|
SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$780.63
|
|
|
Service Code
|
NDC 43598-478-90
|
| Hospital Charge Code |
99694
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$343.48 |
| Max. Negotiated Rate |
$702.57 |
| Rate for Payer: Aetna American Axle |
$507.41
|
| Rate for Payer: Aetna Commercial |
$663.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.41
|
| Rate for Payer: Cash Price |
$624.50
|
| Rate for Payer: Cofinity Commercial |
$671.34
|
| Rate for Payer: Cofinity Commercial |
$546.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.50
|
| Rate for Payer: Healthscope Commercial |
$702.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$546.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$585.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$663.54
|
| Rate for Payer: PHP Commercial |
$663.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.44
|
| Rate for Payer: Priority Health SBD |
$491.80
|
| Rate for Payer: UMR Bronson Commercial |
$343.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$585.47
|
|
|
SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$8.68
|
|
|
Service Code
|
NDC 43598-478-01
|
| Hospital Charge Code |
99694
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$7.81 |
| Rate for Payer: Aetna American Axle |
$5.64
|
| Rate for Payer: Aetna Commercial |
$7.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.64
|
| Rate for Payer: Cash Price |
$6.94
|
| Rate for Payer: Cofinity Commercial |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$6.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.94
|
| Rate for Payer: Healthscope Commercial |
$7.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.38
|
| Rate for Payer: PHP Commercial |
$7.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.08
|
| Rate for Payer: Priority Health SBD |
$5.47
|
| Rate for Payer: UMR Bronson Commercial |
$3.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.51
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$61.42
|
|
|
Service Code
|
NDC 58468-0131-2
|
| Hospital Charge Code |
99695
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.02 |
| Max. Negotiated Rate |
$55.28 |
| Rate for Payer: Aetna American Axle |
$39.92
|
| Rate for Payer: Aetna Commercial |
$52.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.92
|
| Rate for Payer: Cash Price |
$49.14
|
| Rate for Payer: Cofinity Commercial |
$42.99
|
| Rate for Payer: Cofinity Commercial |
$52.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.14
|
| Rate for Payer: Healthscope Commercial |
$55.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.21
|
| Rate for Payer: PHP Commercial |
$52.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.99
|
| Rate for Payer: Priority Health SBD |
$38.69
|
| Rate for Payer: UMR Bronson Commercial |
$27.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.06
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$9.07
|
|
|
Service Code
|
NDC 65862-931-08
|
| Hospital Charge Code |
99695
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: Aetna American Axle |
$5.90
|
| Rate for Payer: Aetna Commercial |
$7.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.90
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Cofinity Commercial |
$6.35
|
| Rate for Payer: Cofinity Commercial |
$7.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.26
|
| Rate for Payer: Healthscope Commercial |
$8.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.71
|
| Rate for Payer: PHP Commercial |
$7.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.35
|
| Rate for Payer: Priority Health SBD |
$5.71
|
| Rate for Payer: UMR Bronson Commercial |
$3.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.80
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$816.05
|
|
|
Service Code
|
NDC 65862-931-90
|
| Hospital Charge Code |
99695
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$359.06 |
| Max. Negotiated Rate |
$734.44 |
| Rate for Payer: Aetna American Axle |
$530.43
|
| Rate for Payer: Aetna Commercial |
$693.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$530.43
|
| Rate for Payer: Cash Price |
$652.84
|
| Rate for Payer: Cofinity Commercial |
$571.24
|
| Rate for Payer: Cofinity Commercial |
$701.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$652.84
|
| Rate for Payer: Healthscope Commercial |
$734.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$571.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$612.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$693.64
|
| Rate for Payer: PHP Commercial |
$693.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.24
|
| Rate for Payer: Priority Health SBD |
$514.11
|
| Rate for Payer: UMR Bronson Commercial |
$359.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$612.04
|
|
|
SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$61.42
|
|
|
Service Code
|
NDC 58468-0131-1
|
| Hospital Charge Code |
99695
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.02 |
| Max. Negotiated Rate |
$55.28 |
| Rate for Payer: Aetna American Axle |
$39.92
|
| Rate for Payer: Aetna Commercial |
$52.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.92
|
| Rate for Payer: Cash Price |
$49.14
|
| Rate for Payer: Cofinity Commercial |
$52.82
|
| Rate for Payer: Cofinity Commercial |
$42.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.14
|
| Rate for Payer: Healthscope Commercial |
$55.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.21
|
| Rate for Payer: PHP Commercial |
$52.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.99
|
| Rate for Payer: Priority Health SBD |
$38.69
|
| Rate for Payer: UMR Bronson Commercial |
$27.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.06
|
|
|
SEVELAMER CARBONATE 800 MG TABLET
|
Facility
|
IP
|
$928.53
|
|
|
Service Code
|
NDC 65162-058-27
|
| Hospital Charge Code |
89201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$408.55 |
| Max. Negotiated Rate |
$835.68 |
| Rate for Payer: Aetna American Axle |
$603.54
|
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.54
|
| Rate for Payer: Cash Price |
$742.82
|
| Rate for Payer: Cofinity Commercial |
$649.97
|
| Rate for Payer: Cofinity Commercial |
$798.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.82
|
| Rate for Payer: Healthscope Commercial |
$835.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$696.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$789.25
|
| Rate for Payer: PHP Commercial |
$789.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.97
|
| Rate for Payer: Priority Health SBD |
$584.97
|
| Rate for Payer: UMR Bronson Commercial |
$408.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$696.40
|
|
|
SEVELAMER CARBONATE 800 MG TABLET
|
Facility
|
IP
|
$2,051.57
|
|
|
Service Code
|
NDC 0955-1050-27
|
| Hospital Charge Code |
89201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$902.69 |
| Max. Negotiated Rate |
$1,846.41 |
| Rate for Payer: Aetna American Axle |
$1,333.52
|
| Rate for Payer: Aetna Commercial |
$1,743.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,333.52
|
| Rate for Payer: Cash Price |
$1,641.26
|
| Rate for Payer: Cofinity Commercial |
$1,436.10
|
| Rate for Payer: Cofinity Commercial |
$1,764.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,641.26
|
| Rate for Payer: Healthscope Commercial |
$1,846.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,436.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,538.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,743.83
|
| Rate for Payer: PHP Commercial |
$1,743.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,436.10
|
| Rate for Payer: Priority Health SBD |
$1,292.49
|
| Rate for Payer: UMR Bronson Commercial |
$902.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,538.68
|
|
|
SEVELAMER CARBONATE 800 MG TABLET
|
Facility
|
IP
|
$390.24
|
|
|
Service Code
|
NDC 0904-6707-06
|
| Hospital Charge Code |
89201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.71 |
| Max. Negotiated Rate |
$351.22 |
| Rate for Payer: Aetna American Axle |
$253.66
|
| Rate for Payer: Aetna Commercial |
$331.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.66
|
| Rate for Payer: Cash Price |
$312.19
|
| Rate for Payer: Cofinity Commercial |
$273.17
|
| Rate for Payer: Cofinity Commercial |
$335.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.19
|
| Rate for Payer: Healthscope Commercial |
$351.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$273.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$331.70
|
| Rate for Payer: PHP Commercial |
$331.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.17
|
| Rate for Payer: Priority Health SBD |
$245.85
|
| Rate for Payer: UMR Bronson Commercial |
$171.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.68
|
|
|
SEVELAMER CARBONATE 800 MG TABLET
|
Facility
|
IP
|
$5,499.50
|
|
|
Service Code
|
NDC 58468-0130-1
|
| Hospital Charge Code |
89201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,419.78 |
| Max. Negotiated Rate |
$4,949.55 |
| Rate for Payer: Aetna American Axle |
$3,574.68
|
| Rate for Payer: Aetna Commercial |
$4,674.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,574.68
|
| Rate for Payer: Cash Price |
$4,399.60
|
| Rate for Payer: Cofinity Commercial |
$3,849.65
|
| Rate for Payer: Cofinity Commercial |
$4,729.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,399.60
|
| Rate for Payer: Healthscope Commercial |
$4,949.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,849.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,124.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,674.58
|
| Rate for Payer: PHP Commercial |
$4,674.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,849.65
|
| Rate for Payer: Priority Health SBD |
$3,464.68
|
| Rate for Payer: UMR Bronson Commercial |
$2,419.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,124.62
|
|
|
SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR WITHOUT INJECTION OF AIR OR LIQUID) (SEPARATE PROCEDURE); ANTERIOR SYNECHIAE, EXCEPT GONIOSYNECHIAE
|
Facility
|
OP
|
$6,520.89
|
|
|
Service Code
|
CPT 65870
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$6,520.89 |
| Rate for Payer: Aetna Medicare |
$2,154.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,589.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,589.26
|
| Rate for Payer: BCBS Complete |
$1,189.82
|
| Rate for Payer: BCBS MAPPO |
$2,071.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,693.81
|
| Rate for Payer: BCN Medicare Advantage |
$2,071.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,071.41
|
| Rate for Payer: Mclaren Medicaid |
$1,133.06
|
| Rate for Payer: Mclaren Medicare |
$2,071.41
|
| Rate for Payer: Meridian Medicaid |
$1,189.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,174.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,382.12
|
| Rate for Payer: PACE Medicare |
$1,967.84
|
| Rate for Payer: PACE SWMI |
$2,071.41
|
| Rate for Payer: PHP Medicare Advantage |
$2,071.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,133.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,520.89
|
| Rate for Payer: Priority Health Medicare |
$2,071.41
|
| Rate for Payer: Priority Health Narrow Network |
$5,216.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2,071.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$637.16
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,071.41
|
| Rate for Payer: UHC Exchange |
$579.24
|
| Rate for Payer: UHC Medicare Advantage |
$2,133.55
|
| Rate for Payer: VA VA |
$2,071.41
|
|
|
SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR WITHOUT INJECTION OF AIR OR LIQUID) (SEPARATE PROCEDURE); CORNEOVITREAL ADHESIONS
|
Facility
|
OP
|
$11,377.15
|
|
|
Service Code
|
CPT 65880
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$649.64 |
| Max. Negotiated Rate |
$11,377.15 |
| Rate for Payer: Aetna Medicare |
$3,758.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,517.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,517.55
|
| Rate for Payer: BCBS Complete |
$2,075.90
|
| Rate for Payer: BCBS MAPPO |
$3,614.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,597.35
|
| Rate for Payer: BCN Medicare Advantage |
$3,614.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,614.04
|
| Rate for Payer: Mclaren Medicaid |
$1,976.88
|
| Rate for Payer: Mclaren Medicare |
$3,614.04
|
| Rate for Payer: Meridian Medicaid |
$2,075.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,794.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,156.15
|
| Rate for Payer: PACE Medicare |
$3,433.34
|
| Rate for Payer: PACE SWMI |
$3,614.04
|
| Rate for Payer: PHP Medicare Advantage |
$3,614.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,976.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,377.15
|
| Rate for Payer: Priority Health Medicare |
$3,614.04
|
| Rate for Payer: Priority Health Narrow Network |
$9,101.72
|
| Rate for Payer: Railroad Medicare Medicare |
$3,614.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$714.60
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,614.04
|
| Rate for Payer: UHC Exchange |
$649.64
|
| Rate for Payer: UHC Medicare Advantage |
$3,722.46
|
| Rate for Payer: VA VA |
$3,614.04
|
|
|
SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR WITHOUT INJECTION OF AIR OR LIQUID) (SEPARATE PROCEDURE); POSTERIOR SYNECHIAE
|
Facility
|
OP
|
$6,520.89
|
|
|
Service Code
|
CPT 65875
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$618.54 |
| Max. Negotiated Rate |
$6,520.89 |
| Rate for Payer: Aetna Medicare |
$2,154.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,589.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,589.26
|
| Rate for Payer: BCBS Complete |
$1,189.82
|
| Rate for Payer: BCBS MAPPO |
$2,071.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,693.81
|
| Rate for Payer: BCN Medicare Advantage |
$2,071.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,071.41
|
| Rate for Payer: Mclaren Medicaid |
$1,133.06
|
| Rate for Payer: Mclaren Medicare |
$2,071.41
|
| Rate for Payer: Meridian Medicaid |
$1,189.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,174.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,382.12
|
| Rate for Payer: PACE Medicare |
$1,967.84
|
| Rate for Payer: PACE SWMI |
$2,071.41
|
| Rate for Payer: PHP Medicare Advantage |
$2,071.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,133.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,520.89
|
| Rate for Payer: Priority Health Medicare |
$2,071.41
|
| Rate for Payer: Priority Health Narrow Network |
$5,216.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2,071.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$680.39
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,071.41
|
| Rate for Payer: UHC Exchange |
$618.54
|
| Rate for Payer: UHC Medicare Advantage |
$2,133.55
|
| Rate for Payer: VA VA |
$2,071.41
|
|
|
SEVOFLURANE INHALATION LIQUID
|
Facility
|
IP
|
$214.38
|
|
|
Service Code
|
NDC 0074-4456-51
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.33 |
| Max. Negotiated Rate |
$192.94 |
| Rate for Payer: Aetna American Axle |
$139.35
|
| Rate for Payer: Aetna Commercial |
$182.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.35
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cofinity Commercial |
$150.07
|
| Rate for Payer: Cofinity Commercial |
$184.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.50
|
| Rate for Payer: Healthscope Commercial |
$192.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$182.22
|
| Rate for Payer: PHP Commercial |
$182.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.07
|
| Rate for Payer: Priority Health SBD |
$135.06
|
| Rate for Payer: UMR Bronson Commercial |
$94.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.78
|
|
|
SEVOFLURANE INHALATION LIQUID
|
Facility
|
IP
|
$223.13
|
|
|
Service Code
|
NDC 10019-651-64
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.18 |
| Max. Negotiated Rate |
$200.82 |
| Rate for Payer: Aetna American Axle |
$145.03
|
| Rate for Payer: Aetna Commercial |
$189.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.03
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cofinity Commercial |
$156.19
|
| Rate for Payer: Cofinity Commercial |
$191.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.50
|
| Rate for Payer: Healthscope Commercial |
$200.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$189.66
|
| Rate for Payer: PHP Commercial |
$189.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.19
|
| Rate for Payer: Priority Health SBD |
$140.57
|
| Rate for Payer: UMR Bronson Commercial |
$98.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.35
|
|
|
SEVOFLURANE INHALATION LIQUID
|
Facility
|
IP
|
$214.38
|
|
|
Service Code
|
NDC 0074-4456-04
|
| Hospital Charge Code |
15119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.33 |
| Max. Negotiated Rate |
$192.94 |
| Rate for Payer: Aetna American Axle |
$139.35
|
| Rate for Payer: Aetna Commercial |
$182.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.35
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cofinity Commercial |
$150.07
|
| Rate for Payer: Cofinity Commercial |
$184.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.50
|
| Rate for Payer: Healthscope Commercial |
$192.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$182.22
|
| Rate for Payer: PHP Commercial |
$182.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.07
|
| Rate for Payer: Priority Health SBD |
$135.06
|
| Rate for Payer: UMR Bronson Commercial |
$94.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.78
|
|
|
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 0.6 TO 1.0 CM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 11311
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$60.90 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$185.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$88.40
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$560.20
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$448.16
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.99
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$60.90
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER 1.1 TO 2.0 CM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 11302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.96 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$185.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$135.86
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$560.20
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$448.16
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.76
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$57.96
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC
|
Facility
|
IP
|
$41,799.58
|
|
|
Service Code
|
MS-DRG 511
|
| Min. Negotiated Rate |
$15,082.81 |
| Max. Negotiated Rate |
$41,799.58 |
| Rate for Payer: Aetna Medicare |
$16,511.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,845.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,845.80
|
| Rate for Payer: BCBS MAPPO |
$15,876.64
|
| Rate for Payer: BCBS Trust/PPO |
$41,799.58
|
| Rate for Payer: BCN Medicare Advantage |
$15,876.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,876.64
|
| Rate for Payer: Mclaren Medicare |
$15,876.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,670.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,258.14
|
| Rate for Payer: PACE Medicare |
$15,082.81
|
| Rate for Payer: PACE SWMI |
$15,876.64
|
| Rate for Payer: PHP Medicare Advantage |
$15,876.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,610.87
|
| Rate for Payer: Priority Health Medicare |
$15,876.64
|
| Rate for Payer: Priority Health Narrow Network |
$22,888.70
|
| Rate for Payer: Railroad Medicare Medicare |
$15,876.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,413.43
|
| Rate for Payer: UHC Core |
$24,938.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,876.64
|
| Rate for Payer: UHC Exchange |
$19,826.35
|
| Rate for Payer: UHC Medicare Advantage |
$16,352.94
|
| Rate for Payer: VA VA |
$15,876.64
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC
|
Facility
|
IP
|
$46,149.41
|
|
|
Service Code
|
MS-DRG 510
|
| Min. Negotiated Rate |
$20,403.53 |
| Max. Negotiated Rate |
$46,149.41 |
| Rate for Payer: Aetna Medicare |
$22,336.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,846.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,846.75
|
| Rate for Payer: BCBS MAPPO |
$21,477.40
|
| Rate for Payer: BCBS Trust/PPO |
$46,149.41
|
| Rate for Payer: BCN Medicare Advantage |
$21,477.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,477.40
|
| Rate for Payer: Mclaren Medicare |
$21,477.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,551.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,699.01
|
| Rate for Payer: PACE Medicare |
$20,403.53
|
| Rate for Payer: PACE SWMI |
$21,477.40
|
| Rate for Payer: PHP Medicare Advantage |
$21,477.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39,040.39
|
| Rate for Payer: Priority Health Medicare |
$21,477.40
|
| Rate for Payer: Priority Health Narrow Network |
$31,232.31
|
| Rate for Payer: Railroad Medicare Medicare |
$21,477.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41,500.03
|
| Rate for Payer: UHC Core |
$34,029.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,477.40
|
| Rate for Payer: UHC Exchange |
$27,053.65
|
| Rate for Payer: UHC Medicare Advantage |
$22,121.72
|
| Rate for Payer: VA VA |
$21,477.40
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$33,828.66
|
|
|
Service Code
|
MS-DRG 512
|
| Min. Negotiated Rate |
$12,300.94 |
| Max. Negotiated Rate |
$33,828.66 |
| Rate for Payer: Aetna Medicare |
$13,466.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,185.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,185.45
|
| Rate for Payer: BCBS MAPPO |
$12,948.36
|
| Rate for Payer: BCBS Trust/PPO |
$33,828.66
|
| Rate for Payer: BCN Medicare Advantage |
$12,948.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,948.36
|
| Rate for Payer: Mclaren Medicare |
$12,948.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,595.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,890.61
|
| Rate for Payer: PACE Medicare |
$12,300.94
|
| Rate for Payer: PACE SWMI |
$12,948.36
|
| Rate for Payer: PHP Medicare Advantage |
$12,948.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,157.90
|
| Rate for Payer: Priority Health Medicare |
$12,948.36
|
| Rate for Payer: Priority Health Narrow Network |
$18,526.32
|
| Rate for Payer: Railroad Medicare Medicare |
$12,948.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,616.91
|
| Rate for Payer: UHC Core |
$20,185.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,948.36
|
| Rate for Payer: UHC Exchange |
$16,047.63
|
| Rate for Payer: UHC Medicare Advantage |
$13,336.81
|
| Rate for Payer: VA VA |
$12,948.36
|
|
|
SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), COMPLICATED, INTRAORAL
|
Facility
|
OP
|
$9,009.23
|
|
|
Service Code
|
CPT 42335
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$261.63 |
| Max. Negotiated Rate |
$9,009.23 |
| Rate for Payer: Aetna Medicare |
$2,976.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$310.17
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,009.23
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$7,207.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.79
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,861.84
|
| Rate for Payer: UHC Exchange |
$261.63
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), SUBLINGUAL OR PAROTID, UNCOMPLICATED, INTRAORAL
|
Facility
|
OP
|
$9,009.23
|
|
|
Service Code
|
CPT 42330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$164.05 |
| Max. Negotiated Rate |
$9,009.23 |
| Rate for Payer: Aetna Medicare |
$2,976.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$185.17
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,009.23
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$7,207.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.46
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,861.84
|
| Rate for Payer: UHC Exchange |
$164.05
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,557.47
|
|
|
Service Code
|
CPT 45330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$55.34 |
| Max. Negotiated Rate |
$2,557.47 |
| Rate for Payer: Aetna Medicare |
$844.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,015.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,015.50
|
| Rate for Payer: BCBS Complete |
$466.64
|
| Rate for Payer: BCBS MAPPO |
$812.40
|
| Rate for Payer: BCBS Trust/PPO |
$888.71
|
| Rate for Payer: BCN Medicare Advantage |
$812.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.40
|
| Rate for Payer: Mclaren Medicaid |
$444.38
|
| Rate for Payer: Mclaren Medicare |
$812.40
|
| Rate for Payer: Meridian Medicaid |
$466.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$934.26
|
| Rate for Payer: PACE Medicare |
$771.78
|
| Rate for Payer: PACE SWMI |
$812.40
|
| Rate for Payer: PHP Medicare Advantage |
$812.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,557.47
|
| Rate for Payer: Priority Health Medicare |
$812.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,045.98
|
| Rate for Payer: Railroad Medicare Medicare |
$812.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.87
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$812.40
|
| Rate for Payer: UHC Exchange |
$55.34
|
| Rate for Payer: UHC Medicare Advantage |
$836.77
|
| Rate for Payer: VA VA |
$812.40
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED)
|
Facility
|
OP
|
$3,302.11
|
|
|
Service Code
|
CPT 45346
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$155.21 |
| Max. Negotiated Rate |
$3,302.11 |
| Rate for Payer: Aetna Medicare |
$1,090.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,311.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,311.18
|
| Rate for Payer: BCBS Complete |
$602.51
|
| Rate for Payer: BCBS MAPPO |
$1,048.94
|
| Rate for Payer: BCBS Trust/PPO |
$821.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.94
|
| Rate for Payer: Mclaren Medicaid |
$573.77
|
| Rate for Payer: Mclaren Medicare |
$1,048.94
|
| Rate for Payer: Meridian Medicaid |
$602.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.28
|
| Rate for Payer: PACE Medicare |
$996.49
|
| Rate for Payer: PACE SWMI |
$1,048.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,302.11
|
| Rate for Payer: Priority Health Medicare |
$1,048.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,641.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.73
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.94
|
| Rate for Payer: UHC Exchange |
$155.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.41
|
| Rate for Payer: VA VA |
$1,048.94
|
|
