|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$1,414.81
|
|
|
Service Code
|
NDC 61958100301
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$336.02 |
| Max. Negotiated Rate |
$1,273.33 |
| Rate for Payer: Aetna Commercial |
$1,202.59
|
| Rate for Payer: Aetna Medicare |
$367.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$442.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$442.13
|
| Rate for Payer: BCBS Complete |
$565.92
|
| Rate for Payer: BCBS MAPPO |
$353.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,163.12
|
| Rate for Payer: BCN Commercial |
$1,100.01
|
| Rate for Payer: BCN Medicare Advantage |
$353.70
|
| Rate for Payer: Cash Price |
$1,131.85
|
| Rate for Payer: Cofinity Commercial |
$1,216.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$353.70
|
| Rate for Payer: Healthscope Commercial |
$1,273.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,061.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$371.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$406.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,202.59
|
| Rate for Payer: Nomi Health Commercial |
$1,160.14
|
| Rate for Payer: PACE Senior Care Partners |
$336.02
|
| Rate for Payer: PACE SWMI |
$353.70
|
| Rate for Payer: PHP Commercial |
$1,202.59
|
| Rate for Payer: PHP Medicare Advantage |
$353.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.63
|
| Rate for Payer: Priority Health HMO/PPO |
$1,230.88
|
| Rate for Payer: Priority Health Medicare |
$357.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$947.92
|
| Rate for Payer: Railroad Medicare Medicare |
$353.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,245.03
|
| Rate for Payer: UHC Core |
$1,181.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$353.70
|
| Rate for Payer: UHC Exchange |
$353.70
|
| Rate for Payer: UHC Medicare Advantage |
$353.70
|
| Rate for Payer: VA VA |
$353.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,061.11
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$154.47
|
|
|
Service Code
|
NDC 70756070360
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$139.02 |
| Rate for Payer: Aetna Commercial |
$131.30
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.27
|
| Rate for Payer: BCBS Complete |
$61.79
|
| Rate for Payer: BCBS MAPPO |
$38.62
|
| Rate for Payer: BCBS Trust/PPO |
$126.99
|
| Rate for Payer: BCN Commercial |
$120.10
|
| Rate for Payer: BCN Medicare Advantage |
$38.62
|
| Rate for Payer: Cash Price |
$123.58
|
| Rate for Payer: Cofinity Commercial |
$132.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.62
|
| Rate for Payer: Healthscope Commercial |
$139.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.30
|
| Rate for Payer: Nomi Health Commercial |
$126.67
|
| Rate for Payer: PACE Senior Care Partners |
$36.69
|
| Rate for Payer: PACE SWMI |
$38.62
|
| Rate for Payer: PHP Commercial |
$131.30
|
| Rate for Payer: PHP Medicare Advantage |
$38.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.41
|
| Rate for Payer: Priority Health HMO/PPO |
$134.39
|
| Rate for Payer: Priority Health Medicare |
$39.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.49
|
| Rate for Payer: Railroad Medicare Medicare |
$38.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.93
|
| Rate for Payer: UHC Core |
$128.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.62
|
| Rate for Payer: UHC Exchange |
$38.62
|
| Rate for Payer: UHC Medicare Advantage |
$38.62
|
| Rate for Payer: VA VA |
$38.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.85
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$5.91
|
|
|
Service Code
|
NDC 60687054911
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna Commercial |
$5.02
|
| Rate for Payer: BCBS Trust/PPO |
$4.82
|
| Rate for Payer: BCN Commercial |
$4.57
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cofinity Commercial |
$5.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.73
|
| Rate for Payer: Healthscope Commercial |
$5.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.02
|
| Rate for Payer: Nomi Health Commercial |
$4.85
|
| Rate for Payer: PHP Commercial |
$5.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.84
|
| Rate for Payer: Priority Health HMO/PPO |
$5.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.20
|
| Rate for Payer: UHC Core |
$4.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.43
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$5.91
|
|
|
Service Code
|
NDC 60687054911
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna Commercial |
$5.02
|
| Rate for Payer: Aetna Medicare |
$1.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.85
|
| Rate for Payer: BCBS Complete |
$2.36
|
| Rate for Payer: BCBS MAPPO |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$4.86
|
| Rate for Payer: BCN Commercial |
$4.60
|
| Rate for Payer: BCN Medicare Advantage |
$1.48
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cofinity Commercial |
$5.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.48
|
| Rate for Payer: Healthscope Commercial |
$5.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.02
|
| Rate for Payer: Nomi Health Commercial |
$4.85
|
| Rate for Payer: PACE Senior Care Partners |
$1.40
|
| Rate for Payer: PACE SWMI |
$1.48
|
| Rate for Payer: PHP Commercial |
$5.02
|
| Rate for Payer: PHP Medicare Advantage |
$1.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.84
|
| Rate for Payer: Priority Health HMO/PPO |
$5.14
|
| Rate for Payer: Priority Health Medicare |
$1.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.96
|
| Rate for Payer: Railroad Medicare Medicare |
$1.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.20
|
| Rate for Payer: UHC Core |
$4.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.48
|
| Rate for Payer: UHC Exchange |
$1.48
|
| Rate for Payer: UHC Medicare Advantage |
$1.48
|
| Rate for Payer: VA VA |
$1.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.43
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$177.12
|
|
|
Service Code
|
NDC 60687054921
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.13 |
| Max. Negotiated Rate |
$159.41 |
| Rate for Payer: Aetna Commercial |
$150.55
|
| Rate for Payer: BCBS Trust/PPO |
$144.58
|
| Rate for Payer: BCN Commercial |
$136.88
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cofinity Commercial |
$152.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.70
|
| Rate for Payer: Healthscope Commercial |
$159.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.55
|
| Rate for Payer: Nomi Health Commercial |
$145.24
|
| Rate for Payer: PHP Commercial |
$150.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.13
|
| Rate for Payer: Priority Health HMO/PPO |
$154.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.87
|
| Rate for Payer: UHC Core |
$147.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.84
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$177.12
|
|
|
Service Code
|
NDC 60687054921
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.07 |
| Max. Negotiated Rate |
$159.41 |
| Rate for Payer: Aetna Commercial |
$150.55
|
| Rate for Payer: Aetna Medicare |
$46.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.35
|
| Rate for Payer: BCBS Complete |
$70.85
|
| Rate for Payer: BCBS MAPPO |
$44.28
|
| Rate for Payer: BCBS Trust/PPO |
$145.61
|
| Rate for Payer: BCN Commercial |
$137.71
|
| Rate for Payer: BCN Medicare Advantage |
$44.28
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cofinity Commercial |
$152.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.28
|
| Rate for Payer: Healthscope Commercial |
$159.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.55
|
| Rate for Payer: Nomi Health Commercial |
$145.24
|
| Rate for Payer: PACE Senior Care Partners |
$42.07
|
| Rate for Payer: PACE SWMI |
$44.28
|
| Rate for Payer: PHP Commercial |
$150.55
|
| Rate for Payer: PHP Medicare Advantage |
$44.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.13
|
| Rate for Payer: Priority Health HMO/PPO |
$154.09
|
| Rate for Payer: Priority Health Medicare |
$44.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.67
|
| Rate for Payer: Railroad Medicare Medicare |
$44.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.87
|
| Rate for Payer: UHC Core |
$147.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.28
|
| Rate for Payer: UHC Exchange |
$44.28
|
| Rate for Payer: UHC Medicare Advantage |
$44.28
|
| Rate for Payer: VA VA |
$44.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.84
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$1,414.81
|
|
|
Service Code
|
NDC 61958100301
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$919.63 |
| Max. Negotiated Rate |
$1,273.33 |
| Rate for Payer: Aetna Commercial |
$1,202.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,154.91
|
| Rate for Payer: BCN Commercial |
$1,093.37
|
| Rate for Payer: Cash Price |
$1,131.85
|
| Rate for Payer: Cofinity Commercial |
$1,216.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.85
|
| Rate for Payer: Healthscope Commercial |
$1,273.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,061.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,202.59
|
| Rate for Payer: Nomi Health Commercial |
$1,160.14
|
| Rate for Payer: PHP Commercial |
$1,202.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.63
|
| Rate for Payer: Priority Health HMO/PPO |
$1,230.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$947.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,245.03
|
| Rate for Payer: UHC Core |
$1,181.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,061.11
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$154.47
|
|
|
Service Code
|
NDC 70756070360
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.41 |
| Max. Negotiated Rate |
$139.02 |
| Rate for Payer: Aetna Commercial |
$131.30
|
| Rate for Payer: BCBS Trust/PPO |
$126.09
|
| Rate for Payer: BCN Commercial |
$119.37
|
| Rate for Payer: Cash Price |
$123.58
|
| Rate for Payer: Cofinity Commercial |
$132.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.58
|
| Rate for Payer: Healthscope Commercial |
$139.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.30
|
| Rate for Payer: Nomi Health Commercial |
$126.67
|
| Rate for Payer: PHP Commercial |
$131.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.41
|
| Rate for Payer: Priority Health HMO/PPO |
$134.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.93
|
| Rate for Payer: UHC Core |
$128.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.85
|
|
|
RECONSTRUCTION OF DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE ADVANCEMENT OR RELEASE (EG, CAMPBELL, GOLDWAITE TYPE PROCEDURE)
|
Facility
|
OP
|
$5,423.52
|
|
|
Service Code
|
CPT 27422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,164.92 |
| Max. Negotiated Rate |
$5,423.52 |
| Rate for Payer: BCBS Complete |
$5,423.52
|
| Rate for Payer: Mclaren Medicaid |
$5,164.92
|
| Rate for Payer: Meridian Medicaid |
$5,423.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,164.92
|
| Rate for Payer: UHCCP Medicaid |
$5,164.92
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$33.56
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.81 |
| Max. Negotiated Rate |
$30.20 |
| Rate for Payer: Aetna Commercial |
$28.53
|
| Rate for Payer: Aetna Commercial |
$31.09
|
| Rate for Payer: Aetna Commercial |
$723.36
|
| Rate for Payer: BCBS Trust/PPO |
$29.86
|
| Rate for Payer: BCBS Trust/PPO |
$27.40
|
| Rate for Payer: BCBS Trust/PPO |
$694.68
|
| Rate for Payer: BCN Commercial |
$28.27
|
| Rate for Payer: BCN Commercial |
$25.94
|
| Rate for Payer: BCN Commercial |
$657.66
|
| Rate for Payer: Cash Price |
$26.85
|
| Rate for Payer: Cash Price |
$680.81
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cofinity Commercial |
$731.87
|
| Rate for Payer: Cofinity Commercial |
$31.46
|
| Rate for Payer: Cofinity Commercial |
$28.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.81
|
| Rate for Payer: Healthscope Commercial |
$32.92
|
| Rate for Payer: Healthscope Commercial |
$30.20
|
| Rate for Payer: Healthscope Commercial |
$765.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.36
|
| Rate for Payer: Nomi Health Commercial |
$27.52
|
| Rate for Payer: Nomi Health Commercial |
$30.00
|
| Rate for Payer: Nomi Health Commercial |
$697.83
|
| Rate for Payer: PHP Commercial |
$31.09
|
| Rate for Payer: PHP Commercial |
$28.53
|
| Rate for Payer: PHP Commercial |
$723.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.78
|
| Rate for Payer: Priority Health HMO/PPO |
$740.38
|
| Rate for Payer: Priority Health HMO/PPO |
$31.82
|
| Rate for Payer: Priority Health HMO/PPO |
$29.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$748.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.53
|
| Rate for Payer: UHC Core |
$28.02
|
| Rate for Payer: UHC Core |
$710.59
|
| Rate for Payer: UHC Core |
$30.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.43
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$33.56
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$30.20 |
| Rate for Payer: Aetna Commercial |
$28.53
|
| Rate for Payer: Aetna Commercial |
$723.36
|
| Rate for Payer: Aetna Commercial |
$31.09
|
| Rate for Payer: Aetna Medicare |
$221.26
|
| Rate for Payer: Aetna Medicare |
$8.73
|
| Rate for Payer: Aetna Medicare |
$9.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$265.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$265.94
|
| Rate for Payer: BCBS Complete |
$14.63
|
| Rate for Payer: BCBS Complete |
$13.42
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS MAPPO |
$212.75
|
| Rate for Payer: BCBS MAPPO |
$8.39
|
| Rate for Payer: BCBS MAPPO |
$9.14
|
| Rate for Payer: BCBS Trust/PPO |
$30.07
|
| Rate for Payer: BCBS Trust/PPO |
$27.59
|
| Rate for Payer: BCBS Trust/PPO |
$699.62
|
| Rate for Payer: BCN Commercial |
$28.44
|
| Rate for Payer: BCN Commercial |
$661.66
|
| Rate for Payer: BCN Commercial |
$26.09
|
| Rate for Payer: BCN Medicare Advantage |
$8.39
|
| Rate for Payer: BCN Medicare Advantage |
$9.14
|
| Rate for Payer: BCN Medicare Advantage |
$212.75
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cash Price |
$680.81
|
| Rate for Payer: Cash Price |
$26.85
|
| Rate for Payer: Cofinity Commercial |
$731.87
|
| Rate for Payer: Cofinity Commercial |
$28.86
|
| Rate for Payer: Cofinity Commercial |
$31.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.39
|
| Rate for Payer: Healthscope Commercial |
$32.92
|
| Rate for Payer: Healthscope Commercial |
$30.20
|
| Rate for Payer: Healthscope Commercial |
$765.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.53
|
| Rate for Payer: Nomi Health Commercial |
$697.83
|
| Rate for Payer: Nomi Health Commercial |
$27.52
|
| Rate for Payer: Nomi Health Commercial |
$30.00
|
| Rate for Payer: PACE Senior Care Partners |
$202.11
|
| Rate for Payer: PACE Senior Care Partners |
$7.97
|
| Rate for Payer: PACE Senior Care Partners |
$8.69
|
| Rate for Payer: PACE SWMI |
$9.14
|
| Rate for Payer: PACE SWMI |
$8.39
|
| Rate for Payer: PACE SWMI |
$212.75
|
| Rate for Payer: PHP Commercial |
$723.36
|
| Rate for Payer: PHP Commercial |
$31.09
|
| Rate for Payer: PHP Commercial |
$28.53
|
| Rate for Payer: PHP Medicare Advantage |
$9.14
|
| Rate for Payer: PHP Medicare Advantage |
$212.75
|
| Rate for Payer: PHP Medicare Advantage |
$8.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.78
|
| Rate for Payer: Priority Health HMO/PPO |
$740.38
|
| Rate for Payer: Priority Health HMO/PPO |
$29.20
|
| Rate for Payer: Priority Health HMO/PPO |
$31.82
|
| Rate for Payer: Priority Health Medicare |
$8.47
|
| Rate for Payer: Priority Health Medicare |
$214.88
|
| Rate for Payer: Priority Health Medicare |
$9.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.49
|
| Rate for Payer: Railroad Medicare Medicare |
$9.14
|
| Rate for Payer: Railroad Medicare Medicare |
$212.75
|
| Rate for Payer: Railroad Medicare Medicare |
$8.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$748.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.53
|
| Rate for Payer: UHC Core |
$710.59
|
| Rate for Payer: UHC Core |
$30.54
|
| Rate for Payer: UHC Core |
$28.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.14
|
| Rate for Payer: UHC Exchange |
$9.14
|
| Rate for Payer: UHC Exchange |
$8.39
|
| Rate for Payer: UHC Exchange |
$212.75
|
| Rate for Payer: UHC Medicare Advantage |
$8.39
|
| Rate for Payer: UHC Medicare Advantage |
$9.14
|
| Rate for Payer: UHC Medicare Advantage |
$212.75
|
| Rate for Payer: VA VA |
$9.14
|
| Rate for Payer: VA VA |
$212.75
|
| Rate for Payer: VA VA |
$8.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.43
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$2,031.52
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
300469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,320.49 |
| Max. Negotiated Rate |
$1,828.37 |
| Rate for Payer: Aetna Commercial |
$1,726.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,658.33
|
| Rate for Payer: BCN Commercial |
$1,569.96
|
| Rate for Payer: Cash Price |
$1,625.22
|
| Rate for Payer: Cofinity Commercial |
$1,747.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.22
|
| Rate for Payer: Healthscope Commercial |
$1,828.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,523.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.79
|
| Rate for Payer: Nomi Health Commercial |
$1,665.85
|
| Rate for Payer: PHP Commercial |
$1,726.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.49
|
| Rate for Payer: Priority Health HMO/PPO |
$1,767.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,361.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,787.74
|
| Rate for Payer: UHC Core |
$1,696.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,523.64
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$2,031.52
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
300469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$1,828.37 |
| Rate for Payer: Aetna Commercial |
$1,726.79
|
| Rate for Payer: Aetna Medicare |
$528.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$634.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$634.85
|
| Rate for Payer: BCBS Complete |
$5.11
|
| Rate for Payer: BCBS MAPPO |
$507.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,670.11
|
| Rate for Payer: BCN Commercial |
$1,579.51
|
| Rate for Payer: BCN Medicare Advantage |
$507.88
|
| Rate for Payer: Cash Price |
$1,625.22
|
| Rate for Payer: Cash Price |
$1,625.22
|
| Rate for Payer: Cofinity Commercial |
$1,747.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$507.88
|
| Rate for Payer: Healthscope Commercial |
$1,828.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,523.64
|
| Rate for Payer: Mclaren Medicaid |
$4.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$533.27
|
| Rate for Payer: Meridian Medicaid |
$5.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$584.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.79
|
| Rate for Payer: Nomi Health Commercial |
$1,665.85
|
| Rate for Payer: PACE Senior Care Partners |
$482.49
|
| Rate for Payer: PACE SWMI |
$507.88
|
| Rate for Payer: PHP Commercial |
$1,726.79
|
| Rate for Payer: PHP Medicare Advantage |
$507.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.49
|
| Rate for Payer: Priority Health HMO/PPO |
$1,767.42
|
| Rate for Payer: Priority Health Medicare |
$512.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,361.12
|
| Rate for Payer: Railroad Medicare Medicare |
$507.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,787.74
|
| Rate for Payer: UHC Core |
$1,696.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$507.88
|
| Rate for Payer: UHC Exchange |
$507.88
|
| Rate for Payer: UHC Medicare Advantage |
$507.88
|
| Rate for Payer: UHCCP Medicaid |
$4.87
|
| Rate for Payer: VA VA |
$507.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,523.64
|
|
|
REMDESIVIR 200 MG/250 ML INFUSION (IV PREMIX)
|
Facility
|
OP
|
$3,520.00
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
300873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna Commercial |
$2,992.00
|
| Rate for Payer: Aetna Medicare |
$915.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,100.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,100.00
|
| Rate for Payer: BCBS Complete |
$5.11
|
| Rate for Payer: BCBS MAPPO |
$880.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,893.79
|
| Rate for Payer: BCN Commercial |
$2,736.80
|
| Rate for Payer: BCN Medicare Advantage |
$880.00
|
| Rate for Payer: Cash Price |
$2,816.00
|
| Rate for Payer: Cash Price |
$2,816.00
|
| Rate for Payer: Cofinity Commercial |
$3,027.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,816.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$880.00
|
| Rate for Payer: Healthscope Commercial |
$3,168.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,640.00
|
| Rate for Payer: Mclaren Medicaid |
$4.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$924.00
|
| Rate for Payer: Meridian Medicaid |
$5.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,012.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,992.00
|
| Rate for Payer: Nomi Health Commercial |
$2,886.40
|
| Rate for Payer: PACE Senior Care Partners |
$836.00
|
| Rate for Payer: PACE SWMI |
$880.00
|
| Rate for Payer: PHP Commercial |
$2,992.00
|
| Rate for Payer: PHP Medicare Advantage |
$880.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,288.00
|
| Rate for Payer: Priority Health HMO/PPO |
$3,062.40
|
| Rate for Payer: Priority Health Medicare |
$888.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,358.40
|
| Rate for Payer: Railroad Medicare Medicare |
$880.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,097.60
|
| Rate for Payer: UHC Core |
$2,939.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$880.00
|
| Rate for Payer: UHC Exchange |
$880.00
|
| Rate for Payer: UHC Medicare Advantage |
$880.00
|
| Rate for Payer: UHCCP Medicaid |
$4.87
|
| Rate for Payer: VA VA |
$880.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,640.00
|
|
|
REMDESIVIR 200 MG/250 ML INFUSION (IV PREMIX)
|
Facility
|
IP
|
$3,520.00
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
300873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,288.00 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna Commercial |
$2,992.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,873.38
|
| Rate for Payer: BCN Commercial |
$2,720.26
|
| Rate for Payer: Cash Price |
$2,816.00
|
| Rate for Payer: Cofinity Commercial |
$3,027.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,816.00
|
| Rate for Payer: Healthscope Commercial |
$3,168.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,640.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,992.00
|
| Rate for Payer: Nomi Health Commercial |
$2,886.40
|
| Rate for Payer: PHP Commercial |
$2,992.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,288.00
|
| Rate for Payer: Priority Health HMO/PPO |
$3,062.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,358.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,097.60
|
| Rate for Payer: UHC Core |
$2,939.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,640.00
|
|
|
REMOVAL OF EMBEDDED FOREIGN BODY, EYELID
|
Facility
|
OP
|
$226.95
|
|
|
Service Code
|
CPT 67938
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$216.13 |
| Max. Negotiated Rate |
$226.95 |
| Rate for Payer: BCBS Complete |
$226.95
|
| Rate for Payer: Mclaren Medicaid |
$216.13
|
| Rate for Payer: Meridian Medicaid |
$226.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$216.13
|
| Rate for Payer: UHCCP Medicaid |
$216.13
|
|
|
REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; SUBCUTANEOUS
|
Facility
|
OP
|
$1,230.09
|
|
|
Service Code
|
CPT 24200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,171.43 |
| Max. Negotiated Rate |
$1,230.09 |
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
|
|
REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL BAND, NAIL, ROD OR PLATE)
|
Facility
|
OP
|
$2,172.87
|
|
|
Service Code
|
CPT 20680
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,069.26 |
| Max. Negotiated Rate |
$2,172.87 |
| Rate for Payer: BCBS Complete |
$2,172.87
|
| Rate for Payer: Mclaren Medicaid |
$2,069.26
|
| Rate for Payer: Meridian Medicaid |
$2,172.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,069.26
|
| Rate for Payer: UHCCP Medicaid |
$2,069.26
|
|
|
REMOVAL OF INTRAUTERINE DEVICE (IUD)
|
Facility
|
OP
|
$230.94
|
|
|
Service Code
|
CPT 58301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$219.93 |
| Max. Negotiated Rate |
$230.94 |
| Rate for Payer: BCBS Complete |
$230.94
|
| Rate for Payer: Mclaren Medicaid |
$219.93
|
| Rate for Payer: Meridian Medicaid |
$230.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$219.93
|
| Rate for Payer: UHCCP Medicaid |
$219.93
|
|
|
REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS
|
Facility
|
OP
|
$150.85
|
|
|
Service Code
|
CPT 11200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$143.66 |
| Max. Negotiated Rate |
$150.85 |
| Rate for Payer: BCBS Complete |
$150.85
|
| Rate for Payer: Mclaren Medicaid |
$143.66
|
| Rate for Payer: Meridian Medicaid |
$150.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.66
|
| Rate for Payer: UHCCP Medicaid |
$143.66
|
|
|
REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$464.73
|
|
|
Service Code
|
CPT 13121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$442.57 |
| Max. Negotiated Rate |
$464.73 |
| Rate for Payer: BCBS Complete |
$464.73
|
| Rate for Payer: Mclaren Medicaid |
$442.57
|
| Rate for Payer: Meridian Medicaid |
$464.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$442.57
|
| Rate for Payer: UHCCP Medicaid |
$442.57
|
|
|
REPAIR, COMPLEX, TRUNK; 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$464.73
|
|
|
Service Code
|
CPT 13101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$442.57 |
| Max. Negotiated Rate |
$464.73 |
| Rate for Payer: BCBS Complete |
$464.73
|
| Rate for Payer: Mclaren Medicaid |
$442.57
|
| Rate for Payer: Meridian Medicaid |
$464.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$442.57
|
| Rate for Payer: UHCCP Medicaid |
$442.57
|
|
|
REPAIR INGUINAL HERNIA, SLIDING, ANY AGE
|
Facility
|
OP
|
$2,679.26
|
|
|
Service Code
|
CPT 49525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,551.51 |
| Max. Negotiated Rate |
$2,679.26 |
| Rate for Payer: BCBS Complete |
$2,679.26
|
| Rate for Payer: Mclaren Medicaid |
$2,551.51
|
| Rate for Payer: Meridian Medicaid |
$2,679.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,551.51
|
| Rate for Payer: UHCCP Medicaid |
$2,551.51
|
|
|
REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$2,679.26
|
|
|
Service Code
|
CPT 49507
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,551.51 |
| Max. Negotiated Rate |
$2,679.26 |
| Rate for Payer: BCBS Complete |
$2,679.26
|
| Rate for Payer: Mclaren Medicaid |
$2,551.51
|
| Rate for Payer: Meridian Medicaid |
$2,679.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,551.51
|
| Rate for Payer: UHCCP Medicaid |
$2,551.51
|
|
|
REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE
|
Facility
|
OP
|
$2,679.26
|
|
|
Service Code
|
CPT 49505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,551.51 |
| Max. Negotiated Rate |
$2,679.26 |
| Rate for Payer: BCBS Complete |
$2,679.26
|
| Rate for Payer: Mclaren Medicaid |
$2,551.51
|
| Rate for Payer: Meridian Medicaid |
$2,679.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,551.51
|
| Rate for Payer: UHCCP Medicaid |
$2,551.51
|
|
