|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
|
OP
|
$54.05
|
|
|
Service Code
|
NDC 00904720660
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna American Axle |
$35.13
|
| Rate for Payer: Aetna Commercial |
$45.94
|
| Rate for Payer: Aetna Medicare |
$27.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.13
|
| Rate for Payer: BCBS Complete |
$21.62
|
| Rate for Payer: Cash Price |
$43.24
|
| Rate for Payer: Cofinity Advantage |
$37.84
|
| Rate for Payer: Cofinity Commercial |
$46.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.24
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.54
|
| Rate for Payer: PHP Commercial |
$45.94
|
| Rate for Payer: Priority Health SBD |
$34.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.13
|
| Rate for Payer: UHC Core |
$28.16
|
| Rate for Payer: UHC Exchange |
$21.24
|
| Rate for Payer: UMR Bronson Commercial |
$20.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.54
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
|
IP
|
$77.55
|
|
|
Service Code
|
NDC 70000043401
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna American Axle |
$50.41
|
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.41
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Advantage |
$54.28
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.16
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: Priority Health SBD |
$48.86
|
| Rate for Payer: UMR Bronson Commercial |
$34.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
|
OP
|
$70.50
|
|
|
Service Code
|
NDC 69618003301
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna American Axle |
$45.83
|
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna Medicare |
$35.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.83
|
| Rate for Payer: BCBS Complete |
$28.20
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Advantage |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.88
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health SBD |
$44.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.83
|
| Rate for Payer: UHC Core |
$36.73
|
| Rate for Payer: UHC Exchange |
$27.71
|
| Rate for Payer: UMR Bronson Commercial |
$26.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
|
OP
|
$77.55
|
|
|
Service Code
|
NDC 70000043401
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.69 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna American Axle |
$50.41
|
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna Medicare |
$38.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.41
|
| Rate for Payer: BCBS Complete |
$31.02
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Advantage |
$54.28
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.16
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: Priority Health SBD |
$48.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.41
|
| Rate for Payer: UHC Core |
$40.40
|
| Rate for Payer: UHC Exchange |
$30.48
|
| Rate for Payer: UMR Bronson Commercial |
$28.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
|
IP
|
$54.05
|
|
|
Service Code
|
NDC 00904720660
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.78 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna American Axle |
$35.13
|
| Rate for Payer: Aetna Commercial |
$45.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.13
|
| Rate for Payer: Cash Price |
$43.24
|
| Rate for Payer: Cofinity Advantage |
$37.84
|
| Rate for Payer: Cofinity Commercial |
$46.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.24
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.54
|
| Rate for Payer: PHP Commercial |
$45.94
|
| Rate for Payer: Priority Health SBD |
$34.05
|
| Rate for Payer: UMR Bronson Commercial |
$23.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.54
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
|
IP
|
$72.85
|
|
|
Service Code
|
NDC 09629513606
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.05 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna American Axle |
$47.35
|
| Rate for Payer: Aetna Commercial |
$61.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.35
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Advantage |
$50.99
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Healthscope Commercial |
$65.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.64
|
| Rate for Payer: PHP Commercial |
$61.92
|
| Rate for Payer: Priority Health SBD |
$45.90
|
| Rate for Payer: UMR Bronson Commercial |
$32.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
|
IP
|
$56.40
|
|
|
Service Code
|
NDC 57896079101
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.82 |
| Max. Negotiated Rate |
$50.76 |
| Rate for Payer: Aetna American Axle |
$36.66
|
| Rate for Payer: Aetna Commercial |
$47.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.66
|
| Rate for Payer: Cash Price |
$45.12
|
| Rate for Payer: Cofinity Advantage |
$39.48
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.12
|
| Rate for Payer: Healthscope Commercial |
$50.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.30
|
| Rate for Payer: PHP Commercial |
$47.94
|
| Rate for Payer: Priority Health SBD |
$35.53
|
| Rate for Payer: UMR Bronson Commercial |
$24.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.30
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
|
OP
|
$72.85
|
|
|
Service Code
|
NDC 09629513606
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna American Axle |
$47.35
|
| Rate for Payer: Aetna Commercial |
$61.92
|
| Rate for Payer: Aetna Medicare |
$36.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.35
|
| Rate for Payer: BCBS Complete |
$29.14
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Advantage |
$50.99
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Healthscope Commercial |
$65.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.64
|
| Rate for Payer: PHP Commercial |
$61.92
|
| Rate for Payer: Priority Health SBD |
$45.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.35
|
| Rate for Payer: UHC Core |
$37.95
|
| Rate for Payer: UHC Exchange |
$28.63
|
| Rate for Payer: UMR Bronson Commercial |
$26.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
|
OP
|
$56.40
|
|
|
Service Code
|
NDC 57896079101
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$50.76 |
| Rate for Payer: Aetna American Axle |
$36.66
|
| Rate for Payer: Aetna Commercial |
$47.94
|
| Rate for Payer: Aetna Medicare |
$28.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.66
|
| Rate for Payer: BCBS Complete |
$22.56
|
| Rate for Payer: Cash Price |
$45.12
|
| Rate for Payer: Cofinity Advantage |
$39.48
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.12
|
| Rate for Payer: Healthscope Commercial |
$50.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.30
|
| Rate for Payer: PHP Commercial |
$47.94
|
| Rate for Payer: Priority Health SBD |
$35.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.66
|
| Rate for Payer: UHC Core |
$29.38
|
| Rate for Payer: UHC Exchange |
$22.17
|
| Rate for Payer: UMR Bronson Commercial |
$20.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.30
|
|
|
SIMPLE PNEUMONIA AND PLEURISY WITH CC
|
Facility
|
IP
|
$13,437.26
|
|
|
Service Code
|
MSDRG 194
|
| Min. Negotiated Rate |
$6,965.83 |
| Max. Negotiated Rate |
$13,437.26 |
| Rate for Payer: Aetna Medicare |
$7,625.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,165.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,165.56
|
| Rate for Payer: BCBS MAPPO |
$7,332.45
|
| Rate for Payer: BCBS Trust/PPO |
$13,437.26
|
| Rate for Payer: BCN Commercial |
$13,437.26
|
| Rate for Payer: BCN Medicare Advantage |
$7,332.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,332.45
|
| Rate for Payer: Mclaren Medicare |
$7,332.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,699.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,432.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,065.69
|
| Rate for Payer: Nomi Health Commercial |
$10,396.11
|
| Rate for Payer: PACE Medicare |
$6,965.83
|
| Rate for Payer: PACE SWMI |
$7,332.45
|
| Rate for Payer: PHP Medicare Advantage |
$7,332.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,992.83
|
| Rate for Payer: Priority Health Medicare |
$7,332.45
|
| Rate for Payer: Priority Health Tiered Network |
$10,394.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,332.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,136.17
|
| Rate for Payer: UHC Core |
$10,990.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,332.45
|
| Rate for Payer: UHC Exchange |
$8,975.31
|
| Rate for Payer: VA VA |
$7,332.45
|
|
|
SIMPLE PNEUMONIA AND PLEURISY WITH MCC
|
Facility
|
IP
|
$21,424.72
|
|
|
Service Code
|
MSDRG 193
|
| Min. Negotiated Rate |
$11,005.65 |
| Max. Negotiated Rate |
$21,424.72 |
| Rate for Payer: Aetna Medicare |
$12,048.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,481.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,481.11
|
| Rate for Payer: BCBS MAPPO |
$11,584.89
|
| Rate for Payer: BCBS Trust/PPO |
$21,085.11
|
| Rate for Payer: BCN Commercial |
$21,085.11
|
| Rate for Payer: BCN Medicare Advantage |
$11,584.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,584.89
|
| Rate for Payer: Mclaren Medicare |
$11,584.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,164.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,322.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,743.38
|
| Rate for Payer: Nomi Health Commercial |
$16,955.76
|
| Rate for Payer: PACE Medicare |
$11,005.65
|
| Rate for Payer: PACE SWMI |
$11,584.89
|
| Rate for Payer: PHP Medicare Advantage |
$11,584.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,190.94
|
| Rate for Payer: Priority Health Medicare |
$11,584.89
|
| Rate for Payer: Priority Health Tiered Network |
$16,952.75
|
| Rate for Payer: Railroad Medicare Medicare |
$11,584.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,424.72
|
| Rate for Payer: UHC Core |
$17,924.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,584.89
|
| Rate for Payer: UHC Exchange |
$14,638.47
|
| Rate for Payer: VA VA |
$11,584.89
|
|
|
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC
|
Facility
|
IP
|
$10,244.55
|
|
|
Service Code
|
MSDRG 195
|
| Min. Negotiated Rate |
$5,556.48 |
| Max. Negotiated Rate |
$10,244.55 |
| Rate for Payer: Aetna Medicare |
$6,082.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,311.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,311.16
|
| Rate for Payer: BCBS MAPPO |
$5,848.93
|
| Rate for Payer: BCBS Trust/PPO |
$9,116.48
|
| Rate for Payer: BCN Commercial |
$9,116.48
|
| Rate for Payer: BCN Medicare Advantage |
$5,848.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,848.93
|
| Rate for Payer: Mclaren Medicare |
$5,848.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,141.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,726.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,433.82
|
| Rate for Payer: Nomi Health Commercial |
$8,107.65
|
| Rate for Payer: PACE Medicare |
$5,556.48
|
| Rate for Payer: PACE SWMI |
$5,848.93
|
| Rate for Payer: PHP Medicare Advantage |
$5,848.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,132.76
|
| Rate for Payer: Priority Health Medicare |
$5,848.93
|
| Rate for Payer: Priority Health Tiered Network |
$8,106.21
|
| Rate for Payer: Railroad Medicare Medicare |
$5,848.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,244.55
|
| Rate for Payer: UHC Core |
$8,570.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,848.93
|
| Rate for Payer: UHC Exchange |
$6,999.60
|
| Rate for Payer: VA VA |
$5,848.93
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM OR LESS
|
Facility
|
OP
|
$646.50
|
|
|
Service Code
|
CPT 12011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$173.24
|
| Rate for Payer: BCN Commercial |
$173.24
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM OR LESS
|
Facility
|
OP
|
$646.50
|
|
|
Service Code
|
CPT 12011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$173.24
|
| Rate for Payer: BCN Commercial |
$173.24
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.6 CM TO 5.0 CM
|
Facility
|
OP
|
$646.50
|
|
|
Service Code
|
CPT 12013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$234.66
|
| Rate for Payer: BCN Commercial |
$234.66
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 20.1 CM TO 30.0 CM
|
Facility
|
OP
|
$1,309.90
|
|
|
Service Code
|
CPT 12006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$297.54
|
| Rate for Payer: BCN Commercial |
$297.54
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 2.5 CM OR LESS
|
Facility
|
OP
|
$646.50
|
|
|
Service Code
|
CPT 12001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$168.87
|
| Rate for Payer: BCN Commercial |
$168.87
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 2.5 CM OR LESS
|
Facility
|
OP
|
$646.50
|
|
|
Service Code
|
CPT 12001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$168.87
|
| Rate for Payer: BCN Commercial |
$168.87
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$646.50
|
|
|
Service Code
|
CPT 12002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$203.62
|
| Rate for Payer: BCN Commercial |
$203.62
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 7.6 CM TO 12.5 CM
|
Facility
|
OP
|
$646.50
|
|
|
Service Code
|
CPT 12004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$265.39
|
| Rate for Payer: BCN Commercial |
$265.39
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
SIMPLE SYRUP
|
Facility
|
OP
|
$190.08
|
|
|
Service Code
|
NDC 00395266116
|
| Hospital Charge Code |
7242
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.33 |
| Max. Negotiated Rate |
$171.07 |
| Rate for Payer: Aetna American Axle |
$123.55
|
| Rate for Payer: Aetna Commercial |
$161.57
|
| Rate for Payer: Aetna Medicare |
$95.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.55
|
| Rate for Payer: BCBS Complete |
$76.03
|
| Rate for Payer: Cash Price |
$152.06
|
| Rate for Payer: Cofinity Advantage |
$133.06
|
| Rate for Payer: Cofinity Commercial |
$163.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.06
|
| Rate for Payer: Healthscope Commercial |
$171.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.56
|
| Rate for Payer: PHP Commercial |
$161.57
|
| Rate for Payer: Priority Health SBD |
$119.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.55
|
| Rate for Payer: UHC Core |
$99.03
|
| Rate for Payer: UHC Exchange |
$74.70
|
| Rate for Payer: UMR Bronson Commercial |
$70.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.56
|
|
|
SIMPLE SYRUP
|
Facility
|
IP
|
$141.90
|
|
|
Service Code
|
NDC 31722093747
|
| Hospital Charge Code |
7242
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$127.71 |
| Rate for Payer: Aetna American Axle |
$92.23
|
| Rate for Payer: Aetna Commercial |
$120.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.23
|
| Rate for Payer: Cash Price |
$113.52
|
| Rate for Payer: Cofinity Advantage |
$99.33
|
| Rate for Payer: Cofinity Commercial |
$122.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.52
|
| Rate for Payer: Healthscope Commercial |
$127.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.42
|
| Rate for Payer: PHP Commercial |
$120.61
|
| Rate for Payer: Priority Health SBD |
$89.40
|
| Rate for Payer: UMR Bronson Commercial |
$62.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.42
|
|
|
SIMPLE SYRUP
|
Facility
|
OP
|
$141.90
|
|
|
Service Code
|
NDC 31722093747
|
| Hospital Charge Code |
7242
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$127.71 |
| Rate for Payer: Aetna American Axle |
$92.23
|
| Rate for Payer: Aetna Commercial |
$120.61
|
| Rate for Payer: Aetna Medicare |
$70.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.23
|
| Rate for Payer: BCBS Complete |
$56.76
|
| Rate for Payer: Cash Price |
$113.52
|
| Rate for Payer: Cofinity Advantage |
$99.33
|
| Rate for Payer: Cofinity Commercial |
$122.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.52
|
| Rate for Payer: Healthscope Commercial |
$127.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.42
|
| Rate for Payer: PHP Commercial |
$120.61
|
| Rate for Payer: Priority Health SBD |
$89.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.23
|
| Rate for Payer: UHC Core |
$73.93
|
| Rate for Payer: UHC Exchange |
$55.77
|
| Rate for Payer: UMR Bronson Commercial |
$52.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.42
|
|
|
SIMPLE SYRUP
|
Facility
|
IP
|
$190.08
|
|
|
Service Code
|
NDC 00395266116
|
| Hospital Charge Code |
7242
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.64 |
| Max. Negotiated Rate |
$171.07 |
| Rate for Payer: Aetna American Axle |
$123.55
|
| Rate for Payer: Aetna Commercial |
$161.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.55
|
| Rate for Payer: Cash Price |
$152.06
|
| Rate for Payer: Cofinity Advantage |
$133.06
|
| Rate for Payer: Cofinity Commercial |
$163.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.06
|
| Rate for Payer: Healthscope Commercial |
$171.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.56
|
| Rate for Payer: PHP Commercial |
$161.57
|
| Rate for Payer: Priority Health SBD |
$119.75
|
| Rate for Payer: UMR Bronson Commercial |
$83.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.56
|
|
|
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT
|
Facility
|
IP
|
$106,449.49
|
|
|
Service Code
|
MSDRG 008
|
| Min. Negotiated Rate |
$45,089.40 |
| Max. Negotiated Rate |
$106,449.49 |
| Rate for Payer: Aetna Medicare |
$49,361.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59,328.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59,328.16
|
| Rate for Payer: BCBS MAPPO |
$47,462.53
|
| Rate for Payer: BCBS Trust/PPO |
$106,449.49
|
| Rate for Payer: BCN Commercial |
$106,449.49
|
| Rate for Payer: BCN Medicare Advantage |
$47,462.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47,462.53
|
| Rate for Payer: Mclaren Medicare |
$47,462.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49,835.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54,581.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$52,208.78
|
| Rate for Payer: Nomi Health Commercial |
$72,299.34
|
| Rate for Payer: PACE Medicare |
$45,089.40
|
| Rate for Payer: PACE SWMI |
$47,462.53
|
| Rate for Payer: PHP Medicare Advantage |
$47,462.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$90,358.15
|
| Rate for Payer: Priority Health Medicare |
$47,462.53
|
| Rate for Payer: Priority Health Tiered Network |
$72,286.51
|
| Rate for Payer: Railroad Medicare Medicare |
$47,462.53
|
| Rate for Payer: VA VA |
$47,462.53
|
|
