|
SUTURE OF DIGITAL NERVE, HAND OR FOOT; 1 NERVE
|
Facility
|
OP
|
$5,402.75
|
|
|
Service Code
|
CPT 64831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$689.27 |
| Max. Negotiated Rate |
$5,402.75 |
| Rate for Payer: Aetna Medicare |
$1,784.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,145.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,145.29
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,723.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Mclaren Medicaid |
$938.78
|
| Rate for Payer: Mclaren Medicare |
$1,716.23
|
| Rate for Payer: Meridian Medicaid |
$985.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,802.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,973.66
|
| Rate for Payer: PACE Medicare |
$1,630.42
|
| Rate for Payer: PACE SWMI |
$1,716.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,716.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$938.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,402.75
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$4,322.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$758.20
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,716.23
|
| Rate for Payer: UHC Exchange |
$689.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: VA VA |
$1,716.23
|
|
|
SUTURE OF DIGITAL NERVE, HAND OR FOOT; EACH ADDITIONAL DIGITAL NERVE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,178.16
|
|
|
Service Code
|
CPT 64832
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$323.19 |
| Max. Negotiated Rate |
$1,178.16 |
| Rate for Payer: BCBS Trust/PPO |
$1,178.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.51
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$323.19
|
|
|
SUTURE OF EACH ADDITIONAL NERVE, HAND OR FOOT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,329.95
|
|
|
Service Code
|
CPT 64837
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$352.66 |
| Max. Negotiated Rate |
$1,329.95 |
| Rate for Payer: BCBS Trust/PPO |
$1,329.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$387.93
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$352.66
|
|
|
SUTURE OF INFRAPATELLAR TENDON; PRIMARY
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 27380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$621.81 |
| 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 |
$4,719.25
|
| 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) |
$683.99
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$621.81
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
SUTURE OF INFRAPATELLAR TENDON; SECONDARY RECONSTRUCTION, INCLUDING FASCIAL OR TENDON GRAFT
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 27381
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$815.66 |
| 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) |
$897.23
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$815.66
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, EXCEPT SCIATIC; WITHOUT TRANSPOSITION
|
Facility
|
OP
|
$18,640.24
|
|
|
Service Code
|
CPT 64857
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,037.01 |
| Max. Negotiated Rate |
$18,640.24 |
| Rate for Payer: Aetna Medicare |
$6,158.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,401.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,401.52
|
| Rate for Payer: BCBS Complete |
$3,401.15
|
| Rate for Payer: BCBS MAPPO |
$5,921.22
|
| Rate for Payer: BCBS Trust/PPO |
$3,268.76
|
| Rate for Payer: BCN Medicare Advantage |
$5,921.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,921.22
|
| Rate for Payer: Mclaren Medicaid |
$3,238.91
|
| Rate for Payer: Mclaren Medicare |
$5,921.22
|
| Rate for Payer: Meridian Medicaid |
$3,401.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,217.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,809.40
|
| Rate for Payer: PACE Medicare |
$5,625.16
|
| Rate for Payer: PACE SWMI |
$5,921.22
|
| Rate for Payer: PHP Medicare Advantage |
$5,921.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,238.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,640.24
|
| Rate for Payer: Priority Health Medicare |
$5,921.22
|
| Rate for Payer: Priority Health Narrow Network |
$14,912.19
|
| Rate for Payer: Railroad Medicare Medicare |
$5,921.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,140.71
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,921.22
|
| Rate for Payer: UHC Exchange |
$1,037.01
|
| Rate for Payer: UHC Medicare Advantage |
$6,098.86
|
| Rate for Payer: VA VA |
$5,921.22
|
|
|
SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; PRIMARY
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 27385
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$606.75 |
| 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 |
$5,084.27
|
| 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) |
$667.42
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; SECONDARY RECONSTRUCTION, INCLUDING FASCIAL OR TENDON GRAFT
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 27386
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$851.35 |
| 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) |
$936.48
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$851.35
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
SUTURE OR REPAIR OF TESTICULAR INJURY
|
Facility
|
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 54670
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$403.41 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,372.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$443.75
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$403.41
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
|
IP
|
$17,527.48
|
|
|
Service Code
|
MS-DRG 312
|
| Min. Negotiated Rate |
$6,808.18 |
| Max. Negotiated Rate |
$17,527.48 |
| Rate for Payer: Aetna Medicare |
$7,453.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,958.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,958.12
|
| Rate for Payer: BCBS MAPPO |
$7,166.50
|
| Rate for Payer: BCBS Trust/PPO |
$17,527.48
|
| Rate for Payer: BCN Medicare Advantage |
$7,166.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,166.50
|
| Rate for Payer: Mclaren Medicare |
$7,166.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,524.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,241.48
|
| Rate for Payer: PACE Medicare |
$6,808.18
|
| Rate for Payer: PACE SWMI |
$7,166.50
|
| Rate for Payer: PHP Medicare Advantage |
$7,166.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,391.16
|
| Rate for Payer: Priority Health Medicare |
$7,166.50
|
| Rate for Payer: Priority Health Narrow Network |
$9,912.93
|
| Rate for Payer: Railroad Medicare Medicare |
$7,166.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,171.83
|
| Rate for Payer: UHC Core |
$10,800.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,166.50
|
| Rate for Payer: UHC Exchange |
$8,586.64
|
| Rate for Payer: UHC Medicare Advantage |
$7,381.50
|
| Rate for Payer: VA VA |
$7,166.50
|
|
|
SYNOVECTOMY, CARPOMETACARPAL JOINT
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$472.50 |
| 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) |
$519.75
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$472.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT;
|
Facility
|
OP
|
$4,497.31
|
|
|
Service Code
|
CPT 25118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$386.38 |
| Max. Negotiated Rate |
$4,497.31 |
| Rate for Payer: Aetna Medicare |
$1,485.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,785.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,785.76
|
| Rate for Payer: BCBS Complete |
$820.59
|
| Rate for Payer: BCBS MAPPO |
$1,428.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,428.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,428.61
|
| Rate for Payer: Mclaren Medicaid |
$781.45
|
| Rate for Payer: Mclaren Medicare |
$1,428.61
|
| Rate for Payer: Meridian Medicaid |
$820.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,500.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,642.90
|
| Rate for Payer: PACE Medicare |
$1,357.18
|
| Rate for Payer: PACE SWMI |
$1,428.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,428.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$781.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,497.31
|
| Rate for Payer: Priority Health Medicare |
$1,428.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,597.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,428.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$425.02
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,428.61
|
| Rate for Payer: UHC Exchange |
$386.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,471.47
|
| Rate for Payer: VA VA |
$1,428.61
|
|
|
SYNOVECTOMY, METACARPOPHALANGEAL JOINT INCLUDING INTRINSIC RELEASE AND EXTENSOR HOOD RECONSTRUCTION, EACH DIGIT
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26135
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$554.69 |
| 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 |
$2,111.70
|
| 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) |
$610.16
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$554.69
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
SYNOVECTOMY, PROXIMAL INTERPHALANGEAL JOINT, INCLUDING EXTENSOR RECONSTRUCTION, EACH INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$4,497.31
|
|
|
Service Code
|
CPT 26140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$510.48 |
| Max. Negotiated Rate |
$4,497.31 |
| Rate for Payer: Aetna Medicare |
$1,485.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,785.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,785.76
|
| Rate for Payer: BCBS Complete |
$820.59
|
| Rate for Payer: BCBS MAPPO |
$1,428.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,377.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,428.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,428.61
|
| Rate for Payer: Mclaren Medicaid |
$781.45
|
| Rate for Payer: Mclaren Medicare |
$1,428.61
|
| Rate for Payer: Meridian Medicaid |
$820.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,500.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,642.90
|
| Rate for Payer: PACE Medicare |
$1,357.18
|
| Rate for Payer: PACE SWMI |
$1,428.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,428.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$781.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,497.31
|
| Rate for Payer: Priority Health Medicare |
$1,428.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,597.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,428.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$561.53
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,428.61
|
| Rate for Payer: UHC Exchange |
$510.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,471.47
|
| Rate for Payer: VA VA |
$1,428.61
|
|
|
SYNOVECTOMY, TENDON SHEATH, RADICAL (TENOSYNOVECTOMY), FLEXOR TENDON, PALM AND/OR FINGER, EACH TENDON
|
Facility
|
OP
|
$4,497.31
|
|
|
Service Code
|
CPT 26145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$518.01 |
| Max. Negotiated Rate |
$4,497.31 |
| Rate for Payer: Aetna Medicare |
$1,485.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,785.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,785.76
|
| Rate for Payer: BCBS Complete |
$820.59
|
| Rate for Payer: BCBS MAPPO |
$1,428.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,377.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,428.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,428.61
|
| Rate for Payer: Mclaren Medicaid |
$781.45
|
| Rate for Payer: Mclaren Medicare |
$1,428.61
|
| Rate for Payer: Meridian Medicaid |
$820.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,500.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,642.90
|
| Rate for Payer: PACE Medicare |
$1,357.18
|
| Rate for Payer: PACE SWMI |
$1,428.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,428.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$781.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,497.31
|
| Rate for Payer: Priority Health Medicare |
$1,428.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,597.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,428.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$569.81
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,428.61
|
| Rate for Payer: UHC Exchange |
$518.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,471.47
|
| Rate for Payer: VA VA |
$1,428.61
|
|
|
TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$436.32
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
24914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$191.98 |
| Max. Negotiated Rate |
$392.69 |
| Rate for Payer: Aetna American Axle |
$283.61
|
| Rate for Payer: Aetna American Axle |
$226.82
|
| Rate for Payer: Aetna American Axle |
$779.94
|
| Rate for Payer: Aetna Commercial |
$296.62
|
| Rate for Payer: Aetna Commercial |
$1,019.92
|
| Rate for Payer: Aetna Commercial |
$370.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$779.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.82
|
| Rate for Payer: Cash Price |
$959.93
|
| Rate for Payer: Cash Price |
$349.06
|
| Rate for Payer: Cash Price |
$279.17
|
| Rate for Payer: Cofinity Commercial |
$839.94
|
| Rate for Payer: Cofinity Commercial |
$300.11
|
| Rate for Payer: Cofinity Commercial |
$1,031.92
|
| Rate for Payer: Cofinity Commercial |
$244.27
|
| Rate for Payer: Cofinity Commercial |
$375.24
|
| Rate for Payer: Cofinity Commercial |
$305.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$959.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.17
|
| Rate for Payer: Healthscope Commercial |
$1,079.92
|
| Rate for Payer: Healthscope Commercial |
$314.06
|
| Rate for Payer: Healthscope Commercial |
$392.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$839.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$244.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$899.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$370.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$296.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,019.92
|
| Rate for Payer: PHP Commercial |
$1,019.92
|
| Rate for Payer: PHP Commercial |
$296.62
|
| Rate for Payer: PHP Commercial |
$370.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$839.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.27
|
| Rate for Payer: Priority Health SBD |
$219.84
|
| Rate for Payer: Priority Health SBD |
$274.88
|
| Rate for Payer: Priority Health SBD |
$755.94
|
| Rate for Payer: UMR Bronson Commercial |
$191.98
|
| Rate for Payer: UMR Bronson Commercial |
$153.54
|
| Rate for Payer: UMR Bronson Commercial |
$527.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$899.93
|
|
|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$446.50
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$196.46 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna American Axle |
$290.22
|
| Rate for Payer: Aetna American Axle |
$1,560.12
|
| Rate for Payer: Aetna American Axle |
$322.30
|
| Rate for Payer: Aetna American Axle |
$365.66
|
| Rate for Payer: Aetna Commercial |
$421.46
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna Commercial |
$2,040.16
|
| Rate for Payer: Aetna Commercial |
$478.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,560.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.66
|
| Rate for Payer: Cash Price |
$1,920.15
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cash Price |
$450.05
|
| Rate for Payer: Cash Price |
$396.67
|
| Rate for Payer: Cofinity Commercial |
$393.79
|
| Rate for Payer: Cofinity Commercial |
$1,680.13
|
| Rate for Payer: Cofinity Commercial |
$2,064.16
|
| Rate for Payer: Cofinity Commercial |
$483.80
|
| Rate for Payer: Cofinity Commercial |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$383.99
|
| Rate for Payer: Cofinity Commercial |
$347.09
|
| Rate for Payer: Cofinity Commercial |
$426.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,920.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.67
|
| Rate for Payer: Healthscope Commercial |
$446.26
|
| Rate for Payer: Healthscope Commercial |
$2,160.17
|
| Rate for Payer: Healthscope Commercial |
$506.30
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,680.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$347.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$393.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,800.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,040.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$379.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$421.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$478.18
|
| Rate for Payer: PHP Commercial |
$478.18
|
| Rate for Payer: PHP Commercial |
$379.52
|
| Rate for Payer: PHP Commercial |
$421.46
|
| Rate for Payer: PHP Commercial |
$2,040.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,680.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.79
|
| Rate for Payer: Priority Health SBD |
$1,512.12
|
| Rate for Payer: Priority Health SBD |
$354.41
|
| Rate for Payer: Priority Health SBD |
$312.38
|
| Rate for Payer: Priority Health SBD |
$281.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,056.08
|
| Rate for Payer: UMR Bronson Commercial |
$196.46
|
| Rate for Payer: UMR Bronson Commercial |
$218.17
|
| Rate for Payer: UMR Bronson Commercial |
$247.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,800.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.88
|
|
|
TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$26.67
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna American Axle |
$17.34
|
| Rate for Payer: Aetna American Axle |
$348.50
|
| Rate for Payer: Aetna American Axle |
$1,610.87
|
| Rate for Payer: Aetna American Axle |
$1,733.28
|
| Rate for Payer: Aetna American Axle |
$1,774.41
|
| Rate for Payer: Aetna American Axle |
$274.56
|
| Rate for Payer: Aetna Commercial |
$359.04
|
| Rate for Payer: Aetna Commercial |
$2,320.38
|
| Rate for Payer: Aetna Commercial |
$2,106.52
|
| Rate for Payer: Aetna Commercial |
$455.74
|
| Rate for Payer: Aetna Commercial |
$22.67
|
| Rate for Payer: Aetna Commercial |
$2,266.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,610.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,733.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,774.41
|
| Rate for Payer: Cash Price |
$21.34
|
| Rate for Payer: Cash Price |
$2,133.27
|
| Rate for Payer: Cash Price |
$428.93
|
| Rate for Payer: Cash Price |
$2,183.89
|
| Rate for Payer: Cash Price |
$1,982.61
|
| Rate for Payer: Cash Price |
$337.92
|
| Rate for Payer: Cofinity Commercial |
$295.68
|
| Rate for Payer: Cofinity Commercial |
$1,734.78
|
| Rate for Payer: Cofinity Commercial |
$2,131.30
|
| Rate for Payer: Cofinity Commercial |
$1,866.61
|
| Rate for Payer: Cofinity Commercial |
$2,293.27
|
| Rate for Payer: Cofinity Commercial |
$18.67
|
| Rate for Payer: Cofinity Commercial |
$22.94
|
| Rate for Payer: Cofinity Commercial |
$1,910.90
|
| Rate for Payer: Cofinity Commercial |
$2,347.68
|
| Rate for Payer: Cofinity Commercial |
$363.26
|
| Rate for Payer: Cofinity Commercial |
$375.31
|
| Rate for Payer: Cofinity Commercial |
$461.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,183.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,982.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,133.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.93
|
| Rate for Payer: Healthscope Commercial |
$380.16
|
| Rate for Payer: Healthscope Commercial |
$2,456.87
|
| Rate for Payer: Healthscope Commercial |
$482.54
|
| Rate for Payer: Healthscope Commercial |
$2,230.43
|
| Rate for Payer: Healthscope Commercial |
$2,399.93
|
| Rate for Payer: Healthscope Commercial |
$24.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$375.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,734.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,866.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,910.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$402.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,858.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,999.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,047.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$455.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$359.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,320.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,106.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,266.60
|
| Rate for Payer: PHP Commercial |
$2,266.60
|
| Rate for Payer: PHP Commercial |
$2,106.52
|
| Rate for Payer: PHP Commercial |
$22.67
|
| Rate for Payer: PHP Commercial |
$359.04
|
| Rate for Payer: PHP Commercial |
$455.74
|
| Rate for Payer: PHP Commercial |
$2,320.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,866.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,734.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,910.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.68
|
| Rate for Payer: Priority Health SBD |
$1,679.95
|
| Rate for Payer: Priority Health SBD |
$16.80
|
| Rate for Payer: Priority Health SBD |
$1,719.81
|
| Rate for Payer: Priority Health SBD |
$1,561.30
|
| Rate for Payer: Priority Health SBD |
$266.11
|
| Rate for Payer: Priority Health SBD |
$337.78
|
| Rate for Payer: UMR Bronson Commercial |
$185.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,090.43
|
| Rate for Payer: UMR Bronson Commercial |
$11.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,173.30
|
| Rate for Payer: UMR Bronson Commercial |
$235.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,201.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,999.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,047.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,858.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$402.12
|
|
|
TACROLIMUS 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$793.65
|
|
|
Service Code
|
HCPCS J7525
|
| Hospital Charge Code |
12935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$349.21 |
| Max. Negotiated Rate |
$714.28 |
| Rate for Payer: Aetna American Axle |
$515.87
|
| Rate for Payer: Aetna Commercial |
$674.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.87
|
| Rate for Payer: Cash Price |
$634.92
|
| Rate for Payer: Cofinity Commercial |
$555.56
|
| Rate for Payer: Cofinity Commercial |
$682.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.92
|
| Rate for Payer: Healthscope Commercial |
$714.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$555.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$595.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$674.60
|
| Rate for Payer: PHP Commercial |
$674.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.56
|
| Rate for Payer: Priority Health SBD |
$500.00
|
| Rate for Payer: UMR Bronson Commercial |
$349.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$595.24
|
|
|
TACROLIMUS XR 0.75 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$446.11
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$196.29 |
| Max. Negotiated Rate |
$401.50 |
| Rate for Payer: Aetna American Axle |
$289.97
|
| Rate for Payer: Aetna Commercial |
$379.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.97
|
| Rate for Payer: Cash Price |
$356.89
|
| Rate for Payer: Cofinity Commercial |
$312.28
|
| Rate for Payer: Cofinity Commercial |
$383.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.89
|
| Rate for Payer: Healthscope Commercial |
$401.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$379.19
|
| Rate for Payer: PHP Commercial |
$379.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.28
|
| Rate for Payer: Priority Health SBD |
$281.05
|
| Rate for Payer: UMR Bronson Commercial |
$196.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.58
|
|
|
TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$594.85
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175522
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$261.73 |
| Max. Negotiated Rate |
$535.36 |
| Rate for Payer: Aetna American Axle |
$386.65
|
| Rate for Payer: Aetna American Axle |
$1,288.84
|
| Rate for Payer: Aetna Commercial |
$505.62
|
| Rate for Payer: Aetna Commercial |
$1,685.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,288.84
|
| Rate for Payer: Cash Price |
$475.88
|
| Rate for Payer: Cash Price |
$1,586.26
|
| Rate for Payer: Cofinity Commercial |
$1,705.23
|
| Rate for Payer: Cofinity Commercial |
$511.57
|
| Rate for Payer: Cofinity Commercial |
$416.40
|
| Rate for Payer: Cofinity Commercial |
$1,387.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,586.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.88
|
| Rate for Payer: Healthscope Commercial |
$535.36
|
| Rate for Payer: Healthscope Commercial |
$1,784.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,387.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$416.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,487.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,685.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$505.62
|
| Rate for Payer: PHP Commercial |
$1,685.41
|
| Rate for Payer: PHP Commercial |
$505.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,387.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.40
|
| Rate for Payer: Priority Health SBD |
$1,249.18
|
| Rate for Payer: Priority Health SBD |
$374.76
|
| Rate for Payer: UMR Bronson Commercial |
$872.45
|
| Rate for Payer: UMR Bronson Commercial |
$261.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,487.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.14
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
IP
|
$387.60
|
|
|
Service Code
|
NDC 63739-143-10
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.54 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Aetna American Axle |
$251.94
|
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.94
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Commercial |
$271.32
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$329.46
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.32
|
| Rate for Payer: Priority Health SBD |
$244.19
|
| Rate for Payer: UMR Bronson Commercial |
$170.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.70
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
IP
|
$270.72
|
|
|
Service Code
|
NDC 0378-0144-91
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.12 |
| Max. Negotiated Rate |
$243.65 |
| Rate for Payer: Aetna American Axle |
$175.97
|
| Rate for Payer: Aetna Commercial |
$230.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.97
|
| Rate for Payer: Cash Price |
$216.58
|
| Rate for Payer: Cofinity Commercial |
$189.50
|
| Rate for Payer: Cofinity Commercial |
$232.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.58
|
| Rate for Payer: Healthscope Commercial |
$243.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.11
|
| Rate for Payer: PHP Commercial |
$230.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.50
|
| Rate for Payer: Priority Health SBD |
$170.55
|
| Rate for Payer: UMR Bronson Commercial |
$119.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.04
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
IP
|
$341.05
|
|
|
Service Code
|
NDC 63739-269-10
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.06 |
| Max. Negotiated Rate |
$306.94 |
| Rate for Payer: Aetna American Axle |
$221.68
|
| Rate for Payer: Aetna Commercial |
$289.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.68
|
| Rate for Payer: Cash Price |
$272.84
|
| Rate for Payer: Cofinity Commercial |
$238.74
|
| Rate for Payer: Cofinity Commercial |
$293.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.84
|
| Rate for Payer: Healthscope Commercial |
$306.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.89
|
| Rate for Payer: PHP Commercial |
$289.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.74
|
| Rate for Payer: Priority Health SBD |
$214.86
|
| Rate for Payer: UMR Bronson Commercial |
$150.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.79
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$109.73
|
|
|
Service Code
|
NDC 50268-740-15
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$98.76 |
| Rate for Payer: Aetna American Axle |
$71.32
|
| Rate for Payer: Aetna Commercial |
$93.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.32
|
| Rate for Payer: Cash Price |
$87.78
|
| Rate for Payer: Cofinity Commercial |
$76.81
|
| Rate for Payer: Cofinity Commercial |
$94.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.78
|
| Rate for Payer: Healthscope Commercial |
$98.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.27
|
| Rate for Payer: PHP Commercial |
$93.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.81
|
| Rate for Payer: Priority Health SBD |
$69.13
|
| Rate for Payer: UMR Bronson Commercial |
$48.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.30
|
|
