|
HC INJECTION FACET JOINT L OR S 2ND LEVEL
|
Facility
|
OP
|
$411.81
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.37 |
| Max. Negotiated Rate |
$370.63 |
| Rate for Payer: Aetna American Axle |
$267.68
|
| Rate for Payer: Aetna Commercial |
$350.04
|
| Rate for Payer: Aetna Medicare |
$205.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.68
|
| Rate for Payer: BCBS Complete |
$164.72
|
| 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 |
$152.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.86
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL
|
Facility
|
IP
|
$617.71
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$271.79 |
| Max. Negotiated Rate |
$555.94 |
| Rate for Payer: Aetna American Axle |
$401.51
|
| Rate for Payer: Aetna Commercial |
$525.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.51
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$432.40
|
| Rate for Payer: Cofinity Commercial |
$531.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.17
|
| Rate for Payer: Healthscope Commercial |
$555.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$432.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.05
|
| Rate for Payer: PHP Commercial |
$525.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.51
|
| Rate for Payer: Priority Health SBD |
$389.16
|
| Rate for Payer: UMR Bronson Commercial |
$271.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.28
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL
|
Facility
|
OP
|
$617.71
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.55 |
| Max. Negotiated Rate |
$555.94 |
| Rate for Payer: Aetna American Axle |
$401.51
|
| Rate for Payer: Aetna Commercial |
$525.05
|
| Rate for Payer: Aetna Medicare |
$308.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.51
|
| Rate for Payer: BCBS Complete |
$247.08
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$432.40
|
| Rate for Payer: Cofinity Commercial |
$531.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.17
|
| Rate for Payer: Healthscope Commercial |
$555.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$432.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.05
|
| Rate for Payer: PHP Commercial |
$525.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.51
|
| Rate for Payer: Priority Health SBD |
$389.16
|
| Rate for Payer: UMR Bronson Commercial |
$228.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.28
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LE
|
Facility
|
IP
|
$411.81
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100295
|
|
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
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LE
|
Facility
|
OP
|
$411.81
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100295
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.37 |
| Max. Negotiated Rate |
$370.63 |
| Rate for Payer: Aetna American Axle |
$267.68
|
| Rate for Payer: Aetna Commercial |
$350.04
|
| Rate for Payer: Aetna Medicare |
$205.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.68
|
| Rate for Payer: BCBS Complete |
$164.72
|
| 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 |
$152.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.86
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL
|
Facility
|
IP
|
$617.71
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$271.79 |
| Max. Negotiated Rate |
$555.94 |
| Rate for Payer: Aetna American Axle |
$401.51
|
| Rate for Payer: Aetna Commercial |
$525.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.51
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$432.40
|
| Rate for Payer: Cofinity Commercial |
$531.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.17
|
| Rate for Payer: Healthscope Commercial |
$555.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$432.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.05
|
| Rate for Payer: PHP Commercial |
$525.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.51
|
| Rate for Payer: Priority Health SBD |
$389.16
|
| Rate for Payer: UMR Bronson Commercial |
$271.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.28
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL
|
Facility
|
OP
|
$617.71
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.55 |
| Max. Negotiated Rate |
$555.94 |
| Rate for Payer: Aetna American Axle |
$401.51
|
| Rate for Payer: Aetna Commercial |
$525.05
|
| Rate for Payer: Aetna Medicare |
$308.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.51
|
| Rate for Payer: BCBS Complete |
$247.08
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$432.40
|
| Rate for Payer: Cofinity Commercial |
$531.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.17
|
| Rate for Payer: Healthscope Commercial |
$555.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$432.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.05
|
| Rate for Payer: PHP Commercial |
$525.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.51
|
| Rate for Payer: Priority Health SBD |
$389.16
|
| Rate for Payer: UMR Bronson Commercial |
$228.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.28
|
|
|
HC INJECTION FOR CEREBRAL SHUNT
|
Facility
|
OP
|
$826.35
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36100270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$305.75 |
| Max. Negotiated Rate |
$1,901.18 |
| Rate for Payer: Aetna American Axle |
$537.13
|
| Rate for Payer: Aetna Commercial |
$702.40
|
| Rate for Payer: Aetna Medicare |
$702.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cofinity Commercial |
$710.66
|
| Rate for Payer: Cofinity Commercial |
$578.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$578.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$743.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$578.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$619.76
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$702.40
|
| Rate for Payer: PACE Medicare |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$702.40
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.13
|
| Rate for Payer: Priority Health Medicare |
$675.40
|
| Rate for Payer: Priority Health SBD |
$520.60
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,901.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Exchange |
$1,290.76
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$362.01
|
| Rate for Payer: UMR Bronson Commercial |
$305.75
|
| Rate for Payer: VA VA |
$675.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$619.76
|
|
|
HC INJECTION FOR CEREBRAL SHUNT
|
Facility
|
IP
|
$826.35
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36100270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$363.59 |
| Max. Negotiated Rate |
$743.72 |
| Rate for Payer: Aetna American Axle |
$537.13
|
| Rate for Payer: Aetna Commercial |
$702.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.13
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cofinity Commercial |
$578.45
|
| Rate for Payer: Cofinity Commercial |
$710.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$578.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.08
|
| Rate for Payer: Healthscope Commercial |
$743.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$578.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$619.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$702.40
|
| Rate for Payer: PHP Commercial |
$702.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.13
|
| Rate for Payer: Priority Health SBD |
$520.60
|
| Rate for Payer: UMR Bronson Commercial |
$363.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$619.76
|
|
|
HC INJECTION FOR HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$656.49
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
36100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.86 |
| Max. Negotiated Rate |
$590.84 |
| Rate for Payer: Aetna American Axle |
$426.72
|
| Rate for Payer: Aetna Commercial |
$558.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.72
|
| Rate for Payer: Cash Price |
$525.19
|
| Rate for Payer: Cofinity Commercial |
$459.54
|
| Rate for Payer: Cofinity Commercial |
$564.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$459.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.19
|
| Rate for Payer: Healthscope Commercial |
$590.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$459.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$492.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.02
|
| Rate for Payer: PHP Commercial |
$558.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.72
|
| Rate for Payer: Priority Health SBD |
$413.59
|
| Rate for Payer: UMR Bronson Commercial |
$288.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$492.37
|
|
|
HC INJECTION FOR HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$656.49
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
36100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$242.90 |
| Max. Negotiated Rate |
$590.84 |
| Rate for Payer: Aetna American Axle |
$426.72
|
| Rate for Payer: Aetna Commercial |
$558.02
|
| Rate for Payer: Aetna Medicare |
$328.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.72
|
| Rate for Payer: BCBS Complete |
$262.60
|
| Rate for Payer: Cash Price |
$525.19
|
| Rate for Payer: Cofinity Commercial |
$459.54
|
| Rate for Payer: Cofinity Commercial |
$564.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$459.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.19
|
| Rate for Payer: Healthscope Commercial |
$590.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$459.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$492.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.02
|
| Rate for Payer: PHP Commercial |
$558.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.72
|
| Rate for Payer: Priority Health SBD |
$413.59
|
| Rate for Payer: UMR Bronson Commercial |
$242.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$492.37
|
|
|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
OP
|
$1,309.24
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$484.42 |
| Max. Negotiated Rate |
$1,178.32 |
| Rate for Payer: Aetna American Axle |
$851.01
|
| Rate for Payer: Aetna Commercial |
$1,112.85
|
| Rate for Payer: Aetna Medicare |
$654.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.01
|
| Rate for Payer: BCBS Complete |
$523.70
|
| Rate for Payer: Cash Price |
$1,047.39
|
| Rate for Payer: Cofinity Commercial |
$1,125.95
|
| Rate for Payer: Cofinity Commercial |
$916.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$916.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,047.39
|
| Rate for Payer: Healthscope Commercial |
$1,178.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$916.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$981.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,112.85
|
| Rate for Payer: PHP Commercial |
$1,112.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.01
|
| Rate for Payer: Priority Health SBD |
$824.82
|
| Rate for Payer: UMR Bronson Commercial |
$484.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$981.93
|
|
|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
IP
|
$1,309.24
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$576.07 |
| Max. Negotiated Rate |
$1,178.32 |
| Rate for Payer: Aetna American Axle |
$851.01
|
| Rate for Payer: Aetna Commercial |
$1,112.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.01
|
| Rate for Payer: Cash Price |
$1,047.39
|
| Rate for Payer: Cofinity Commercial |
$1,125.95
|
| Rate for Payer: Cofinity Commercial |
$916.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$916.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,047.39
|
| Rate for Payer: Healthscope Commercial |
$1,178.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$916.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$981.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,112.85
|
| Rate for Payer: PHP Commercial |
$1,112.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.01
|
| Rate for Payer: Priority Health SBD |
$824.82
|
| Rate for Payer: UMR Bronson Commercial |
$576.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$981.93
|
|
|
HC INJECTION HIP ARTHROGRAM BIL
|
Facility
|
IP
|
$1,214.02
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$534.17 |
| Max. Negotiated Rate |
$1,092.62 |
| Rate for Payer: Aetna American Axle |
$789.11
|
| Rate for Payer: Aetna Commercial |
$1,031.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$789.11
|
| Rate for Payer: Cash Price |
$971.22
|
| Rate for Payer: Cofinity Commercial |
$1,044.06
|
| Rate for Payer: Cofinity Commercial |
$849.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$849.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$971.22
|
| Rate for Payer: Healthscope Commercial |
$1,092.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,031.92
|
| Rate for Payer: PHP Commercial |
$1,031.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.11
|
| Rate for Payer: Priority Health SBD |
$764.83
|
| Rate for Payer: UMR Bronson Commercial |
$534.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.51
|
|
|
HC INJECTION HIP ARTHROGRAM BIL
|
Facility
|
OP
|
$1,214.02
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$449.19 |
| Max. Negotiated Rate |
$1,092.62 |
| Rate for Payer: Aetna American Axle |
$789.11
|
| Rate for Payer: Aetna Commercial |
$1,031.92
|
| Rate for Payer: Aetna Medicare |
$607.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$789.11
|
| Rate for Payer: BCBS Complete |
$485.61
|
| Rate for Payer: Cash Price |
$971.22
|
| Rate for Payer: Cofinity Commercial |
$1,044.06
|
| Rate for Payer: Cofinity Commercial |
$849.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$849.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$971.22
|
| Rate for Payer: Healthscope Commercial |
$1,092.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,031.92
|
| Rate for Payer: PHP Commercial |
$1,031.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.11
|
| Rate for Payer: Priority Health SBD |
$764.83
|
| Rate for Payer: UMR Bronson Commercial |
$449.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.51
|
|
|
HC INJECTION INTRALESIONAL UP TO 7 LESIONS
|
Facility
|
OP
|
$147.11
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
76100134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.43 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna American Axle |
$95.62
|
| Rate for Payer: Aetna Commercial |
$125.04
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$126.51
|
| Rate for Payer: Cofinity Commercial |
$102.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$132.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.33
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$125.04
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$92.68
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: UMR Bronson Commercial |
$54.43
|
| Rate for Payer: VA VA |
$193.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.33
|
|
|
HC INJECTION INTRALESIONAL UP TO 7 LESIONS
|
Facility
|
IP
|
$147.11
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
76100134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.73 |
| Max. Negotiated Rate |
$132.40 |
| Rate for Payer: Aetna American Axle |
$95.62
|
| Rate for Payer: Aetna Commercial |
$125.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.62
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$102.98
|
| Rate for Payer: Cofinity Commercial |
$126.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Healthscope Commercial |
$132.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: PHP Commercial |
$125.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: Priority Health SBD |
$92.68
|
| Rate for Payer: UMR Bronson Commercial |
$64.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.33
|
|
|
HC INJECTION, IRON DEXTRAN, 50 MG
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT J1750
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna American Axle |
$40.57
|
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: UMR Bronson Commercial |
$27.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC INJECTION, IRON DEXTRAN, 50 MG
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT J1750
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna American Axle |
$40.57
|
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$18.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.64
|
| Rate for Payer: BCBS Complete |
$10.19
|
| Rate for Payer: BCBS MAPPO |
$18.11
|
| Rate for Payer: BCN Medicare Advantage |
$18.11
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.11
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Mclaren Medicaid |
$9.71
|
| Rate for Payer: Mclaren Medicare |
$18.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.02
|
| Rate for Payer: Meridian Medicaid |
$10.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PACE Medicare |
$17.20
|
| Rate for Payer: PACE SWMI |
$18.11
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$18.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health Medicare |
$18.11
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: Railroad Medicare Medicare |
$18.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.11
|
| Rate for Payer: UHC Exchange |
$34.61
|
| Rate for Payer: UHC Medicare Advantage |
$18.11
|
| Rate for Payer: UHCCP Medicaid |
$9.71
|
| Rate for Payer: UMR Bronson Commercial |
$23.10
|
| Rate for Payer: VA VA |
$18.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
63600098
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna American Axle |
$13.53
|
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: UMR Bronson Commercial |
$9.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
63600098
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna American Axle |
$13.53
|
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$0.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Exchange |
$0.57
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHCCP Medicaid |
$0.16
|
| Rate for Payer: UMR Bronson Commercial |
$7.70
|
| Rate for Payer: VA VA |
$0.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC INJECTION, LINCOMYCIN HCL, UP TO 300 MG
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT J2010
|
| Hospital Charge Code |
63600099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna American Axle |
$29.76
|
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna Medicare |
$22.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.76
|
| Rate for Payer: BCBS Complete |
$18.31
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$32.05
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health SBD |
$28.84
|
| Rate for Payer: UMR Bronson Commercial |
$16.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.34
|
|
|
HC INJECTION, LINCOMYCIN HCL, UP TO 300 MG
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT J2010
|
| Hospital Charge Code |
63600099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.14 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna American Axle |
$29.76
|
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.76
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$32.05
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health SBD |
$28.84
|
| Rate for Payer: UMR Bronson Commercial |
$20.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.34
|
|
|
HC INJECTION LUMBAR DISKOGRAPHY
|
Facility
|
IP
|
$2,349.53
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
36100282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,033.79 |
| Max. Negotiated Rate |
$2,114.58 |
| Rate for Payer: Aetna American Axle |
$1,527.19
|
| Rate for Payer: Aetna Commercial |
$1,997.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,527.19
|
| Rate for Payer: Cash Price |
$1,879.62
|
| Rate for Payer: Cofinity Commercial |
$1,644.67
|
| Rate for Payer: Cofinity Commercial |
$2,020.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,644.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,879.62
|
| Rate for Payer: Healthscope Commercial |
$2,114.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,644.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,762.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,997.10
|
| Rate for Payer: PHP Commercial |
$1,997.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,527.19
|
| Rate for Payer: Priority Health SBD |
$1,480.20
|
| Rate for Payer: UMR Bronson Commercial |
$1,033.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,762.15
|
|
|
HC INJECTION LUMBAR DISKOGRAPHY
|
Facility
|
OP
|
$2,349.53
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
36100282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$869.33 |
| Max. Negotiated Rate |
$2,114.58 |
| Rate for Payer: Aetna American Axle |
$1,527.19
|
| Rate for Payer: Aetna Commercial |
$1,997.10
|
| Rate for Payer: Aetna Medicare |
$1,174.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,527.19
|
| Rate for Payer: BCBS Complete |
$939.81
|
| Rate for Payer: Cash Price |
$1,879.62
|
| Rate for Payer: Cofinity Commercial |
$1,644.67
|
| Rate for Payer: Cofinity Commercial |
$2,020.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,644.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,879.62
|
| Rate for Payer: Healthscope Commercial |
$2,114.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,644.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,762.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,997.10
|
| Rate for Payer: PHP Commercial |
$1,997.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,527.19
|
| Rate for Payer: Priority Health SBD |
$1,480.20
|
| Rate for Payer: UMR Bronson Commercial |
$869.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,762.15
|
|
