|
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 |
$57.81 |
| Max. Negotiated Rate |
$700.00 |
| 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: BCBS Trust/PPO |
$336.09
|
| Rate for Payer: BCN Commercial |
$336.09
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cash Price |
$408.42
|
| Rate for Payer: Cofinity Commercial |
$439.05
|
| Rate for Payer: Cofinity Commercial |
$357.36
|
| 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: UHC All Payor (Choice/PPO) |
$63.59
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$57.81
|
| Rate for Payer: UMR Bronson Commercial |
$188.89
|
| 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 |
$86.26 |
| Max. Negotiated Rate |
$2,741.59 |
| Rate for Payer: Aetna American Axle |
$1,609.61
|
| Rate for Payer: Aetna Commercial |
$2,104.88
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,609.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,023.05
|
| Rate for Payer: BCN Commercial |
$1,023.05
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$1,981.06
|
| 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 |
$872.29
|
| 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 |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,104.88
|
| Rate for Payer: Nomi Health Commercial |
$1,831.81
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$2,104.88
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,609.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,741.59
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,193.27
|
| Rate for Payer: Priority Health SBD |
$1,560.09
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.89
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$86.26
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$467.55
|
| Rate for Payer: UMR Bronson Commercial |
$916.24
|
| Rate for Payer: VA VA |
$872.29
|
| 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
|
|
|
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 |
$48.82 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$267.68
|
| Rate for Payer: Aetna Commercial |
$350.04
|
| Rate for Payer: Aetna Medicare |
$205.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.68
|
| Rate for Payer: BCBS Complete |
$164.72
|
| Rate for Payer: BCBS Trust/PPO |
$308.28
|
| Rate for Payer: BCN Commercial |
$308.28
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cofinity Commercial |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$288.27
|
| 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: UHC All Payor (Choice/PPO) |
$53.70
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$48.82
|
| 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
|
OP
|
$617.71
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.82 |
| Max. Negotiated Rate |
$700.00 |
| 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: BCBS Trust/PPO |
$308.28
|
| Rate for Payer: BCN Commercial |
$308.28
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$531.23
|
| Rate for Payer: Cofinity Commercial |
$432.40
|
| 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: UHC All Payor (Choice/PPO) |
$53.70
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$48.82
|
| 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 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 3RD + LE
|
Facility
|
OP
|
$411.81
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100295
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$49.71 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$267.68
|
| Rate for Payer: Aetna Commercial |
$350.04
|
| Rate for Payer: Aetna Medicare |
$205.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.68
|
| Rate for Payer: BCBS Complete |
$164.72
|
| Rate for Payer: BCBS Trust/PPO |
$309.54
|
| Rate for Payer: BCN Commercial |
$309.54
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cofinity Commercial |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$288.27
|
| 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: UHC All Payor (Choice/PPO) |
$54.68
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$49.71
|
| 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 + 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 + 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 |
$49.71 |
| Max. Negotiated Rate |
$700.00 |
| 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: BCBS Trust/PPO |
$309.54
|
| Rate for Payer: BCN Commercial |
$309.54
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cash Price |
$494.17
|
| Rate for Payer: Cofinity Commercial |
$531.23
|
| Rate for Payer: Cofinity Commercial |
$432.40
|
| 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: UHC All Payor (Choice/PPO) |
$54.68
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$49.71
|
| 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 |
$54.08 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna American Axle |
$537.13
|
| Rate for Payer: Aetna Commercial |
$702.40
|
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$426.89
|
| Rate for Payer: BCN Commercial |
$426.89
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$661.08
|
| 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 |
$578.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$578.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$743.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$578.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$619.76
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$702.40
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$702.40
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Priority Health SBD |
$520.60
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.49
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$54.08
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: UMR Bronson Commercial |
$305.75
|
| Rate for Payer: VA VA |
$678.52
|
| 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 |
$578.44
|
| Rate for Payer: Cofinity Commercial |
$710.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$578.44
|
| 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 |
$578.44
|
| 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 |
$55.37 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$426.72
|
| Rate for Payer: Aetna Commercial |
$558.02
|
| Rate for Payer: Aetna Medicare |
$328.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.72
|
| Rate for Payer: BCBS Complete |
$262.60
|
| Rate for Payer: BCBS Trust/PPO |
$354.90
|
| Rate for Payer: BCN Commercial |
$354.90
|
| Rate for Payer: Cash Price |
$525.19
|
| Rate for Payer: Cash Price |
$525.19
|
| Rate for Payer: Cash Price |
$525.19
|
| Rate for Payer: Cofinity Commercial |
$564.58
|
| Rate for Payer: Cofinity Commercial |
$459.54
|
| 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: UHC All Payor (Choice/PPO) |
$60.91
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$55.37
|
| Rate for Payer: UMR Bronson Commercial |
$242.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$492.37
|
|
|
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
|
Facility
|
OP
|
$1,309.24
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.03 |
| 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: BCBS Trust/PPO |
$431.13
|
| Rate for Payer: BCN Commercial |
$431.13
|
| Rate for Payer: Cash Price |
$1,047.39
|
| Rate for Payer: Cash Price |
$1,047.39
|
| Rate for Payer: Cash Price |
$1,047.39
|
| Rate for Payer: Cofinity Commercial |
$916.47
|
| Rate for Payer: Cofinity Commercial |
$1,125.95
|
| 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: UHC All Payor (Choice/PPO) |
$71.53
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$65.03
|
| Rate for Payer: UMR Bronson Commercial |
$484.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$981.93
|
|
|
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 |
$65.03 |
| 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: BCBS Trust/PPO |
$431.13
|
| Rate for Payer: BCN Commercial |
$431.13
|
| Rate for Payer: Cash Price |
$971.22
|
| Rate for Payer: Cash Price |
$971.22
|
| Rate for Payer: Cash Price |
$971.22
|
| Rate for Payer: Cofinity Commercial |
$849.81
|
| Rate for Payer: Cofinity Commercial |
$1,044.06
|
| 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 |
$910.52
|
| 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: UHC All Payor (Choice/PPO) |
$71.53
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$65.03
|
| Rate for Payer: UMR Bronson Commercial |
$449.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.52
|
|
|
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 |
$910.52
|
| 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 |
$910.52
|
|
|
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 |
$28.58 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$95.62
|
| Rate for Payer: Aetna Commercial |
$125.04
|
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$223.52
|
| Rate for Payer: BCN Commercial |
$223.52
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cash Price |
$117.69
|
| 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: Health Alliance Plan Medicare Advantage |
$194.68
|
| 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 |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$125.04
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Priority Health SBD |
$92.68
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.44
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$28.58
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: UMR Bronson Commercial |
$54.43
|
| Rate for Payer: VA VA |
$194.68
|
| 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 |
$46.82
|
| 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 |
$46.82
|
|
|
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 |
$9.33 |
| 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 |
$18.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.75
|
| Rate for Payer: BCBS Complete |
$9.79
|
| Rate for Payer: BCBS MAPPO |
$17.40
|
| Rate for Payer: BCBS Trust/PPO |
$47.64
|
| Rate for Payer: BCN Commercial |
$47.64
|
| Rate for Payer: BCN Medicare Advantage |
$17.40
|
| 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 |
$17.40
|
| 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 |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$9.33
|
| Rate for Payer: Mclaren Medicare |
$17.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.27
|
| Rate for Payer: Meridian Medicaid |
$9.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$52.20
|
| Rate for Payer: PACE Medicare |
$16.53
|
| Rate for Payer: PACE SWMI |
$17.40
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$17.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.86
|
| Rate for Payer: Priority Health Medicare |
$17.40
|
| Rate for Payer: Priority Health Narrow Network |
$40.69
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: Railroad Medicare Medicare |
$17.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.40
|
| Rate for Payer: UHC Exchange |
$33.25
|
| Rate for Payer: UHC Medicare Advantage |
$17.40
|
| Rate for Payer: UHCCP Medicaid |
$9.33
|
| Rate for Payer: UMR Bronson Commercial |
$23.10
|
| Rate for Payer: VA VA |
$17.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.82
|
|
|
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 |
$0.39 |
| 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 |
$0.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.91
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS MAPPO |
$0.73
|
| Rate for Payer: BCBS Trust/PPO |
$1.83
|
| Rate for Payer: BCN Commercial |
$1.83
|
| Rate for Payer: BCN Medicare Advantage |
$0.73
|
| 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 |
$0.73
|
| 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 |
$0.39
|
| Rate for Payer: Mclaren Medicare |
$0.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.77
|
| Rate for Payer: Meridian Medicaid |
$0.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$2.19
|
| Rate for Payer: PACE Medicare |
$0.69
|
| Rate for Payer: PACE SWMI |
$0.73
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$0.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.95
|
| Rate for Payer: Priority Health Medicare |
$0.73
|
| Rate for Payer: Priority Health Narrow Network |
$1.56
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: Railroad Medicare Medicare |
$0.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.73
|
| Rate for Payer: UHC Exchange |
$1.40
|
| Rate for Payer: UHC Medicare Advantage |
$0.73
|
| Rate for Payer: UHCCP Medicaid |
$0.39
|
| Rate for Payer: UMR Bronson Commercial |
$7.70
|
| Rate for Payer: VA VA |
$0.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
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
|
|
