|
REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; FEMORAL AND ENTIRE TIBIAL COMPONENT
|
Facility
|
OP
|
$13,752.00
|
|
|
Service Code
|
CPT 27487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.23 |
| Max. Negotiated Rate |
$13,752.00 |
| Rate for Payer: BCBS Trust/PPO |
$13,673.23
|
| Rate for Payer: BCN Commercial |
$13,673.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,865.85
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Exchange |
$1,696.23
|
|
|
REVISION OF TOTAL SHOULDER ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUMERAL AND GLENOID COMPONENT
|
Facility
|
OP
|
$19,156.68
|
|
|
Service Code
|
CPT 23474
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,680.19 |
| Max. Negotiated Rate |
$19,156.68 |
| Rate for Payer: BCBS Trust/PPO |
$19,156.68
|
| Rate for Payer: BCN Commercial |
$19,156.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,848.21
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Exchange |
$1,680.19
|
|
|
REVISION OF TOTAL SHOULDER ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUMERAL OR GLENOID COMPONENT
|
Facility
|
OP
|
$39,622.51
|
|
|
Service Code
|
CPT 23473
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,555.55 |
| Max. Negotiated Rate |
$39,622.51 |
| Rate for Payer: Aetna Medicare |
$13,110.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,758.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,758.31
|
| Rate for Payer: BCBS Complete |
$7,095.02
|
| Rate for Payer: BCBS MAPPO |
$12,606.65
|
| Rate for Payer: BCBS Trust/PPO |
$7,147.55
|
| Rate for Payer: BCN Commercial |
$7,147.55
|
| Rate for Payer: BCN Medicare Advantage |
$12,606.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,606.65
|
| Rate for Payer: Mclaren Medicaid |
$6,757.16
|
| Rate for Payer: Mclaren Medicare |
$12,606.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,236.98
|
| Rate for Payer: Meridian Medicaid |
$7,095.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,497.65
|
| Rate for Payer: Nomi Health Commercial |
$26,473.96
|
| Rate for Payer: PACE Medicare |
$11,976.32
|
| Rate for Payer: PACE SWMI |
$12,606.65
|
| Rate for Payer: PHP Medicare Advantage |
$12,606.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,757.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39,622.51
|
| Rate for Payer: Priority Health Medicare |
$12,606.65
|
| Rate for Payer: Priority Health Narrow Network |
$31,698.01
|
| Rate for Payer: Railroad Medicare Medicare |
$12,606.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,711.10
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,606.65
|
| Rate for Payer: UHC Exchange |
$1,555.55
|
| Rate for Payer: UHC Medicare Advantage |
$12,606.65
|
| Rate for Payer: UHCCP Medicaid |
$6,757.16
|
| Rate for Payer: VA VA |
$12,606.65
|
|
|
REVISION OF TRACHEOSTOMY SCAR
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 31830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$351.90 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,708.82
|
| Rate for Payer: BCN Commercial |
$1,708.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$387.09
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$351.90
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
REVISION, OPEN, ARTERIOVENOUS FISTULA; WITHOUT THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$16,646.50
|
|
|
Service Code
|
CPT 36832
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$731.12 |
| Max. Negotiated Rate |
$16,646.50 |
| Rate for Payer: Aetna Medicare |
$5,508.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,620.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,620.50
|
| Rate for Payer: BCBS Complete |
$2,980.81
|
| Rate for Payer: BCBS MAPPO |
$5,296.40
|
| Rate for Payer: BCBS Trust/PPO |
$5,796.37
|
| Rate for Payer: BCN Commercial |
$5,796.37
|
| Rate for Payer: BCN Medicare Advantage |
$5,296.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,296.40
|
| Rate for Payer: Mclaren Medicaid |
$2,838.87
|
| Rate for Payer: Mclaren Medicare |
$5,296.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,561.22
|
| Rate for Payer: Meridian Medicaid |
$2,980.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,090.86
|
| Rate for Payer: Nomi Health Commercial |
$11,122.44
|
| Rate for Payer: PACE Medicare |
$5,031.58
|
| Rate for Payer: PACE SWMI |
$5,296.40
|
| Rate for Payer: PHP Medicare Advantage |
$5,296.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,838.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,646.50
|
| Rate for Payer: Priority Health Medicare |
$5,296.40
|
| Rate for Payer: Priority Health Narrow Network |
$13,317.20
|
| Rate for Payer: Railroad Medicare Medicare |
$5,296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$804.23
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,296.40
|
| Rate for Payer: UHC Exchange |
$731.12
|
| Rate for Payer: UHC Medicare Advantage |
$5,296.40
|
| Rate for Payer: UHCCP Medicaid |
$2,838.87
|
| Rate for Payer: VA VA |
$5,296.40
|
|
|
REVISION, OPEN, ARTERIOVENOUS FISTULA; WITH THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$16,646.50
|
|
|
Service Code
|
CPT 36833
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$780.41 |
| Max. Negotiated Rate |
$16,646.50 |
| Rate for Payer: Aetna Medicare |
$5,508.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,620.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,620.50
|
| Rate for Payer: BCBS Complete |
$2,980.81
|
| Rate for Payer: BCBS MAPPO |
$5,296.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,853.37
|
| Rate for Payer: BCN Commercial |
$3,853.37
|
| Rate for Payer: BCN Medicare Advantage |
$5,296.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,296.40
|
| Rate for Payer: Mclaren Medicaid |
$2,838.87
|
| Rate for Payer: Mclaren Medicare |
$5,296.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,561.22
|
| Rate for Payer: Meridian Medicaid |
$2,980.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,090.86
|
| Rate for Payer: Nomi Health Commercial |
$11,122.44
|
| Rate for Payer: PACE Medicare |
$5,031.58
|
| Rate for Payer: PACE SWMI |
$5,296.40
|
| Rate for Payer: PHP Medicare Advantage |
$5,296.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,838.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,646.50
|
| Rate for Payer: Priority Health Medicare |
$5,296.40
|
| Rate for Payer: Priority Health Narrow Network |
$13,317.20
|
| Rate for Payer: Railroad Medicare Medicare |
$5,296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.45
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,296.40
|
| Rate for Payer: UHC Exchange |
$780.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,296.40
|
| Rate for Payer: UHCCP Medicaid |
$2,838.87
|
| Rate for Payer: VA VA |
$5,296.40
|
|
|
REVISION OR REMOVAL OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER
|
Facility
|
OP
|
$38,401.49
|
|
|
Service Code
|
CPT 61888
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$396.12 |
| Max. Negotiated Rate |
$38,401.49 |
| Rate for Payer: Aetna Medicare |
$12,706.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,272.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,272.70
|
| Rate for Payer: BCBS Complete |
$6,876.38
|
| Rate for Payer: BCBS MAPPO |
$12,218.16
|
| Rate for Payer: BCBS Trust/PPO |
$5,180.89
|
| Rate for Payer: BCN Commercial |
$5,180.89
|
| Rate for Payer: BCN Medicare Advantage |
$12,218.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,218.16
|
| Rate for Payer: Mclaren Medicaid |
$6,548.93
|
| Rate for Payer: Mclaren Medicare |
$12,218.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,829.07
|
| Rate for Payer: Meridian Medicaid |
$6,876.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,050.88
|
| Rate for Payer: Nomi Health Commercial |
$25,658.14
|
| Rate for Payer: PACE Medicare |
$11,607.25
|
| Rate for Payer: PACE SWMI |
$12,218.16
|
| Rate for Payer: PHP Medicare Advantage |
$12,218.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,548.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,401.49
|
| Rate for Payer: Priority Health Medicare |
$12,218.16
|
| Rate for Payer: Priority Health Narrow Network |
$30,721.19
|
| Rate for Payer: Railroad Medicare Medicare |
$12,218.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.73
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,218.16
|
| Rate for Payer: UHC Exchange |
$396.12
|
| Rate for Payer: UHC Medicare Advantage |
$12,218.16
|
| Rate for Payer: UHCCP Medicaid |
$6,548.93
|
| Rate for Payer: VA VA |
$12,218.16
|
|
|
REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, WITH DETACHABLE CONNECTION TO ELECTRODE ARRAY
|
Facility
|
OP
|
$10,590.19
|
|
|
Service Code
|
CPT 63688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$10,590.19 |
| Rate for Payer: Aetna Medicare |
$3,504.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,211.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,211.84
|
| Rate for Payer: BCBS Complete |
$1,896.34
|
| Rate for Payer: BCBS MAPPO |
$3,369.47
|
| Rate for Payer: BCBS Trust/PPO |
$2,264.44
|
| Rate for Payer: BCN Commercial |
$2,264.44
|
| Rate for Payer: BCN Medicare Advantage |
$3,369.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,369.47
|
| Rate for Payer: Mclaren Medicaid |
$1,806.04
|
| Rate for Payer: Mclaren Medicare |
$3,369.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,537.94
|
| Rate for Payer: Meridian Medicaid |
$1,896.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,874.89
|
| Rate for Payer: Nomi Health Commercial |
$7,075.89
|
| Rate for Payer: PACE Medicare |
$3,201.00
|
| Rate for Payer: PACE SWMI |
$3,369.47
|
| Rate for Payer: PHP Medicare Advantage |
$3,369.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,806.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,590.19
|
| Rate for Payer: Priority Health Medicare |
$3,369.47
|
| Rate for Payer: Priority Health Narrow Network |
$8,472.15
|
| Rate for Payer: Railroad Medicare Medicare |
$3,369.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.75
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,369.47
|
| Rate for Payer: UHC Exchange |
$292.50
|
| Rate for Payer: UHC Medicare Advantage |
$3,369.47
|
| Rate for Payer: UHCCP Medicaid |
$1,806.04
|
| Rate for Payer: VA VA |
$3,369.47
|
|
|
REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR ELECTRODE ARRAY
|
Facility
|
OP
|
$10,590.19
|
|
|
Service Code
|
CPT 64585
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$137.89 |
| Max. Negotiated Rate |
$10,590.19 |
| Rate for Payer: Aetna Medicare |
$3,504.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,211.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,211.84
|
| Rate for Payer: BCBS Complete |
$1,896.34
|
| Rate for Payer: BCBS MAPPO |
$3,369.47
|
| Rate for Payer: BCBS Trust/PPO |
$2,264.44
|
| Rate for Payer: BCN Commercial |
$2,264.44
|
| Rate for Payer: BCN Medicare Advantage |
$3,369.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,369.47
|
| Rate for Payer: Mclaren Medicaid |
$1,806.04
|
| Rate for Payer: Mclaren Medicare |
$3,369.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,537.94
|
| Rate for Payer: Meridian Medicaid |
$1,896.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,874.89
|
| Rate for Payer: Nomi Health Commercial |
$7,075.89
|
| Rate for Payer: PACE Medicare |
$3,201.00
|
| Rate for Payer: PACE SWMI |
$3,369.47
|
| Rate for Payer: PHP Medicare Advantage |
$3,369.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,806.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,590.19
|
| Rate for Payer: Priority Health Medicare |
$3,369.47
|
| Rate for Payer: Priority Health Narrow Network |
$8,472.15
|
| Rate for Payer: Railroad Medicare Medicare |
$3,369.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.68
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,369.47
|
| Rate for Payer: UHC Exchange |
$137.89
|
| Rate for Payer: UHC Medicare Advantage |
$3,369.47
|
| Rate for Payer: UHCCP Medicaid |
$1,806.04
|
| Rate for Payer: VA VA |
$3,369.47
|
|
|
REVISION OR REMOVAL OF PERIPHERAL, SACRAL, OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, WITH DETACHABLE CONNECTION TO ELECTRODE ARRAY
|
Facility
|
OP
|
$10,590.19
|
|
|
Service Code
|
CPT 64595
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$221.38 |
| Max. Negotiated Rate |
$10,590.19 |
| Rate for Payer: Aetna Medicare |
$3,504.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,211.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,211.84
|
| Rate for Payer: BCBS Complete |
$1,896.34
|
| Rate for Payer: BCBS MAPPO |
$3,369.47
|
| Rate for Payer: BCBS Trust/PPO |
$2,641.85
|
| Rate for Payer: BCN Commercial |
$2,641.85
|
| Rate for Payer: BCN Medicare Advantage |
$3,369.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,369.47
|
| Rate for Payer: Mclaren Medicaid |
$1,806.04
|
| Rate for Payer: Mclaren Medicare |
$3,369.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,537.94
|
| Rate for Payer: Meridian Medicaid |
$1,896.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,874.89
|
| Rate for Payer: Nomi Health Commercial |
$7,075.89
|
| Rate for Payer: PACE Medicare |
$3,201.00
|
| Rate for Payer: PACE SWMI |
$3,369.47
|
| Rate for Payer: PHP Medicare Advantage |
$3,369.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,806.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,590.19
|
| Rate for Payer: Priority Health Medicare |
$3,369.47
|
| Rate for Payer: Priority Health Narrow Network |
$8,472.15
|
| Rate for Payer: Railroad Medicare Medicare |
$3,369.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.52
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,369.47
|
| Rate for Payer: UHC Exchange |
$221.38
|
| Rate for Payer: UHC Medicare Advantage |
$3,369.47
|
| Rate for Payer: UHCCP Medicaid |
$1,806.04
|
| Rate for Payer: VA VA |
$3,369.47
|
|
|
REVISION OR REPAIR OF OPERATIVE WOUND OF ANTERIOR SEGMENT, ANY TYPE, EARLY OR LATE, MAJOR OR MINOR PROCEDURE
|
Facility
|
OP
|
$7,184.18
|
|
|
Service Code
|
CPT 66250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$519.18 |
| Max. Negotiated Rate |
$7,184.18 |
| Rate for Payer: Aetna Medicare |
$2,377.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,857.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,857.24
|
| Rate for Payer: BCBS Complete |
$1,286.44
|
| Rate for Payer: BCBS MAPPO |
$2,285.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,438.92
|
| Rate for Payer: BCN Commercial |
$1,438.92
|
| Rate for Payer: BCN Medicare Advantage |
$2,285.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,285.79
|
| Rate for Payer: Mclaren Medicaid |
$1,225.18
|
| Rate for Payer: Mclaren Medicare |
$2,285.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,400.08
|
| Rate for Payer: Meridian Medicaid |
$1,286.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,628.66
|
| Rate for Payer: Nomi Health Commercial |
$4,800.16
|
| Rate for Payer: PACE Medicare |
$2,171.50
|
| Rate for Payer: PACE SWMI |
$2,285.79
|
| Rate for Payer: PHP Medicare Advantage |
$2,285.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,225.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,184.18
|
| Rate for Payer: Priority Health Medicare |
$2,285.79
|
| Rate for Payer: Priority Health Narrow Network |
$5,747.34
|
| Rate for Payer: Railroad Medicare Medicare |
$2,285.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$571.10
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,285.79
|
| Rate for Payer: UHC Exchange |
$519.18
|
| Rate for Payer: UHC Medicare Advantage |
$2,285.79
|
| Rate for Payer: UHCCP Medicaid |
$1,225.18
|
| Rate for Payer: VA VA |
$2,285.79
|
|
|
RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO CONGENITAL CLEFT LIP AND/OR PALATE, INCLUDING COLUMELLAR LENGTHENING; TIP, SEPTUM, OSTEOTOMIES
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 30462
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,520.43 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,703.90
|
| Rate for Payer: BCN Commercial |
$3,703.90
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,672.47
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$1,520.43
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
RHINOPLASTY, PRIMARY; INCLUDING MAJOR SEPTAL REPAIR
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 30420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,377.25 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$6,228.72
|
| Rate for Payer: BCN Commercial |
$6,228.72
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,514.98
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$1,377.25
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
RHINOPLASTY, PRIMARY; LATERAL AND ALAR CARTILAGES AND/OR ELEVATION OF NASAL TIP
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 30400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,153.79 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,935.22
|
| Rate for Payer: BCN Commercial |
$1,935.22
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,269.17
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$1,153.79
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
RHINOPLASTY, SECONDARY; INTERMEDIATE REVISION (BONY WORK WITH OSTEOTOMIES)
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 30435
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,260.51 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,968.49
|
| Rate for Payer: BCN Commercial |
$3,968.49
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,386.56
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$1,260.51
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
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)/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
|
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
|
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 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) 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 |
$661.60 |
| Rate for Payer: Aetna American Axle |
$186.75
|
| Rate for Payer: Aetna American Axle |
$186.74
|
| Rate for Payer: Aetna American Axle |
$152.99
|
| Rate for Payer: Aetna Commercial |
$244.21
|
| Rate for Payer: Aetna Commercial |
$200.06
|
| Rate for Payer: Aetna Commercial |
$244.20
|
| Rate for Payer: Aetna Medicare |
$143.64
|
| Rate for Payer: Aetna Medicare |
$117.68
|
| Rate for Payer: Aetna Medicare |
$143.66
|
| 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: BCBS Complete |
$114.92
|
| Rate for Payer: BCBS Complete |
$114.92
|
| Rate for Payer: BCBS Complete |
$94.15
|
| Rate for Payer: BCBS Trust/PPO |
$661.60
|
| Rate for Payer: BCBS Trust/PPO |
$661.60
|
| Rate for Payer: BCBS Trust/PPO |
$661.60
|
| Rate for Payer: BCN Commercial |
$661.60
|
| Rate for Payer: BCN Commercial |
$661.60
|
| Rate for Payer: BCN Commercial |
$661.60
|
| Rate for Payer: Cash Price |
$229.83
|
| Rate for Payer: Cash Price |
$229.85
|
| Rate for Payer: Cash Price |
$188.30
|
| Rate for Payer: Cash Price |
$229.83
|
| Rate for Payer: Cash Price |
$188.30
|
| Rate for Payer: Cash Price |
$229.85
|
| 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 |
$201.10
|
| Rate for Payer: Cofinity Commercial |
$201.12
|
| Rate for Payer: Cofinity Commercial |
$247.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.85
|
| Rate for Payer: Healthscope Commercial |
$258.58
|
| Rate for Payer: Healthscope Commercial |
$258.56
|
| Rate for Payer: Healthscope Commercial |
$211.83
|
| 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 |
$176.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.47
|
| 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 |
$244.21
|
| Rate for Payer: PHP Commercial |
$200.06
|
| Rate for Payer: PHP Commercial |
$244.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.99
|
| 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 SBD |
$180.99
|
| Rate for Payer: Priority Health SBD |
$181.01
|
| Rate for Payer: Priority Health SBD |
$148.28
|
| 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 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-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 |
$17.61 |
| 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 |
$34.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,008.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.08
|
| Rate for Payer: BCBS Complete |
$18.49
|
| Rate for Payer: BCBS MAPPO |
$32.86
|
| Rate for Payer: BCBS Trust/PPO |
$94.29
|
| Rate for Payer: BCN Commercial |
$94.29
|
| Rate for Payer: BCN Medicare Advantage |
$32.86
|
| 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 |
$32.86
|
| 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 |
$17.61
|
| Rate for Payer: Mclaren Medicare |
$32.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.50
|
| Rate for Payer: Meridian Medicaid |
$18.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,164.56
|
| Rate for Payer: Nomi Health Commercial |
$98.58
|
| Rate for Payer: PACE Medicare |
$31.22
|
| Rate for Payer: PACE SWMI |
$32.86
|
| Rate for Payer: PHP Commercial |
$9,164.56
|
| Rate for Payer: PHP Medicare Advantage |
$32.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,008.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.83
|
| Rate for Payer: Priority Health Medicare |
$32.86
|
| Rate for Payer: Priority Health Narrow Network |
$79.06
|
| Rate for Payer: Priority Health SBD |
$6,792.55
|
| Rate for Payer: Railroad Medicare Medicare |
$32.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.86
|
| Rate for Payer: UHC Exchange |
$62.80
|
| Rate for Payer: UHC Medicare Advantage |
$32.86
|
| Rate for Payer: UHCCP Medicaid |
$17.61
|
| Rate for Payer: UMR Bronson Commercial |
$3,989.28
|
| Rate for Payer: VA VA |
$32.86
|
| 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
|
|
