|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$1,414.81
|
|
|
Service Code
|
NDC 61958100301
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$523.48 |
| Max. Negotiated Rate |
$1,273.33 |
| Rate for Payer: Aetna American Axle |
$919.63
|
| Rate for Payer: Aetna Commercial |
$1,202.59
|
| Rate for Payer: Aetna Medicare |
$707.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$919.63
|
| Rate for Payer: BCBS Complete |
$565.92
|
| Rate for Payer: Cash Price |
$1,131.85
|
| Rate for Payer: Cofinity Commercial |
$1,216.74
|
| Rate for Payer: Cofinity Commercial |
$990.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$990.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.85
|
| Rate for Payer: Healthscope Commercial |
$1,273.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$990.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,061.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,202.59
|
| Rate for Payer: PHP Commercial |
$1,202.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.63
|
| Rate for Payer: Priority Health SBD |
$891.33
|
| Rate for Payer: UMR Bronson Commercial |
$523.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,061.11
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$381.03
|
|
|
Service Code
|
NDC 45963041806
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.65 |
| Max. Negotiated Rate |
$342.93 |
| Rate for Payer: Aetna American Axle |
$247.67
|
| Rate for Payer: Aetna Commercial |
$323.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.67
|
| Rate for Payer: Cash Price |
$304.82
|
| Rate for Payer: Cofinity Commercial |
$266.72
|
| Rate for Payer: Cofinity Commercial |
$327.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.82
|
| Rate for Payer: Healthscope Commercial |
$342.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.88
|
| Rate for Payer: PHP Commercial |
$323.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.67
|
| Rate for Payer: Priority Health SBD |
$240.05
|
| Rate for Payer: UMR Bronson Commercial |
$167.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.77
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$1,414.81
|
|
|
Service Code
|
NDC 61958100301
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$622.52 |
| Max. Negotiated Rate |
$1,273.33 |
| Rate for Payer: Aetna American Axle |
$919.63
|
| Rate for Payer: Aetna Commercial |
$1,202.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$919.63
|
| Rate for Payer: Cash Price |
$1,131.85
|
| Rate for Payer: Cofinity Commercial |
$1,216.74
|
| Rate for Payer: Cofinity Commercial |
$990.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$990.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.85
|
| Rate for Payer: Healthscope Commercial |
$1,273.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$990.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,061.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,202.59
|
| Rate for Payer: PHP Commercial |
$1,202.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.63
|
| Rate for Payer: Priority Health SBD |
$891.33
|
| Rate for Payer: UMR Bronson Commercial |
$622.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,061.11
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$177.12
|
|
|
Service Code
|
NDC 60687054921
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.93 |
| Max. Negotiated Rate |
$159.41 |
| Rate for Payer: Aetna American Axle |
$115.13
|
| Rate for Payer: Aetna Commercial |
$150.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.13
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cofinity Commercial |
$123.98
|
| Rate for Payer: Cofinity Commercial |
$152.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.70
|
| Rate for Payer: Healthscope Commercial |
$159.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.55
|
| Rate for Payer: PHP Commercial |
$150.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.13
|
| Rate for Payer: Priority Health SBD |
$111.59
|
| Rate for Payer: UMR Bronson Commercial |
$77.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.84
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$177.12
|
|
|
Service Code
|
NDC 60687054921
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.53 |
| Max. Negotiated Rate |
$159.41 |
| Rate for Payer: Aetna American Axle |
$115.13
|
| Rate for Payer: Aetna Commercial |
$150.55
|
| Rate for Payer: Aetna Medicare |
$88.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.13
|
| Rate for Payer: BCBS Complete |
$70.85
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cofinity Commercial |
$123.98
|
| Rate for Payer: Cofinity Commercial |
$152.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.70
|
| Rate for Payer: Healthscope Commercial |
$159.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.55
|
| Rate for Payer: PHP Commercial |
$150.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.13
|
| Rate for Payer: Priority Health SBD |
$111.59
|
| Rate for Payer: UMR Bronson Commercial |
$65.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.84
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$5.91
|
|
|
Service Code
|
NDC 60687054911
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna American Axle |
$3.84
|
| Rate for Payer: Aetna Commercial |
$5.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.84
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cofinity Commercial |
$4.14
|
| Rate for Payer: Cofinity Commercial |
$5.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.73
|
| Rate for Payer: Healthscope Commercial |
$5.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.02
|
| Rate for Payer: PHP Commercial |
$5.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.84
|
| Rate for Payer: Priority Health SBD |
$3.72
|
| Rate for Payer: UMR Bronson Commercial |
$2.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.43
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$154.47
|
|
|
Service Code
|
NDC 31722066860
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.97 |
| Max. Negotiated Rate |
$139.02 |
| Rate for Payer: Aetna American Axle |
$100.41
|
| Rate for Payer: Aetna Commercial |
$131.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.41
|
| Rate for Payer: Cash Price |
$123.58
|
| Rate for Payer: Cofinity Commercial |
$108.13
|
| Rate for Payer: Cofinity Commercial |
$132.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.58
|
| Rate for Payer: Healthscope Commercial |
$139.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.30
|
| Rate for Payer: PHP Commercial |
$131.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.41
|
| Rate for Payer: Priority Health SBD |
$97.32
|
| Rate for Payer: UMR Bronson Commercial |
$67.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.85
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$381.03
|
|
|
Service Code
|
NDC 45963041806
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.98 |
| Max. Negotiated Rate |
$342.93 |
| Rate for Payer: Aetna American Axle |
$247.67
|
| Rate for Payer: Aetna Commercial |
$323.88
|
| Rate for Payer: Aetna Medicare |
$190.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.67
|
| Rate for Payer: BCBS Complete |
$152.41
|
| Rate for Payer: Cash Price |
$304.82
|
| Rate for Payer: Cofinity Commercial |
$266.72
|
| Rate for Payer: Cofinity Commercial |
$327.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.82
|
| Rate for Payer: Healthscope Commercial |
$342.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.88
|
| Rate for Payer: PHP Commercial |
$323.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.67
|
| Rate for Payer: Priority Health SBD |
$240.05
|
| Rate for Payer: UMR Bronson Commercial |
$140.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.77
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
IP
|
$295.93
|
|
|
Service Code
|
NDC 23155074603
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.21 |
| Max. Negotiated Rate |
$266.34 |
| Rate for Payer: Aetna American Axle |
$192.35
|
| Rate for Payer: Aetna Commercial |
$251.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.35
|
| Rate for Payer: Cash Price |
$236.74
|
| Rate for Payer: Cofinity Commercial |
$207.15
|
| Rate for Payer: Cofinity Commercial |
$254.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.74
|
| Rate for Payer: Healthscope Commercial |
$266.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.54
|
| Rate for Payer: PHP Commercial |
$251.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.35
|
| Rate for Payer: Priority Health SBD |
$186.44
|
| Rate for Payer: UMR Bronson Commercial |
$130.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.95
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
OP
|
$4,305.03
|
|
|
Service Code
|
NDC 68546014256
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,592.86 |
| Max. Negotiated Rate |
$3,874.53 |
| Rate for Payer: Aetna American Axle |
$2,798.27
|
| Rate for Payer: Aetna Commercial |
$3,659.28
|
| Rate for Payer: Aetna Medicare |
$2,152.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,798.27
|
| Rate for Payer: BCBS Complete |
$1,722.01
|
| Rate for Payer: Cash Price |
$3,444.02
|
| Rate for Payer: Cofinity Commercial |
$3,013.52
|
| Rate for Payer: Cofinity Commercial |
$3,702.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,013.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,444.02
|
| Rate for Payer: Healthscope Commercial |
$3,874.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,013.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,228.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,659.28
|
| Rate for Payer: PHP Commercial |
$3,659.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,798.27
|
| Rate for Payer: Priority Health SBD |
$2,712.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,592.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,228.77
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
OP
|
$1,417.59
|
|
|
Service Code
|
NDC 00378127093
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$524.51 |
| Max. Negotiated Rate |
$1,275.83 |
| Rate for Payer: Aetna American Axle |
$921.43
|
| Rate for Payer: Aetna Commercial |
$1,204.95
|
| Rate for Payer: Aetna Medicare |
$708.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.43
|
| Rate for Payer: BCBS Complete |
$567.04
|
| Rate for Payer: Cash Price |
$1,134.07
|
| Rate for Payer: Cofinity Commercial |
$1,219.13
|
| Rate for Payer: Cofinity Commercial |
$992.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$992.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,134.07
|
| Rate for Payer: Healthscope Commercial |
$1,275.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$992.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,063.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,204.95
|
| Rate for Payer: PHP Commercial |
$1,204.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.43
|
| Rate for Payer: Priority Health SBD |
$893.08
|
| Rate for Payer: UMR Bronson Commercial |
$524.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,063.19
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
IP
|
$1,417.59
|
|
|
Service Code
|
NDC 00378127093
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$623.74 |
| Max. Negotiated Rate |
$1,275.83 |
| Rate for Payer: Aetna American Axle |
$921.43
|
| Rate for Payer: Aetna Commercial |
$1,204.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.43
|
| Rate for Payer: Cash Price |
$1,134.07
|
| Rate for Payer: Cofinity Commercial |
$1,219.13
|
| Rate for Payer: Cofinity Commercial |
$992.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$992.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,134.07
|
| Rate for Payer: Healthscope Commercial |
$1,275.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$992.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,063.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,204.95
|
| Rate for Payer: PHP Commercial |
$1,204.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.43
|
| Rate for Payer: Priority Health SBD |
$893.08
|
| Rate for Payer: UMR Bronson Commercial |
$623.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,063.19
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
OP
|
$342.44
|
|
|
Service Code
|
NDC 67877025930
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Aetna American Axle |
$222.59
|
| Rate for Payer: Aetna Commercial |
$291.07
|
| Rate for Payer: Aetna Medicare |
$171.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.59
|
| Rate for Payer: BCBS Complete |
$136.98
|
| Rate for Payer: Cash Price |
$273.95
|
| Rate for Payer: Cofinity Commercial |
$239.71
|
| Rate for Payer: Cofinity Commercial |
$294.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.95
|
| Rate for Payer: Healthscope Commercial |
$308.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.07
|
| Rate for Payer: PHP Commercial |
$291.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.59
|
| Rate for Payer: Priority Health SBD |
$215.74
|
| Rate for Payer: UMR Bronson Commercial |
$126.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.83
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
IP
|
$4,305.03
|
|
|
Service Code
|
NDC 68546014256
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,894.21 |
| Max. Negotiated Rate |
$3,874.53 |
| Rate for Payer: Aetna American Axle |
$2,798.27
|
| Rate for Payer: Aetna Commercial |
$3,659.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,798.27
|
| Rate for Payer: Cash Price |
$3,444.02
|
| Rate for Payer: Cofinity Commercial |
$3,013.52
|
| Rate for Payer: Cofinity Commercial |
$3,702.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,013.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,444.02
|
| Rate for Payer: Healthscope Commercial |
$3,874.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,013.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,228.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,659.28
|
| Rate for Payer: PHP Commercial |
$3,659.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,798.27
|
| Rate for Payer: Priority Health SBD |
$2,712.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,894.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,228.77
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
IP
|
$342.44
|
|
|
Service Code
|
NDC 67877025930
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.67 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Aetna American Axle |
$222.59
|
| Rate for Payer: Aetna Commercial |
$291.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.59
|
| Rate for Payer: Cash Price |
$273.95
|
| Rate for Payer: Cofinity Commercial |
$239.71
|
| Rate for Payer: Cofinity Commercial |
$294.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.95
|
| Rate for Payer: Healthscope Commercial |
$308.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.07
|
| Rate for Payer: PHP Commercial |
$291.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.59
|
| Rate for Payer: Priority Health SBD |
$215.74
|
| Rate for Payer: UMR Bronson Commercial |
$150.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.83
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
OP
|
$295.93
|
|
|
Service Code
|
NDC 23155074603
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.49 |
| Max. Negotiated Rate |
$266.34 |
| Rate for Payer: Aetna American Axle |
$192.35
|
| Rate for Payer: Aetna Commercial |
$251.54
|
| Rate for Payer: Aetna Medicare |
$147.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.35
|
| Rate for Payer: BCBS Complete |
$118.37
|
| Rate for Payer: Cash Price |
$236.74
|
| Rate for Payer: Cofinity Commercial |
$207.15
|
| Rate for Payer: Cofinity Commercial |
$254.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.74
|
| Rate for Payer: Healthscope Commercial |
$266.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.54
|
| Rate for Payer: PHP Commercial |
$251.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.35
|
| Rate for Payer: Priority Health SBD |
$186.44
|
| Rate for Payer: UMR Bronson Commercial |
$109.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.95
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,490.03
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
33591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,535.61 |
| Max. Negotiated Rate |
$3,141.03 |
| Rate for Payer: Aetna American Axle |
$2,268.52
|
| Rate for Payer: Aetna Commercial |
$2,966.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,268.52
|
| Rate for Payer: Cash Price |
$2,792.02
|
| Rate for Payer: Cofinity Commercial |
$2,443.02
|
| Rate for Payer: Cofinity Commercial |
$3,001.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,443.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,792.02
|
| Rate for Payer: Healthscope Commercial |
$3,141.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,443.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,617.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,966.53
|
| Rate for Payer: PHP Commercial |
$2,966.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,268.52
|
| Rate for Payer: Priority Health SBD |
$2,198.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,535.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,617.52
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,490.03
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
33591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$202.35 |
| Max. Negotiated Rate |
$3,141.03 |
| Rate for Payer: Aetna American Axle |
$2,268.52
|
| Rate for Payer: Aetna Commercial |
$2,966.53
|
| Rate for Payer: Aetna Medicare |
$392.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,268.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$471.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$471.90
|
| Rate for Payer: BCBS Complete |
$212.47
|
| Rate for Payer: BCBS MAPPO |
$377.52
|
| Rate for Payer: BCN Medicare Advantage |
$377.52
|
| Rate for Payer: Cash Price |
$2,792.02
|
| Rate for Payer: Cash Price |
$2,792.02
|
| Rate for Payer: Cofinity Commercial |
$3,001.43
|
| Rate for Payer: Cofinity Commercial |
$2,443.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,443.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,792.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$377.52
|
| Rate for Payer: Healthscope Commercial |
$3,141.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,443.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,617.52
|
| Rate for Payer: Mclaren Medicaid |
$202.35
|
| Rate for Payer: Mclaren Medicare |
$377.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$396.40
|
| Rate for Payer: Meridian Medicaid |
$212.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$434.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,966.53
|
| Rate for Payer: PACE Medicare |
$358.64
|
| Rate for Payer: PACE SWMI |
$377.52
|
| Rate for Payer: PHP Commercial |
$2,966.53
|
| Rate for Payer: PHP Medicare Advantage |
$377.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,268.52
|
| Rate for Payer: Priority Health Medicare |
$377.52
|
| Rate for Payer: Priority Health SBD |
$2,198.72
|
| Rate for Payer: Railroad Medicare Medicare |
$377.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,062.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$377.52
|
| Rate for Payer: UHC Exchange |
$721.48
|
| Rate for Payer: UHC Medicare Advantage |
$377.52
|
| Rate for Payer: UHCCP Medicaid |
$202.35
|
| Rate for Payer: UMR Bronson Commercial |
$1,291.31
|
| Rate for Payer: VA VA |
$377.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,617.52
|
|
|
RAVULIZUMAB-CWVZ 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16,650.41
|
|
|
Service Code
|
HCPCS J1303
|
| Hospital Charge Code |
195284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,326.18 |
| Max. Negotiated Rate |
$14,985.37 |
| Rate for Payer: Aetna American Axle |
$10,822.77
|
| Rate for Payer: Aetna American Axle |
$39,683.44
|
| Rate for Payer: Aetna Commercial |
$14,152.85
|
| Rate for Payer: Aetna Commercial |
$51,893.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,822.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39,683.44
|
| Rate for Payer: Cash Price |
$13,320.33
|
| Rate for Payer: Cash Price |
$48,841.16
|
| Rate for Payer: Cofinity Commercial |
$52,504.25
|
| Rate for Payer: Cofinity Commercial |
$42,736.01
|
| Rate for Payer: Cofinity Commercial |
$11,655.29
|
| Rate for Payer: Cofinity Commercial |
$14,319.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,655.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$42,736.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,320.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48,841.16
|
| Rate for Payer: Healthscope Commercial |
$14,985.37
|
| Rate for Payer: Healthscope Commercial |
$54,946.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,655.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42,736.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,487.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45,788.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51,893.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,152.85
|
| Rate for Payer: PHP Commercial |
$51,893.73
|
| Rate for Payer: PHP Commercial |
$14,152.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,822.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39,683.44
|
| Rate for Payer: Priority Health SBD |
$10,489.76
|
| Rate for Payer: Priority Health SBD |
$38,462.41
|
| Rate for Payer: UMR Bronson Commercial |
$7,326.18
|
| Rate for Payer: UMR Bronson Commercial |
$26,862.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,487.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45,788.59
|
|
|
RAVULIZUMAB-CWVZ 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$61,051.45
|
|
|
Service Code
|
HCPCS J1303
|
| Hospital Charge Code |
195284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.66 |
| Max. Negotiated Rate |
$54,946.31 |
| Rate for Payer: Aetna American Axle |
$39,683.44
|
| Rate for Payer: Aetna American Axle |
$10,822.77
|
| Rate for Payer: Aetna Commercial |
$14,152.85
|
| Rate for Payer: Aetna Commercial |
$51,893.73
|
| Rate for Payer: Aetna Medicare |
$234.11
|
| Rate for Payer: Aetna Medicare |
$234.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39,683.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,822.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$281.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$281.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$281.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$281.39
|
| Rate for Payer: BCBS Complete |
$126.69
|
| Rate for Payer: BCBS Complete |
$126.69
|
| Rate for Payer: BCBS MAPPO |
$225.11
|
| Rate for Payer: BCBS MAPPO |
$225.11
|
| Rate for Payer: BCN Medicare Advantage |
$225.11
|
| Rate for Payer: BCN Medicare Advantage |
$225.11
|
| Rate for Payer: Cash Price |
$13,320.33
|
| Rate for Payer: Cash Price |
$48,841.16
|
| Rate for Payer: Cash Price |
$48,841.16
|
| Rate for Payer: Cash Price |
$13,320.33
|
| Rate for Payer: Cofinity Commercial |
$11,655.29
|
| Rate for Payer: Cofinity Commercial |
$14,319.35
|
| Rate for Payer: Cofinity Commercial |
$42,736.01
|
| Rate for Payer: Cofinity Commercial |
$52,504.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,655.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$42,736.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48,841.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,320.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.11
|
| Rate for Payer: Healthscope Commercial |
$54,946.31
|
| Rate for Payer: Healthscope Commercial |
$14,985.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42,736.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,655.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,487.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45,788.59
|
| Rate for Payer: Mclaren Medicaid |
$120.66
|
| Rate for Payer: Mclaren Medicaid |
$120.66
|
| Rate for Payer: Mclaren Medicare |
$225.11
|
| Rate for Payer: Mclaren Medicare |
$225.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$236.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$236.37
|
| Rate for Payer: Meridian Medicaid |
$126.69
|
| Rate for Payer: Meridian Medicaid |
$126.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$258.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$258.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51,893.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,152.85
|
| Rate for Payer: PACE Medicare |
$213.85
|
| Rate for Payer: PACE Medicare |
$213.85
|
| Rate for Payer: PACE SWMI |
$225.11
|
| Rate for Payer: PACE SWMI |
$225.11
|
| Rate for Payer: PHP Commercial |
$14,152.85
|
| Rate for Payer: PHP Commercial |
$51,893.73
|
| Rate for Payer: PHP Medicare Advantage |
$225.11
|
| Rate for Payer: PHP Medicare Advantage |
$225.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,822.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39,683.44
|
| Rate for Payer: Priority Health Medicare |
$225.11
|
| Rate for Payer: Priority Health Medicare |
$225.11
|
| Rate for Payer: Priority Health SBD |
$10,489.76
|
| Rate for Payer: Priority Health SBD |
$38,462.41
|
| Rate for Payer: Railroad Medicare Medicare |
$225.11
|
| Rate for Payer: Railroad Medicare Medicare |
$225.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$633.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$633.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.11
|
| Rate for Payer: UHC Exchange |
$430.21
|
| Rate for Payer: UHC Exchange |
$430.21
|
| Rate for Payer: UHC Medicare Advantage |
$225.11
|
| Rate for Payer: UHC Medicare Advantage |
$225.11
|
| Rate for Payer: UHCCP Medicaid |
$120.66
|
| Rate for Payer: UHCCP Medicaid |
$120.66
|
| Rate for Payer: UMR Bronson Commercial |
$6,160.65
|
| Rate for Payer: UMR Bronson Commercial |
$22,589.04
|
| Rate for Payer: VA VA |
$225.11
|
| Rate for Payer: VA VA |
$225.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45,788.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,487.81
|
|
|
REALIGNMENT OF EXTENSOR TENDON, HAND, EACH TENDON
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 26437
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
RECONSTRUCTION (ADVANCEMENT), POSTERIOR TIBIAL TENDON WITH EXCISION OF ACCESSORY TARSAL NAVICULAR BONE (EG, KIDNER TYPE PROCEDURE)
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 28238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
RECONSTRUCTION, ANGULAR DEFORMITY OF TOE, SOFT TISSUE PROCEDURES ONLY (EG, OVERLAPPING SECOND TOE, FIFTH TOE, CURLY TOES)
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28313
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
RECONSTRUCTION, COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT, SINGLE; WITH LOCAL TISSUE (EG, ADDUCTOR ADVANCEMENT)
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 26542
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
RECONSTRUCTION, COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT, SINGLE; WITH TENDON OR FASCIAL GRAFT (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 26541
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
