|
REVISION OR REPAIR OF OPERATIVE WOUND OF ANTERIOR SEGMENT, ANY TYPE, EARLY OR LATE, MAJOR OR MINOR PROCEDURE
|
Facility
|
OP
|
$6,404.71
|
|
|
Service Code
|
CPT 66250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,219.56 |
| Max. Negotiated Rate |
$6,404.71 |
| Rate for Payer: Aetna Medicare |
$2,366.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,844.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,844.11
|
| Rate for Payer: BCBS Complete |
$1,280.53
|
| Rate for Payer: BCBS MAPPO |
$2,275.29
|
| Rate for Payer: BCN Medicare Advantage |
$2,275.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,275.29
|
| Rate for Payer: Mclaren Medicaid |
$1,219.56
|
| Rate for Payer: Mclaren Medicare |
$2,275.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,389.05
|
| Rate for Payer: Meridian Medicaid |
$1,280.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,616.58
|
| Rate for Payer: PACE Medicare |
$2,161.53
|
| Rate for Payer: PACE SWMI |
$2,275.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,275.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,219.56
|
| Rate for Payer: Priority Health Medicare |
$2,275.29
|
| Rate for Payer: Railroad Medicare Medicare |
$2,275.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,404.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,275.29
|
| Rate for Payer: UHC Exchange |
$4,348.31
|
| Rate for Payer: UHC Medicare Advantage |
$2,275.29
|
| Rate for Payer: UHCCP Medicaid |
$1,219.56
|
| Rate for Payer: VA VA |
$2,275.29
|
|
|
RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO CONGENITAL CLEFT LIP AND/OR PALATE, INCLUDING COLUMELLAR LENGTHENING; TIP, SEPTUM, OSTEOTOMIES
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 30462
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
RHINOPLASTY, PRIMARY; INCLUDING MAJOR SEPTAL REPAIR
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 30420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
RHINOPLASTY, PRIMARY; LATERAL AND ALAR CARTILAGES AND/OR ELEVATION OF NASAL TIP
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 30400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
RHINOPLASTY, SECONDARY; INTERMEDIATE REVISION (BONY WORK WITH OSTEOTOMIES)
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 30435
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE
|
Facility
|
OP
|
$257.02
|
|
|
Service Code
|
NDC 44206030090
|
| Hospital Charge Code |
38072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.10 |
| Max. Negotiated Rate |
$231.32 |
| Rate for Payer: Aetna American Axle |
$167.06
|
| Rate for Payer: Aetna Commercial |
$218.47
|
| Rate for Payer: Aetna Medicare |
$128.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.06
|
| Rate for Payer: BCBS Complete |
$102.81
|
| Rate for Payer: Cash Price |
$205.62
|
| Rate for Payer: Cofinity Commercial |
$179.91
|
| Rate for Payer: Cofinity Commercial |
$221.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.62
|
| Rate for Payer: Healthscope Commercial |
$231.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.47
|
| Rate for Payer: PHP Commercial |
$218.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.06
|
| Rate for Payer: Priority Health SBD |
$161.92
|
| Rate for Payer: UMR Bronson Commercial |
$95.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.76
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE
|
Facility
|
IP
|
$257.02
|
|
|
Service Code
|
NDC 44206030001
|
| Hospital Charge Code |
38072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.09 |
| Max. Negotiated Rate |
$231.32 |
| Rate for Payer: Aetna American Axle |
$167.06
|
| Rate for Payer: Aetna Commercial |
$218.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.06
|
| Rate for Payer: Cash Price |
$205.62
|
| Rate for Payer: Cofinity Commercial |
$179.91
|
| Rate for Payer: Cofinity Commercial |
$221.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.62
|
| Rate for Payer: Healthscope Commercial |
$231.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.47
|
| Rate for Payer: PHP Commercial |
$218.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.06
|
| Rate for Payer: Priority Health SBD |
$161.92
|
| Rate for Payer: UMR Bronson Commercial |
$113.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.76
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE
|
Facility
|
IP
|
$257.04
|
|
|
Service Code
|
NDC 44206030010
|
| Hospital Charge Code |
38072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.10 |
| Max. Negotiated Rate |
$231.34 |
| Rate for Payer: Aetna American Axle |
$167.08
|
| Rate for Payer: Aetna Commercial |
$218.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.08
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$179.93
|
| Rate for Payer: Cofinity Commercial |
$221.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.63
|
| Rate for Payer: Healthscope Commercial |
$231.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.48
|
| Rate for Payer: PHP Commercial |
$218.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.08
|
| Rate for Payer: Priority Health SBD |
$161.94
|
| Rate for Payer: UMR Bronson Commercial |
$113.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.78
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE
|
Facility
|
IP
|
$257.02
|
|
|
Service Code
|
NDC 44206030090
|
| Hospital Charge Code |
38072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.09 |
| Max. Negotiated Rate |
$231.32 |
| Rate for Payer: Aetna American Axle |
$167.06
|
| Rate for Payer: Aetna Commercial |
$218.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.06
|
| Rate for Payer: Cash Price |
$205.62
|
| Rate for Payer: Cofinity Commercial |
$179.91
|
| Rate for Payer: Cofinity Commercial |
$221.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.62
|
| Rate for Payer: Healthscope Commercial |
$231.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.47
|
| Rate for Payer: PHP Commercial |
$218.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.06
|
| Rate for Payer: Priority Health SBD |
$161.92
|
| Rate for Payer: UMR Bronson Commercial |
$113.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.76
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE
|
Facility
|
OP
|
$257.04
|
|
|
Service Code
|
NDC 44206030010
|
| Hospital Charge Code |
38072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.10 |
| Max. Negotiated Rate |
$231.34 |
| Rate for Payer: Aetna American Axle |
$167.08
|
| Rate for Payer: Aetna Commercial |
$218.48
|
| Rate for Payer: Aetna Medicare |
$128.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.08
|
| Rate for Payer: BCBS Complete |
$102.82
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$179.93
|
| Rate for Payer: Cofinity Commercial |
$221.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.63
|
| Rate for Payer: Healthscope Commercial |
$231.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.48
|
| Rate for Payer: PHP Commercial |
$218.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.08
|
| Rate for Payer: Priority Health SBD |
$161.94
|
| Rate for Payer: UMR Bronson Commercial |
$95.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.78
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE
|
Facility
|
OP
|
$257.02
|
|
|
Service Code
|
NDC 44206030001
|
| Hospital Charge Code |
38072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.10 |
| Max. Negotiated Rate |
$231.32 |
| Rate for Payer: Aetna American Axle |
$167.06
|
| Rate for Payer: Aetna Commercial |
$218.47
|
| Rate for Payer: Aetna Medicare |
$128.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.06
|
| Rate for Payer: BCBS Complete |
$102.81
|
| Rate for Payer: Cash Price |
$205.62
|
| Rate for Payer: Cofinity Commercial |
$179.91
|
| Rate for Payer: Cofinity Commercial |
$221.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.62
|
| Rate for Payer: Healthscope Commercial |
$231.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.47
|
| Rate for Payer: PHP Commercial |
$218.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.06
|
| Rate for Payer: Priority Health SBD |
$161.92
|
| Rate for Payer: UMR Bronson Commercial |
$95.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.76
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$235.37
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
11283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.56 |
| Max. Negotiated Rate |
$211.83 |
| Rate for Payer: Aetna American Axle |
$152.99
|
| Rate for Payer: Aetna American Axle |
$186.74
|
| Rate for Payer: Aetna American Axle |
$186.75
|
| Rate for Payer: Aetna Commercial |
$244.20
|
| Rate for Payer: Aetna Commercial |
$200.06
|
| Rate for Payer: Aetna Commercial |
$244.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.74
|
| Rate for Payer: Cash Price |
$229.85
|
| Rate for Payer: Cash Price |
$229.83
|
| Rate for Payer: Cash Price |
$188.30
|
| Rate for Payer: Cofinity Commercial |
$202.42
|
| Rate for Payer: Cofinity Commercial |
$247.07
|
| Rate for Payer: Cofinity Commercial |
$201.10
|
| Rate for Payer: Cofinity Commercial |
$247.09
|
| Rate for Payer: Cofinity Commercial |
$201.12
|
| Rate for Payer: Cofinity Commercial |
$164.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.83
|
| Rate for Payer: Healthscope Commercial |
$258.56
|
| Rate for Payer: Healthscope Commercial |
$211.83
|
| Rate for Payer: Healthscope Commercial |
$258.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.20
|
| Rate for Payer: PHP Commercial |
$244.21
|
| Rate for Payer: PHP Commercial |
$244.20
|
| Rate for Payer: PHP Commercial |
$200.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.99
|
| Rate for Payer: Priority Health SBD |
$181.01
|
| Rate for Payer: Priority Health SBD |
$180.99
|
| Rate for Payer: Priority Health SBD |
$148.28
|
| Rate for Payer: UMR Bronson Commercial |
$103.56
|
| Rate for Payer: UMR Bronson Commercial |
$126.42
|
| Rate for Payer: UMR Bronson Commercial |
$126.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.47
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$287.31
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
11283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.30 |
| Max. Negotiated Rate |
$258.58 |
| Rate for Payer: Aetna American Axle |
$186.75
|
| Rate for Payer: Aetna American Axle |
$152.99
|
| Rate for Payer: Aetna American Axle |
$186.74
|
| Rate for Payer: Aetna Commercial |
$244.21
|
| Rate for Payer: Aetna Commercial |
$244.20
|
| Rate for Payer: Aetna Commercial |
$200.06
|
| Rate for Payer: Aetna Medicare |
$143.66
|
| Rate for Payer: Aetna Medicare |
$143.65
|
| Rate for Payer: Aetna Medicare |
$117.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.99
|
| Rate for Payer: BCBS Complete |
$94.15
|
| Rate for Payer: BCBS Complete |
$114.92
|
| Rate for Payer: BCBS Complete |
$114.92
|
| Rate for Payer: Cash Price |
$229.85
|
| Rate for Payer: Cash Price |
$229.83
|
| Rate for Payer: Cash Price |
$188.30
|
| Rate for Payer: Cofinity Commercial |
$247.07
|
| Rate for Payer: Cofinity Commercial |
$164.76
|
| Rate for Payer: Cofinity Commercial |
$202.42
|
| Rate for Payer: Cofinity Commercial |
$247.09
|
| Rate for Payer: Cofinity Commercial |
$201.12
|
| Rate for Payer: Cofinity Commercial |
$201.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.85
|
| Rate for Payer: Healthscope Commercial |
$211.83
|
| Rate for Payer: Healthscope Commercial |
$258.56
|
| Rate for Payer: Healthscope Commercial |
$258.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.21
|
| Rate for Payer: PHP Commercial |
$200.06
|
| Rate for Payer: PHP Commercial |
$244.20
|
| Rate for Payer: PHP Commercial |
$244.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.99
|
| Rate for Payer: Priority Health SBD |
$180.99
|
| Rate for Payer: Priority Health SBD |
$148.28
|
| Rate for Payer: Priority Health SBD |
$181.01
|
| Rate for Payer: UMR Bronson Commercial |
$106.30
|
| Rate for Payer: UMR Bronson Commercial |
$87.09
|
| Rate for Payer: UMR Bronson Commercial |
$106.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.48
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 15,000 UNIT (3,000 MCG)/13 ML INJ. SOLN
|
Facility
|
OP
|
$10,781.83
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
70576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$9,703.65 |
| Rate for Payer: Aetna American Axle |
$7,008.19
|
| Rate for Payer: Aetna Commercial |
$9,164.56
|
| Rate for Payer: Aetna Medicare |
$26.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,008.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.82
|
| Rate for Payer: BCBS Complete |
$14.33
|
| Rate for Payer: BCBS MAPPO |
$25.46
|
| Rate for Payer: BCN Medicare Advantage |
$25.46
|
| Rate for Payer: Cash Price |
$8,625.46
|
| Rate for Payer: Cash Price |
$8,625.46
|
| Rate for Payer: Cofinity Commercial |
$9,272.37
|
| Rate for Payer: Cofinity Commercial |
$7,547.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,547.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,625.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$9,703.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,547.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,086.37
|
| Rate for Payer: Mclaren Medicaid |
$13.65
|
| Rate for Payer: Mclaren Medicare |
$25.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.73
|
| Rate for Payer: Meridian Medicaid |
$14.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,164.56
|
| Rate for Payer: PACE Medicare |
$24.19
|
| Rate for Payer: PACE SWMI |
$25.46
|
| Rate for Payer: PHP Commercial |
$9,164.56
|
| Rate for Payer: PHP Medicare Advantage |
$25.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,008.19
|
| Rate for Payer: Priority Health Medicare |
$25.46
|
| Rate for Payer: Priority Health SBD |
$6,792.55
|
| Rate for Payer: Railroad Medicare Medicare |
$25.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.46
|
| Rate for Payer: UHC Exchange |
$48.66
|
| Rate for Payer: UHC Medicare Advantage |
$25.46
|
| Rate for Payer: UHCCP Medicaid |
$13.65
|
| Rate for Payer: UMR Bronson Commercial |
$3,989.28
|
| Rate for Payer: VA VA |
$25.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,086.37
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 15,000 UNIT (3,000 MCG)/13 ML INJ. SOLN
|
Facility
|
IP
|
$10,781.83
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
70576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,744.01 |
| Max. Negotiated Rate |
$9,703.65 |
| Rate for Payer: Aetna American Axle |
$7,008.19
|
| Rate for Payer: Aetna Commercial |
$9,164.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,008.19
|
| Rate for Payer: Cash Price |
$8,625.46
|
| Rate for Payer: Cofinity Commercial |
$7,547.28
|
| Rate for Payer: Cofinity Commercial |
$9,272.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,547.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,625.46
|
| Rate for Payer: Healthscope Commercial |
$9,703.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,547.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,086.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,164.56
|
| Rate for Payer: PHP Commercial |
$9,164.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,008.19
|
| Rate for Payer: Priority Health SBD |
$6,792.55
|
| Rate for Payer: UMR Bronson Commercial |
$4,744.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,086.37
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 1,500 UNIT (300 MCG)/1.3 ML INJECT.SOLN
|
Facility
|
OP
|
$1,367.04
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
70575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$1,230.34 |
| Rate for Payer: Aetna American Axle |
$888.58
|
| Rate for Payer: Aetna American Axle |
$862.71
|
| Rate for Payer: Aetna Commercial |
$1,128.15
|
| Rate for Payer: Aetna Commercial |
$1,161.98
|
| Rate for Payer: Aetna Medicare |
$26.48
|
| Rate for Payer: Aetna Medicare |
$26.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.82
|
| Rate for Payer: BCBS Complete |
$14.33
|
| Rate for Payer: BCBS Complete |
$14.33
|
| Rate for Payer: BCBS MAPPO |
$25.46
|
| Rate for Payer: BCBS MAPPO |
$25.46
|
| Rate for Payer: BCN Medicare Advantage |
$25.46
|
| Rate for Payer: BCN Medicare Advantage |
$25.46
|
| Rate for Payer: Cash Price |
$1,061.79
|
| Rate for Payer: Cash Price |
$1,093.63
|
| Rate for Payer: Cash Price |
$1,093.63
|
| Rate for Payer: Cash Price |
$1,061.79
|
| Rate for Payer: Cofinity Commercial |
$1,141.43
|
| Rate for Payer: Cofinity Commercial |
$929.07
|
| Rate for Payer: Cofinity Commercial |
$1,175.65
|
| Rate for Payer: Cofinity Commercial |
$956.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$929.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$956.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,093.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$1,230.34
|
| Rate for Payer: Healthscope Commercial |
$1,194.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$956.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$929.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$995.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,025.28
|
| Rate for Payer: Mclaren Medicaid |
$13.65
|
| Rate for Payer: Mclaren Medicaid |
$13.65
|
| Rate for Payer: Mclaren Medicare |
$25.46
|
| Rate for Payer: Mclaren Medicare |
$25.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.73
|
| Rate for Payer: Meridian Medicaid |
$14.33
|
| Rate for Payer: Meridian Medicaid |
$14.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,161.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,128.15
|
| Rate for Payer: PACE Medicare |
$24.19
|
| Rate for Payer: PACE Medicare |
$24.19
|
| Rate for Payer: PACE SWMI |
$25.46
|
| Rate for Payer: PACE SWMI |
$25.46
|
| Rate for Payer: PHP Commercial |
$1,128.15
|
| Rate for Payer: PHP Commercial |
$1,161.98
|
| Rate for Payer: PHP Medicare Advantage |
$25.46
|
| Rate for Payer: PHP Medicare Advantage |
$25.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$888.58
|
| Rate for Payer: Priority Health Medicare |
$25.46
|
| Rate for Payer: Priority Health Medicare |
$25.46
|
| Rate for Payer: Priority Health SBD |
$836.16
|
| Rate for Payer: Priority Health SBD |
$861.24
|
| Rate for Payer: Railroad Medicare Medicare |
$25.46
|
| Rate for Payer: Railroad Medicare Medicare |
$25.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.46
|
| Rate for Payer: UHC Exchange |
$48.66
|
| Rate for Payer: UHC Exchange |
$48.66
|
| Rate for Payer: UHC Medicare Advantage |
$25.46
|
| Rate for Payer: UHC Medicare Advantage |
$25.46
|
| Rate for Payer: UHCCP Medicaid |
$13.65
|
| Rate for Payer: UHCCP Medicaid |
$13.65
|
| Rate for Payer: UMR Bronson Commercial |
$491.08
|
| Rate for Payer: UMR Bronson Commercial |
$505.80
|
| Rate for Payer: VA VA |
$25.46
|
| Rate for Payer: VA VA |
$25.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,025.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$995.43
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 1,500 UNIT (300 MCG)/1.3 ML INJECT.SOLN
|
Facility
|
IP
|
$1,327.24
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
70575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$583.99 |
| Max. Negotiated Rate |
$1,194.52 |
| Rate for Payer: Aetna American Axle |
$862.71
|
| Rate for Payer: Aetna American Axle |
$888.58
|
| Rate for Payer: Aetna Commercial |
$1,128.15
|
| Rate for Payer: Aetna Commercial |
$1,161.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.58
|
| Rate for Payer: Cash Price |
$1,061.79
|
| Rate for Payer: Cash Price |
$1,093.63
|
| Rate for Payer: Cofinity Commercial |
$956.93
|
| Rate for Payer: Cofinity Commercial |
$1,175.65
|
| Rate for Payer: Cofinity Commercial |
$1,141.43
|
| Rate for Payer: Cofinity Commercial |
$929.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$929.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$956.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,093.63
|
| Rate for Payer: Healthscope Commercial |
$1,194.52
|
| Rate for Payer: Healthscope Commercial |
$1,230.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$929.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$956.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$995.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,025.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,161.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,128.15
|
| Rate for Payer: PHP Commercial |
$1,161.98
|
| Rate for Payer: PHP Commercial |
$1,128.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$888.58
|
| Rate for Payer: Priority Health SBD |
$836.16
|
| Rate for Payer: Priority Health SBD |
$861.24
|
| Rate for Payer: UMR Bronson Commercial |
$583.99
|
| Rate for Payer: UMR Bronson Commercial |
$601.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$995.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,025.28
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 5,000 UNIT (1,000 MCG)/4.4 ML INJ. SOLN
|
Facility
|
OP
|
$4,556.01
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
70574
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$4,100.41 |
| Rate for Payer: Aetna American Axle |
$2,961.41
|
| Rate for Payer: Aetna Commercial |
$3,872.61
|
| Rate for Payer: Aetna Medicare |
$26.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,961.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.82
|
| Rate for Payer: BCBS Complete |
$14.33
|
| Rate for Payer: BCBS MAPPO |
$25.46
|
| Rate for Payer: BCN Medicare Advantage |
$25.46
|
| Rate for Payer: Cash Price |
$3,644.81
|
| Rate for Payer: Cash Price |
$3,644.81
|
| Rate for Payer: Cofinity Commercial |
$3,918.17
|
| Rate for Payer: Cofinity Commercial |
$3,189.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,189.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,644.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$4,100.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,189.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,417.01
|
| Rate for Payer: Mclaren Medicaid |
$13.65
|
| Rate for Payer: Mclaren Medicare |
$25.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.73
|
| Rate for Payer: Meridian Medicaid |
$14.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,872.61
|
| Rate for Payer: PACE Medicare |
$24.19
|
| Rate for Payer: PACE SWMI |
$25.46
|
| Rate for Payer: PHP Commercial |
$3,872.61
|
| Rate for Payer: PHP Medicare Advantage |
$25.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,961.41
|
| Rate for Payer: Priority Health Medicare |
$25.46
|
| Rate for Payer: Priority Health SBD |
$2,870.29
|
| Rate for Payer: Railroad Medicare Medicare |
$25.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.46
|
| Rate for Payer: UHC Exchange |
$48.66
|
| Rate for Payer: UHC Medicare Advantage |
$25.46
|
| Rate for Payer: UHCCP Medicaid |
$13.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,685.72
|
| Rate for Payer: VA VA |
$25.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,417.01
|
|
|
RHO(D) IMMUNE GLOBULIN-MALTOSE 5,000 UNIT (1,000 MCG)/4.4 ML INJ. SOLN
|
Facility
|
IP
|
$4,556.01
|
|
|
Service Code
|
HCPCS J2792
|
| Hospital Charge Code |
70574
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,004.64 |
| Max. Negotiated Rate |
$4,100.41 |
| Rate for Payer: Aetna American Axle |
$2,961.41
|
| Rate for Payer: Aetna Commercial |
$3,872.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,961.41
|
| Rate for Payer: Cash Price |
$3,644.81
|
| Rate for Payer: Cofinity Commercial |
$3,189.21
|
| Rate for Payer: Cofinity Commercial |
$3,918.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,189.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,644.81
|
| Rate for Payer: Healthscope Commercial |
$4,100.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,189.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,417.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,872.61
|
| Rate for Payer: PHP Commercial |
$3,872.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,961.41
|
| Rate for Payer: Priority Health SBD |
$2,870.29
|
| Rate for Payer: UMR Bronson Commercial |
$2,004.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,417.01
|
|
|
RHYTIDECTOMY; SUPERFICIAL MUSCULOAPONEUROTIC SYSTEM (SMAS) FLAP
|
Facility
|
OP
|
$10,050.52
|
|
|
Service Code
|
CPT 15829
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,913.77 |
| Max. Negotiated Rate |
$10,050.52 |
| Rate for Payer: Aetna Medicare |
$3,713.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,463.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,463.09
|
| Rate for Payer: BCBS Complete |
$2,009.46
|
| Rate for Payer: BCBS MAPPO |
$3,570.47
|
| Rate for Payer: BCN Medicare Advantage |
$3,570.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,570.47
|
| Rate for Payer: Mclaren Medicaid |
$1,913.77
|
| Rate for Payer: Mclaren Medicare |
$3,570.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,748.99
|
| Rate for Payer: Meridian Medicaid |
$2,009.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,106.04
|
| Rate for Payer: PACE Medicare |
$3,391.95
|
| Rate for Payer: PACE SWMI |
$3,570.47
|
| Rate for Payer: PHP Medicare Advantage |
$3,570.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,913.77
|
| Rate for Payer: Priority Health Medicare |
$3,570.47
|
| Rate for Payer: Railroad Medicare Medicare |
$3,570.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,050.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,570.47
|
| Rate for Payer: UHC Exchange |
$6,823.53
|
| Rate for Payer: UHC Medicare Advantage |
$3,570.47
|
| Rate for Payer: UHCCP Medicaid |
$1,913.77
|
| Rate for Payer: VA VA |
$3,570.47
|
|
|
RIFABUTIN 150 MG CAPSULE
|
Facility
|
IP
|
$10,981.23
|
|
|
Service Code
|
NDC 00013530117
|
| Hospital Charge Code |
11290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,831.74 |
| Max. Negotiated Rate |
$9,883.11 |
| Rate for Payer: Aetna American Axle |
$7,137.80
|
| Rate for Payer: Aetna Commercial |
$9,334.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,137.80
|
| Rate for Payer: Cash Price |
$8,784.98
|
| Rate for Payer: Cofinity Commercial |
$7,686.86
|
| Rate for Payer: Cofinity Commercial |
$9,443.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,686.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,784.98
|
| Rate for Payer: Healthscope Commercial |
$9,883.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,686.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,235.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,334.05
|
| Rate for Payer: PHP Commercial |
$9,334.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,137.80
|
| Rate for Payer: Priority Health SBD |
$6,918.17
|
| Rate for Payer: UMR Bronson Commercial |
$4,831.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,235.92
|
|
|
RIFABUTIN 150 MG CAPSULE
|
Facility
|
OP
|
$10,981.23
|
|
|
Service Code
|
NDC 00013530117
|
| Hospital Charge Code |
11290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,063.06 |
| Max. Negotiated Rate |
$9,883.11 |
| Rate for Payer: Aetna American Axle |
$7,137.80
|
| Rate for Payer: Aetna Commercial |
$9,334.05
|
| Rate for Payer: Aetna Medicare |
$5,490.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,137.80
|
| Rate for Payer: BCBS Complete |
$4,392.49
|
| Rate for Payer: Cash Price |
$8,784.98
|
| Rate for Payer: Cofinity Commercial |
$7,686.86
|
| Rate for Payer: Cofinity Commercial |
$9,443.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,686.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,784.98
|
| Rate for Payer: Healthscope Commercial |
$9,883.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,686.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,235.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,334.05
|
| Rate for Payer: PHP Commercial |
$9,334.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,137.80
|
| Rate for Payer: Priority Health SBD |
$6,918.17
|
| Rate for Payer: UMR Bronson Commercial |
$4,063.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,235.92
|
|
|
RIFABUTIN 150 MG CAPSULE
|
Facility
|
OP
|
$4,052.98
|
|
|
Service Code
|
NDC 59762135001
|
| Hospital Charge Code |
11290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,499.60 |
| Max. Negotiated Rate |
$3,647.68 |
| Rate for Payer: Aetna American Axle |
$2,634.44
|
| Rate for Payer: Aetna Commercial |
$3,445.03
|
| Rate for Payer: Aetna Medicare |
$2,026.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,634.44
|
| Rate for Payer: BCBS Complete |
$1,621.19
|
| Rate for Payer: Cash Price |
$3,242.38
|
| Rate for Payer: Cofinity Commercial |
$2,837.09
|
| Rate for Payer: Cofinity Commercial |
$3,485.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,837.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,242.38
|
| Rate for Payer: Healthscope Commercial |
$3,647.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,837.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,039.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,445.03
|
| Rate for Payer: PHP Commercial |
$3,445.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,634.44
|
| Rate for Payer: Priority Health SBD |
$2,553.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,499.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,039.74
|
|
|
RIFABUTIN 150 MG CAPSULE
|
Facility
|
IP
|
$4,052.98
|
|
|
Service Code
|
NDC 59762135001
|
| Hospital Charge Code |
11290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,783.31 |
| Max. Negotiated Rate |
$3,647.68 |
| Rate for Payer: Aetna American Axle |
$2,634.44
|
| Rate for Payer: Aetna Commercial |
$3,445.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,634.44
|
| Rate for Payer: Cash Price |
$3,242.38
|
| Rate for Payer: Cofinity Commercial |
$2,837.09
|
| Rate for Payer: Cofinity Commercial |
$3,485.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,837.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,242.38
|
| Rate for Payer: Healthscope Commercial |
$3,647.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,837.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,039.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,445.03
|
| Rate for Payer: PHP Commercial |
$3,445.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,634.44
|
| Rate for Payer: Priority Health SBD |
$2,553.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,783.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,039.74
|
|
|
RIFABUTIN 150 MG CAPSULE
|
Facility
|
OP
|
$4,334.18
|
|
|
Service Code
|
NDC 70954004110
|
| Hospital Charge Code |
11290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,603.65 |
| Max. Negotiated Rate |
$3,900.76 |
| Rate for Payer: Aetna American Axle |
$2,817.22
|
| Rate for Payer: Aetna Commercial |
$3,684.05
|
| Rate for Payer: Aetna Medicare |
$2,167.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,817.22
|
| Rate for Payer: BCBS Complete |
$1,733.67
|
| Rate for Payer: Cash Price |
$3,467.34
|
| Rate for Payer: Cofinity Commercial |
$3,033.93
|
| Rate for Payer: Cofinity Commercial |
$3,727.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,033.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,467.34
|
| Rate for Payer: Healthscope Commercial |
$3,900.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,033.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,250.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,684.05
|
| Rate for Payer: PHP Commercial |
$3,684.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,817.22
|
| Rate for Payer: Priority Health SBD |
$2,730.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,603.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,250.64
|
|
