|
SUTURE OF 1 NERVE; HAND OR FOOT, COMMON SENSORY NERVE
|
Facility
|
OP
|
$19,720.92
|
|
|
Service Code
|
CPT 64834
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$718.85 |
| Max. Negotiated Rate |
$19,720.92 |
| Rate for Payer: Aetna Medicare |
$6,525.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,843.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,843.22
|
| Rate for Payer: BCBS Complete |
$3,531.33
|
| Rate for Payer: BCBS MAPPO |
$6,274.58
|
| Rate for Payer: BCBS Trust/PPO |
$3,428.32
|
| Rate for Payer: BCN Commercial |
$3,428.32
|
| Rate for Payer: BCN Medicare Advantage |
$6,274.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,274.58
|
| Rate for Payer: Mclaren Medicaid |
$3,363.17
|
| Rate for Payer: Mclaren Medicare |
$6,274.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,588.31
|
| Rate for Payer: Meridian Medicaid |
$3,531.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,215.77
|
| Rate for Payer: Nomi Health Commercial |
$13,176.62
|
| Rate for Payer: PACE Medicare |
$5,960.85
|
| Rate for Payer: PACE SWMI |
$6,274.58
|
| Rate for Payer: PHP Medicare Advantage |
$6,274.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,363.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,720.92
|
| Rate for Payer: Priority Health Medicare |
$6,274.58
|
| Rate for Payer: Priority Health Narrow Network |
$15,776.74
|
| Rate for Payer: Railroad Medicare Medicare |
$6,274.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$790.74
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,274.58
|
| Rate for Payer: UHC Exchange |
$718.85
|
| Rate for Payer: UHC Medicare Advantage |
$6,274.58
|
| Rate for Payer: UHCCP Medicaid |
$3,363.17
|
| Rate for Payer: VA VA |
$6,274.58
|
|
|
SUTURE OF 1 NERVE; MEDIAN MOTOR THENAR
|
Facility
|
OP
|
$19,720.92
|
|
|
Service Code
|
CPT 64835
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$791.36 |
| Max. Negotiated Rate |
$19,720.92 |
| Rate for Payer: Aetna Medicare |
$6,525.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,843.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,843.22
|
| Rate for Payer: BCBS Complete |
$3,531.33
|
| Rate for Payer: BCBS MAPPO |
$6,274.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,956.74
|
| Rate for Payer: BCN Commercial |
$2,956.74
|
| Rate for Payer: BCN Medicare Advantage |
$6,274.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,274.58
|
| Rate for Payer: Mclaren Medicaid |
$3,363.17
|
| Rate for Payer: Mclaren Medicare |
$6,274.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,588.31
|
| Rate for Payer: Meridian Medicaid |
$3,531.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,215.77
|
| Rate for Payer: Nomi Health Commercial |
$13,176.62
|
| Rate for Payer: PACE Medicare |
$5,960.85
|
| Rate for Payer: PACE SWMI |
$6,274.58
|
| Rate for Payer: PHP Medicare Advantage |
$6,274.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,363.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,720.92
|
| Rate for Payer: Priority Health Medicare |
$6,274.58
|
| Rate for Payer: Priority Health Narrow Network |
$15,776.74
|
| Rate for Payer: Railroad Medicare Medicare |
$6,274.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$870.50
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,274.58
|
| Rate for Payer: UHC Exchange |
$791.36
|
| Rate for Payer: UHC Medicare Advantage |
$6,274.58
|
| Rate for Payer: UHCCP Medicaid |
$3,363.17
|
| Rate for Payer: VA VA |
$6,274.58
|
|
|
SUTURE OF 1 NERVE; ULNAR MOTOR
|
Facility
|
OP
|
$19,720.92
|
|
|
Service Code
|
CPT 64836
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$791.36 |
| Max. Negotiated Rate |
$19,720.92 |
| Rate for Payer: Aetna Medicare |
$6,525.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,843.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,843.22
|
| Rate for Payer: BCBS Complete |
$3,531.33
|
| Rate for Payer: BCBS MAPPO |
$6,274.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,956.74
|
| Rate for Payer: BCN Commercial |
$2,956.74
|
| Rate for Payer: BCN Medicare Advantage |
$6,274.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,274.58
|
| Rate for Payer: Mclaren Medicaid |
$3,363.17
|
| Rate for Payer: Mclaren Medicare |
$6,274.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,588.31
|
| Rate for Payer: Meridian Medicaid |
$3,531.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,215.77
|
| Rate for Payer: Nomi Health Commercial |
$13,176.62
|
| Rate for Payer: PACE Medicare |
$5,960.85
|
| Rate for Payer: PACE SWMI |
$6,274.58
|
| Rate for Payer: PHP Medicare Advantage |
$6,274.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,363.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,720.92
|
| Rate for Payer: Priority Health Medicare |
$6,274.58
|
| Rate for Payer: Priority Health Narrow Network |
$15,776.74
|
| Rate for Payer: Railroad Medicare Medicare |
$6,274.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$870.50
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,274.58
|
| Rate for Payer: UHC Exchange |
$791.36
|
| Rate for Payer: UHC Medicare Advantage |
$6,274.58
|
| Rate for Payer: UHCCP Medicaid |
$3,363.17
|
| Rate for Payer: VA VA |
$6,274.58
|
|
|
SUTURE OF DIGITAL NERVE, HAND OR FOOT; 1 NERVE
|
Facility
|
OP
|
$6,013.44
|
|
|
Service Code
|
CPT 64831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$669.29 |
| Max. Negotiated Rate |
$6,013.44 |
| Rate for Payer: Aetna Medicare |
$1,989.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,391.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,391.60
|
| Rate for Payer: BCBS Complete |
$1,076.79
|
| Rate for Payer: BCBS MAPPO |
$1,913.28
|
| Rate for Payer: BCBS Trust/PPO |
$3,905.42
|
| Rate for Payer: BCN Commercial |
$3,905.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,913.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,913.28
|
| Rate for Payer: Mclaren Medicaid |
$1,025.52
|
| Rate for Payer: Mclaren Medicare |
$1,913.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,008.94
|
| Rate for Payer: Meridian Medicaid |
$1,076.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,200.27
|
| Rate for Payer: Nomi Health Commercial |
$4,017.89
|
| Rate for Payer: PACE Medicare |
$1,817.62
|
| Rate for Payer: PACE SWMI |
$1,913.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,913.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,025.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,013.44
|
| Rate for Payer: Priority Health Medicare |
$1,913.28
|
| Rate for Payer: Priority Health Narrow Network |
$4,810.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,913.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$736.22
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,913.28
|
| Rate for Payer: UHC Exchange |
$669.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,913.28
|
| Rate for Payer: UHCCP Medicaid |
$1,025.52
|
| Rate for Payer: VA VA |
$1,913.28
|
|
|
SUTURE OF DIGITAL NERVE, HAND OR FOOT; EACH ADDITIONAL DIGITAL NERVE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,235.67
|
|
|
Service Code
|
CPT 64832
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$320.15 |
| Max. Negotiated Rate |
$1,235.67 |
| Rate for Payer: BCBS Trust/PPO |
$1,235.67
|
| Rate for Payer: BCN Commercial |
$1,235.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.16
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$320.15
|
|
|
SUTURE OF EACH ADDITIONAL MAJOR PERIPHERAL NERVE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$918.55
|
|
|
Service Code
|
CPT 64859
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$238.29 |
| Max. Negotiated Rate |
$918.55 |
| Rate for Payer: BCBS Trust/PPO |
$918.55
|
| Rate for Payer: BCN Commercial |
$918.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.12
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$238.29
|
|
|
SUTURE OF EACH ADDITIONAL NERVE, HAND OR FOOT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,394.87
|
|
|
Service Code
|
CPT 64837
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$350.55 |
| Max. Negotiated Rate |
$1,394.87 |
| Rate for Payer: BCBS Trust/PPO |
$1,394.87
|
| Rate for Payer: BCN Commercial |
$1,394.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.60
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$350.55
|
|
|
SUTURE OF INFRAPATELLAR TENDON; PRIMARY
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 27380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$601.14 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,949.61
|
| Rate for Payer: BCN Commercial |
$4,949.61
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$661.25
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$601.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
SUTURE OF INFRAPATELLAR TENDON; SECONDARY RECONSTRUCTION, INCLUDING FASCIAL OR TENDON GRAFT
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 27381
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$793.04 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,126.82
|
| Rate for Payer: BCN Commercial |
$4,126.82
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$872.34
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$793.04
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, EXCEPT SCIATIC; WITHOUT TRANSPOSITION
|
Facility
|
OP
|
$19,720.92
|
|
|
Service Code
|
CPT 64857
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,018.10 |
| Max. Negotiated Rate |
$19,720.92 |
| Rate for Payer: Aetna Medicare |
$6,525.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,843.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,843.22
|
| Rate for Payer: BCBS Complete |
$3,531.33
|
| Rate for Payer: BCBS MAPPO |
$6,274.58
|
| Rate for Payer: BCBS Trust/PPO |
$3,428.32
|
| Rate for Payer: BCN Commercial |
$3,428.32
|
| Rate for Payer: BCN Medicare Advantage |
$6,274.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,274.58
|
| Rate for Payer: Mclaren Medicaid |
$3,363.17
|
| Rate for Payer: Mclaren Medicare |
$6,274.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,588.31
|
| Rate for Payer: Meridian Medicaid |
$3,531.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,215.77
|
| Rate for Payer: Nomi Health Commercial |
$13,176.62
|
| Rate for Payer: PACE Medicare |
$5,960.85
|
| Rate for Payer: PACE SWMI |
$6,274.58
|
| Rate for Payer: PHP Medicare Advantage |
$6,274.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,363.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,720.92
|
| Rate for Payer: Priority Health Medicare |
$6,274.58
|
| Rate for Payer: Priority Health Narrow Network |
$15,776.74
|
| Rate for Payer: Railroad Medicare Medicare |
$6,274.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,119.91
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,274.58
|
| Rate for Payer: UHC Exchange |
$1,018.10
|
| Rate for Payer: UHC Medicare Advantage |
$6,274.58
|
| Rate for Payer: UHCCP Medicaid |
$3,363.17
|
| Rate for Payer: VA VA |
$6,274.58
|
|
|
SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; PRIMARY
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 27385
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$584.78 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$5,332.45
|
| Rate for Payer: BCN Commercial |
$5,332.45
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$643.26
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$584.78
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; SECONDARY RECONSTRUCTION, INCLUDING FASCIAL OR TENDON GRAFT
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 27386
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$827.15 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,126.82
|
| Rate for Payer: BCN Commercial |
$4,126.82
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$909.86
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$827.15
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
SUTURE OR REPAIR OF TESTICULAR INJURY
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 54670
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$393.83 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,439.79
|
| Rate for Payer: BCN Commercial |
$1,439.79
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.21
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$393.83
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
SYNOVECTOMY, CARPOMETACARPAL JOINT
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.77 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$502.45
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$456.77
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT;
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 25118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$372.43 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,214.78
|
| Rate for Payer: BCN Commercial |
$2,214.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$409.67
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$372.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
SYNOVECTOMY, METACARPOPHALANGEAL JOINT INCLUDING INTRINSIC RELEASE AND EXTENSOR HOOD RECONSTRUCTION, EACH DIGIT
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26135
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$537.59 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,214.78
|
| Rate for Payer: BCN Commercial |
$2,214.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$591.35
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$537.59
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
SYNOVECTOMY, PROXIMAL INTERPHALANGEAL JOINT, INCLUDING EXTENSOR RECONSTRUCTION, EACH INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 26140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$493.73 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,444.32
|
| Rate for Payer: BCN Commercial |
$1,444.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.10
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$493.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
SYNOVECTOMY, TENDON SHEATH, RADICAL (TENOSYNOVECTOMY), FLEXOR TENDON, PALM AND/OR FINGER, EACH TENDON
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 26145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$501.38 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,444.32
|
| Rate for Payer: BCN Commercial |
$1,444.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$551.52
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$501.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$353.76
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
24914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.65 |
| Max. Negotiated Rate |
$318.38 |
| Rate for Payer: Aetna American Axle |
$229.94
|
| Rate for Payer: Aetna American Axle |
$803.51
|
| Rate for Payer: Aetna American Axle |
$282.36
|
| Rate for Payer: Aetna Commercial |
$300.70
|
| Rate for Payer: Aetna Commercial |
$1,050.74
|
| Rate for Payer: Aetna Commercial |
$369.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.51
|
| Rate for Payer: Cash Price |
$347.52
|
| Rate for Payer: Cash Price |
$283.01
|
| Rate for Payer: Cash Price |
$988.94
|
| Rate for Payer: Cofinity Commercial |
$865.32
|
| Rate for Payer: Cofinity Commercial |
$1,063.11
|
| Rate for Payer: Cofinity Commercial |
$247.63
|
| Rate for Payer: Cofinity Commercial |
$304.23
|
| Rate for Payer: Cofinity Commercial |
$304.08
|
| Rate for Payer: Cofinity Commercial |
$373.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$865.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$988.94
|
| Rate for Payer: Healthscope Commercial |
$390.96
|
| Rate for Payer: Healthscope Commercial |
$1,112.55
|
| Rate for Payer: Healthscope Commercial |
$318.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$865.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$927.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,050.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.24
|
| Rate for Payer: PHP Commercial |
$1,050.74
|
| Rate for Payer: PHP Commercial |
$369.24
|
| Rate for Payer: PHP Commercial |
$300.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$803.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.36
|
| Rate for Payer: Priority Health SBD |
$222.87
|
| Rate for Payer: Priority Health SBD |
$778.79
|
| Rate for Payer: Priority Health SBD |
$273.67
|
| Rate for Payer: UMR Bronson Commercial |
$191.14
|
| Rate for Payer: UMR Bronson Commercial |
$155.65
|
| Rate for Payer: UMR Bronson Commercial |
$543.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$927.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.32
|
|
|
TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
OP
|
$434.40
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
24914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$390.96 |
| Rate for Payer: Cash Price |
$988.94
|
| Rate for Payer: Cash Price |
$283.01
|
| Rate for Payer: Cash Price |
$988.94
|
| Rate for Payer: Cash Price |
$347.52
|
| Rate for Payer: Cofinity Commercial |
$304.23
|
| Rate for Payer: Cofinity Commercial |
$1,063.11
|
| Rate for Payer: Cofinity Commercial |
$865.32
|
| Rate for Payer: Cofinity Commercial |
$247.63
|
| Rate for Payer: Cofinity Commercial |
$304.08
|
| Rate for Payer: Cofinity Commercial |
$373.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$865.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.63
|
| Rate for Payer: Aetna American Axle |
$282.36
|
| Rate for Payer: Aetna American Axle |
$229.94
|
| Rate for Payer: Aetna American Axle |
$803.51
|
| Rate for Payer: Aetna Commercial |
$369.24
|
| Rate for Payer: Aetna Commercial |
$1,050.74
|
| Rate for Payer: Aetna Commercial |
$300.70
|
| Rate for Payer: Aetna Medicare |
$176.88
|
| Rate for Payer: Aetna Medicare |
$618.08
|
| Rate for Payer: Aetna Medicare |
$217.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.94
|
| Rate for Payer: BCBS Complete |
$141.50
|
| Rate for Payer: BCBS Complete |
$173.76
|
| Rate for Payer: BCBS Complete |
$494.47
|
| Rate for Payer: BCBS Trust/PPO |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.66
|
| Rate for Payer: BCN Commercial |
$0.66
|
| Rate for Payer: BCN Commercial |
$0.66
|
| Rate for Payer: BCN Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$283.01
|
| Rate for Payer: Cash Price |
$347.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$988.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.52
|
| Rate for Payer: Healthscope Commercial |
$390.96
|
| Rate for Payer: Healthscope Commercial |
$318.38
|
| Rate for Payer: Healthscope Commercial |
$1,112.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$865.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$927.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,050.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.24
|
| Rate for Payer: PHP Commercial |
$369.24
|
| Rate for Payer: PHP Commercial |
$1,050.74
|
| Rate for Payer: PHP Commercial |
$300.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$803.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.36
|
| Rate for Payer: Priority Health SBD |
$222.87
|
| Rate for Payer: Priority Health SBD |
$273.67
|
| Rate for Payer: Priority Health SBD |
$778.79
|
| Rate for Payer: UMR Bronson Commercial |
$160.73
|
| Rate for Payer: UMR Bronson Commercial |
$457.38
|
| Rate for Payer: UMR Bronson Commercial |
$130.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$927.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.80
|
|
|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
OP
|
$581.76
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$523.58 |
| Rate for Payer: Aetna American Axle |
$378.14
|
| Rate for Payer: Aetna American Axle |
$331.03
|
| Rate for Payer: Aetna American Axle |
$1,606.78
|
| Rate for Payer: Aetna American Axle |
$169.42
|
| Rate for Payer: Aetna Commercial |
$494.50
|
| Rate for Payer: Aetna Commercial |
$221.54
|
| Rate for Payer: Aetna Commercial |
$2,101.17
|
| Rate for Payer: Aetna Commercial |
$432.89
|
| Rate for Payer: Aetna Medicare |
$254.64
|
| Rate for Payer: Aetna Medicare |
$130.32
|
| Rate for Payer: Aetna Medicare |
$1,235.98
|
| Rate for Payer: Aetna Medicare |
$290.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,606.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.42
|
| Rate for Payer: BCBS Complete |
$203.71
|
| Rate for Payer: BCBS Complete |
$988.79
|
| Rate for Payer: BCBS Complete |
$232.70
|
| Rate for Payer: BCBS Complete |
$104.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.66
|
| Rate for Payer: BCN Commercial |
$0.66
|
| Rate for Payer: BCN Commercial |
$0.66
|
| Rate for Payer: BCN Commercial |
$0.66
|
| Rate for Payer: BCN Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$208.51
|
| Rate for Payer: Cash Price |
$465.41
|
| Rate for Payer: Cash Price |
$407.42
|
| Rate for Payer: Cash Price |
$208.51
|
| Rate for Payer: Cash Price |
$1,977.58
|
| Rate for Payer: Cash Price |
$1,977.58
|
| Rate for Payer: Cash Price |
$407.42
|
| Rate for Payer: Cash Price |
$465.41
|
| Rate for Payer: Cofinity Commercial |
$500.31
|
| Rate for Payer: Cofinity Commercial |
$224.15
|
| Rate for Payer: Cofinity Commercial |
$1,730.38
|
| Rate for Payer: Cofinity Commercial |
$2,125.89
|
| Rate for Payer: Cofinity Commercial |
$182.45
|
| Rate for Payer: Cofinity Commercial |
$356.50
|
| Rate for Payer: Cofinity Commercial |
$437.98
|
| Rate for Payer: Cofinity Commercial |
$407.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$356.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,730.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$407.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,977.58
|
| Rate for Payer: Healthscope Commercial |
$2,224.77
|
| Rate for Payer: Healthscope Commercial |
$523.58
|
| Rate for Payer: Healthscope Commercial |
$458.35
|
| Rate for Payer: Healthscope Commercial |
$234.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$356.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,730.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$407.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,853.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,101.17
|
| Rate for Payer: PHP Commercial |
$494.50
|
| Rate for Payer: PHP Commercial |
$221.54
|
| Rate for Payer: PHP Commercial |
$2,101.17
|
| Rate for Payer: PHP Commercial |
$432.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,606.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.03
|
| Rate for Payer: Priority Health SBD |
$1,557.34
|
| Rate for Payer: Priority Health SBD |
$320.85
|
| Rate for Payer: Priority Health SBD |
$164.20
|
| Rate for Payer: Priority Health SBD |
$366.51
|
| Rate for Payer: UMR Bronson Commercial |
$914.63
|
| Rate for Payer: UMR Bronson Commercial |
$188.43
|
| Rate for Payer: UMR Bronson Commercial |
$215.25
|
| Rate for Payer: UMR Bronson Commercial |
$96.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,853.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.32
|
|
|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$509.28
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$224.08 |
| Max. Negotiated Rate |
$458.35 |
| Rate for Payer: Aetna American Axle |
$331.03
|
| Rate for Payer: Aetna American Axle |
$169.42
|
| Rate for Payer: Aetna American Axle |
$1,606.78
|
| Rate for Payer: Aetna American Axle |
$378.14
|
| Rate for Payer: Aetna Commercial |
$432.89
|
| Rate for Payer: Aetna Commercial |
$494.50
|
| Rate for Payer: Aetna Commercial |
$221.54
|
| Rate for Payer: Aetna Commercial |
$2,101.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,606.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.03
|
| Rate for Payer: Cash Price |
$208.51
|
| Rate for Payer: Cash Price |
$407.42
|
| Rate for Payer: Cash Price |
$1,977.58
|
| Rate for Payer: Cash Price |
$465.41
|
| Rate for Payer: Cofinity Commercial |
$1,730.38
|
| Rate for Payer: Cofinity Commercial |
$500.31
|
| Rate for Payer: Cofinity Commercial |
$407.23
|
| Rate for Payer: Cofinity Commercial |
$356.50
|
| Rate for Payer: Cofinity Commercial |
$182.45
|
| Rate for Payer: Cofinity Commercial |
$224.15
|
| Rate for Payer: Cofinity Commercial |
$437.98
|
| Rate for Payer: Cofinity Commercial |
$2,125.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$356.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$407.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,730.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,977.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.51
|
| Rate for Payer: Healthscope Commercial |
$458.35
|
| Rate for Payer: Healthscope Commercial |
$2,224.77
|
| Rate for Payer: Healthscope Commercial |
$234.58
|
| Rate for Payer: Healthscope Commercial |
$523.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,730.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$407.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$356.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,853.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$381.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,101.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.89
|
| Rate for Payer: PHP Commercial |
$432.89
|
| Rate for Payer: PHP Commercial |
$494.50
|
| Rate for Payer: PHP Commercial |
$2,101.17
|
| Rate for Payer: PHP Commercial |
$221.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,606.78
|
| Rate for Payer: Priority Health SBD |
$366.51
|
| Rate for Payer: Priority Health SBD |
$1,557.34
|
| Rate for Payer: Priority Health SBD |
$164.20
|
| Rate for Payer: Priority Health SBD |
$320.85
|
| Rate for Payer: UMR Bronson Commercial |
$224.08
|
| Rate for Payer: UMR Bronson Commercial |
$255.97
|
| Rate for Payer: UMR Bronson Commercial |
$114.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,087.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,853.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$381.96
|
|
|
TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$1,003.44
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$441.51 |
| Max. Negotiated Rate |
$903.10 |
| Rate for Payer: Aetna American Axle |
$652.24
|
| Rate for Payer: Aetna American Axle |
$1,811.93
|
| Rate for Payer: Aetna American Axle |
$17.34
|
| Rate for Payer: Aetna American Axle |
$1,647.18
|
| Rate for Payer: Aetna American Axle |
$1,733.28
|
| Rate for Payer: Aetna American Axle |
$497.95
|
| Rate for Payer: Aetna Commercial |
$852.92
|
| Rate for Payer: Aetna Commercial |
$2,154.01
|
| Rate for Payer: Aetna Commercial |
$22.67
|
| Rate for Payer: Aetna Commercial |
$651.17
|
| Rate for Payer: Aetna Commercial |
$2,369.44
|
| Rate for Payer: Aetna Commercial |
$2,266.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$652.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,647.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,733.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,811.93
|
| Rate for Payer: Cash Price |
$2,230.06
|
| Rate for Payer: Cash Price |
$21.34
|
| Rate for Payer: Cash Price |
$802.75
|
| Rate for Payer: Cash Price |
$2,133.27
|
| Rate for Payer: Cash Price |
$2,027.30
|
| Rate for Payer: Cash Price |
$612.86
|
| Rate for Payer: Cofinity Commercial |
$2,397.32
|
| Rate for Payer: Cofinity Commercial |
$702.41
|
| Rate for Payer: Cofinity Commercial |
$22.94
|
| Rate for Payer: Cofinity Commercial |
$18.67
|
| Rate for Payer: Cofinity Commercial |
$1,866.61
|
| Rate for Payer: Cofinity Commercial |
$1,773.89
|
| Rate for Payer: Cofinity Commercial |
$2,179.35
|
| Rate for Payer: Cofinity Commercial |
$2,293.27
|
| Rate for Payer: Cofinity Commercial |
$862.96
|
| Rate for Payer: Cofinity Commercial |
$658.83
|
| Rate for Payer: Cofinity Commercial |
$536.26
|
| Rate for Payer: Cofinity Commercial |
$1,951.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,773.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$536.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,951.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$702.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,866.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$802.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,230.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,133.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,027.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.86
|
| Rate for Payer: Healthscope Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$689.47
|
| Rate for Payer: Healthscope Commercial |
$2,508.82
|
| Rate for Payer: Healthscope Commercial |
$2,280.72
|
| Rate for Payer: Healthscope Commercial |
$2,399.93
|
| Rate for Payer: Healthscope Commercial |
$903.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,951.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$702.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,773.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,866.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,090.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,900.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$752.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,999.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,369.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$651.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$852.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,154.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,266.60
|
| Rate for Payer: PHP Commercial |
$852.92
|
| Rate for Payer: PHP Commercial |
$2,154.01
|
| Rate for Payer: PHP Commercial |
$22.67
|
| Rate for Payer: PHP Commercial |
$2,369.44
|
| Rate for Payer: PHP Commercial |
$2,266.60
|
| Rate for Payer: PHP Commercial |
$651.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,647.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$652.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,811.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,733.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.95
|
| Rate for Payer: Priority Health SBD |
$1,756.18
|
| Rate for Payer: Priority Health SBD |
$16.80
|
| Rate for Payer: Priority Health SBD |
$632.17
|
| Rate for Payer: Priority Health SBD |
$1,596.50
|
| Rate for Payer: Priority Health SBD |
$1,679.95
|
| Rate for Payer: Priority Health SBD |
$482.63
|
| Rate for Payer: UMR Bronson Commercial |
$337.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,115.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,173.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,226.54
|
| Rate for Payer: UMR Bronson Commercial |
$11.73
|
| Rate for Payer: UMR Bronson Commercial |
$441.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,900.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,999.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,090.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$752.58
|
|
|
TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
OP
|
$766.08
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$689.47 |
| Rate for Payer: Aetna American Axle |
$497.95
|
| Rate for Payer: Aetna American Axle |
$1,647.18
|
| Rate for Payer: Aetna American Axle |
$652.24
|
| Rate for Payer: Aetna American Axle |
$1,733.28
|
| Rate for Payer: Aetna American Axle |
$17.34
|
| Rate for Payer: Aetna American Axle |
$1,811.93
|
| Rate for Payer: Aetna Commercial |
$2,266.60
|
| Rate for Payer: Aetna Commercial |
$2,369.44
|
| Rate for Payer: Aetna Commercial |
$2,154.01
|
| Rate for Payer: Aetna Commercial |
$852.92
|
| Rate for Payer: Aetna Commercial |
$651.17
|
| Rate for Payer: Aetna Commercial |
$22.67
|
| Rate for Payer: Aetna Medicare |
$383.04
|
| Rate for Payer: Aetna Medicare |
$13.34
|
| Rate for Payer: Aetna Medicare |
$1,267.06
|
| Rate for Payer: Aetna Medicare |
$1,393.79
|
| Rate for Payer: Aetna Medicare |
$1,333.30
|
| Rate for Payer: Aetna Medicare |
$501.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$652.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,733.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,647.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,811.93
|
| Rate for Payer: BCBS Complete |
$1,115.03
|
| Rate for Payer: BCBS Complete |
$10.67
|
| Rate for Payer: BCBS Complete |
$401.38
|
| Rate for Payer: BCBS Complete |
$1,066.64
|
| Rate for Payer: BCBS Complete |
$1,013.65
|
| Rate for Payer: BCBS Complete |
$306.43
|
| Rate for Payer: BCBS Trust/PPO |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.66
|
| Rate for Payer: BCN Commercial |
$0.66
|
| Rate for Payer: BCN Commercial |
$0.66
|
| Rate for Payer: BCN Commercial |
$0.66
|
| Rate for Payer: BCN Commercial |
$0.66
|
| Rate for Payer: BCN Commercial |
$0.66
|
| Rate for Payer: BCN Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$612.86
|
| Rate for Payer: Cash Price |
$2,133.27
|
| Rate for Payer: Cash Price |
$2,230.06
|
| Rate for Payer: Cash Price |
$2,027.30
|
| Rate for Payer: Cash Price |
$802.75
|
| Rate for Payer: Cash Price |
$2,027.30
|
| Rate for Payer: Cash Price |
$2,133.27
|
| Rate for Payer: Cash Price |
$2,230.06
|
| Rate for Payer: Cash Price |
$612.86
|
| Rate for Payer: Cash Price |
$21.34
|
| Rate for Payer: Cash Price |
$21.34
|
| Rate for Payer: Cash Price |
$802.75
|
| Rate for Payer: Cofinity Commercial |
$1,866.61
|
| Rate for Payer: Cofinity Commercial |
$536.26
|
| Rate for Payer: Cofinity Commercial |
$1,773.89
|
| Rate for Payer: Cofinity Commercial |
$862.96
|
| Rate for Payer: Cofinity Commercial |
$702.41
|
| Rate for Payer: Cofinity Commercial |
$2,179.35
|
| Rate for Payer: Cofinity Commercial |
$2,397.32
|
| Rate for Payer: Cofinity Commercial |
$1,951.31
|
| Rate for Payer: Cofinity Commercial |
$22.94
|
| Rate for Payer: Cofinity Commercial |
$18.67
|
| Rate for Payer: Cofinity Commercial |
$2,293.27
|
| Rate for Payer: Cofinity Commercial |
$658.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,951.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,866.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$702.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,773.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$536.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,133.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$802.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,230.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,027.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.86
|
| Rate for Payer: Healthscope Commercial |
$2,508.82
|
| Rate for Payer: Healthscope Commercial |
$689.47
|
| Rate for Payer: Healthscope Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$2,399.93
|
| Rate for Payer: Healthscope Commercial |
$2,280.72
|
| Rate for Payer: Healthscope Commercial |
$903.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$702.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,773.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,866.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,951.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,999.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,900.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,090.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$752.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,266.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$852.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,154.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$651.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,369.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.67
|
| Rate for Payer: PHP Commercial |
$2,266.60
|
| Rate for Payer: PHP Commercial |
$22.67
|
| Rate for Payer: PHP Commercial |
$2,154.01
|
| Rate for Payer: PHP Commercial |
$852.92
|
| Rate for Payer: PHP Commercial |
$2,369.44
|
| Rate for Payer: PHP Commercial |
$651.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,733.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,811.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$652.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,647.18
|
| Rate for Payer: Priority Health SBD |
$1,756.18
|
| Rate for Payer: Priority Health SBD |
$1,596.50
|
| Rate for Payer: Priority Health SBD |
$1,679.95
|
| Rate for Payer: Priority Health SBD |
$16.80
|
| Rate for Payer: Priority Health SBD |
$632.17
|
| Rate for Payer: Priority Health SBD |
$482.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,031.40
|
| Rate for Payer: UMR Bronson Commercial |
$283.45
|
| Rate for Payer: UMR Bronson Commercial |
$986.64
|
| Rate for Payer: UMR Bronson Commercial |
$371.27
|
| Rate for Payer: UMR Bronson Commercial |
$937.63
|
| Rate for Payer: UMR Bronson Commercial |
$9.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$752.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,900.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,999.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,090.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.00
|
|
|
TACROLIMUS 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$817.46
|
|
|
Service Code
|
HCPCS J7525
|
| Hospital Charge Code |
12935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$764.01 |
| Rate for Payer: Aetna American Axle |
$531.35
|
| Rate for Payer: Aetna Commercial |
$694.84
|
| Rate for Payer: Aetna Medicare |
$264.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$531.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$318.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$318.34
|
| Rate for Payer: BCBS Complete |
$143.33
|
| Rate for Payer: BCBS MAPPO |
$254.67
|
| Rate for Payer: BCBS Trust/PPO |
$686.95
|
| Rate for Payer: BCN Commercial |
$686.95
|
| Rate for Payer: BCN Medicare Advantage |
$254.67
|
| Rate for Payer: Cash Price |
$653.97
|
| Rate for Payer: Cash Price |
$653.97
|
| Rate for Payer: Cofinity Commercial |
$703.02
|
| Rate for Payer: Cofinity Commercial |
$572.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$572.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$254.67
|
| Rate for Payer: Healthscope Commercial |
$735.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$572.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$613.10
|
| Rate for Payer: Mclaren Medicaid |
$136.50
|
| Rate for Payer: Mclaren Medicare |
$254.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$267.40
|
| Rate for Payer: Meridian Medicaid |
$143.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$292.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.84
|
| Rate for Payer: Nomi Health Commercial |
$764.01
|
| Rate for Payer: PACE Medicare |
$241.94
|
| Rate for Payer: PACE SWMI |
$254.67
|
| Rate for Payer: PHP Commercial |
$694.84
|
| Rate for Payer: PHP Medicare Advantage |
$254.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$733.24
|
| Rate for Payer: Priority Health Medicare |
$254.67
|
| Rate for Payer: Priority Health Narrow Network |
$586.59
|
| Rate for Payer: Priority Health SBD |
$515.00
|
| Rate for Payer: Railroad Medicare Medicare |
$254.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$716.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$254.67
|
| Rate for Payer: UHC Exchange |
$486.70
|
| Rate for Payer: UHC Medicare Advantage |
$254.67
|
| Rate for Payer: UHCCP Medicaid |
$136.50
|
| Rate for Payer: UMR Bronson Commercial |
$302.46
|
| Rate for Payer: VA VA |
$254.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$613.10
|
|
