|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,412.76
|
|
|
Service Code
|
HCPCS J9308
|
| Hospital Charge Code |
170507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.42 |
| Max. Negotiated Rate |
$5,771.48 |
| Rate for Payer: Aetna American Axle |
$4,168.29
|
| Rate for Payer: Aetna Commercial |
$5,450.85
|
| Rate for Payer: Aetna Medicare |
$73.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,168.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.80
|
| Rate for Payer: BCBS Complete |
$40.35
|
| Rate for Payer: BCBS MAPPO |
$70.24
|
| Rate for Payer: BCBS Trust/PPO |
$226.97
|
| Rate for Payer: BCN Medicare Advantage |
$70.24
|
| Rate for Payer: Cash Price |
$5,130.21
|
| Rate for Payer: Cash Price |
$5,130.21
|
| Rate for Payer: Cofinity Commercial |
$4,488.93
|
| Rate for Payer: Cofinity Commercial |
$5,514.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,130.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.24
|
| Rate for Payer: Healthscope Commercial |
$5,771.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,488.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,809.57
|
| Rate for Payer: Mclaren Medicaid |
$38.42
|
| Rate for Payer: Mclaren Medicare |
$70.24
|
| Rate for Payer: Meridian Medicaid |
$40.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,450.85
|
| Rate for Payer: PACE Medicare |
$66.73
|
| Rate for Payer: PACE SWMI |
$70.24
|
| Rate for Payer: PHP Commercial |
$5,450.85
|
| Rate for Payer: PHP Medicare Advantage |
$70.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,488.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.66
|
| Rate for Payer: Priority Health Medicare |
$70.24
|
| Rate for Payer: Priority Health Narrow Network |
$162.13
|
| Rate for Payer: Priority Health SBD |
$4,040.04
|
| Rate for Payer: Railroad Medicare Medicare |
$70.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.24
|
| Rate for Payer: UHC Medicare Advantage |
$72.35
|
| Rate for Payer: UMR Bronson Commercial |
$2,372.72
|
| Rate for Payer: VA VA |
$70.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,809.57
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$154.47
|
|
|
Service Code
|
NDC 70756-703-60
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.97 |
| Max. Negotiated Rate |
$139.02 |
| Rate for Payer: Aetna American Axle |
$100.41
|
| Rate for Payer: Aetna Commercial |
$131.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.41
|
| Rate for Payer: Cash Price |
$123.58
|
| Rate for Payer: Cofinity Commercial |
$108.13
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$108.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.30
|
| Rate for Payer: PHP Commercial |
$131.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.13
|
| Rate for Payer: Priority Health SBD |
$97.32
|
| Rate for Payer: UMR Bronson Commercial |
$67.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.85
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$5.78
|
|
|
Service Code
|
NDC 60687-549-11
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: Aetna American Axle |
$3.76
|
| Rate for Payer: Aetna Commercial |
$4.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.76
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cofinity Commercial |
$4.05
|
| Rate for Payer: Cofinity Commercial |
$4.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.62
|
| Rate for Payer: Healthscope Commercial |
$5.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.91
|
| Rate for Payer: PHP Commercial |
$4.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.05
|
| Rate for Payer: Priority Health SBD |
$3.64
|
| Rate for Payer: UMR Bronson Commercial |
$2.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.34
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$381.03
|
|
|
Service Code
|
NDC 45963-418-06
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.65 |
| Max. Negotiated Rate |
$342.93 |
| Rate for Payer: Aetna American Axle |
$247.67
|
| Rate for Payer: Aetna Commercial |
$323.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.67
|
| Rate for Payer: Cash Price |
$304.82
|
| Rate for Payer: Cofinity Commercial |
$266.72
|
| Rate for Payer: Cofinity Commercial |
$327.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.82
|
| Rate for Payer: Healthscope Commercial |
$342.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.88
|
| Rate for Payer: PHP Commercial |
$323.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.72
|
| Rate for Payer: Priority Health SBD |
$240.05
|
| Rate for Payer: UMR Bronson Commercial |
$167.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.77
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$1,414.81
|
|
|
Service Code
|
NDC 61958-1003-1
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$622.52 |
| Max. Negotiated Rate |
$1,273.33 |
| Rate for Payer: Aetna American Axle |
$919.63
|
| Rate for Payer: Aetna Commercial |
$1,202.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$919.63
|
| Rate for Payer: Cash Price |
$1,131.85
|
| Rate for Payer: Cofinity Commercial |
$1,216.74
|
| Rate for Payer: Cofinity Commercial |
$990.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.85
|
| Rate for Payer: Healthscope Commercial |
$1,273.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$990.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,061.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,202.59
|
| Rate for Payer: PHP Commercial |
$1,202.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.37
|
| Rate for Payer: Priority Health SBD |
$891.33
|
| Rate for Payer: UMR Bronson Commercial |
$622.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,061.11
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$173.38
|
|
|
Service Code
|
NDC 60687-549-21
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.29 |
| Max. Negotiated Rate |
$156.04 |
| Rate for Payer: Aetna American Axle |
$112.70
|
| Rate for Payer: Aetna Commercial |
$147.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.70
|
| Rate for Payer: Cash Price |
$138.70
|
| Rate for Payer: Cofinity Commercial |
$121.37
|
| Rate for Payer: Cofinity Commercial |
$149.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.70
|
| Rate for Payer: Healthscope Commercial |
$156.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.37
|
| Rate for Payer: PHP Commercial |
$147.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.37
|
| Rate for Payer: Priority Health SBD |
$109.23
|
| Rate for Payer: UMR Bronson Commercial |
$76.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.04
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
IP
|
$335.56
|
|
|
Service Code
|
NDC 67877-259-30
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.65 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: Aetna American Axle |
$218.11
|
| Rate for Payer: Aetna Commercial |
$285.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.11
|
| Rate for Payer: Cash Price |
$268.45
|
| Rate for Payer: Cofinity Commercial |
$234.89
|
| Rate for Payer: Cofinity Commercial |
$288.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.45
|
| Rate for Payer: Healthscope Commercial |
$302.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$285.23
|
| Rate for Payer: PHP Commercial |
$285.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.89
|
| Rate for Payer: Priority Health SBD |
$211.40
|
| Rate for Payer: UMR Bronson Commercial |
$147.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.67
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
IP
|
$295.93
|
|
|
Service Code
|
NDC 23155-746-03
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.21 |
| Max. Negotiated Rate |
$266.34 |
| Rate for Payer: Aetna American Axle |
$192.35
|
| Rate for Payer: Aetna Commercial |
$251.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.35
|
| Rate for Payer: Cash Price |
$236.74
|
| Rate for Payer: Cofinity Commercial |
$207.15
|
| Rate for Payer: Cofinity Commercial |
$254.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.74
|
| Rate for Payer: Healthscope Commercial |
$266.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.54
|
| Rate for Payer: PHP Commercial |
$251.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.15
|
| Rate for Payer: Priority Health SBD |
$186.44
|
| Rate for Payer: UMR Bronson Commercial |
$130.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.95
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
IP
|
$1,417.59
|
|
|
Service Code
|
NDC 0378-1270-93
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$623.74 |
| Max. Negotiated Rate |
$1,275.83 |
| Rate for Payer: Aetna American Axle |
$921.43
|
| Rate for Payer: Aetna Commercial |
$1,204.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.43
|
| Rate for Payer: Cash Price |
$1,134.07
|
| Rate for Payer: Cofinity Commercial |
$1,219.13
|
| Rate for Payer: Cofinity Commercial |
$992.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,134.07
|
| Rate for Payer: Healthscope Commercial |
$1,275.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$992.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,063.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,204.95
|
| Rate for Payer: PHP Commercial |
$1,204.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$992.31
|
| Rate for Payer: Priority Health SBD |
$893.08
|
| Rate for Payer: UMR Bronson Commercial |
$623.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,063.19
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
IP
|
$3,935.18
|
|
|
Service Code
|
NDC 68546-142-56
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,731.48 |
| Max. Negotiated Rate |
$3,541.66 |
| Rate for Payer: Aetna American Axle |
$2,557.87
|
| Rate for Payer: Aetna Commercial |
$3,344.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,557.87
|
| Rate for Payer: Cash Price |
$3,148.14
|
| Rate for Payer: Cofinity Commercial |
$2,754.63
|
| Rate for Payer: Cofinity Commercial |
$3,384.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,148.14
|
| Rate for Payer: Healthscope Commercial |
$3,541.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,754.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,951.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,344.90
|
| Rate for Payer: PHP Commercial |
$3,344.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,754.63
|
| Rate for Payer: Priority Health SBD |
$2,479.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,731.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,951.38
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,438.46
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
33591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,512.92 |
| Max. Negotiated Rate |
$3,094.61 |
| Rate for Payer: Aetna American Axle |
$2,235.00
|
| Rate for Payer: Aetna Commercial |
$2,922.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,235.00
|
| Rate for Payer: Cash Price |
$2,750.77
|
| Rate for Payer: Cofinity Commercial |
$2,406.92
|
| Rate for Payer: Cofinity Commercial |
$2,957.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,750.77
|
| Rate for Payer: Healthscope Commercial |
$3,094.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,406.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,578.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,922.69
|
| Rate for Payer: PHP Commercial |
$2,922.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,406.92
|
| Rate for Payer: Priority Health SBD |
$2,166.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,512.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,578.84
|
|
|
RAVULIZUMAB-CWVZ 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$61,051.45
|
|
|
Service Code
|
HCPCS J1303
|
| Hospital Charge Code |
195284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26,862.64 |
| Max. Negotiated Rate |
$54,946.30 |
| Rate for Payer: Aetna American Axle |
$39,683.44
|
| Rate for Payer: Aetna American Axle |
$10,822.77
|
| Rate for Payer: Aetna Commercial |
$14,152.85
|
| Rate for Payer: Aetna Commercial |
$51,893.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,822.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39,683.44
|
| Rate for Payer: Cash Price |
$48,841.16
|
| Rate for Payer: Cash Price |
$13,320.33
|
| Rate for Payer: Cofinity Commercial |
$11,655.29
|
| Rate for Payer: Cofinity Commercial |
$14,319.35
|
| Rate for Payer: Cofinity Commercial |
$42,736.02
|
| Rate for Payer: Cofinity Commercial |
$52,504.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,320.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48,841.16
|
| Rate for Payer: Healthscope Commercial |
$54,946.30
|
| Rate for Payer: Healthscope Commercial |
$14,985.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,655.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42,736.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45,788.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,487.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51,893.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,152.85
|
| Rate for Payer: PHP Commercial |
$14,152.85
|
| Rate for Payer: PHP Commercial |
$51,893.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42,736.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,655.29
|
| Rate for Payer: Priority Health SBD |
$38,462.41
|
| Rate for Payer: Priority Health SBD |
$10,489.76
|
| Rate for Payer: UMR Bronson Commercial |
$7,326.18
|
| Rate for Payer: UMR Bronson Commercial |
$26,862.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45,788.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,487.81
|
|
|
RAVULIZUMAB-CWVZ 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$61,051.45
|
|
|
Service Code
|
HCPCS J1303
|
| Hospital Charge Code |
195284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.31 |
| Max. Negotiated Rate |
$54,946.30 |
| Rate for Payer: Aetna American Axle |
$39,683.44
|
| Rate for Payer: Aetna American Axle |
$10,822.77
|
| Rate for Payer: Aetna Commercial |
$14,152.85
|
| Rate for Payer: Aetna Commercial |
$51,893.73
|
| Rate for Payer: Aetna Medicare |
$230.64
|
| Rate for Payer: Aetna Medicare |
$230.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,822.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39,683.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$277.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$277.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$277.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$277.22
|
| Rate for Payer: BCBS Complete |
$127.39
|
| Rate for Payer: BCBS Complete |
$127.39
|
| Rate for Payer: BCBS MAPPO |
$221.77
|
| Rate for Payer: BCBS MAPPO |
$221.77
|
| Rate for Payer: BCBS Trust/PPO |
$716.65
|
| Rate for Payer: BCBS Trust/PPO |
$716.65
|
| Rate for Payer: BCN Medicare Advantage |
$221.77
|
| Rate for Payer: BCN Medicare Advantage |
$221.77
|
| Rate for Payer: Cash Price |
$13,320.33
|
| Rate for Payer: Cash Price |
$48,841.16
|
| Rate for Payer: Cash Price |
$48,841.16
|
| Rate for Payer: Cash Price |
$13,320.33
|
| Rate for Payer: Cofinity Commercial |
$14,319.35
|
| Rate for Payer: Cofinity Commercial |
$11,655.29
|
| Rate for Payer: Cofinity Commercial |
$42,736.02
|
| Rate for Payer: Cofinity Commercial |
$52,504.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,320.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48,841.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.77
|
| Rate for Payer: Healthscope Commercial |
$54,946.30
|
| Rate for Payer: Healthscope Commercial |
$14,985.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,655.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42,736.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,487.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45,788.59
|
| Rate for Payer: Mclaren Medicaid |
$121.31
|
| Rate for Payer: Mclaren Medicaid |
$121.31
|
| Rate for Payer: Mclaren Medicare |
$221.77
|
| Rate for Payer: Mclaren Medicare |
$221.77
|
| Rate for Payer: Meridian Medicaid |
$127.39
|
| Rate for Payer: Meridian Medicaid |
$127.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$232.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$232.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$255.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$255.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,152.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51,893.73
|
| Rate for Payer: PACE Medicare |
$210.68
|
| Rate for Payer: PACE Medicare |
$210.68
|
| Rate for Payer: PACE SWMI |
$221.77
|
| Rate for Payer: PACE SWMI |
$221.77
|
| Rate for Payer: PHP Commercial |
$51,893.73
|
| Rate for Payer: PHP Commercial |
$14,152.85
|
| Rate for Payer: PHP Medicare Advantage |
$221.77
|
| Rate for Payer: PHP Medicare Advantage |
$221.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42,736.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,655.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$651.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$651.02
|
| Rate for Payer: Priority Health Medicare |
$221.77
|
| Rate for Payer: Priority Health Medicare |
$221.77
|
| Rate for Payer: Priority Health Narrow Network |
$520.82
|
| Rate for Payer: Priority Health Narrow Network |
$520.82
|
| Rate for Payer: Priority Health SBD |
$10,489.76
|
| Rate for Payer: Priority Health SBD |
$38,462.41
|
| Rate for Payer: Railroad Medicare Medicare |
$221.77
|
| Rate for Payer: Railroad Medicare Medicare |
$221.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.77
|
| Rate for Payer: UHC Medicare Advantage |
$228.43
|
| Rate for Payer: UHC Medicare Advantage |
$228.43
|
| Rate for Payer: UMR Bronson Commercial |
$6,160.65
|
| Rate for Payer: UMR Bronson Commercial |
$22,589.04
|
| Rate for Payer: VA VA |
$221.77
|
| Rate for Payer: VA VA |
$221.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,487.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45,788.59
|
|
|
REALIGNMENT OF EXTENSOR TENDON, HAND, EACH TENDON
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26437
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$664.71 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,810.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$731.18
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$664.71
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
RECONSTRUCTION (ADVANCEMENT), POSTERIOR TIBIAL TENDON WITH EXCISION OF ACCESSORY TARSAL NAVICULAR BONE (EG, KIDNER TYPE PROCEDURE)
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 28238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$484.29 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$4,194.07
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.72
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$484.29
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
RECONSTRUCTION, ANGULAR DEFORMITY OF TOE, SOFT TISSUE PROCEDURES ONLY (EG, OVERLAPPING SECOND TOE, FIFTH TOE, CURLY TOES)
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 28313
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$359.53 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,810.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.48
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$359.53
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
RECONSTRUCTION, COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT, SINGLE; WITH TENDON OR FASCIAL GRAFT (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26541
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$831.38 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,337.98
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$914.52
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$831.38
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
RECONSTRUCTION LATERAL COLLATERAL LIGAMENT, ELBOW, WITH TENDON GRAFT (INCLUDES HARVESTING OF GRAFT)
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 24344
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,096.60 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$4,590.53
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,206.26
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$1,096.60
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
RECONSTRUCTION MEDIAL COLLATERAL LIGAMENT, ELBOW, WITH TENDON GRAFT (INCLUDES HARVESTING OF GRAFT)
|
Facility
|
OP
|
$36,827.89
|
|
|
Service Code
|
CPT 24346
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,096.60 |
| Max. Negotiated Rate |
$36,827.89 |
| Rate for Payer: Aetna Medicare |
$12,166.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,623.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,623.31
|
| Rate for Payer: BCBS Complete |
$6,719.70
|
| Rate for Payer: BCBS MAPPO |
$11,698.65
|
| Rate for Payer: BCBS Trust/PPO |
$7,393.38
|
| Rate for Payer: BCN Medicare Advantage |
$11,698.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,698.65
|
| Rate for Payer: Mclaren Medicaid |
$6,399.16
|
| Rate for Payer: Mclaren Medicare |
$11,698.65
|
| Rate for Payer: Meridian Medicaid |
$6,719.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,283.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,453.45
|
| Rate for Payer: PACE Medicare |
$11,113.72
|
| Rate for Payer: PACE SWMI |
$11,698.65
|
| Rate for Payer: PHP Medicare Advantage |
$11,698.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,399.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,827.89
|
| Rate for Payer: Priority Health Medicare |
$11,698.65
|
| Rate for Payer: Priority Health Narrow Network |
$29,462.31
|
| Rate for Payer: Railroad Medicare Medicare |
$11,698.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,206.26
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,698.65
|
| Rate for Payer: UHC Exchange |
$1,096.60
|
| Rate for Payer: UHC Medicare Advantage |
$12,049.61
|
| Rate for Payer: VA VA |
$11,698.65
|
|
|
RECONSTRUCTION MIDFACE, LEFORT I; 2 PIECES, SEGMENT MOVEMENT IN ANY DIRECTION, WITHOUT BONE GRAFT
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 21142
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,335.64 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$4,906.62
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,469.20
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,335.64
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
RECONSTRUCTION MIDFACE, LEFORT I; 3 OR MORE PIECES, SEGMENT MOVEMENT IN ANY DIRECTION, WITHOUT BONE GRAFT
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 21143
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,376.57 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$5,098.17
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,514.23
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,376.57
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
RECONSTRUCTION MIDFACE, LEFORT I; SINGLE PIECE, SEGMENT MOVEMENT IN ANY DIRECTION (EG, FOR LONG FACE SYNDROME), WITHOUT BONE GRAFT
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 21141
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,301.58 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$4,680.15
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,431.74
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,301.58
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
RECONSTRUCTION OF DISLOCATING PATELLA; (EG, HAUSER TYPE PROCEDURE)
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 27420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$747.22 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,934.75
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$821.94
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$747.22
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
RECONSTRUCTION OF DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE ADVANCEMENT OR RELEASE (EG, CAMPBELL, GOLDWAITE TYPE PROCEDURE)
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 27422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$738.71 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,934.75
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$812.58
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$738.71
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
RECONSTRUCTION OF EXTERNAL AUDITORY CANAL (MEATOPLASTY) (EG, FOR STENOSIS DUE TO INJURY, INFECTION) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 69310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.51 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,531.52
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,211.66
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,101.51
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
