|
RECONSTRUCTION OF TENDON PULLEY, EACH TENDON; WITH LOCAL TISSUES (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 26500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$653.61 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,126.82
|
| Rate for Payer: BCN Commercial |
$4,126.82
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$718.97
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$653.61
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
RECONSTRUCTION OF TENDON PULLEY, EACH TENDON; WITH TENDON OR FASCIAL GRAFT (INCLUDES OBTAINING GRAFT) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$720.43 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,372.99
|
| Rate for Payer: BCN Commercial |
$2,372.99
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$792.47
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$720.43
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
RECONSTRUCTION, TOE(S); POLYDACTYLY
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28344
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$268.19 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.01
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$268.19
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
RECONSTRUCTIVE REPAIR OF PECTUS EXCAVATUM OR CARINATUM; MINIMALLY INVASIVE APPROACH (NUSS PROCEDURE), WITH THORACOSCOPY
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 21743
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,703.94 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,277.38
|
| Rate for Payer: BCN Commercial |
$2,277.38
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,948.57
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$6,075.39
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
RECTAL SENSATION, TONE, AND COMPLIANCE TEST (IE, RESPONSE TO GRADED BALLOON DISTENTION)
|
Facility
|
OP
|
$1,914.06
|
|
|
Service Code
|
CPT 91120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$1,914.06 |
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,914.06
|
| Rate for Payer: BCN Commercial |
$1,914.06
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Nomi Health Commercial |
$915.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.92
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$767.14
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$495.87
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$450.79
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$163.53
|
| Rate for Payer: VA VA |
$305.10
|
|
|
REDUCTION OF TORSION OF TESTIS, SURGICAL, WITH OR WITHOUT FIXATION OF CONTRALATERAL TESTIS
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 54600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$436.61 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,613.67
|
| Rate for Payer: BCN Commercial |
$3,613.67
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.27
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$436.61
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$131.55
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.88 |
| Max. Negotiated Rate |
$118.40 |
| Rate for Payer: Aetna American Axle |
$85.51
|
| Rate for Payer: Aetna American Axle |
$40.35
|
| Rate for Payer: Aetna American Axle |
$24.79
|
| Rate for Payer: Aetna American Axle |
$17.67
|
| Rate for Payer: Aetna American Axle |
$21.81
|
| Rate for Payer: Aetna American Axle |
$553.16
|
| Rate for Payer: Aetna Commercial |
$111.82
|
| Rate for Payer: Aetna Commercial |
$23.11
|
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: Aetna Commercial |
$723.36
|
| Rate for Payer: Aetna Commercial |
$52.77
|
| Rate for Payer: Aetna Commercial |
$28.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.35
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$105.24
|
| Rate for Payer: Cash Price |
$26.85
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$680.81
|
| Rate for Payer: Cofinity Commercial |
$53.39
|
| Rate for Payer: Cofinity Commercial |
$113.13
|
| Rate for Payer: Cofinity Commercial |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$26.70
|
| Rate for Payer: Cofinity Commercial |
$23.49
|
| Rate for Payer: Cofinity Commercial |
$19.03
|
| Rate for Payer: Cofinity Commercial |
$23.38
|
| Rate for Payer: Cofinity Commercial |
$28.86
|
| Rate for Payer: Cofinity Commercial |
$92.08
|
| Rate for Payer: Cofinity Commercial |
$731.87
|
| Rate for Payer: Cofinity Commercial |
$595.71
|
| Rate for Payer: Cofinity Commercial |
$43.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$595.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.81
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Healthscope Commercial |
$765.91
|
| Rate for Payer: Healthscope Commercial |
$55.87
|
| Rate for Payer: Healthscope Commercial |
$24.47
|
| Rate for Payer: Healthscope Commercial |
$30.20
|
| Rate for Payer: Healthscope Commercial |
$118.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$595.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.53
|
| Rate for Payer: PHP Commercial |
$111.82
|
| Rate for Payer: PHP Commercial |
$23.11
|
| Rate for Payer: PHP Commercial |
$32.42
|
| Rate for Payer: PHP Commercial |
$52.77
|
| Rate for Payer: PHP Commercial |
$28.53
|
| Rate for Payer: PHP Commercial |
$723.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.16
|
| Rate for Payer: Priority Health SBD |
$39.11
|
| Rate for Payer: Priority Health SBD |
$24.03
|
| Rate for Payer: Priority Health SBD |
$82.88
|
| Rate for Payer: Priority Health SBD |
$17.13
|
| Rate for Payer: Priority Health SBD |
$21.14
|
| Rate for Payer: Priority Health SBD |
$536.14
|
| Rate for Payer: UMR Bronson Commercial |
$374.44
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
| Rate for Payer: UMR Bronson Commercial |
$14.77
|
| Rate for Payer: UMR Bronson Commercial |
$27.32
|
| Rate for Payer: UMR Bronson Commercial |
$16.78
|
| Rate for Payer: UMR Bronson Commercial |
$57.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.66
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$851.01
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$765.91 |
| Rate for Payer: Aetna American Axle |
$553.16
|
| Rate for Payer: Aetna American Axle |
$17.67
|
| Rate for Payer: Aetna American Axle |
$85.51
|
| Rate for Payer: Aetna American Axle |
$21.81
|
| Rate for Payer: Aetna American Axle |
$24.79
|
| Rate for Payer: Aetna American Axle |
$40.35
|
| Rate for Payer: Aetna Commercial |
$28.53
|
| Rate for Payer: Aetna Commercial |
$52.77
|
| Rate for Payer: Aetna Commercial |
$23.11
|
| Rate for Payer: Aetna Commercial |
$111.82
|
| Rate for Payer: Aetna Commercial |
$723.36
|
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: Aetna Medicare |
$425.50
|
| Rate for Payer: Aetna Medicare |
$19.07
|
| Rate for Payer: Aetna Medicare |
$13.60
|
| Rate for Payer: Aetna Medicare |
$31.04
|
| Rate for Payer: Aetna Medicare |
$16.78
|
| Rate for Payer: Aetna Medicare |
$65.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.35
|
| Rate for Payer: BCBS Complete |
$24.83
|
| Rate for Payer: BCBS Complete |
$15.26
|
| Rate for Payer: BCBS Complete |
$52.62
|
| Rate for Payer: BCBS Complete |
$13.42
|
| Rate for Payer: BCBS Complete |
$10.88
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS Trust/PPO |
$7.75
|
| Rate for Payer: BCBS Trust/PPO |
$7.75
|
| Rate for Payer: BCBS Trust/PPO |
$7.75
|
| Rate for Payer: BCBS Trust/PPO |
$7.75
|
| Rate for Payer: BCBS Trust/PPO |
$7.75
|
| Rate for Payer: BCBS Trust/PPO |
$7.75
|
| Rate for Payer: BCN Commercial |
$7.75
|
| Rate for Payer: BCN Commercial |
$7.75
|
| Rate for Payer: BCN Commercial |
$7.75
|
| Rate for Payer: BCN Commercial |
$7.75
|
| Rate for Payer: BCN Commercial |
$7.75
|
| Rate for Payer: BCN Commercial |
$7.75
|
| Rate for Payer: Cash Price |
$680.81
|
| Rate for Payer: Cash Price |
$26.85
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$105.24
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$26.85
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cash Price |
$680.81
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$105.24
|
| Rate for Payer: Cofinity Commercial |
$23.49
|
| Rate for Payer: Cofinity Commercial |
$595.71
|
| Rate for Payer: Cofinity Commercial |
$19.03
|
| Rate for Payer: Cofinity Commercial |
$92.08
|
| Rate for Payer: Cofinity Commercial |
$113.13
|
| Rate for Payer: Cofinity Commercial |
$23.38
|
| Rate for Payer: Cofinity Commercial |
$53.39
|
| Rate for Payer: Cofinity Commercial |
$43.46
|
| Rate for Payer: Cofinity Commercial |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$26.70
|
| Rate for Payer: Cofinity Commercial |
$28.86
|
| Rate for Payer: Cofinity Commercial |
$731.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$595.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.81
|
| Rate for Payer: Healthscope Commercial |
$55.87
|
| Rate for Payer: Healthscope Commercial |
$765.91
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Healthscope Commercial |
$30.20
|
| Rate for Payer: Healthscope Commercial |
$24.47
|
| Rate for Payer: Healthscope Commercial |
$118.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$595.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.42
|
| Rate for Payer: PHP Commercial |
$28.53
|
| Rate for Payer: PHP Commercial |
$32.42
|
| Rate for Payer: PHP Commercial |
$23.11
|
| Rate for Payer: PHP Commercial |
$111.82
|
| Rate for Payer: PHP Commercial |
$52.77
|
| Rate for Payer: PHP Commercial |
$723.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.67
|
| Rate for Payer: Priority Health SBD |
$39.11
|
| Rate for Payer: Priority Health SBD |
$17.13
|
| Rate for Payer: Priority Health SBD |
$21.14
|
| Rate for Payer: Priority Health SBD |
$24.03
|
| Rate for Payer: Priority Health SBD |
$82.88
|
| Rate for Payer: Priority Health SBD |
$536.14
|
| Rate for Payer: UMR Bronson Commercial |
$22.97
|
| Rate for Payer: UMR Bronson Commercial |
$314.87
|
| Rate for Payer: UMR Bronson Commercial |
$12.42
|
| Rate for Payer: UMR Bronson Commercial |
$48.67
|
| Rate for Payer: UMR Bronson Commercial |
$10.06
|
| Rate for Payer: UMR Bronson Commercial |
$14.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.60
|
|
|
REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT TENDON GRAFT
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 24342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$751.14 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,667.92
|
| Rate for Payer: BCN Commercial |
$4,667.92
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$826.25
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$751.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
REINSERTION OF SPINAL FIXATION DEVICE
|
Facility
|
OP
|
$13,752.00
|
|
|
Service Code
|
CPT 22849
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,284.63 |
| Max. Negotiated Rate |
$13,752.00 |
| Rate for Payer: BCBS Trust/PPO |
$4,769.62
|
| Rate for Payer: BCN Commercial |
$4,769.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,413.09
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Exchange |
$1,284.63
|
|
|
RELEASE, INTRINSIC MUSCLES OF HAND, EACH MUSCLE
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26593
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$610.51 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$671.56
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$610.51
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
RELEASE, TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)
|
Facility
|
OP
|
$6,013.44
|
|
|
Service Code
|
CPT 28035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$344.98 |
| Max. Negotiated Rate |
$6,013.44 |
| Rate for Payer: Aetna Medicare |
$1,989.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,391.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,391.60
|
| Rate for Payer: BCBS Complete |
$1,076.79
|
| Rate for Payer: BCBS MAPPO |
$1,913.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,484.71
|
| Rate for Payer: BCN Commercial |
$1,484.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,913.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,913.28
|
| Rate for Payer: Mclaren Medicaid |
$1,025.52
|
| Rate for Payer: Mclaren Medicare |
$1,913.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,008.94
|
| Rate for Payer: Meridian Medicaid |
$1,076.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,200.27
|
| Rate for Payer: Nomi Health Commercial |
$4,017.89
|
| Rate for Payer: PACE Medicare |
$1,817.62
|
| Rate for Payer: PACE SWMI |
$1,913.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,913.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,025.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,013.44
|
| Rate for Payer: Priority Health Medicare |
$1,913.28
|
| Rate for Payer: Priority Health Narrow Network |
$4,810.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,913.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.48
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,913.28
|
| Rate for Payer: UHC Exchange |
$344.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,913.28
|
| Rate for Payer: UHCCP Medicaid |
$1,025.52
|
| Rate for Payer: VA VA |
$1,913.28
|
|
|
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 |
$3.40 |
| Max. Negotiated Rate |
$1,828.37 |
| Rate for Payer: Priority Health SBD |
$1,279.86
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$12.14
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.40
|
| Rate for Payer: UMR Bronson Commercial |
$751.66
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Priority Health Narrow Network |
$14.64
|
| Rate for Payer: Aetna American Axle |
$1,320.49
|
| Rate for Payer: Aetna Commercial |
$1,726.79
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,320.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.94
|
| Rate for Payer: BCBS Complete |
$3.57
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$17.12
|
| Rate for Payer: BCN Commercial |
$17.12
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| 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 |
$6.35
|
| 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 |
$3.40
|
| Rate for Payer: Mclaren Medicare |
$6.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.67
|
| Rate for Payer: Meridian Medicaid |
$3.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.79
|
| Rate for Payer: Nomi Health Commercial |
$19.05
|
| Rate for Payer: PACE Medicare |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$1,726.79
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.30
|
| Rate for Payer: Priority Health Medicare |
$6.35
|
| 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 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 |
$172.10
|
| 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 |
$172.10
|
|
|
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
|
$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 |
$172.10
|
| 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 |
$172.10
|
|
|
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
|
$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
|
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 |
$209.32
|
| 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
|
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
|
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
|
|
