|
TROPICAMIDE 0.5 % EYE DROPS
|
Facility
|
IP
|
$21.84
|
|
|
Service Code
|
NDC 17478-101-12
|
| Hospital Charge Code |
8249
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna American Axle |
$14.20
|
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.20
|
| Rate for Payer: Cash Price |
$17.47
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Cofinity Commercial |
$18.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.47
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.56
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.29
|
| Rate for Payer: Priority Health SBD |
$13.76
|
| Rate for Payer: UMR Bronson Commercial |
$9.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.38
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
|
IP
|
$31.08
|
|
|
Service Code
|
NDC 61314-355-01
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$27.97 |
| Rate for Payer: Aetna American Axle |
$20.20
|
| Rate for Payer: Aetna Commercial |
$26.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.20
|
| Rate for Payer: Cash Price |
$24.86
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Cofinity Commercial |
$26.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.86
|
| Rate for Payer: Healthscope Commercial |
$27.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.42
|
| Rate for Payer: PHP Commercial |
$26.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.76
|
| Rate for Payer: Priority Health SBD |
$19.58
|
| Rate for Payer: UMR Bronson Commercial |
$13.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.31
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
|
IP
|
$26.20
|
|
|
Service Code
|
NDC 17478-102-12
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$23.58 |
| Rate for Payer: Aetna American Axle |
$17.03
|
| Rate for Payer: Aetna Commercial |
$22.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.03
|
| Rate for Payer: Cash Price |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$22.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.96
|
| Rate for Payer: Healthscope Commercial |
$23.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.27
|
| Rate for Payer: PHP Commercial |
$22.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.34
|
| Rate for Payer: Priority Health SBD |
$16.51
|
| Rate for Payer: UMR Bronson Commercial |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.65
|
|
|
TRYPAN BLUE 0.06 % INTRAOCULAR SYRINGE
|
Facility
|
IP
|
$182.04
|
|
|
Service Code
|
NDC 68803-612-10
|
| Hospital Charge Code |
88317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$80.10 |
| Max. Negotiated Rate |
$163.84 |
| Rate for Payer: Aetna American Axle |
$118.33
|
| Rate for Payer: Aetna Commercial |
$154.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.33
|
| Rate for Payer: Cash Price |
$145.63
|
| Rate for Payer: Cofinity Commercial |
$127.43
|
| Rate for Payer: Cofinity Commercial |
$156.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.63
|
| Rate for Payer: Healthscope Commercial |
$163.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.73
|
| Rate for Payer: PHP Commercial |
$154.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.43
|
| Rate for Payer: Priority Health SBD |
$114.69
|
| Rate for Payer: UMR Bronson Commercial |
$80.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.53
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION
|
Facility
|
IP
|
$232.42
|
|
|
Service Code
|
NDC 49281-752-78
|
| Hospital Charge Code |
8259
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.26 |
| Max. Negotiated Rate |
$209.18 |
| Rate for Payer: Aetna American Axle |
$151.07
|
| Rate for Payer: Aetna Commercial |
$197.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.07
|
| Rate for Payer: Cash Price |
$185.94
|
| Rate for Payer: Cofinity Commercial |
$162.69
|
| Rate for Payer: Cofinity Commercial |
$199.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.94
|
| Rate for Payer: Healthscope Commercial |
$209.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.56
|
| Rate for Payer: PHP Commercial |
$197.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.69
|
| Rate for Payer: Priority Health SBD |
$146.42
|
| Rate for Payer: UMR Bronson Commercial |
$102.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.32
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION
|
Facility
|
IP
|
$267.99
|
|
|
Service Code
|
NDC 42023-104-01
|
| Hospital Charge Code |
8259
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$117.92 |
| Max. Negotiated Rate |
$241.19 |
| Rate for Payer: Aetna American Axle |
$174.19
|
| Rate for Payer: Aetna Commercial |
$227.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.19
|
| Rate for Payer: Cash Price |
$214.39
|
| Rate for Payer: Cofinity Commercial |
$187.59
|
| Rate for Payer: Cofinity Commercial |
$230.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.39
|
| Rate for Payer: Healthscope Commercial |
$241.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.79
|
| Rate for Payer: PHP Commercial |
$227.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.59
|
| Rate for Payer: Priority Health SBD |
$168.83
|
| Rate for Payer: UMR Bronson Commercial |
$117.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.99
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION
|
Facility
|
IP
|
$1,054.50
|
|
|
Service Code
|
NDC 42023-104-05
|
| Hospital Charge Code |
8259
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$463.98 |
| Max. Negotiated Rate |
$949.05 |
| Rate for Payer: Aetna American Axle |
$685.42
|
| Rate for Payer: Aetna Commercial |
$896.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$685.42
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cofinity Commercial |
$738.15
|
| Rate for Payer: Cofinity Commercial |
$906.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$843.60
|
| Rate for Payer: Healthscope Commercial |
$949.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$738.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$790.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$896.32
|
| Rate for Payer: PHP Commercial |
$896.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$738.15
|
| Rate for Payer: Priority Health SBD |
$664.34
|
| Rate for Payer: UMR Bronson Commercial |
$463.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$790.88
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION
|
Facility
|
IP
|
$232.42
|
|
|
Service Code
|
NDC 49281-752-21
|
| Hospital Charge Code |
8259
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.26 |
| Max. Negotiated Rate |
$209.18 |
| Rate for Payer: Aetna American Axle |
$151.07
|
| Rate for Payer: Aetna Commercial |
$197.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.07
|
| Rate for Payer: Cash Price |
$185.94
|
| Rate for Payer: Cofinity Commercial |
$162.69
|
| Rate for Payer: Cofinity Commercial |
$199.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.94
|
| Rate for Payer: Healthscope Commercial |
$209.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.56
|
| Rate for Payer: PHP Commercial |
$197.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.69
|
| Rate for Payer: Priority Health SBD |
$146.42
|
| Rate for Payer: UMR Bronson Commercial |
$102.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.32
|
|
|
TUBE THORACOSTOMY, INCLUDES CONNECTION TO DRAINAGE SYSTEM (EG, WATER SEAL), WHEN PERFORMED, OPEN (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,481.48
|
|
|
Service Code
|
CPT 32551
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$150.30 |
| Max. Negotiated Rate |
$4,481.48 |
| Rate for Payer: Aetna Medicare |
$1,480.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,779.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,779.46
|
| Rate for Payer: BCBS Complete |
$817.70
|
| Rate for Payer: BCBS MAPPO |
$1,423.57
|
| Rate for Payer: BCBS Trust/PPO |
$833.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,423.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,423.57
|
| Rate for Payer: Mclaren Medicaid |
$778.69
|
| Rate for Payer: Mclaren Medicare |
$1,423.57
|
| Rate for Payer: Meridian Medicaid |
$817.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,494.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,637.11
|
| Rate for Payer: PACE Medicare |
$1,352.39
|
| Rate for Payer: PACE SWMI |
$1,423.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,423.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$778.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,481.48
|
| Rate for Payer: Priority Health Medicare |
$1,423.57
|
| Rate for Payer: Priority Health Narrow Network |
$3,585.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,423.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.33
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,423.57
|
| Rate for Payer: UHC Exchange |
$150.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,466.28
|
| Rate for Payer: VA VA |
$1,423.57
|
|
|
TYMPANIC MEMBRANE REPAIR, WITH OR WITHOUT SITE PREPARATION OF PERFORATION FOR CLOSURE, WITH OR WITHOUT PATCH
|
Facility
|
OP
|
$4,267.42
|
|
|
Service Code
|
CPT 69610
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$263.05 |
| Max. Negotiated Rate |
$4,267.42 |
| Rate for Payer: Aetna Medicare |
$1,409.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,694.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,694.48
|
| Rate for Payer: BCBS Complete |
$778.65
|
| Rate for Payer: BCBS MAPPO |
$1,355.58
|
| Rate for Payer: BCBS Trust/PPO |
$263.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,355.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,355.58
|
| Rate for Payer: Mclaren Medicaid |
$741.50
|
| Rate for Payer: Mclaren Medicare |
$1,355.58
|
| Rate for Payer: Meridian Medicaid |
$778.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,423.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,558.92
|
| Rate for Payer: PACE Medicare |
$1,287.80
|
| Rate for Payer: PACE SWMI |
$1,355.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,355.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$741.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,267.42
|
| Rate for Payer: Priority Health Medicare |
$1,355.58
|
| Rate for Payer: Priority Health Narrow Network |
$3,413.94
|
| Rate for Payer: Railroad Medicare Medicare |
$1,355.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.28
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,355.58
|
| Rate for Payer: UHC Exchange |
$283.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,396.25
|
| Rate for Payer: VA VA |
$1,355.58
|
|
|
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITH INTACT OR RECONSTRUCTED CANAL WALL, WITH OSSICULAR CHAIN RECONSTRUCTION
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 69644
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,483.31 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,783.79
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,631.64
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,483.31
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITH INTACT OR RECONSTRUCTED WALL, WITHOUT OSSICULAR CHAIN RECONSTRUCTION
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 69643
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,206.95 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,657.65
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,327.64
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,206.95
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITH OSSICULAR CHAIN RECONSTRUCTION
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 69642
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,320.90 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$7,442.24
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,452.99
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,320.90
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITHOUT OSSICULAR CHAIN RECONSTRUCTION
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 69641
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,029.15 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$7,046.54
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,132.06
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,029.15
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR SURGERY), INITIAL OR REVISION; WITH OSSICULAR CHAIN RECONSTRUCTION AND SYNTHETIC PROSTHESIS (EG, PARTIAL OSSICULAR REPLACEMENT PROSTHESIS [PORP], TOTAL OSSICULAR REPLACEMENT PROSTHESIS [TORP])
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 69633
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,040.28 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$5,287.94
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,144.31
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,040.28
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR SURGERY), INITIAL OR REVISION; WITHOUT OSSICULAR CHAIN RECONSTRUCTION
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 69631
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$880.49 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$5,752.74
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$968.54
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$880.49
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), GENERAL ANESTHESIA
|
Facility
|
OP
|
$4,267.42
|
|
|
Service Code
|
CPT 69436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$158.48 |
| Max. Negotiated Rate |
$4,267.42 |
| Rate for Payer: Aetna Medicare |
$1,409.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,694.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,694.48
|
| Rate for Payer: BCBS Complete |
$778.65
|
| Rate for Payer: BCBS MAPPO |
$1,355.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,745.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,355.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,355.58
|
| Rate for Payer: Mclaren Medicaid |
$741.50
|
| Rate for Payer: Mclaren Medicare |
$1,355.58
|
| Rate for Payer: Meridian Medicaid |
$778.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,423.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,558.92
|
| Rate for Payer: PACE Medicare |
$1,287.80
|
| Rate for Payer: PACE SWMI |
$1,355.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,355.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$741.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,267.42
|
| Rate for Payer: Priority Health Medicare |
$1,355.58
|
| Rate for Payer: Priority Health Narrow Network |
$3,413.94
|
| Rate for Payer: Railroad Medicare Medicare |
$1,355.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.33
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,355.58
|
| Rate for Payer: UHC Exchange |
$158.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,396.25
|
| Rate for Payer: VA VA |
$1,355.58
|
|
|
UBLITUXIMAB-XIIY 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25,566.66
|
|
|
Service Code
|
HCPCS J2329
|
| Hospital Charge Code |
202689
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.01 |
| Max. Negotiated Rate |
$23,009.99 |
| Rate for Payer: Aetna American Axle |
$16,618.33
|
| Rate for Payer: Aetna Commercial |
$21,731.66
|
| Rate for Payer: Aetna Medicare |
$70.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,618.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.58
|
| Rate for Payer: BCBS Complete |
$38.87
|
| Rate for Payer: BCBS MAPPO |
$67.66
|
| Rate for Payer: BCBS Trust/PPO |
$218.63
|
| Rate for Payer: BCN Medicare Advantage |
$67.66
|
| Rate for Payer: Cash Price |
$20,453.33
|
| Rate for Payer: Cash Price |
$20,453.33
|
| Rate for Payer: Cofinity Commercial |
$17,896.66
|
| Rate for Payer: Cofinity Commercial |
$21,987.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,453.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.66
|
| Rate for Payer: Healthscope Commercial |
$23,009.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,896.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,175.00
|
| Rate for Payer: Mclaren Medicaid |
$37.01
|
| Rate for Payer: Mclaren Medicare |
$67.66
|
| Rate for Payer: Meridian Medicaid |
$38.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,731.66
|
| Rate for Payer: PACE Medicare |
$64.28
|
| Rate for Payer: PACE SWMI |
$67.66
|
| Rate for Payer: PHP Commercial |
$21,731.66
|
| Rate for Payer: PHP Medicare Advantage |
$67.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,896.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.99
|
| Rate for Payer: Priority Health Medicare |
$67.66
|
| Rate for Payer: Priority Health Narrow Network |
$157.59
|
| Rate for Payer: Priority Health SBD |
$16,107.00
|
| Rate for Payer: Railroad Medicare Medicare |
$67.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.66
|
| Rate for Payer: UHC Medicare Advantage |
$69.69
|
| Rate for Payer: UMR Bronson Commercial |
$9,459.66
|
| Rate for Payer: VA VA |
$67.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,175.00
|
|
|
UBLITUXIMAB-XIIY 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25,566.66
|
|
|
Service Code
|
HCPCS J2329
|
| Hospital Charge Code |
202689
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,249.33 |
| Max. Negotiated Rate |
$23,009.99 |
| Rate for Payer: Aetna American Axle |
$16,618.33
|
| Rate for Payer: Aetna Commercial |
$21,731.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,618.33
|
| Rate for Payer: Cash Price |
$20,453.33
|
| Rate for Payer: Cofinity Commercial |
$17,896.66
|
| Rate for Payer: Cofinity Commercial |
$21,987.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,453.33
|
| Rate for Payer: Healthscope Commercial |
$23,009.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,896.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,175.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,731.66
|
| Rate for Payer: PHP Commercial |
$21,731.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,896.66
|
| Rate for Payer: Priority Health SBD |
$16,107.00
|
| Rate for Payer: UMR Bronson Commercial |
$11,249.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,175.00
|
|
|
ULIPRISTAL 30 MG TABLET
|
Facility
|
IP
|
$123.70
|
|
|
Service Code
|
NDC 50102-911-01
|
| Hospital Charge Code |
106079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.43 |
| Max. Negotiated Rate |
$111.33 |
| Rate for Payer: Aetna American Axle |
$80.40
|
| Rate for Payer: Aetna Commercial |
$105.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.40
|
| Rate for Payer: Cash Price |
$98.96
|
| Rate for Payer: Cofinity Commercial |
$106.38
|
| Rate for Payer: Cofinity Commercial |
$86.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.96
|
| Rate for Payer: Healthscope Commercial |
$111.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.14
|
| Rate for Payer: PHP Commercial |
$105.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.59
|
| Rate for Payer: Priority Health SBD |
$77.93
|
| Rate for Payer: UMR Bronson Commercial |
$54.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.78
|
|
|
ULIPRISTAL 30 MG TABLET
|
Facility
|
IP
|
$133.35
|
|
|
Service Code
|
NDC 73302-456-01
|
| Hospital Charge Code |
106079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.67 |
| Max. Negotiated Rate |
$120.02 |
| Rate for Payer: Aetna American Axle |
$86.68
|
| Rate for Payer: Aetna Commercial |
$113.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.68
|
| Rate for Payer: Cash Price |
$106.68
|
| Rate for Payer: Cofinity Commercial |
$114.68
|
| Rate for Payer: Cofinity Commercial |
$93.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.68
|
| Rate for Payer: Healthscope Commercial |
$120.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.35
|
| Rate for Payer: PHP Commercial |
$113.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.34
|
| Rate for Payer: Priority Health SBD |
$84.01
|
| Rate for Payer: UMR Bronson Commercial |
$58.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.01
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC
|
Facility
|
IP
|
$98,935.39
|
|
|
Service Code
|
MS-DRG 278
|
| Min. Negotiated Rate |
$33,140.13 |
| Max. Negotiated Rate |
$98,935.39 |
| Rate for Payer: Aetna Medicare |
$36,279.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43,605.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43,605.44
|
| Rate for Payer: BCBS MAPPO |
$34,884.35
|
| Rate for Payer: BCBS Trust/PPO |
$98,935.39
|
| Rate for Payer: BCN Medicare Advantage |
$34,884.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34,884.35
|
| Rate for Payer: Mclaren Medicare |
$34,884.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36,628.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40,117.00
|
| Rate for Payer: PACE Medicare |
$33,140.13
|
| Rate for Payer: PACE SWMI |
$34,884.35
|
| Rate for Payer: PHP Medicare Advantage |
$34,884.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64,006.38
|
| Rate for Payer: Priority Health Medicare |
$34,884.35
|
| Rate for Payer: Priority Health Narrow Network |
$51,205.10
|
| Rate for Payer: Railroad Medicare Medicare |
$34,884.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68,038.94
|
| Rate for Payer: UHC Core |
$55,790.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$34,884.35
|
| Rate for Payer: UHC Exchange |
$44,354.22
|
| Rate for Payer: UHC Medicare Advantage |
$35,930.88
|
| Rate for Payer: VA VA |
$34,884.35
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC
|
Facility
|
IP
|
$56,022.59
|
|
|
Service Code
|
MS-DRG 279
|
| Min. Negotiated Rate |
$23,917.48 |
| Max. Negotiated Rate |
$56,022.59 |
| Rate for Payer: Aetna Medicare |
$26,183.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,470.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,470.36
|
| Rate for Payer: BCBS MAPPO |
$25,176.29
|
| Rate for Payer: BCBS Trust/PPO |
$56,022.59
|
| Rate for Payer: BCN Medicare Advantage |
$25,176.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,176.29
|
| Rate for Payer: Mclaren Medicare |
$25,176.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26,435.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,952.73
|
| Rate for Payer: PACE Medicare |
$23,917.48
|
| Rate for Payer: PACE SWMI |
$25,176.29
|
| Rate for Payer: PHP Medicare Advantage |
$25,176.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45,928.35
|
| Rate for Payer: Priority Health Medicare |
$25,176.29
|
| Rate for Payer: Priority Health Narrow Network |
$36,742.68
|
| Rate for Payer: Railroad Medicare Medicare |
$25,176.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48,821.95
|
| Rate for Payer: UHC Core |
$40,033.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$25,176.29
|
| Rate for Payer: UHC Exchange |
$31,826.77
|
| Rate for Payer: UHC Medicare Advantage |
$25,931.58
|
| Rate for Payer: VA VA |
$25,176.29
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM
|
Facility
|
IP
|
$54,225.87
|
|
|
Service Code
|
MS-DRG 173
|
| Min. Negotiated Rate |
$22,997.99 |
| Max. Negotiated Rate |
$54,225.87 |
| Rate for Payer: Aetna Medicare |
$25,176.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,260.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,260.51
|
| Rate for Payer: BCBS MAPPO |
$24,208.41
|
| Rate for Payer: BCBS Trust/PPO |
$54,225.87
|
| Rate for Payer: BCN Medicare Advantage |
$24,208.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,208.41
|
| Rate for Payer: Mclaren Medicare |
$24,208.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25,418.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,839.67
|
| Rate for Payer: PACE Medicare |
$22,997.99
|
| Rate for Payer: PACE SWMI |
$24,208.41
|
| Rate for Payer: PHP Medicare Advantage |
$24,208.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44,126.00
|
| Rate for Payer: Priority Health Medicare |
$24,208.41
|
| Rate for Payer: Priority Health Narrow Network |
$35,300.80
|
| Rate for Payer: Railroad Medicare Medicare |
$24,208.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46,906.05
|
| Rate for Payer: UHC Core |
$38,462.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$24,208.41
|
| Rate for Payer: UHC Exchange |
$30,577.80
|
| Rate for Payer: UHC Medicare Advantage |
$24,934.66
|
| Rate for Payer: VA VA |
$24,208.41
|
|
|
ULTRASOUND GUIDANCE FOR VASCULAR ACCESS REQUIRING ULTRASOUND EVALUATION OF POTENTIAL ACCESS SITES, DOCUMENTATION OF SELECTED VESSEL PATENCY, CONCURRENT REALTIME ULTRASOUND VISUALIZATION OF VASCULAR NEEDLE ENTRY, WITH PERMANENT RECORDING AND REPORTING (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$48.14
|
|
|
Service Code
|
CPT 76937
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$48.14 |
| Rate for Payer: BCBS Trust/PPO |
$48.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.43
|
| Rate for Payer: UHC Exchange |
$37.66
|
|
