|
CERTOLIZUMAB PEGOL 400 MG (200 MG X 2 VIALS) SUBCUTANEOUS KIT
|
Facility
|
IP
|
$21,549.94
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
91495
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,481.97 |
| Max. Negotiated Rate |
$19,394.95 |
| Rate for Payer: Aetna American Axle |
$14,007.46
|
| Rate for Payer: Aetna Commercial |
$18,317.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,007.46
|
| Rate for Payer: Cash Price |
$17,239.95
|
| Rate for Payer: Cofinity Commercial |
$15,084.96
|
| Rate for Payer: Cofinity Commercial |
$18,532.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,084.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,239.95
|
| Rate for Payer: Healthscope Commercial |
$19,394.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,084.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,162.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,317.45
|
| Rate for Payer: PHP Commercial |
$18,317.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,007.46
|
| Rate for Payer: Priority Health SBD |
$13,576.46
|
| Rate for Payer: UMR Bronson Commercial |
$9,481.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,162.46
|
|
|
CERTOLIZUMAB PEGOL 400 MG (200 MG X 2 VIALS) SUBCUTANEOUS KIT
|
Facility
|
OP
|
$21,549.94
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
91495
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$19,394.95 |
| Rate for Payer: Aetna American Axle |
$14,007.46
|
| Rate for Payer: Aetna Commercial |
$18,317.45
|
| Rate for Payer: Aetna Medicare |
$4.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,007.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.88
|
| Rate for Payer: BCBS Complete |
$2.19
|
| Rate for Payer: BCBS MAPPO |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$12.52
|
| Rate for Payer: BCN Commercial |
$12.52
|
| Rate for Payer: BCN Medicare Advantage |
$3.90
|
| Rate for Payer: Cash Price |
$17,239.95
|
| Rate for Payer: Cash Price |
$17,239.95
|
| Rate for Payer: Cofinity Commercial |
$18,532.95
|
| Rate for Payer: Cofinity Commercial |
$15,084.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,084.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,239.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.90
|
| Rate for Payer: Healthscope Commercial |
$19,394.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,084.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,162.46
|
| Rate for Payer: Mclaren Medicaid |
$2.09
|
| Rate for Payer: Mclaren Medicare |
$3.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.10
|
| Rate for Payer: Meridian Medicaid |
$2.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,317.45
|
| Rate for Payer: Nomi Health Commercial |
$11.70
|
| Rate for Payer: PACE Medicare |
$3.70
|
| Rate for Payer: PACE SWMI |
$3.90
|
| Rate for Payer: PHP Commercial |
$18,317.45
|
| Rate for Payer: PHP Medicare Advantage |
$3.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,007.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.40
|
| Rate for Payer: Priority Health Medicare |
$3.90
|
| Rate for Payer: Priority Health Narrow Network |
$10.72
|
| Rate for Payer: Priority Health SBD |
$13,576.46
|
| Rate for Payer: Railroad Medicare Medicare |
$3.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.90
|
| Rate for Payer: UHC Exchange |
$7.45
|
| Rate for Payer: UHC Medicare Advantage |
$3.90
|
| Rate for Payer: UHCCP Medicaid |
$2.09
|
| Rate for Payer: UMR Bronson Commercial |
$7,973.48
|
| Rate for Payer: VA VA |
$3.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,162.46
|
|
|
CERVICAL LYMPHADENECTOMY (MODIFIED RADICAL NECK DISSECTION)
|
Facility
|
OP
|
$7,967.67
|
|
|
Service Code
|
CPT 38724
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,402.38 |
| Max. Negotiated Rate |
$7,967.67 |
| Rate for Payer: BCBS Trust/PPO |
$7,967.67
|
| Rate for Payer: BCN Commercial |
$7,967.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,542.62
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Exchange |
$1,402.38
|
|
|
CESAREAN DELIVERY ONLY;
|
Facility
|
OP
|
$3,358.32
|
|
|
Service Code
|
CPT 59514
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$900.28 |
| Max. Negotiated Rate |
$3,358.32 |
| Rate for Payer: BCBS Trust/PPO |
$3,358.32
|
| Rate for Payer: BCN Commercial |
$3,358.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$990.31
|
| Rate for Payer: UHC Exchange |
$900.28
|
|
|
CETIRIZINE 10 MG TABLET
|
Facility
|
OP
|
$336.05
|
|
|
Service Code
|
NDC 51079059720
|
| Hospital Charge Code |
9506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna American Axle |
$218.43
|
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna Medicare |
$168.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.43
|
| Rate for Payer: BCBS Complete |
$134.42
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$235.24
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.43
|
| Rate for Payer: Priority Health SBD |
$211.71
|
| Rate for Payer: UMR Bronson Commercial |
$124.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
CETIRIZINE 10 MG TABLET
|
Facility
|
OP
|
$244.40
|
|
|
Service Code
|
NDC 00904671761
|
| Hospital Charge Code |
9506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.43 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna American Axle |
$158.86
|
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: Aetna Medicare |
$122.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.86
|
| Rate for Payer: BCBS Complete |
$97.76
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.74
|
| Rate for Payer: PHP Commercial |
$207.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.86
|
| Rate for Payer: Priority Health SBD |
$153.97
|
| Rate for Payer: UMR Bronson Commercial |
$90.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
CETIRIZINE 10 MG TABLET
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 51079059720
|
| Hospital Charge Code |
9506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.86 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna American Axle |
$218.43
|
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.43
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$235.24
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.43
|
| Rate for Payer: Priority Health SBD |
$211.71
|
| Rate for Payer: UMR Bronson Commercial |
$147.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
CETIRIZINE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$191.76
|
|
|
Service Code
|
NDC 51991083716
|
| Hospital Charge Code |
70838
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.95 |
| Max. Negotiated Rate |
$172.58 |
| Rate for Payer: Aetna American Axle |
$124.64
|
| Rate for Payer: Aetna Commercial |
$163.00
|
| Rate for Payer: Aetna Medicare |
$95.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.64
|
| Rate for Payer: BCBS Complete |
$76.70
|
| Rate for Payer: Cash Price |
$153.41
|
| Rate for Payer: Cofinity Commercial |
$134.23
|
| Rate for Payer: Cofinity Commercial |
$164.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.41
|
| Rate for Payer: Healthscope Commercial |
$172.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.00
|
| Rate for Payer: PHP Commercial |
$163.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.64
|
| Rate for Payer: Priority Health SBD |
$120.81
|
| Rate for Payer: UMR Bronson Commercial |
$70.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.82
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,555.41
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
37989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,564.38 |
| Max. Negotiated Rate |
$3,199.87 |
| Rate for Payer: Aetna American Axle |
$2,311.02
|
| Rate for Payer: Aetna Commercial |
$3,022.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,311.02
|
| Rate for Payer: Cash Price |
$2,844.33
|
| Rate for Payer: Cofinity Commercial |
$2,488.79
|
| Rate for Payer: Cofinity Commercial |
$3,057.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,488.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,844.33
|
| Rate for Payer: Healthscope Commercial |
$3,199.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,488.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,666.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,022.10
|
| Rate for Payer: PHP Commercial |
$3,022.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,311.02
|
| Rate for Payer: Priority Health SBD |
$2,239.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,564.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,666.56
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,555.41
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
37989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.33 |
| Max. Negotiated Rate |
$3,199.87 |
| Rate for Payer: Aetna American Axle |
$2,311.02
|
| Rate for Payer: Aetna Commercial |
$3,022.10
|
| Rate for Payer: Aetna Medicare |
$80.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,311.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.38
|
| Rate for Payer: BCBS Complete |
$43.39
|
| Rate for Payer: BCBS MAPPO |
$77.10
|
| Rate for Payer: BCBS Trust/PPO |
$199.72
|
| Rate for Payer: BCN Commercial |
$199.72
|
| Rate for Payer: BCN Medicare Advantage |
$77.10
|
| Rate for Payer: Cash Price |
$2,844.33
|
| Rate for Payer: Cash Price |
$2,844.33
|
| Rate for Payer: Cofinity Commercial |
$3,057.65
|
| Rate for Payer: Cofinity Commercial |
$2,488.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,488.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,844.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.10
|
| Rate for Payer: Healthscope Commercial |
$3,199.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,488.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,666.56
|
| Rate for Payer: Mclaren Medicaid |
$41.33
|
| Rate for Payer: Mclaren Medicare |
$77.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.96
|
| Rate for Payer: Meridian Medicaid |
$43.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,022.10
|
| Rate for Payer: Nomi Health Commercial |
$231.30
|
| Rate for Payer: PACE Medicare |
$73.24
|
| Rate for Payer: PACE SWMI |
$77.10
|
| Rate for Payer: PHP Commercial |
$3,022.10
|
| Rate for Payer: PHP Medicare Advantage |
$77.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,311.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.24
|
| Rate for Payer: Priority Health Medicare |
$77.10
|
| Rate for Payer: Priority Health Narrow Network |
$173.79
|
| Rate for Payer: Priority Health SBD |
$2,239.91
|
| Rate for Payer: Railroad Medicare Medicare |
$77.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.10
|
| Rate for Payer: UHC Exchange |
$147.35
|
| Rate for Payer: UHC Medicare Advantage |
$77.10
|
| Rate for Payer: UHCCP Medicaid |
$41.33
|
| Rate for Payer: UMR Bronson Commercial |
$1,315.50
|
| Rate for Payer: VA VA |
$77.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,666.56
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$7,110.37
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
118617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,128.56 |
| Max. Negotiated Rate |
$6,399.33 |
| Rate for Payer: Aetna American Axle |
$4,621.74
|
| Rate for Payer: Aetna Commercial |
$6,043.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,621.74
|
| Rate for Payer: Cash Price |
$5,688.30
|
| Rate for Payer: Cofinity Commercial |
$4,977.26
|
| Rate for Payer: Cofinity Commercial |
$6,114.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,977.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,688.30
|
| Rate for Payer: Healthscope Commercial |
$6,399.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,977.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,332.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,043.81
|
| Rate for Payer: PHP Commercial |
$6,043.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,621.74
|
| Rate for Payer: Priority Health SBD |
$4,479.53
|
| Rate for Payer: UMR Bronson Commercial |
$3,128.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,332.78
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$7,110.37
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
118617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.33 |
| Max. Negotiated Rate |
$6,399.33 |
| Rate for Payer: Aetna American Axle |
$4,621.74
|
| Rate for Payer: Aetna Commercial |
$6,043.81
|
| Rate for Payer: Aetna Medicare |
$80.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,621.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.38
|
| Rate for Payer: BCBS Complete |
$43.39
|
| Rate for Payer: BCBS MAPPO |
$77.10
|
| Rate for Payer: BCBS Trust/PPO |
$199.72
|
| Rate for Payer: BCN Commercial |
$199.72
|
| Rate for Payer: BCN Medicare Advantage |
$77.10
|
| Rate for Payer: Cash Price |
$5,688.30
|
| Rate for Payer: Cash Price |
$5,688.30
|
| Rate for Payer: Cofinity Commercial |
$6,114.92
|
| Rate for Payer: Cofinity Commercial |
$4,977.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,977.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,688.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.10
|
| Rate for Payer: Healthscope Commercial |
$6,399.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,977.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,332.78
|
| Rate for Payer: Mclaren Medicaid |
$41.33
|
| Rate for Payer: Mclaren Medicare |
$77.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.96
|
| Rate for Payer: Meridian Medicaid |
$43.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,043.81
|
| Rate for Payer: Nomi Health Commercial |
$231.30
|
| Rate for Payer: PACE Medicare |
$73.24
|
| Rate for Payer: PACE SWMI |
$77.10
|
| Rate for Payer: PHP Commercial |
$6,043.81
|
| Rate for Payer: PHP Medicare Advantage |
$77.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,621.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.24
|
| Rate for Payer: Priority Health Medicare |
$77.10
|
| Rate for Payer: Priority Health Narrow Network |
$173.79
|
| Rate for Payer: Priority Health SBD |
$4,479.53
|
| Rate for Payer: Railroad Medicare Medicare |
$77.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.10
|
| Rate for Payer: UHC Exchange |
$147.35
|
| Rate for Payer: UHC Medicare Advantage |
$77.10
|
| Rate for Payer: UHCCP Medicaid |
$41.33
|
| Rate for Payer: UMR Bronson Commercial |
$2,630.84
|
| Rate for Payer: VA VA |
$77.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,332.78
|
|
|
CHANGE OF CYSTOSTOMY TUBE; COMPLICATED
|
Facility
|
OP
|
$2,055.42
|
|
|
Service Code
|
CPT 51710
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$76.69 |
| Max. Negotiated Rate |
$2,055.42 |
| Rate for Payer: Aetna Medicare |
$680.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$817.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$817.46
|
| Rate for Payer: BCBS Complete |
$368.05
|
| Rate for Payer: BCBS MAPPO |
$653.97
|
| Rate for Payer: BCBS Trust/PPO |
$539.51
|
| Rate for Payer: BCN Commercial |
$539.51
|
| Rate for Payer: BCN Medicare Advantage |
$653.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.97
|
| Rate for Payer: Mclaren Medicaid |
$350.53
|
| Rate for Payer: Mclaren Medicare |
$653.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.67
|
| Rate for Payer: Meridian Medicaid |
$368.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.07
|
| Rate for Payer: Nomi Health Commercial |
$1,373.34
|
| Rate for Payer: PACE Medicare |
$621.27
|
| Rate for Payer: PACE SWMI |
$653.97
|
| Rate for Payer: PHP Medicare Advantage |
$653.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,055.42
|
| Rate for Payer: Priority Health Medicare |
$653.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,644.34
|
| Rate for Payer: Railroad Medicare Medicare |
$653.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.36
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$653.97
|
| Rate for Payer: UHC Exchange |
$76.69
|
| Rate for Payer: UHC Medicare Advantage |
$653.97
|
| Rate for Payer: UHCCP Medicaid |
$350.53
|
| Rate for Payer: VA VA |
$653.97
|
|
|
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
|
Facility
|
OP
|
$748.94
|
|
|
Service Code
|
CPT 51705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$748.94 |
| Rate for Payer: Aetna Medicare |
$247.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: BCBS Complete |
$134.11
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$241.00
|
| Rate for Payer: BCN Commercial |
$241.00
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Mclaren Medicaid |
$127.72
|
| Rate for Payer: Mclaren Medicare |
$238.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: Meridian Medicaid |
$134.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Nomi Health Commercial |
$500.41
|
| Rate for Payer: PACE Medicare |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.94
|
| Rate for Payer: Priority Health Medicare |
$238.29
|
| Rate for Payer: Priority Health Narrow Network |
$599.15
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.45
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Exchange |
$49.50
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: UHCCP Medicaid |
$127.72
|
| Rate for Payer: VA VA |
$238.29
|
|
|
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
|
Facility
|
OP
|
$748.94
|
|
|
Service Code
|
CPT 51705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$748.94 |
| Rate for Payer: Aetna Medicare |
$247.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: BCBS Complete |
$134.11
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$241.00
|
| Rate for Payer: BCN Commercial |
$241.00
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Mclaren Medicaid |
$127.72
|
| Rate for Payer: Mclaren Medicare |
$238.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: Meridian Medicaid |
$134.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Nomi Health Commercial |
$500.41
|
| Rate for Payer: PACE Medicare |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.94
|
| Rate for Payer: Priority Health Medicare |
$238.29
|
| Rate for Payer: Priority Health Narrow Network |
$599.15
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.45
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Exchange |
$49.50
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: UHCCP Medicaid |
$127.72
|
| Rate for Payer: VA VA |
$238.29
|
|
|
CHANGE OF URETEROSTOMY TUBE OR EXTERNALLY ACCESSIBLE URETERAL STENT VIA ILEAL CONDUIT
|
Facility
|
OP
|
$6,308.24
|
|
|
Service Code
|
CPT 50688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$73.52 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,358.68
|
| Rate for Payer: BCN Commercial |
$1,358.68
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.87
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$73.52
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
CHEMICAL CAUTERIZATION OF GRANULATION TISSUE (IE, PROUD FLESH)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 17250
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35.85 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$129.12
|
| Rate for Payer: BCN Commercial |
$129.12
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.44
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$35.85
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
CHEMICAL CAUTERIZATION OF GRANULATION TISSUE (IE, PROUD FLESH)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 17250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$35.85 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$129.12
|
| Rate for Payer: BCN Commercial |
$129.12
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.44
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$35.85
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
CHEMICAL PEELS
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 00172
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: UMR Bronson Commercial |
$35.42
|
|
|
CHEMODENERVATION OF INTERNAL ANAL SPHINCTER
|
Facility
|
OP
|
$3,630.90
|
|
|
Service Code
|
CPT 46505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$239.12 |
| Max. Negotiated Rate |
$3,630.90 |
| Rate for Payer: Aetna Medicare |
$1,201.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,444.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,444.05
|
| Rate for Payer: BCBS Complete |
$650.17
|
| Rate for Payer: BCBS MAPPO |
$1,155.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,090.53
|
| Rate for Payer: BCN Commercial |
$2,090.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.24
|
| Rate for Payer: Mclaren Medicaid |
$619.21
|
| Rate for Payer: Mclaren Medicare |
$1,155.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,213.00
|
| Rate for Payer: Meridian Medicaid |
$650.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,328.53
|
| Rate for Payer: Nomi Health Commercial |
$2,426.00
|
| Rate for Payer: PACE Medicare |
$1,097.48
|
| Rate for Payer: PACE SWMI |
$1,155.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,630.90
|
| Rate for Payer: Priority Health Medicare |
$1,155.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,904.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,155.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.03
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,155.24
|
| Rate for Payer: UHC Exchange |
$239.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,155.24
|
| Rate for Payer: UHCCP Medicaid |
$619.21
|
| Rate for Payer: VA VA |
$1,155.24
|
|
|
CHEMODENERVATION OF MUSCLE(S); MUSCLE(S) INNERVATED BY FACIAL NERVE, UNILATERAL (EG, FOR BLEPHAROSPASM, HEMIFACIAL SPASM)
|
Facility
|
OP
|
$909.03
|
|
|
Service Code
|
CPT 64612
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$114.07 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$304.95
|
| Rate for Payer: BCN Commercial |
$304.95
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Nomi Health Commercial |
$607.36
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$909.03
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$727.22
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.48
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$114.07
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: VA VA |
$289.22
|
|
|
CHEMODENERVATION OF MUSCLE(S); NECK MUSCLE(S), EXCLUDING MUSCLES OF THE LARYNX, UNILATERAL (EG, FOR CERVICAL DYSTONIA, SPASMODIC TORTICOLLIS)
|
Facility
|
OP
|
$909.03
|
|
|
Service Code
|
CPT 64616
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$107.66 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$304.95
|
| Rate for Payer: BCN Commercial |
$304.95
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Nomi Health Commercial |
$607.36
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$909.03
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$727.22
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.43
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$107.66
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: VA VA |
$289.22
|
|
|
CHERRY FLAVOR (BULK) ORAL LIQUID
|
Facility
|
IP
|
$153.26
|
|
|
Service Code
|
NDC 00395266216
|
| Hospital Charge Code |
1562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.43 |
| Max. Negotiated Rate |
$137.93 |
| Rate for Payer: Aetna American Axle |
$99.62
|
| Rate for Payer: Aetna Commercial |
$130.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.62
|
| Rate for Payer: Cash Price |
$122.61
|
| Rate for Payer: Cofinity Commercial |
$107.28
|
| Rate for Payer: Cofinity Commercial |
$131.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.61
|
| Rate for Payer: Healthscope Commercial |
$137.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.27
|
| Rate for Payer: PHP Commercial |
$130.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.62
|
| Rate for Payer: Priority Health SBD |
$96.55
|
| Rate for Payer: UMR Bronson Commercial |
$67.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.94
|
|
|
CHERRY FLAVOR (BULK) ORAL LIQUID
|
Facility
|
OP
|
$153.26
|
|
|
Service Code
|
NDC 00395266216
|
| Hospital Charge Code |
1562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.71 |
| Max. Negotiated Rate |
$137.93 |
| Rate for Payer: Aetna American Axle |
$99.62
|
| Rate for Payer: Aetna Commercial |
$130.27
|
| Rate for Payer: Aetna Medicare |
$76.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.62
|
| Rate for Payer: BCBS Complete |
$61.30
|
| Rate for Payer: Cash Price |
$122.61
|
| Rate for Payer: Cofinity Commercial |
$107.28
|
| Rate for Payer: Cofinity Commercial |
$131.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.61
|
| Rate for Payer: Healthscope Commercial |
$137.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.27
|
| Rate for Payer: PHP Commercial |
$130.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.62
|
| Rate for Payer: Priority Health SBD |
$96.55
|
| Rate for Payer: UMR Bronson Commercial |
$56.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.94
|
|
|
CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS
|
Professional
|
Both
|
$1,373.00
|
|
|
Service Code
|
HCPCS 77295
|
| Min. Negotiated Rate |
$145.05 |
| Max. Negotiated Rate |
$892.45 |
| Rate for Payer: Aetna Commercial |
$595.39
|
| Rate for Payer: Aetna Commercial |
$595.39
|
| Rate for Payer: Aetna Medicare |
$462.09
|
| Rate for Payer: Aetna Medicare |
$462.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.82
|
| Rate for Payer: BCBS Complete |
$152.30
|
| Rate for Payer: BCBS Complete |
$152.30
|
| Rate for Payer: BCBS MAPPO |
$444.32
|
| Rate for Payer: BCBS MAPPO |
$444.32
|
| Rate for Payer: BCBS Trust/PPO |
$192.72
|
| Rate for Payer: BCBS Trust/PPO |
$192.72
|
| Rate for Payer: BCN Commercial |
$699.98
|
| Rate for Payer: BCN Commercial |
$699.98
|
| Rate for Payer: BCN Medicare Advantage |
$444.32
|
| Rate for Payer: BCN Medicare Advantage |
$444.32
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cash Price |
$1,398.40
|
| Rate for Payer: Cash Price |
$1,398.40
|
| Rate for Payer: Cofinity Commercial |
$595.39
|
| Rate for Payer: Cofinity Commercial |
$639.82
|
| Rate for Payer: Cofinity Commercial |
$639.82
|
| Rate for Payer: Cofinity Commercial |
$595.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$466.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$466.54
|
| Rate for Payer: Meridian Medicaid |
$152.30
|
| Rate for Payer: Meridian Medicaid |
$152.30
|
| Rate for Payer: Nomi Health Commercial |
$533.18
|
| Rate for Payer: Nomi Health Commercial |
$533.18
|
| Rate for Payer: PACE SWMI |
$444.32
|
| Rate for Payer: PACE SWMI |
$444.32
|
| Rate for Payer: PHP Commercial |
$622.05
|
| Rate for Payer: PHP Commercial |
$622.05
|
| Rate for Payer: PHP Medicare Advantage |
$444.32
|
| Rate for Payer: PHP Medicare Advantage |
$444.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$740.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$740.13
|
| Rate for Payer: Priority Health Medicare |
$444.32
|
| Rate for Payer: Priority Health Medicare |
$444.32
|
| Rate for Payer: Priority Health Narrow Network |
$740.13
|
| Rate for Payer: Priority Health Narrow Network |
$740.13
|
| Rate for Payer: Priority Health SBD |
$343.89
|
| Rate for Payer: Priority Health SBD |
$343.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$444.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$444.32
|
| Rate for Payer: UHC Medicare Advantage |
$444.32
|
| Rate for Payer: UHC Medicare Advantage |
$444.32
|
| Rate for Payer: UHCCP Medicaid |
$145.05
|
| Rate for Payer: UHCCP Medicaid |
$145.05
|
| Rate for Payer: UMR Bronson Commercial |
$804.08
|
| Rate for Payer: UMR Bronson Commercial |
$631.58
|
|
