|
CONJUGATED ESTROGENS 1.25 MG TABLET
|
Facility
|
OP
|
$2,551.15
|
|
|
Service Code
|
NDC 00046110481
|
| Hospital Charge Code |
2938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$943.93 |
| Max. Negotiated Rate |
$2,296.04 |
| Rate for Payer: Aetna American Axle |
$1,658.25
|
| Rate for Payer: Aetna Commercial |
$2,168.48
|
| Rate for Payer: Aetna Medicare |
$1,275.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,658.25
|
| Rate for Payer: BCBS Complete |
$1,020.46
|
| Rate for Payer: Cash Price |
$2,040.92
|
| Rate for Payer: Cofinity Commercial |
$1,785.80
|
| Rate for Payer: Cofinity Commercial |
$2,193.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,785.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.92
|
| Rate for Payer: Healthscope Commercial |
$2,296.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,785.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,913.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.48
|
| Rate for Payer: PHP Commercial |
$2,168.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.25
|
| Rate for Payer: Priority Health SBD |
$1,607.22
|
| Rate for Payer: UMR Bronson Commercial |
$943.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,913.36
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$1,175.88
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
9972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$205.24 |
| Max. Negotiated Rate |
$1,148.73 |
| Rate for Payer: Aetna American Axle |
$764.32
|
| Rate for Payer: Aetna Commercial |
$999.50
|
| Rate for Payer: Aetna Medicare |
$398.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$478.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$478.64
|
| Rate for Payer: BCBS Complete |
$215.50
|
| Rate for Payer: BCBS MAPPO |
$382.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,032.44
|
| Rate for Payer: BCN Commercial |
$1,032.44
|
| Rate for Payer: BCN Medicare Advantage |
$382.91
|
| Rate for Payer: Cash Price |
$940.70
|
| Rate for Payer: Cash Price |
$940.70
|
| Rate for Payer: Cofinity Commercial |
$823.12
|
| Rate for Payer: Cofinity Commercial |
$1,011.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$823.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$382.91
|
| Rate for Payer: Healthscope Commercial |
$1,058.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$823.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$881.91
|
| Rate for Payer: Mclaren Medicaid |
$205.24
|
| Rate for Payer: Mclaren Medicare |
$382.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$402.06
|
| Rate for Payer: Meridian Medicaid |
$215.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$440.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.50
|
| Rate for Payer: Nomi Health Commercial |
$1,148.73
|
| Rate for Payer: PACE Medicare |
$363.76
|
| Rate for Payer: PACE SWMI |
$382.91
|
| Rate for Payer: PHP Commercial |
$999.50
|
| Rate for Payer: PHP Medicare Advantage |
$382.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,101.66
|
| Rate for Payer: Priority Health Medicare |
$382.91
|
| Rate for Payer: Priority Health Narrow Network |
$881.33
|
| Rate for Payer: Priority Health SBD |
$740.80
|
| Rate for Payer: Railroad Medicare Medicare |
$382.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,077.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$382.91
|
| Rate for Payer: UHC Exchange |
$731.78
|
| Rate for Payer: UHC Medicare Advantage |
$382.91
|
| Rate for Payer: UHCCP Medicaid |
$205.24
|
| Rate for Payer: UMR Bronson Commercial |
$435.08
|
| Rate for Payer: VA VA |
$382.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$881.91
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$1,175.88
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
9972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$517.39 |
| Max. Negotiated Rate |
$1,058.29 |
| Rate for Payer: Aetna American Axle |
$764.32
|
| Rate for Payer: Aetna Commercial |
$999.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.32
|
| Rate for Payer: Cash Price |
$940.70
|
| Rate for Payer: Cofinity Commercial |
$1,011.26
|
| Rate for Payer: Cofinity Commercial |
$823.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$823.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.70
|
| Rate for Payer: Healthscope Commercial |
$1,058.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$823.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$881.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.50
|
| Rate for Payer: PHP Commercial |
$999.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.32
|
| Rate for Payer: Priority Health SBD |
$740.80
|
| Rate for Payer: UMR Bronson Commercial |
$517.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$881.91
|
|
|
CONJUNCTIVAL FLAP; BRIDGE OR PARTIAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$11,612.55
|
|
|
Service Code
|
CPT 68360
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$382.72 |
| Max. Negotiated Rate |
$11,612.55 |
| Rate for Payer: Aetna Medicare |
$3,842.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,618.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,618.44
|
| Rate for Payer: BCBS Complete |
$2,079.41
|
| Rate for Payer: BCBS MAPPO |
$3,694.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,031.85
|
| Rate for Payer: BCN Commercial |
$2,031.85
|
| Rate for Payer: BCN Medicare Advantage |
$3,694.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,694.75
|
| Rate for Payer: Mclaren Medicaid |
$1,980.39
|
| Rate for Payer: Mclaren Medicare |
$3,694.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,879.49
|
| Rate for Payer: Meridian Medicaid |
$2,079.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,248.96
|
| Rate for Payer: Nomi Health Commercial |
$7,758.98
|
| Rate for Payer: PACE Medicare |
$3,510.01
|
| Rate for Payer: PACE SWMI |
$3,694.75
|
| Rate for Payer: PHP Medicare Advantage |
$3,694.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,980.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,612.55
|
| Rate for Payer: Priority Health Medicare |
$3,694.75
|
| Rate for Payer: Priority Health Narrow Network |
$9,290.04
|
| Rate for Payer: Railroad Medicare Medicare |
$3,694.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$420.99
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,694.75
|
| Rate for Payer: UHC Exchange |
$382.72
|
| Rate for Payer: UHC Medicare Advantage |
$3,694.75
|
| Rate for Payer: UHCCP Medicaid |
$1,980.39
|
| Rate for Payer: VA VA |
$3,694.75
|
|
|
CONJUNCTIVOPLASTY; WITH CONJUNCTIVAL GRAFT OR EXTENSIVE REARRANGEMENT
|
Facility
|
OP
|
$7,184.18
|
|
|
Service Code
|
CPT 68320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$503.26 |
| Max. Negotiated Rate |
$7,184.18 |
| Rate for Payer: Aetna Medicare |
$2,377.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,857.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,857.24
|
| Rate for Payer: BCBS Complete |
$1,286.44
|
| Rate for Payer: BCBS MAPPO |
$2,285.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,738.00
|
| Rate for Payer: BCN Commercial |
$1,738.00
|
| Rate for Payer: BCN Medicare Advantage |
$2,285.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,285.79
|
| Rate for Payer: Mclaren Medicaid |
$1,225.18
|
| Rate for Payer: Mclaren Medicare |
$2,285.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,400.08
|
| Rate for Payer: Meridian Medicaid |
$1,286.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,628.66
|
| Rate for Payer: Nomi Health Commercial |
$4,800.16
|
| Rate for Payer: PACE Medicare |
$2,171.50
|
| Rate for Payer: PACE SWMI |
$2,285.79
|
| Rate for Payer: PHP Medicare Advantage |
$2,285.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,225.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,184.18
|
| Rate for Payer: Priority Health Medicare |
$2,285.79
|
| Rate for Payer: Priority Health Narrow Network |
$5,747.34
|
| Rate for Payer: Railroad Medicare Medicare |
$2,285.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$553.59
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,285.79
|
| Rate for Payer: UHC Exchange |
$503.26
|
| Rate for Payer: UHC Medicare Advantage |
$2,285.79
|
| Rate for Payer: UHCCP Medicaid |
$1,225.18
|
| Rate for Payer: VA VA |
$2,285.79
|
|
|
CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIAN TARSORRHAPHY, OR CANTHORRHAPHY;
|
Facility
|
OP
|
$7,184.18
|
|
|
Service Code
|
CPT 67880
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$343.60 |
| Max. Negotiated Rate |
$7,184.18 |
| Rate for Payer: Aetna Medicare |
$2,377.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,857.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,857.24
|
| Rate for Payer: BCBS Complete |
$1,286.44
|
| Rate for Payer: BCBS MAPPO |
$2,285.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,438.92
|
| Rate for Payer: BCN Commercial |
$1,438.92
|
| Rate for Payer: BCN Medicare Advantage |
$2,285.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,285.79
|
| Rate for Payer: Mclaren Medicaid |
$1,225.18
|
| Rate for Payer: Mclaren Medicare |
$2,285.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,400.08
|
| Rate for Payer: Meridian Medicaid |
$1,286.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,628.66
|
| Rate for Payer: Nomi Health Commercial |
$4,800.16
|
| Rate for Payer: PACE Medicare |
$2,171.50
|
| Rate for Payer: PACE SWMI |
$2,285.79
|
| Rate for Payer: PHP Medicare Advantage |
$2,285.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,225.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,184.18
|
| Rate for Payer: Priority Health Medicare |
$2,285.79
|
| Rate for Payer: Priority Health Narrow Network |
$5,747.34
|
| Rate for Payer: Railroad Medicare Medicare |
$2,285.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.96
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,285.79
|
| Rate for Payer: UHC Exchange |
$343.60
|
| Rate for Payer: UHC Medicare Advantage |
$2,285.79
|
| Rate for Payer: UHCCP Medicaid |
$1,225.18
|
| Rate for Payer: VA VA |
$2,285.79
|
|
|
CONTROL NASAL HEMORRHAGE, ANTERIOR, COMPLEX (EXTENSIVE CAUTERY AND/OR PACKING) ANY METHOD
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 30903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$233.71
|
| Rate for Payer: BCN Commercial |
$233.71
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Nomi Health Commercial |
$265.21
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.86
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$75.33
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: VA VA |
$126.29
|
|
|
CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (LIMITED CAUTERY AND/OR PACKING) ANY METHOD
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 30901
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$179.57
|
| Rate for Payer: BCN Commercial |
$179.57
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Nomi Health Commercial |
$378.87
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.78
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$55.25
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: VA VA |
$126.29
|
|
|
CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY METHOD; INITIAL
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 30905
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$249.38
|
| Rate for Payer: BCN Commercial |
$249.38
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Nomi Health Commercial |
$265.21
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.31
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$103.01
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: VA VA |
$126.29
|
|
|
CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY METHOD; INITIAL
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 30905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$249.38
|
| Rate for Payer: BCN Commercial |
$249.38
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Nomi Health Commercial |
$265.21
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.31
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$103.01
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: VA VA |
$126.29
|
|
|
CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY METHOD; SUBSEQUENT
|
Facility
|
OP
|
$715.11
|
|
|
Service Code
|
CPT 30906
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$121.95 |
| Max. Negotiated Rate |
$715.11 |
| Rate for Payer: Aetna Medicare |
$236.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$284.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$284.40
|
| Rate for Payer: BCBS Complete |
$128.05
|
| Rate for Payer: BCBS MAPPO |
$227.52
|
| Rate for Payer: BCBS Trust/PPO |
$149.05
|
| Rate for Payer: BCN Commercial |
$149.05
|
| Rate for Payer: BCN Medicare Advantage |
$227.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.52
|
| Rate for Payer: Mclaren Medicaid |
$121.95
|
| Rate for Payer: Mclaren Medicare |
$227.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$238.90
|
| Rate for Payer: Meridian Medicaid |
$128.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.65
|
| Rate for Payer: Nomi Health Commercial |
$477.79
|
| Rate for Payer: PACE Medicare |
$216.14
|
| Rate for Payer: PACE SWMI |
$227.52
|
| Rate for Payer: PHP Medicare Advantage |
$227.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$715.11
|
| Rate for Payer: Priority Health Medicare |
$227.52
|
| Rate for Payer: Priority Health Narrow Network |
$572.09
|
| Rate for Payer: Railroad Medicare Medicare |
$227.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.57
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$227.52
|
| Rate for Payer: UHC Exchange |
$128.70
|
| Rate for Payer: UHC Medicare Advantage |
$227.52
|
| Rate for Payer: UHCCP Medicaid |
$121.95
|
| Rate for Payer: VA VA |
$227.52
|
|
|
CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POST-TONSILLECTOMY); SIMPLE
|
Facility
|
OP
|
$1,568.21
|
|
|
Service Code
|
CPT 42960
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$155.30 |
| Max. Negotiated Rate |
$1,568.21 |
| Rate for Payer: Aetna Medicare |
$518.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.69
|
| Rate for Payer: BCBS Complete |
$280.81
|
| Rate for Payer: BCBS MAPPO |
$498.95
|
| Rate for Payer: BCBS Trust/PPO |
$512.37
|
| Rate for Payer: BCN Commercial |
$512.37
|
| Rate for Payer: BCN Medicare Advantage |
$498.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.95
|
| Rate for Payer: Mclaren Medicaid |
$267.44
|
| Rate for Payer: Mclaren Medicare |
$498.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.90
|
| Rate for Payer: Meridian Medicaid |
$280.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.79
|
| Rate for Payer: Nomi Health Commercial |
$1,047.80
|
| Rate for Payer: PACE Medicare |
$474.00
|
| Rate for Payer: PACE SWMI |
$498.95
|
| Rate for Payer: PHP Medicare Advantage |
$498.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,568.21
|
| Rate for Payer: Priority Health Medicare |
$498.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,254.57
|
| Rate for Payer: Railroad Medicare Medicare |
$498.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.83
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.95
|
| Rate for Payer: UHC Exchange |
$155.30
|
| Rate for Payer: UHC Medicare Advantage |
$498.95
|
| Rate for Payer: UHCCP Medicaid |
$267.44
|
| Rate for Payer: VA VA |
$498.95
|
|
|
CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POST-TONSILLECTOMY); WITH SECONDARY SURGICAL INTERVENTION
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 42962
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$498.05 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,720.52
|
| Rate for Payer: BCN Commercial |
$3,720.52
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$547.86
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$498.05
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
CONVERSION OF PREVIOUS HIP SURGERY TO TOTAL HIP ARTHROPLASTY, WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT
|
Facility
|
OP
|
$13,752.00
|
|
|
Service Code
|
CPT 27132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,616.43 |
| Max. Negotiated Rate |
$13,752.00 |
| Rate for Payer: BCBS Trust/PPO |
$11,390.69
|
| Rate for Payer: BCN Commercial |
$11,390.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,778.07
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Exchange |
$1,616.43
|
|
|
COPANLISIB 60 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23,588.67
|
|
|
Service Code
|
HCPCS J9057
|
| Hospital Charge Code |
184552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.79 |
| Max. Negotiated Rate |
$21,229.80 |
| Rate for Payer: Aetna American Axle |
$15,332.64
|
| Rate for Payer: Aetna Commercial |
$20,050.37
|
| Rate for Payer: Aetna Medicare |
$92.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,332.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.45
|
| Rate for Payer: BCBS Complete |
$50.18
|
| Rate for Payer: BCBS MAPPO |
$89.16
|
| Rate for Payer: BCBS Trust/PPO |
$228.97
|
| Rate for Payer: BCN Commercial |
$228.97
|
| Rate for Payer: BCN Medicare Advantage |
$89.16
|
| Rate for Payer: Cash Price |
$18,870.94
|
| Rate for Payer: Cash Price |
$18,870.94
|
| Rate for Payer: Cofinity Commercial |
$20,286.26
|
| Rate for Payer: Cofinity Commercial |
$16,512.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$16,512.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,870.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.16
|
| Rate for Payer: Healthscope Commercial |
$21,229.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,512.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17,691.50
|
| Rate for Payer: Mclaren Medicaid |
$47.79
|
| Rate for Payer: Mclaren Medicare |
$89.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.62
|
| Rate for Payer: Meridian Medicaid |
$50.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,050.37
|
| Rate for Payer: Nomi Health Commercial |
$267.48
|
| Rate for Payer: PACE Medicare |
$84.70
|
| Rate for Payer: PACE SWMI |
$89.16
|
| Rate for Payer: PHP Commercial |
$20,050.37
|
| Rate for Payer: PHP Medicare Advantage |
$89.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,332.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.13
|
| Rate for Payer: Priority Health Medicare |
$89.16
|
| Rate for Payer: Priority Health Narrow Network |
$213.70
|
| Rate for Payer: Priority Health SBD |
$14,860.86
|
| Rate for Payer: Railroad Medicare Medicare |
$89.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.16
|
| Rate for Payer: UHC Exchange |
$170.39
|
| Rate for Payer: UHC Medicare Advantage |
$89.16
|
| Rate for Payer: UHCCP Medicaid |
$47.79
|
| Rate for Payer: UMR Bronson Commercial |
$8,727.81
|
| Rate for Payer: VA VA |
$89.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17,691.50
|
|
|
COPANLISIB 60 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23,588.67
|
|
|
Service Code
|
HCPCS J9057
|
| Hospital Charge Code |
184552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,379.01 |
| Max. Negotiated Rate |
$21,229.80 |
| Rate for Payer: Aetna American Axle |
$15,332.64
|
| Rate for Payer: Aetna Commercial |
$20,050.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,332.64
|
| Rate for Payer: Cash Price |
$18,870.94
|
| Rate for Payer: Cofinity Commercial |
$16,512.07
|
| Rate for Payer: Cofinity Commercial |
$20,286.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$16,512.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,870.94
|
| Rate for Payer: Healthscope Commercial |
$21,229.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,512.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17,691.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,050.37
|
| Rate for Payer: PHP Commercial |
$20,050.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,332.64
|
| Rate for Payer: Priority Health SBD |
$14,860.86
|
| Rate for Payer: UMR Bronson Commercial |
$10,379.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17,691.50
|
|
|
COPPER 380 SQUARE MM INTRAUTERINE DEVICE
|
Facility
|
OP
|
$2,689.90
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
167586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$920.08 |
| Max. Negotiated Rate |
$3,045.61 |
| Rate for Payer: Aetna American Axle |
$1,748.44
|
| Rate for Payer: Aetna Commercial |
$2,286.42
|
| Rate for Payer: Aetna Medicare |
$1,344.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,748.44
|
| Rate for Payer: BCBS Complete |
$1,075.96
|
| Rate for Payer: BCBS Trust/PPO |
$3,045.61
|
| Rate for Payer: BCN Commercial |
$3,045.61
|
| Rate for Payer: Cash Price |
$2,151.92
|
| Rate for Payer: Cash Price |
$2,151.92
|
| Rate for Payer: Cofinity Commercial |
$1,882.93
|
| Rate for Payer: Cofinity Commercial |
$2,313.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,882.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,151.92
|
| Rate for Payer: Healthscope Commercial |
$2,420.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,882.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,017.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,286.42
|
| Rate for Payer: PHP Commercial |
$2,286.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,748.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,150.10
|
| Rate for Payer: Priority Health Narrow Network |
$920.08
|
| Rate for Payer: Priority Health SBD |
$1,694.64
|
| Rate for Payer: UMR Bronson Commercial |
$995.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,017.42
|
|
|
COPPER 380 SQUARE MM INTRAUTERINE DEVICE
|
Facility
|
IP
|
$2,689.90
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
167586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,183.56 |
| Max. Negotiated Rate |
$2,420.91 |
| Rate for Payer: Aetna American Axle |
$1,748.44
|
| Rate for Payer: Aetna Commercial |
$2,286.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,748.44
|
| Rate for Payer: Cash Price |
$2,151.92
|
| Rate for Payer: Cofinity Commercial |
$1,882.93
|
| Rate for Payer: Cofinity Commercial |
$2,313.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,882.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,151.92
|
| Rate for Payer: Healthscope Commercial |
$2,420.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,882.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,017.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,286.42
|
| Rate for Payer: PHP Commercial |
$2,286.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,748.44
|
| Rate for Payer: Priority Health SBD |
$1,694.64
|
| Rate for Payer: UMR Bronson Commercial |
$1,183.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,017.42
|
|
|
COPPER GLYCINATE AMINO ACID CHELATE 2.5 MG TABLET
|
Facility
|
OP
|
$209.15
|
|
|
Service Code
|
NDC 03398400640
|
| Hospital Charge Code |
163478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.39 |
| Max. Negotiated Rate |
$188.24 |
| Rate for Payer: Aetna American Axle |
$135.95
|
| Rate for Payer: Aetna Commercial |
$177.78
|
| Rate for Payer: Aetna Medicare |
$104.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.95
|
| Rate for Payer: BCBS Complete |
$83.66
|
| Rate for Payer: Cash Price |
$167.32
|
| Rate for Payer: Cofinity Commercial |
$146.40
|
| Rate for Payer: Cofinity Commercial |
$179.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.32
|
| Rate for Payer: Healthscope Commercial |
$188.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.78
|
| Rate for Payer: PHP Commercial |
$177.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.95
|
| Rate for Payer: Priority Health SBD |
$131.76
|
| Rate for Payer: UMR Bronson Commercial |
$77.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.86
|
|
|
COPPER GLYCINATE AMINO ACID CHELATE 2.5 MG TABLET
|
Facility
|
OP
|
$209.15
|
|
|
Service Code
|
NDC 09900000385
|
| Hospital Charge Code |
163478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.39 |
| Max. Negotiated Rate |
$188.24 |
| Rate for Payer: Aetna American Axle |
$135.95
|
| Rate for Payer: Aetna Commercial |
$177.78
|
| Rate for Payer: Aetna Medicare |
$104.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.95
|
| Rate for Payer: BCBS Complete |
$83.66
|
| Rate for Payer: Cash Price |
$167.32
|
| Rate for Payer: Cofinity Commercial |
$146.40
|
| Rate for Payer: Cofinity Commercial |
$179.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.32
|
| Rate for Payer: Healthscope Commercial |
$188.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.78
|
| Rate for Payer: PHP Commercial |
$177.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.95
|
| Rate for Payer: Priority Health SBD |
$131.76
|
| Rate for Payer: UMR Bronson Commercial |
$77.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.86
|
|
|
COPPER GLYCINATE AMINO ACID CHELATE 2.5 MG TABLET
|
Facility
|
IP
|
$209.15
|
|
|
Service Code
|
NDC 09900000385
|
| Hospital Charge Code |
163478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.03 |
| Max. Negotiated Rate |
$188.24 |
| Rate for Payer: Aetna American Axle |
$135.95
|
| Rate for Payer: Aetna Commercial |
$177.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.95
|
| Rate for Payer: Cash Price |
$167.32
|
| Rate for Payer: Cofinity Commercial |
$146.40
|
| Rate for Payer: Cofinity Commercial |
$179.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.32
|
| Rate for Payer: Healthscope Commercial |
$188.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.78
|
| Rate for Payer: PHP Commercial |
$177.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.95
|
| Rate for Payer: Priority Health SBD |
$131.76
|
| Rate for Payer: UMR Bronson Commercial |
$92.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.86
|
|
|
COPPER GLYCINATE AMINO ACID CHELATE 2.5 MG TABLET
|
Facility
|
IP
|
$209.15
|
|
|
Service Code
|
NDC 03398400640
|
| Hospital Charge Code |
163478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.03 |
| Max. Negotiated Rate |
$188.24 |
| Rate for Payer: Aetna American Axle |
$135.95
|
| Rate for Payer: Aetna Commercial |
$177.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.95
|
| Rate for Payer: Cash Price |
$167.32
|
| Rate for Payer: Cofinity Commercial |
$146.40
|
| Rate for Payer: Cofinity Commercial |
$179.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.32
|
| Rate for Payer: Healthscope Commercial |
$188.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.78
|
| Rate for Payer: PHP Commercial |
$177.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.95
|
| Rate for Payer: Priority Health SBD |
$131.76
|
| Rate for Payer: UMR Bronson Commercial |
$92.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.86
|
|
|
CORPORA CAVERNOSA-GLANS PENIS FISTULIZATION (EG, BIOPSY NEEDLE, WINTER PROCEDURE, RONGEUR, OR PUNCH) FOR PRIAPISM
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 54435
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$398.86 |
| 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 |
$1,712.85
|
| Rate for Payer: BCN Commercial |
$1,712.85
|
| 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) |
$438.75
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$398.86
|
| 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
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH DISTAL METATARSAL OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28296
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$493.91 |
| 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 |
$2,663.44
|
| Rate for Payer: BCN Commercial |
$2,663.44
|
| 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) |
$543.30
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$493.91
|
| 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
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH DOUBLE OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 28299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$573.58 |
| 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 |
$4,713.05
|
| Rate for Payer: BCN Commercial |
$4,713.05
|
| 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) |
$630.94
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$573.58
|
| 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
|
|
