.15
|
| Rate for Payer: Cofinity Commercial |
$1,635.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,331.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,521.32
|
| Rate for Payer: Healthscope Commercial |
$1,711.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,331.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,426.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,616.40
|
| Rate for Payer: PHP Commercial |
$1,616.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.07
|
| Rate for Payer: Priority Health SBD |
$1,198.04
|
| Rate for Payer: UMR Bronson Commercial |
$836.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,426.24
|
|
|
HC INJECTION FACET JOINT C OR T 1ST LEVEL BIL
|
Facility
|
OP
|
$1,901.65
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
36100626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$2,444.12 |
| Rate for Payer: Aetna American Axle |
$1,236.07
|
| Rate for Payer: Aetna Commercial |
$1,616.40
|
| Rate for Payer: Aetna Medicare |
$903.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,236.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$1,521.32
|
| Rate for Payer: Cash Price |
$1,521.32
|
| Rate for Payer: Cofinity Commercial |
$1,635.42
|
| Rate for Payer: Cofinity Commercial |
$1,331.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,331.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,521.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$1,711.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,331.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,426.24
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,616.40
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$1,616.40
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.07
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health SBD |
$1,198.04
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,444.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,659.37
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: UMR Bronson Commercial |
$703.61
|
| Rate for Payer: VA VA |
$868.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,426.24
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL
|
Facility
|
OP
|
$340.34
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100291
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.93 |
| Max. Negotiated Rate |
$306.31 |
| Rate for Payer: Aetna American Axle |
$221.22
|
| Rate for Payer: Aetna Commercial |
$289.29
|
| Rate for Payer: Aetna Medicare |
$170.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.22
|
| Rate for Payer: BCBS Complete |
$136.14
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$238.24
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Healthscope Commercial |
$306.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: PHP Commercial |
$289.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health SBD |
$214.41
|
| Rate for Payer: UMR Bronson Commercial |
$125.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.25
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL
|
Facility
|
IP
|
$340.34
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100291
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$149.75 |
| Max. Negotiated Rate |
$306.31 |
| Rate for Payer: Aetna American Axle |
$221.22
|
| Rate for Payer: Aetna Commercial |
$289.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.22
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$238.24
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Healthscope Commercial |
$306.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: PHP Commercial |
$289.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health SBD |
$214.41
|
| Rate for Payer: UMR Bronson Commercial |
$149.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.25
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL
|
Facility
|
OP
|
$510.52
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.89 |
| Max. Negotiated Rate |
$459.47 |
| Rate for Payer: Aetna American Axle |
$331.84
|
| Rate for Payer: Aetna Commercial |
$433.94
|
| Rate for Payer: Aetna Medicare |
$255.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.84
|
| Rate for Payer: BCBS Complete |
$204.21
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cofinity Commercial |
$357.36
|
| Rate for Payer: Cofinity Commercial |
$439.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.42
|
| Rate for Payer: Healthscope Commercial |
$459.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.94
|
| Rate for Payer: PHP Commercial |
$433.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.84
|
| Rate for Payer: Priority Health SBD |
$321.63
|
| Rate for Payer: UMR Bronson Commercial |
$188.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.89
|
|
|
HC INJECTION FACET JOINT C OR T 2ND LEVEL BIL
|
Facility
|
IP
|
$510.52
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
36100627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$224.63 |
| Max. Negotiated Rate |
$459.47 |
| Rate for Payer: Aetna American Axle |
$331.84
|
| Rate for Payer: Aetna Commercial |
$433.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.84
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cofinity Commercial |
$357.36
|
| Rate for Payer: Cofinity Commercial |
$439.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.42
|
| Rate for Payer: Healthscope Commercial |
$459.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.94
|
| Rate for Payer: PHP Commercial |
$433.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.84
|
| Rate for Payer: Priority Health SBD |
$321.63
|
| Rate for Payer: UMR Bronson Commercial |
$224.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.89
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL
|
Facility
|
OP
|
$340.34
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100292
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.93 |
| Max. Negotiated Rate |
$306.31 |
| Rate for Payer: Aetna American Axle |
$221.22
|
| Rate for Payer: Aetna Commercial |
$289.29
|
| Rate for Payer: Aetna Medicare |
$170.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.22
|
| Rate for Payer: BCBS Complete |
$136.14
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$238.24
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Healthscope Commercial |
$306.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: PHP Commercial |
$289.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health SBD |
$214.41
|
| Rate for Payer: UMR Bronson Commercial |
$125.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.25
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL
|
Facility
|
IP
|
$340.34
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100292
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$149.75 |
| Max. Negotiated Rate |
$306.31 |
| Rate for Payer: Aetna American Axle |
$221.22
|
| Rate for Payer: Aetna Commercial |
$289.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.22
|
| Rate for Payer: Cash Price |
$272.27
|
| Rate for Payer: Cofinity Commercial |
$238.24
|
| Rate for Payer: Cofinity Commercial |
$292.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.27
|
| Rate for Payer: Healthscope Commercial |
$306.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.29
|
| Rate for Payer: PHP Commercial |
$289.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.22
|
| Rate for Payer: Priority Health SBD |
$214.41
|
| Rate for Payer: UMR Bronson Commercial |
$149.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.25
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL BIL
|
Facility
|
OP
|
$510.52
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.89 |
| Max. Negotiated Rate |
$459.47 |
| Rate for Payer: Aetna American Axle |
$331.84
|
| Rate for Payer: Aetna Commercial |
$433.94
|
| Rate for Payer: Aetna Medicare |
$255.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.84
|
| Rate for Payer: BCBS Complete |
$204.21
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cofinity Commercial |
$357.36
|
| Rate for Payer: Cofinity Commercial |
$439.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.42
|
| Rate for Payer: Healthscope Commercial |
$459.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.94
|
| Rate for Payer: PHP Commercial |
$433.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.84
|
| Rate for Payer: Priority Health SBD |
$321.63
|
| Rate for Payer: UMR Bronson Commercial |
$188.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.89
|
|
|
HC INJECTION FACET JOINT C OR T 3RD + LEVEL BIL
|
Facility
|
IP
|
$510.52
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
36100628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$224.63 |
| Max. Negotiated Rate |
$459.47 |
| Rate for Payer: Aetna American Axle |
$331.84
|
| Rate for Payer: Aetna Commercial |
$433.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.84
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cofinity Commercial |
$357.36
|
| Rate for Payer: Cofinity Commercial |
$439.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.42
|
| Rate for Payer: Healthscope Commercial |
$459.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.94
|
| Rate for Payer: PHP Commercial |
$433.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.84
|
| Rate for Payer: Priority Health SBD |
$321.63
|
| Rate for Payer: UMR Bronson Commercial |
$224.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.89
|
|
|
HC INJECTION FACET JOINT L OR S 1ST LEVEL BIL
|
Facility
|
IP
|
$2,476.33
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,089.59 |
| Max. Negotiated Rate |
$2,228.70 |
| Rate for Payer: Aetna American Axle |
$1,609.61
|
| Rate for Payer: Aetna Commercial |
$2,104.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,609.61
|
| Rate for Payer: Cash Price |
$1,981.06
|
| Rate for Payer: Cofinity Commercial |
$1,733.43
|
| Rate for Payer: Cofinity Commercial |
$2,129.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,733.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,981.06
|
| Rate for Payer: Healthscope Commercial |
$2,228.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,733.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,857.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,104.88
|
| Rate for Payer: PHP Commercial |
$2,104.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,609.61
|
| Rate for Payer: Priority Health SBD |
$1,560.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,089.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,857.25
|
|
|
HC INJECTION FACET JOINT L OR S 1ST LEVEL BIL
|
Facility
|
OP
|
$2,476.33
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$2,444.12 |
| Rate for Payer: Aetna American Axle |
$1,609.61
|
| Rate for Payer: Aetna Commercial |
$2,104.88
|
| Rate for Payer: Aetna Medicare |
$903.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,609.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$1,981.06
|
| Rate for Payer: Cash Price |
$1,981.06
|
| Rate for Payer: Cofinity Commercial |
$2,129.64
|
| Rate for Payer: Cofinity Commercial |
$1,733.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,733.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,981.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$2,228.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,733.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,857.25
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,104.88
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$2,104.88
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,609.61
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health SBD |
$1,560.09
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,444.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,659.37
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: UMR Bronson Commercial |
$916.24
|
| Rate for Payer: VA VA |
$868.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,857.25
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL
|
Facility
|
IP
|
$411.81
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$181.20 |
| Max. Negotiated Rate |
$370.63 |
| Rate for Payer: Aetna American Axle |
$267.68
|
| Rate for Payer: Aetna Commercial |
$350.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.68
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cofinity Commercial |
$288.27
|
| Rate for Payer: Cofinity Commercial |
$354.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$288.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.45
|
| Rate for Payer: Healthscope Commercial |
$370.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.04
|
| Rate for Payer: PHP Commercial |
$350.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.68
|
| Rate for Payer: Priority Health SBD |
$259.44
|
| Rate for Payer: UMR Bronson Commercial |
$181.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.86
|
|
