|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$9,078.96
|
|
|
Service Code
|
NDC 0406-9915-01
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,994.74 |
| Max. Negotiated Rate |
$8,171.06 |
| Rate for Payer: Aetna American Axle |
$5,901.32
|
| Rate for Payer: Aetna Commercial |
$7,717.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,901.32
|
| Rate for Payer: Cash Price |
$7,263.17
|
| Rate for Payer: Cofinity Commercial |
$6,355.27
|
| Rate for Payer: Cofinity Commercial |
$7,807.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,263.17
|
| Rate for Payer: Healthscope Commercial |
$8,171.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,355.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,809.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,717.12
|
| Rate for Payer: PHP Commercial |
$7,717.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,355.27
|
| Rate for Payer: Priority Health SBD |
$5,719.74
|
| Rate for Payer: UMR Bronson Commercial |
$3,994.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,809.22
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$2,127.84
|
|
|
Service Code
|
NDC 0378-3110-01
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$936.25 |
| Max. Negotiated Rate |
$1,915.06 |
| Rate for Payer: Aetna American Axle |
$1,383.10
|
| Rate for Payer: Aetna Commercial |
$1,808.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,383.10
|
| Rate for Payer: Cash Price |
$1,702.27
|
| Rate for Payer: Cofinity Commercial |
$1,489.49
|
| Rate for Payer: Cofinity Commercial |
$1,829.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.27
|
| Rate for Payer: Healthscope Commercial |
$1,915.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,489.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,595.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,808.66
|
| Rate for Payer: PHP Commercial |
$1,808.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,489.49
|
| Rate for Payer: Priority Health SBD |
$1,340.54
|
| Rate for Payer: UMR Bronson Commercial |
$936.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,595.88
|
|
|
TEMOZOLOMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$1,007.83
|
|
|
Service Code
|
HCPCS J8700
|
| Hospital Charge Code |
25894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$443.45 |
| Max. Negotiated Rate |
$907.05 |
| Rate for Payer: Aetna American Axle |
$655.09
|
| Rate for Payer: Aetna American Axle |
$140.50
|
| Rate for Payer: Aetna Commercial |
$183.74
|
| Rate for Payer: Aetna Commercial |
$856.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$655.09
|
| Rate for Payer: Cash Price |
$172.93
|
| Rate for Payer: Cash Price |
$806.26
|
| Rate for Payer: Cofinity Commercial |
$151.31
|
| Rate for Payer: Cofinity Commercial |
$185.90
|
| Rate for Payer: Cofinity Commercial |
$866.73
|
| Rate for Payer: Cofinity Commercial |
$705.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$806.26
|
| Rate for Payer: Healthscope Commercial |
$907.05
|
| Rate for Payer: Healthscope Commercial |
$194.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$705.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$755.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$856.66
|
| Rate for Payer: PHP Commercial |
$183.74
|
| Rate for Payer: PHP Commercial |
$856.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.31
|
| Rate for Payer: Priority Health SBD |
$136.18
|
| Rate for Payer: Priority Health SBD |
$634.93
|
| Rate for Payer: UMR Bronson Commercial |
$443.45
|
| Rate for Payer: UMR Bronson Commercial |
$95.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$755.87
|
|
|
TEMOZOLOMIDE 140 MG CAPSULE
|
Facility
|
IP
|
$1,868.47
|
|
|
Service Code
|
HCPCS J8700
|
| Hospital Charge Code |
81461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$822.13 |
| Max. Negotiated Rate |
$1,681.62 |
| Rate for Payer: Aetna American Axle |
$1,214.51
|
| Rate for Payer: Aetna American Axle |
$106.40
|
| Rate for Payer: Aetna American Axle |
$80.97
|
| Rate for Payer: Aetna American Axle |
$568.33
|
| Rate for Payer: Aetna American Axle |
$185.09
|
| Rate for Payer: Aetna Commercial |
$105.88
|
| Rate for Payer: Aetna Commercial |
$242.05
|
| Rate for Payer: Aetna Commercial |
$139.14
|
| Rate for Payer: Aetna Commercial |
$743.20
|
| Rate for Payer: Aetna Commercial |
$1,588.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,214.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.33
|
| Rate for Payer: Cash Price |
$99.66
|
| Rate for Payer: Cash Price |
$1,494.78
|
| Rate for Payer: Cash Price |
$699.48
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cash Price |
$227.81
|
| Rate for Payer: Cofinity Commercial |
$612.04
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$1,606.88
|
| Rate for Payer: Cofinity Commercial |
$244.89
|
| Rate for Payer: Cofinity Commercial |
$1,307.93
|
| Rate for Payer: Cofinity Commercial |
$107.13
|
| Rate for Payer: Cofinity Commercial |
$199.33
|
| Rate for Payer: Cofinity Commercial |
$751.94
|
| Rate for Payer: Cofinity Commercial |
$114.58
|
| Rate for Payer: Cofinity Commercial |
$140.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,494.78
|
| Rate for Payer: Healthscope Commercial |
$786.92
|
| Rate for Payer: Healthscope Commercial |
$256.28
|
| Rate for Payer: Healthscope Commercial |
$112.11
|
| Rate for Payer: Healthscope Commercial |
$1,681.62
|
| Rate for Payer: Healthscope Commercial |
$147.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,307.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$612.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$655.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,401.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$743.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,588.20
|
| Rate for Payer: PHP Commercial |
$105.88
|
| Rate for Payer: PHP Commercial |
$139.14
|
| Rate for Payer: PHP Commercial |
$743.20
|
| Rate for Payer: PHP Commercial |
$242.05
|
| Rate for Payer: PHP Commercial |
$1,588.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,307.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.20
|
| Rate for Payer: Priority Health SBD |
$550.84
|
| Rate for Payer: Priority Health SBD |
$78.48
|
| Rate for Payer: Priority Health SBD |
$179.40
|
| Rate for Payer: Priority Health SBD |
$103.12
|
| Rate for Payer: Priority Health SBD |
$1,177.14
|
| Rate for Payer: UMR Bronson Commercial |
$384.71
|
| Rate for Payer: UMR Bronson Commercial |
$125.29
|
| Rate for Payer: UMR Bronson Commercial |
$822.13
|
| Rate for Payer: UMR Bronson Commercial |
$72.02
|
| Rate for Payer: UMR Bronson Commercial |
$54.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,401.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$655.76
|
|
|
TEMPORARY CLOSURE OF EYELIDS BY SUTURE (EG, FROST SUTURE)
|
Facility
|
OP
|
$2,833.02
|
|
|
Service Code
|
CPT 67875
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$92.99 |
| Max. Negotiated Rate |
$2,833.02 |
| Rate for Payer: Aetna Medicare |
$935.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,124.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,124.91
|
| Rate for Payer: BCBS Complete |
$516.92
|
| Rate for Payer: BCBS MAPPO |
$899.93
|
| Rate for Payer: BCBS Trust/PPO |
$725.17
|
| Rate for Payer: BCN Medicare Advantage |
$899.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$899.93
|
| Rate for Payer: Mclaren Medicaid |
$492.26
|
| Rate for Payer: Mclaren Medicare |
$899.93
|
| Rate for Payer: Meridian Medicaid |
$516.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$944.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,034.92
|
| Rate for Payer: PACE Medicare |
$854.93
|
| Rate for Payer: PACE SWMI |
$899.93
|
| Rate for Payer: PHP Medicare Advantage |
$899.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,833.02
|
| Rate for Payer: Priority Health Medicare |
$899.93
|
| Rate for Payer: Priority Health Narrow Network |
$2,266.42
|
| Rate for Payer: Railroad Medicare Medicare |
$899.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.29
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$899.93
|
| Rate for Payer: UHC Exchange |
$92.99
|
| Rate for Payer: UHC Medicare Advantage |
$926.93
|
| Rate for Payer: VA VA |
$899.93
|
|
|
TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST DILUTION) INTRAVENOUS SOLN
|
Facility
|
IP
|
$3,046.51
|
|
|
Service Code
|
HCPCS J9330
|
| Hospital Charge Code |
82228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,340.46 |
| Max. Negotiated Rate |
$2,741.86 |
| Rate for Payer: Aetna American Axle |
$1,980.23
|
| Rate for Payer: Aetna American Axle |
$1,791.29
|
| Rate for Payer: Aetna American Axle |
$5,060.62
|
| Rate for Payer: Aetna Commercial |
$2,589.53
|
| Rate for Payer: Aetna Commercial |
$6,617.73
|
| Rate for Payer: Aetna Commercial |
$2,342.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,060.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,980.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,791.29
|
| Rate for Payer: Cash Price |
$6,228.46
|
| Rate for Payer: Cash Price |
$2,204.66
|
| Rate for Payer: Cash Price |
$2,437.21
|
| Rate for Payer: Cofinity Commercial |
$2,370.01
|
| Rate for Payer: Cofinity Commercial |
$5,449.90
|
| Rate for Payer: Cofinity Commercial |
$1,929.08
|
| Rate for Payer: Cofinity Commercial |
$2,132.56
|
| Rate for Payer: Cofinity Commercial |
$2,620.00
|
| Rate for Payer: Cofinity Commercial |
$6,695.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,204.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,437.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,228.46
|
| Rate for Payer: Healthscope Commercial |
$7,007.01
|
| Rate for Payer: Healthscope Commercial |
$2,480.25
|
| Rate for Payer: Healthscope Commercial |
$2,741.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,449.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,929.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,132.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,066.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,284.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,839.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,617.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,342.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,589.53
|
| Rate for Payer: PHP Commercial |
$2,342.46
|
| Rate for Payer: PHP Commercial |
$6,617.73
|
| Rate for Payer: PHP Commercial |
$2,589.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,132.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,929.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,449.90
|
| Rate for Payer: Priority Health SBD |
$4,904.91
|
| Rate for Payer: Priority Health SBD |
$1,736.17
|
| Rate for Payer: Priority Health SBD |
$1,919.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,340.46
|
| Rate for Payer: UMR Bronson Commercial |
$1,212.57
|
| Rate for Payer: UMR Bronson Commercial |
$3,425.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,284.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,839.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,066.87
|
|
|
TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST DILUTION) INTRAVENOUS SOLN
|
Facility
|
OP
|
$3,046.51
|
|
|
Service Code
|
HCPCS J9330
|
| Hospital Charge Code |
82228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$2,741.86 |
| Rate for Payer: Aetna American Axle |
$1,980.23
|
| Rate for Payer: Aetna American Axle |
$5,060.62
|
| Rate for Payer: Aetna Commercial |
$2,589.53
|
| Rate for Payer: Aetna Commercial |
$6,617.73
|
| Rate for Payer: Aetna Medicare |
$32.23
|
| Rate for Payer: Aetna Medicare |
$32.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,060.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,980.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.74
|
| Rate for Payer: BCBS Complete |
$17.80
|
| Rate for Payer: BCBS Complete |
$17.80
|
| Rate for Payer: BCBS MAPPO |
$30.99
|
| Rate for Payer: BCBS MAPPO |
$30.99
|
| Rate for Payer: BCBS Trust/PPO |
$100.13
|
| Rate for Payer: BCBS Trust/PPO |
$100.13
|
| Rate for Payer: BCN Medicare Advantage |
$30.99
|
| Rate for Payer: BCN Medicare Advantage |
$30.99
|
| Rate for Payer: Cash Price |
$6,228.46
|
| Rate for Payer: Cash Price |
$6,228.46
|
| Rate for Payer: Cash Price |
$2,437.21
|
| Rate for Payer: Cash Price |
$2,437.21
|
| Rate for Payer: Cofinity Commercial |
$2,620.00
|
| Rate for Payer: Cofinity Commercial |
$6,695.59
|
| Rate for Payer: Cofinity Commercial |
$5,449.90
|
| Rate for Payer: Cofinity Commercial |
$2,132.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,437.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,228.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.99
|
| Rate for Payer: Healthscope Commercial |
$7,007.01
|
| Rate for Payer: Healthscope Commercial |
$2,741.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,449.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,132.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,284.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,839.18
|
| Rate for Payer: Mclaren Medicaid |
$16.95
|
| Rate for Payer: Mclaren Medicaid |
$16.95
|
| Rate for Payer: Mclaren Medicare |
$30.99
|
| Rate for Payer: Mclaren Medicare |
$30.99
|
| Rate for Payer: Meridian Medicaid |
$17.80
|
| Rate for Payer: Meridian Medicaid |
$17.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,589.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,617.73
|
| Rate for Payer: PACE Medicare |
$29.44
|
| Rate for Payer: PACE Medicare |
$29.44
|
| Rate for Payer: PACE SWMI |
$30.99
|
| Rate for Payer: PACE SWMI |
$30.99
|
| Rate for Payer: PHP Commercial |
$6,617.73
|
| Rate for Payer: PHP Commercial |
$2,589.53
|
| Rate for Payer: PHP Medicare Advantage |
$30.99
|
| Rate for Payer: PHP Medicare Advantage |
$30.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,449.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,132.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.15
|
| Rate for Payer: Priority Health Medicare |
$30.99
|
| Rate for Payer: Priority Health Medicare |
$30.99
|
| Rate for Payer: Priority Health Narrow Network |
$69.72
|
| Rate for Payer: Priority Health Narrow Network |
$69.72
|
| Rate for Payer: Priority Health SBD |
$4,904.91
|
| Rate for Payer: Priority Health SBD |
$1,919.30
|
| Rate for Payer: Railroad Medicare Medicare |
$30.99
|
| Rate for Payer: Railroad Medicare Medicare |
$30.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.99
|
| Rate for Payer: UHC Medicare Advantage |
$31.92
|
| Rate for Payer: UHC Medicare Advantage |
$31.92
|
| Rate for Payer: UMR Bronson Commercial |
$2,880.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,127.21
|
| Rate for Payer: VA VA |
$30.99
|
| Rate for Payer: VA VA |
$30.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,284.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,839.18
|
|
|
TENDONITIS, MYOSITIS AND BURSITIS WITH MCC
|
Facility
|
IP
|
$32,614.93
|
|
|
Service Code
|
MS-DRG 557
|
| Min. Negotiated Rate |
$11,883.66 |
| Max. Negotiated Rate |
$32,614.93 |
| Rate for Payer: Aetna Medicare |
$13,009.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,636.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,636.40
|
| Rate for Payer: BCBS MAPPO |
$12,509.12
|
| Rate for Payer: BCBS Trust/PPO |
$32,614.93
|
| Rate for Payer: BCN Medicare Advantage |
$12,509.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,509.12
|
| Rate for Payer: Mclaren Medicare |
$12,509.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,134.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,385.49
|
| Rate for Payer: PACE Medicare |
$11,883.66
|
| Rate for Payer: PACE SWMI |
$12,509.12
|
| Rate for Payer: PHP Medicare Advantage |
$12,509.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,339.96
|
| Rate for Payer: Priority Health Medicare |
$12,509.12
|
| Rate for Payer: Priority Health Narrow Network |
$17,871.97
|
| Rate for Payer: Railroad Medicare Medicare |
$12,509.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,747.43
|
| Rate for Payer: UHC Core |
$19,472.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,509.12
|
| Rate for Payer: UHC Exchange |
$15,480.82
|
| Rate for Payer: UHC Medicare Advantage |
$12,884.39
|
| Rate for Payer: VA VA |
$12,509.12
|
|
|
TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC
|
Facility
|
IP
|
$13,399.11
|
|
|
Service Code
|
MS-DRG 558
|
| Min. Negotiated Rate |
$6,917.27 |
| Max. Negotiated Rate |
$13,399.11 |
| Rate for Payer: Aetna Medicare |
$7,572.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,101.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,101.68
|
| Rate for Payer: BCBS MAPPO |
$7,281.34
|
| Rate for Payer: BCBS Trust/PPO |
$10,664.75
|
| Rate for Payer: BCN Medicare Advantage |
$7,281.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,281.34
|
| Rate for Payer: Mclaren Medicare |
$7,281.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,645.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,373.54
|
| Rate for Payer: PACE Medicare |
$6,917.27
|
| Rate for Payer: PACE SWMI |
$7,281.34
|
| Rate for Payer: PHP Medicare Advantage |
$7,281.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,604.97
|
| Rate for Payer: Priority Health Medicare |
$7,281.34
|
| Rate for Payer: Priority Health Narrow Network |
$10,083.98
|
| Rate for Payer: Railroad Medicare Medicare |
$7,281.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,399.11
|
| Rate for Payer: UHC Core |
$10,987.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,281.34
|
| Rate for Payer: UHC Exchange |
$8,734.81
|
| Rate for Payer: UHC Medicare Advantage |
$7,499.78
|
| Rate for Payer: VA VA |
$7,281.34
|
|
|
TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)
|
Facility
|
OP
|
$4,497.31
|
|
|
Service Code
|
CPT 26055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$294.04 |
| 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 |
$1,466.29
|
| 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) |
$323.44
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,428.61
|
| Rate for Payer: UHC Exchange |
$294.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,471.47
|
| Rate for Payer: VA VA |
$1,428.61
|
|
|
TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST, SINGLE; EACH TENDON
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 25310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$621.81 |
| 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 |
$2,518.37
|
| 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) |
$683.99
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$621.81
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST, SINGLE; WITH TENDON GRAFT(S) (INCLUDES OBTAINING GRAFT), EACH TENDON
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 25312
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$715.13 |
| 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 |
$2,684.07
|
| 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) |
$786.64
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$715.13
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26,150.27
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
186094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,506.12 |
| Max. Negotiated Rate |
$23,535.24 |
| Rate for Payer: Aetna American Axle |
$16,997.68
|
| Rate for Payer: Aetna Commercial |
$22,227.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,997.68
|
| Rate for Payer: Cash Price |
$20,920.22
|
| Rate for Payer: Cofinity Commercial |
$18,305.19
|
| Rate for Payer: Cofinity Commercial |
$22,489.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,920.22
|
| Rate for Payer: Healthscope Commercial |
$23,535.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,305.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,612.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22,227.73
|
| Rate for Payer: PHP Commercial |
$22,227.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,305.19
|
| Rate for Payer: Priority Health SBD |
$16,474.67
|
| Rate for Payer: UMR Bronson Commercial |
$11,506.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,612.70
|
|
|
TENODESIS AT WRIST; FLEXORS OF FINGERS
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 25300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$689.92 |
| 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 |
$2,262.55
|
| 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) |
$758.91
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$689.92
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
TENODESIS OF LONG TENDON OF BICEPS
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 23430
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$741.00 |
| 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 |
$4,976.83
|
| 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) |
$815.10
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$741.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
TENODESIS; OF PROXIMAL INTERPHALANGEAL JOINT, EACH JOINT
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26471
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$658.16 |
| 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) |
$723.98
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$658.16
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET
|
Facility
|
IP
|
$4,522.03
|
|
|
Service Code
|
NDC 61958-0401-1
|
| Hospital Charge Code |
31684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,989.69 |
| Max. Negotiated Rate |
$4,069.83 |
| Rate for Payer: Aetna American Axle |
$2,939.32
|
| Rate for Payer: Aetna Commercial |
$3,843.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,939.32
|
| Rate for Payer: Cash Price |
$3,617.62
|
| Rate for Payer: Cofinity Commercial |
$3,165.42
|
| Rate for Payer: Cofinity Commercial |
$3,888.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,617.62
|
| Rate for Payer: Healthscope Commercial |
$4,069.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,165.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,391.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,843.73
|
| Rate for Payer: PHP Commercial |
$3,843.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,165.42
|
| Rate for Payer: Priority Health SBD |
$2,848.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,989.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,391.52
|
|
|
TENOLYSIS, EXTENSOR TENDON, HAND OR FINGER, EACH TENDON
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$601.84 |
| 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 |
$1,959.58
|
| 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) |
$662.02
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$601.84
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
TENOLYSIS, FLEXOR, FOOT; MULTIPLE TENDONS
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 28222
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$367.39 |
| 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) |
$404.13
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$367.39
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
TENOLYSIS, FLEXOR, FOOT; SINGLE TENDON
|
Facility
|
OP
|
$4,497.31
|
|
|
Service Code
|
CPT 28220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.21 |
| 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 |
$362.20
|
| 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) |
$333.53
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,428.61
|
| Rate for Payer: UHC Exchange |
$303.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,471.47
|
| Rate for Payer: VA VA |
$1,428.61
|
|
|
TENOLYSIS, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 25295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$528.49 |
| 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 |
$2,157.69
|
| 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) |
$581.34
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$528.49
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR ANKLE; MULTIPLE TENDONS (THROUGH SEPARATE INCISION[S])
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 27681
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$505.57 |
| 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) |
$556.13
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$505.57
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR ANKLE; SINGLE, EACH TENDON
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 27680
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$419.13 |
| 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) |
$461.04
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$419.13
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
TENOLYSIS, FLEXOR TENDON; PALM OR FINGER, EACH TENDON
|
Facility
|
OP
|
$4,497.31
|
|
|
Service Code
|
CPT 26440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$647.68 |
| 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 |
$1,998.53
|
| 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) |
$712.45
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,428.61
|
| Rate for Payer: UHC Exchange |
$647.68
|
| Rate for Payer: UHC Medicare Advantage |
$1,471.47
|
| Rate for Payer: VA VA |
$1,428.61
|
|
|
TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); DEBRIDEMENT, SOFT TISSUE AND/OR BONE, OPEN
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 24358
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.44 |
| 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) |
$584.58
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$531.44
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
