|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.6 CM TO 5.0 CM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 12013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$56.65 |
| 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 |
$185.20
|
| 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) |
$62.32
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$56.65
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 7.6 CM TO 12.5 CM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 12015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$92.01 |
| 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 |
$288.32
|
| 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) |
$101.21
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$92.01
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 7.6 CM TO 12.5 CM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 12015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$92.01 |
| 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 |
$288.32
|
| 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) |
$101.21
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$92.01
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 12.6 CM TO 20.0 CM
|
Facility
|
OP
|
$1,115.78
|
|
|
Service Code
|
CPT 12005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$92.67 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$398.96
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.94
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$92.67
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 12.6 CM TO 20.0 CM
|
Facility
|
OP
|
$1,115.78
|
|
|
Service Code
|
CPT 12005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$92.67 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$398.96
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.94
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$92.67
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 20.1 CM TO 30.0 CM
|
Facility
|
OP
|
$1,115.78
|
|
|
Service Code
|
CPT 12006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$113.29 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$234.83
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.62
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$113.29
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 2.5 CM OR LESS
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 12001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$43.88 |
| 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 |
$133.28
|
| 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) |
$48.27
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$43.88
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 2.5 CM OR LESS
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 12001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$43.88 |
| 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 |
$133.28
|
| 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) |
$48.27
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$43.88
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 12002
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$57.63 |
| 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 |
$160.70
|
| 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) |
$63.39
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$57.63
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 12002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.63 |
| 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 |
$160.70
|
| 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) |
$63.39
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$57.63
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 7.6 CM TO 12.5 CM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 12004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.04 |
| 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 |
$209.45
|
| 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) |
$79.24
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$72.04
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); OVER 30.0 CM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 12007
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$97.34 |
| 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 |
$156.00
|
| 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) |
$154.88
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$140.80
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
SIMPLE SYRUP
|
Facility
|
IP
|
$153.26
|
|
|
Service Code
|
NDC 3172293747
|
| Hospital Charge Code |
7242
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.43 |
| Max. Negotiated Rate |
$137.93 |
| Rate for Payer: Aetna American Axle |
$99.62
|
| Rate for Payer: Aetna Commercial |
$130.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.62
|
| Rate for Payer: Cash Price |
$122.61
|
| Rate for Payer: Cofinity Commercial |
$107.28
|
| Rate for Payer: Cofinity Commercial |
$131.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.61
|
| Rate for Payer: Healthscope Commercial |
$137.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.27
|
| Rate for Payer: PHP Commercial |
$130.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.28
|
| Rate for Payer: Priority Health SBD |
$96.55
|
| Rate for Payer: UMR Bronson Commercial |
$67.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.94
|
|
|
SIMPLE SYRUP
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
NDC 395266116
|
| Hospital Charge Code |
7242
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna American Axle |
$93.60
|
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.60
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$123.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.20
|
| Rate for Payer: Healthscope Commercial |
$129.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.40
|
| Rate for Payer: PHP Commercial |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.80
|
| Rate for Payer: Priority Health SBD |
$90.72
|
| Rate for Payer: UMR Bronson Commercial |
$63.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.00
|
|
|
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT
|
Facility
|
IP
|
$97,445.24
|
|
|
Service Code
|
MS-DRG 008
|
| Min. Negotiated Rate |
$39,006.22 |
| Max. Negotiated Rate |
$97,445.24 |
| Rate for Payer: Aetna Medicare |
$42,701.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51,323.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51,323.98
|
| Rate for Payer: BCBS MAPPO |
$41,059.18
|
| Rate for Payer: BCBS Trust/PPO |
$97,445.24
|
| Rate for Payer: BCN Medicare Advantage |
$41,059.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41,059.18
|
| Rate for Payer: Mclaren Medicare |
$41,059.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43,112.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47,218.06
|
| Rate for Payer: PACE Medicare |
$39,006.22
|
| Rate for Payer: PACE SWMI |
$41,059.18
|
| Rate for Payer: PHP Medicare Advantage |
$41,059.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75,504.97
|
| Rate for Payer: Priority Health Medicare |
$41,059.18
|
| Rate for Payer: Priority Health Narrow Network |
$60,403.98
|
| Rate for Payer: Railroad Medicare Medicare |
$41,059.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80,261.97
|
| Rate for Payer: UHC Core |
$65,813.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$41,059.18
|
| Rate for Payer: UHC Exchange |
$52,322.34
|
| Rate for Payer: UHC Medicare Advantage |
$42,290.96
|
| Rate for Payer: VA VA |
$41,059.18
|
|
|
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS
|
Facility
|
IP
|
$148,037.45
|
|
|
Service Code
|
MS-DRG 019
|
| Min. Negotiated Rate |
$59,005.01 |
| Max. Negotiated Rate |
$148,037.45 |
| Rate for Payer: Aetna Medicare |
$64,594.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77,638.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77,638.18
|
| Rate for Payer: BCBS MAPPO |
$62,110.54
|
| Rate for Payer: BCBS Trust/PPO |
$148,037.45
|
| Rate for Payer: BCN Medicare Advantage |
$62,110.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62,110.54
|
| Rate for Payer: Mclaren Medicare |
$62,110.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65,216.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71,427.12
|
| Rate for Payer: PACE Medicare |
$59,005.01
|
| Rate for Payer: PACE SWMI |
$62,110.54
|
| Rate for Payer: PHP Medicare Advantage |
$62,110.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114,706.09
|
| Rate for Payer: Priority Health Medicare |
$62,110.54
|
| Rate for Payer: Priority Health Narrow Network |
$91,764.87
|
| Rate for Payer: Railroad Medicare Medicare |
$62,110.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121,932.85
|
| Rate for Payer: UHC Core |
$99,982.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$62,110.54
|
| Rate for Payer: UHC Exchange |
$79,487.36
|
| Rate for Payer: UHC Medicare Advantage |
$63,973.86
|
| Rate for Payer: VA VA |
$62,110.54
|
|
|
SIMVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$230.54
|
|
|
Service Code
|
NDC 68180-478-02
|
| Hospital Charge Code |
11364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.44 |
| Max. Negotiated Rate |
$207.49 |
| Rate for Payer: Aetna American Axle |
$149.85
|
| Rate for Payer: Aetna Commercial |
$195.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.85
|
| Rate for Payer: Cash Price |
$184.43
|
| Rate for Payer: Cofinity Commercial |
$161.38
|
| Rate for Payer: Cofinity Commercial |
$198.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.43
|
| Rate for Payer: Healthscope Commercial |
$207.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$195.96
|
| Rate for Payer: PHP Commercial |
$195.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.38
|
| Rate for Payer: Priority Health SBD |
$145.24
|
| Rate for Payer: UMR Bronson Commercial |
$101.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.90
|
|
|
SIMVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$206.80
|
|
|
Service Code
|
NDC 51079-456-20
|
| Hospital Charge Code |
11366
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.99 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna American Axle |
$134.42
|
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.42
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Commercial |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.78
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.76
|
| Rate for Payer: Priority Health SBD |
$130.28
|
| Rate for Payer: UMR Bronson Commercial |
$90.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
SIMVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$258.50
|
|
|
Service Code
|
NDC 63739-573-10
|
| Hospital Charge Code |
11366
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.74 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna American Axle |
$168.02
|
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.02
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cofinity Commercial |
$180.95
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.80
|
| Rate for Payer: Healthscope Commercial |
$232.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.72
|
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.95
|
| Rate for Payer: Priority Health SBD |
$162.86
|
| Rate for Payer: UMR Bronson Commercial |
$113.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.88
|
|
|
SIMVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
NDC 51079-456-01
|
| Hospital Charge Code |
11366
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna American Axle |
$1.35
|
| Rate for Payer: Aetna Commercial |
$1.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.76
|
| Rate for Payer: PHP Commercial |
$1.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.45
|
| Rate for Payer: Priority Health SBD |
$1.30
|
| Rate for Payer: UMR Bronson Commercial |
$0.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.55
|
|
|
SINCALIDE 5 MCG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$430.73
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
11368
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.52 |
| Max. Negotiated Rate |
$387.66 |
| Rate for Payer: Aetna American Axle |
$279.97
|
| Rate for Payer: Aetna Commercial |
$366.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.97
|
| Rate for Payer: Cash Price |
$344.58
|
| Rate for Payer: Cofinity Commercial |
$301.51
|
| Rate for Payer: Cofinity Commercial |
$370.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.58
|
| Rate for Payer: Healthscope Commercial |
$387.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$366.12
|
| Rate for Payer: PHP Commercial |
$366.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.51
|
| Rate for Payer: Priority Health SBD |
$271.36
|
| Rate for Payer: UMR Bronson Commercial |
$189.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.05
|
|
|
SINUS AND MASTOID PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$40,455.13
|
|
|
Service Code
|
MS-DRG 135
|
| Min. Negotiated Rate |
$19,902.05 |
| Max. Negotiated Rate |
$40,455.13 |
| Rate for Payer: Aetna Medicare |
$21,787.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,186.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,186.91
|
| Rate for Payer: BCBS MAPPO |
$20,949.53
|
| Rate for Payer: BCBS Trust/PPO |
$35,296.19
|
| Rate for Payer: BCN Medicare Advantage |
$20,949.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,949.53
|
| Rate for Payer: Mclaren Medicare |
$20,949.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,997.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,091.96
|
| Rate for Payer: PACE Medicare |
$19,902.05
|
| Rate for Payer: PACE SWMI |
$20,949.53
|
| Rate for Payer: PHP Medicare Advantage |
$20,949.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,057.42
|
| Rate for Payer: Priority Health Medicare |
$20,949.53
|
| Rate for Payer: Priority Health Narrow Network |
$30,445.94
|
| Rate for Payer: Railroad Medicare Medicare |
$20,949.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40,455.13
|
| Rate for Payer: UHC Core |
$33,172.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$20,949.53
|
| Rate for Payer: UHC Exchange |
$26,372.48
|
| Rate for Payer: UHC Medicare Advantage |
$21,578.02
|
| Rate for Payer: VA VA |
$20,949.53
|
|
|
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$20,927.43
|
|
|
Service Code
|
MS-DRG 136
|
| Min. Negotiated Rate |
$8,131.77 |
| Max. Negotiated Rate |
$20,927.43 |
| Rate for Payer: Aetna Medicare |
$8,902.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,699.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,699.70
|
| Rate for Payer: BCBS MAPPO |
$8,559.76
|
| Rate for Payer: BCBS Trust/PPO |
$20,927.43
|
| Rate for Payer: BCN Medicare Advantage |
$8,559.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,559.76
|
| Rate for Payer: Mclaren Medicare |
$8,559.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,987.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,843.72
|
| Rate for Payer: PACE Medicare |
$8,131.77
|
| Rate for Payer: PACE SWMI |
$8,559.76
|
| Rate for Payer: PHP Medicare Advantage |
$8,559.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,476.01
|
| Rate for Payer: Priority Health Medicare |
$8,559.76
|
| Rate for Payer: Priority Health Narrow Network |
$10,780.81
|
| Rate for Payer: Railroad Medicare Medicare |
$8,559.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,325.03
|
| Rate for Payer: UHC Core |
$11,746.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,559.76
|
| Rate for Payer: UHC Exchange |
$9,338.41
|
| Rate for Payer: UHC Medicare Advantage |
$8,816.55
|
| Rate for Payer: VA VA |
$8,559.76
|
|
|
SINUSOTOMY, MAXILLARY (ANTROTOMY); INTRANASAL
|
Facility
|
OP
|
$9,009.23
|
|
|
Service Code
|
CPT 31020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$337.59 |
| 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 |
$1,629.30
|
| 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) |
$371.35
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,861.84
|
| Rate for Payer: UHC Exchange |
$337.59
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
SIPULEUCEL-T IN LACTATED RINGERS 50 MILLION CELL/250 ML IV SUSPENSION
|
Facility
|
OP
|
$317,963.84
|
|
|
Service Code
|
HCPCS Q2043
|
| Hospital Charge Code |
104852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29,224.38 |
| Max. Negotiated Rate |
$286,167.46 |
| Rate for Payer: Aetna American Axle |
$206,676.50
|
| Rate for Payer: Aetna Commercial |
$270,269.26
|
| Rate for Payer: Aetna Medicare |
$55,563.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206,676.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66,783.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66,783.32
|
| Rate for Payer: BCBS Complete |
$30,688.27
|
| Rate for Payer: BCBS MAPPO |
$53,426.66
|
| Rate for Payer: BCBS Trust/PPO |
$171,473.55
|
| Rate for Payer: BCN Medicare Advantage |
$53,426.66
|
| Rate for Payer: Cash Price |
$254,371.07
|
| Rate for Payer: Cash Price |
$254,371.07
|
| Rate for Payer: Cofinity Commercial |
$273,448.90
|
| Rate for Payer: Cofinity Commercial |
$222,574.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254,371.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53,426.66
|
| Rate for Payer: Healthscope Commercial |
$286,167.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222,574.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238,472.88
|
| Rate for Payer: Mclaren Medicaid |
$29,224.38
|
| Rate for Payer: Mclaren Medicare |
$53,426.66
|
| Rate for Payer: Meridian Medicaid |
$30,688.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56,097.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61,440.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270,269.26
|
| Rate for Payer: PACE Medicare |
$50,755.32
|
| Rate for Payer: PACE SWMI |
$53,426.66
|
| Rate for Payer: PHP Commercial |
$270,269.26
|
| Rate for Payer: PHP Medicare Advantage |
$53,426.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$29,224.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222,574.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157,043.14
|
| Rate for Payer: Priority Health Medicare |
$53,426.66
|
| Rate for Payer: Priority Health Narrow Network |
$125,634.51
|
| Rate for Payer: Priority Health SBD |
$200,317.22
|
| Rate for Payer: Railroad Medicare Medicare |
$53,426.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$53,426.66
|
| Rate for Payer: UHC Medicare Advantage |
$55,029.46
|
| Rate for Payer: UMR Bronson Commercial |
$117,646.62
|
| Rate for Payer: VA VA |
$53,426.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238,472.88
|
|
