|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$2,031.52
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
300469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$1,828.37 |
| Rate for Payer: Aetna American Axle |
$1,320.49
|
| Rate for Payer: Aetna Commercial |
$1,726.79
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,320.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.41
|
| Rate for Payer: BCBS Complete |
$3.79
|
| Rate for Payer: BCBS MAPPO |
$6.73
|
| Rate for Payer: BCN Medicare Advantage |
$6.73
|
| Rate for Payer: Cash Price |
$1,625.22
|
| Rate for Payer: Cash Price |
$1,625.22
|
| Rate for Payer: Cofinity Commercial |
$1,747.11
|
| Rate for Payer: Cofinity Commercial |
$1,422.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,422.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.73
|
| Rate for Payer: Healthscope Commercial |
$1,828.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,422.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,523.64
|
| Rate for Payer: Mclaren Medicaid |
$3.61
|
| Rate for Payer: Mclaren Medicare |
$6.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.07
|
| Rate for Payer: Meridian Medicaid |
$3.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.79
|
| Rate for Payer: PACE Medicare |
$6.39
|
| Rate for Payer: PACE SWMI |
$6.73
|
| Rate for Payer: PHP Commercial |
$1,726.79
|
| Rate for Payer: PHP Medicare Advantage |
$6.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.49
|
| Rate for Payer: Priority Health Medicare |
$6.73
|
| Rate for Payer: Priority Health SBD |
$1,279.86
|
| Rate for Payer: Railroad Medicare Medicare |
$6.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.73
|
| Rate for Payer: UHC Exchange |
$12.86
|
| Rate for Payer: UHC Medicare Advantage |
$6.73
|
| Rate for Payer: UHCCP Medicaid |
$3.61
|
| Rate for Payer: UMR Bronson Commercial |
$751.66
|
| Rate for Payer: VA VA |
$6.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,523.64
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$2,031.52
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
300469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$893.87 |
| Max. Negotiated Rate |
$1,828.37 |
| Rate for Payer: Aetna American Axle |
$1,320.49
|
| Rate for Payer: Aetna Commercial |
$1,726.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,320.49
|
| Rate for Payer: Cash Price |
$1,625.22
|
| Rate for Payer: Cofinity Commercial |
$1,422.06
|
| Rate for Payer: Cofinity Commercial |
$1,747.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,422.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.22
|
| Rate for Payer: Healthscope Commercial |
$1,828.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,422.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,523.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.79
|
| Rate for Payer: PHP Commercial |
$1,726.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.49
|
| Rate for Payer: Priority Health SBD |
$1,279.86
|
| Rate for Payer: UMR Bronson Commercial |
$893.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,523.64
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$238.60
|
|
|
Service Code
|
NDC 63323072301
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$88.28 |
| Max. Negotiated Rate |
$214.74 |
| Rate for Payer: Aetna American Axle |
$155.09
|
| Rate for Payer: Aetna Commercial |
$202.81
|
| Rate for Payer: Aetna Medicare |
$119.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.09
|
| Rate for Payer: BCBS Complete |
$95.44
|
| Rate for Payer: Cash Price |
$190.88
|
| Rate for Payer: Cofinity Commercial |
$167.02
|
| Rate for Payer: Cofinity Commercial |
$205.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.88
|
| Rate for Payer: Healthscope Commercial |
$214.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.81
|
| Rate for Payer: PHP Commercial |
$202.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.09
|
| Rate for Payer: Priority Health SBD |
$150.32
|
| Rate for Payer: UMR Bronson Commercial |
$88.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.95
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$238.60
|
|
|
Service Code
|
NDC 63323072303
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$214.74 |
| Rate for Payer: Aetna American Axle |
$155.09
|
| Rate for Payer: Aetna Commercial |
$202.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.09
|
| Rate for Payer: Cash Price |
$190.88
|
| Rate for Payer: Cofinity Commercial |
$167.02
|
| Rate for Payer: Cofinity Commercial |
$205.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.88
|
| Rate for Payer: Healthscope Commercial |
$214.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.81
|
| Rate for Payer: PHP Commercial |
$202.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.09
|
| Rate for Payer: Priority Health SBD |
$150.32
|
| Rate for Payer: UMR Bronson Commercial |
$104.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.95
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$238.60
|
|
|
Service Code
|
NDC 63323072303
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$88.28 |
| Max. Negotiated Rate |
$214.74 |
| Rate for Payer: Aetna American Axle |
$155.09
|
| Rate for Payer: Aetna Commercial |
$202.81
|
| Rate for Payer: Aetna Medicare |
$119.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.09
|
| Rate for Payer: BCBS Complete |
$95.44
|
| Rate for Payer: Cash Price |
$190.88
|
| Rate for Payer: Cofinity Commercial |
$167.02
|
| Rate for Payer: Cofinity Commercial |
$205.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.88
|
| Rate for Payer: Healthscope Commercial |
$214.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.81
|
| Rate for Payer: PHP Commercial |
$202.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.09
|
| Rate for Payer: Priority Health SBD |
$150.32
|
| Rate for Payer: UMR Bronson Commercial |
$88.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.95
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$229.46
|
|
|
Service Code
|
NDC 67457019803
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$206.51 |
| Rate for Payer: Aetna American Axle |
$149.15
|
| Rate for Payer: Aetna Commercial |
$195.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.15
|
| Rate for Payer: Cash Price |
$183.57
|
| Rate for Payer: Cofinity Commercial |
$160.62
|
| Rate for Payer: Cofinity Commercial |
$197.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.57
|
| Rate for Payer: Healthscope Commercial |
$206.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.04
|
| Rate for Payer: PHP Commercial |
$195.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.15
|
| Rate for Payer: Priority Health SBD |
$144.56
|
| Rate for Payer: UMR Bronson Commercial |
$100.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.09
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$229.46
|
|
|
Service Code
|
NDC 67457019803
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.90 |
| Max. Negotiated Rate |
$206.51 |
| Rate for Payer: Aetna American Axle |
$149.15
|
| Rate for Payer: Aetna Commercial |
$195.04
|
| Rate for Payer: Aetna Medicare |
$114.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.15
|
| Rate for Payer: BCBS Complete |
$91.78
|
| Rate for Payer: Cash Price |
$183.57
|
| Rate for Payer: Cofinity Commercial |
$160.62
|
| Rate for Payer: Cofinity Commercial |
$197.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.57
|
| Rate for Payer: Healthscope Commercial |
$206.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.04
|
| Rate for Payer: PHP Commercial |
$195.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.15
|
| Rate for Payer: Priority Health SBD |
$144.56
|
| Rate for Payer: UMR Bronson Commercial |
$84.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.09
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$238.60
|
|
|
Service Code
|
NDC 63323072301
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$214.74 |
| Rate for Payer: Aetna American Axle |
$155.09
|
| Rate for Payer: Aetna Commercial |
$202.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.09
|
| Rate for Payer: Cash Price |
$190.88
|
| Rate for Payer: Cofinity Commercial |
$167.02
|
| Rate for Payer: Cofinity Commercial |
$205.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.88
|
| Rate for Payer: Healthscope Commercial |
$214.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.81
|
| Rate for Payer: PHP Commercial |
$202.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.09
|
| Rate for Payer: Priority Health SBD |
$150.32
|
| Rate for Payer: UMR Bronson Commercial |
$104.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.95
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$418.63
|
|
|
Service Code
|
NDC 63323072401
|
| Hospital Charge Code |
18400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$376.77 |
| Rate for Payer: Aetna American Axle |
$272.11
|
| Rate for Payer: Aetna Commercial |
$355.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.11
|
| Rate for Payer: Cash Price |
$334.90
|
| Rate for Payer: Cofinity Commercial |
$293.04
|
| Rate for Payer: Cofinity Commercial |
$360.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$293.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.90
|
| Rate for Payer: Healthscope Commercial |
$376.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.84
|
| Rate for Payer: PHP Commercial |
$355.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.11
|
| Rate for Payer: Priority Health SBD |
$263.74
|
| Rate for Payer: UMR Bronson Commercial |
$184.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.97
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$418.63
|
|
|
Service Code
|
NDC 63323072405
|
| Hospital Charge Code |
18400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$376.77 |
| Rate for Payer: Aetna American Axle |
$272.11
|
| Rate for Payer: Aetna Commercial |
$355.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.11
|
| Rate for Payer: Cash Price |
$334.90
|
| Rate for Payer: Cofinity Commercial |
$293.04
|
| Rate for Payer: Cofinity Commercial |
$360.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$293.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.90
|
| Rate for Payer: Healthscope Commercial |
$376.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.84
|
| Rate for Payer: PHP Commercial |
$355.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.11
|
| Rate for Payer: Priority Health SBD |
$263.74
|
| Rate for Payer: UMR Bronson Commercial |
$184.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.97
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$418.63
|
|
|
Service Code
|
NDC 63323072401
|
| Hospital Charge Code |
18400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$154.89 |
| Max. Negotiated Rate |
$376.77 |
| Rate for Payer: Aetna American Axle |
$272.11
|
| Rate for Payer: Aetna Commercial |
$355.84
|
| Rate for Payer: Aetna Medicare |
$209.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.11
|
| Rate for Payer: BCBS Complete |
$167.45
|
| Rate for Payer: Cash Price |
$334.90
|
| Rate for Payer: Cofinity Commercial |
$293.04
|
| Rate for Payer: Cofinity Commercial |
$360.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$293.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.90
|
| Rate for Payer: Healthscope Commercial |
$376.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.84
|
| Rate for Payer: PHP Commercial |
$355.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.11
|
| Rate for Payer: Priority Health SBD |
$263.74
|
| Rate for Payer: UMR Bronson Commercial |
$154.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.97
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$313.39
|
|
|
Service Code
|
NDC 67457019899
|
| Hospital Charge Code |
18400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$115.95 |
| Max. Negotiated Rate |
$282.05 |
| Rate for Payer: Aetna American Axle |
$203.70
|
| Rate for Payer: Aetna Commercial |
$266.38
|
| Rate for Payer: Aetna Medicare |
$156.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.70
|
| Rate for Payer: BCBS Complete |
$125.36
|
| Rate for Payer: Cash Price |
$250.71
|
| Rate for Payer: Cofinity Commercial |
$219.37
|
| Rate for Payer: Cofinity Commercial |
$269.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$219.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.71
|
| Rate for Payer: Healthscope Commercial |
$282.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.38
|
| Rate for Payer: PHP Commercial |
$266.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.70
|
| Rate for Payer: Priority Health SBD |
$197.44
|
| Rate for Payer: UMR Bronson Commercial |
$115.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.04
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$313.39
|
|
|
Service Code
|
NDC 67457019899
|
| Hospital Charge Code |
18400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$137.89 |
| Max. Negotiated Rate |
$282.05 |
| Rate for Payer: Aetna American Axle |
$203.70
|
| Rate for Payer: Aetna Commercial |
$266.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.70
|
| Rate for Payer: Cash Price |
$250.71
|
| Rate for Payer: Cofinity Commercial |
$219.37
|
| Rate for Payer: Cofinity Commercial |
$269.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$219.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.71
|
| Rate for Payer: Healthscope Commercial |
$282.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.38
|
| Rate for Payer: PHP Commercial |
$266.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.70
|
| Rate for Payer: Priority Health SBD |
$197.44
|
| Rate for Payer: UMR Bronson Commercial |
$137.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.04
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$313.39
|
|
|
Service Code
|
NDC 67457019805
|
| Hospital Charge Code |
18400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$137.89 |
| Max. Negotiated Rate |
$282.05 |
| Rate for Payer: Aetna American Axle |
$203.70
|
| Rate for Payer: Aetna Commercial |
$266.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.70
|
| Rate for Payer: Cash Price |
$250.71
|
| Rate for Payer: Cofinity Commercial |
$219.37
|
| Rate for Payer: Cofinity Commercial |
$269.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$219.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.71
|
| Rate for Payer: Healthscope Commercial |
$282.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.38
|
| Rate for Payer: PHP Commercial |
$266.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.70
|
| Rate for Payer: Priority Health SBD |
$197.44
|
| Rate for Payer: UMR Bronson Commercial |
$137.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.04
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$418.63
|
|
|
Service Code
|
NDC 63323072405
|
| Hospital Charge Code |
18400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$154.89 |
| Max. Negotiated Rate |
$376.77 |
| Rate for Payer: Aetna American Axle |
$272.11
|
| Rate for Payer: Aetna Commercial |
$355.84
|
| Rate for Payer: Aetna Medicare |
$209.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.11
|
| Rate for Payer: BCBS Complete |
$167.45
|
| Rate for Payer: Cash Price |
$334.90
|
| Rate for Payer: Cofinity Commercial |
$293.04
|
| Rate for Payer: Cofinity Commercial |
$360.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$293.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.90
|
| Rate for Payer: Healthscope Commercial |
$376.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.84
|
| Rate for Payer: PHP Commercial |
$355.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.11
|
| Rate for Payer: Priority Health SBD |
$263.74
|
| Rate for Payer: UMR Bronson Commercial |
$154.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.97
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$313.39
|
|
|
Service Code
|
NDC 67457019805
|
| Hospital Charge Code |
18400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$115.95 |
| Max. Negotiated Rate |
$282.05 |
| Rate for Payer: Aetna American Axle |
$203.70
|
| Rate for Payer: Aetna Commercial |
$266.38
|
| Rate for Payer: Aetna Medicare |
$156.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.70
|
| Rate for Payer: BCBS Complete |
$125.36
|
| Rate for Payer: Cash Price |
$250.71
|
| Rate for Payer: Cofinity Commercial |
$219.37
|
| Rate for Payer: Cofinity Commercial |
$269.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$219.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.71
|
| Rate for Payer: Healthscope Commercial |
$282.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.38
|
| Rate for Payer: PHP Commercial |
$266.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.70
|
| Rate for Payer: Priority Health SBD |
$197.44
|
| Rate for Payer: UMR Bronson Commercial |
$115.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.04
|
|
|
REMOVAL AND REPLACEMENT OF NON-INFLATABLE (SEMI-RIGID) OR INFLATABLE (SELF-CONTAINED) PENILE PROSTHESIS AT THE SAME OPERATIVE SESSION
|
Facility
|
OP
|
$55,259.25
|
|
|
Service Code
|
CPT 54416
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,522.21 |
| Max. Negotiated Rate |
$55,259.25 |
| Rate for Payer: Aetna Medicare |
$20,416.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,538.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,538.72
|
| Rate for Payer: BCBS Complete |
$11,048.32
|
| Rate for Payer: BCBS MAPPO |
$19,630.98
|
| Rate for Payer: BCN Medicare Advantage |
$19,630.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,630.98
|
| Rate for Payer: Mclaren Medicaid |
$10,522.21
|
| Rate for Payer: Mclaren Medicare |
$19,630.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,612.53
|
| Rate for Payer: Meridian Medicaid |
$11,048.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,575.63
|
| Rate for Payer: PACE Medicare |
$18,649.43
|
| Rate for Payer: PACE SWMI |
$19,630.98
|
| Rate for Payer: PHP Medicare Advantage |
$19,630.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,522.21
|
| Rate for Payer: Priority Health Medicare |
$19,630.98
|
| Rate for Payer: Railroad Medicare Medicare |
$19,630.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55,259.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,630.98
|
| Rate for Payer: UHC Exchange |
$37,516.77
|
| Rate for Payer: UHC Medicare Advantage |
$19,630.98
|
| Rate for Payer: UHCCP Medicaid |
$10,522.21
|
| Rate for Payer: VA VA |
$19,630.98
|
|
|
REMOVAL BY CONTOURING OF BENIGN TUMOR OF FACIAL BONE (EG, FIBROUS DYSPLASIA)
|
Facility
|
OP
|
$8,903.25
|
|
|
Service Code
|
CPT 21029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Exchange |
$6,044.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,695.31
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITH GENERAL ANESTHESIA
|
Facility
|
OP
|
$4,448.08
|
|
|
Service Code
|
CPT 69205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$3,019.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
REMOVAL FOREIGN BODY, INTRANASAL; REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$8,903.25
|
|
|
Service Code
|
CPT 30310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Exchange |
$6,044.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,695.31
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL
|
Facility
|
OP
|
$163.07
|
|
|
Service Code
|
CPT 69210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$163.07 |
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$110.71
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$57.93
|
|
|
REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL
|
Facility
|
OP
|
$163.07
|
|
|
Service Code
|
CPT 69210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$163.07 |
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$110.71
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$57.93
|
|
|
REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL
|
Facility
|
OP
|
$163.07
|
|
|
Service Code
|
CPT 69209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$163.07 |
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$110.71
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$57.93
|
|
|
REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL
|
Facility
|
OP
|
$163.07
|
|
|
Service Code
|
CPT 69209
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$163.07 |
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$110.71
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$57.93
|
|
|
REMOVAL, IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Facility
|
OP
|
$1,931.58
|
|
|
Service Code
|
CPT 11976
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,311.40
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: VA VA |
$686.20
|
|
