|
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 |
$146.41
|
| Rate for Payer: Cofinity Commercial |
$179.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.41
|
| 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 |
$146.41
|
| 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
|
$9,468.51
|
|
|
Service Code
|
CPT 54435
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.95 |
| Max. Negotiated Rate |
$9,468.51 |
| Rate for Payer: Aetna Medicare |
$3,498.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,204.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,204.64
|
| Rate for Payer: BCBS Complete |
$1,893.10
|
| Rate for Payer: BCBS MAPPO |
$3,363.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,363.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,363.71
|
| Rate for Payer: Mclaren Medicaid |
$1,802.95
|
| Rate for Payer: Mclaren Medicare |
$3,363.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,531.90
|
| Rate for Payer: Meridian Medicaid |
$1,893.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,868.27
|
| Rate for Payer: PACE Medicare |
$3,195.52
|
| Rate for Payer: PACE SWMI |
$3,363.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,363.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.95
|
| Rate for Payer: Priority Health Medicare |
$3,363.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3,363.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,468.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,363.71
|
| Rate for Payer: UHC Exchange |
$6,428.39
|
| Rate for Payer: UHC Medicare Advantage |
$3,363.71
|
| Rate for Payer: UHCCP Medicaid |
$1,802.95
|
| Rate for Payer: VA VA |
$3,363.71
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH DISTAL METATARSAL OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28296
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH DOUBLE OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 28299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH FIRST METATARSAL AND MEDIAL CUNEIFORM JOINT ARTHRODESIS, ANY METHOD
|
Facility
|
OP
|
$35,323.48
|
|
|
Service Code
|
CPT 28297
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,726.13 |
| Max. Negotiated Rate |
$35,323.48 |
| Rate for Payer: Aetna Medicare |
$13,050.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,685.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,685.94
|
| Rate for Payer: BCBS Complete |
$7,062.44
|
| Rate for Payer: BCBS MAPPO |
$12,548.75
|
| Rate for Payer: BCN Medicare Advantage |
$12,548.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,548.75
|
| Rate for Payer: Mclaren Medicaid |
$6,726.13
|
| Rate for Payer: Mclaren Medicare |
$12,548.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,176.19
|
| Rate for Payer: Meridian Medicaid |
$7,062.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,431.06
|
| Rate for Payer: PACE Medicare |
$11,921.31
|
| Rate for Payer: PACE SWMI |
$12,548.75
|
| Rate for Payer: PHP Medicare Advantage |
$12,548.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,726.13
|
| Rate for Payer: Priority Health Medicare |
$12,548.75
|
| Rate for Payer: Railroad Medicare Medicare |
$12,548.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,323.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,548.75
|
| Rate for Payer: UHC Exchange |
$23,981.92
|
| Rate for Payer: UHC Medicare Advantage |
$12,548.75
|
| Rate for Payer: UHCCP Medicaid |
$6,726.13
|
| Rate for Payer: VA VA |
$12,548.75
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH PROXIMAL METATARSAL OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH PROXIMAL PHALANX OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 28298
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH RESECTION OF PROXIMAL PHALANX BASE, WHEN PERFORMED, ANY METHOD
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL PHALANGECTOMY)
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
CORRECTION OF LAGOPHTHALMOS, WITH IMPLANTATION OF UPPER EYELID LID LOAD (EG, GOLD WEIGHT)
|
Facility
|
OP
|
$6,404.71
|
|
|
Service Code
|
CPT 67912
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,219.56 |
| Max. Negotiated Rate |
$6,404.71 |
| Rate for Payer: Aetna Medicare |
$2,366.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,844.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,844.11
|
| Rate for Payer: BCBS Complete |
$1,280.53
|
| Rate for Payer: BCBS MAPPO |
$2,275.29
|
| Rate for Payer: BCN Medicare Advantage |
$2,275.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,275.29
|
| Rate for Payer: Mclaren Medicaid |
$1,219.56
|
| Rate for Payer: Mclaren Medicare |
$2,275.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,389.05
|
| Rate for Payer: Meridian Medicaid |
$1,280.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,616.58
|
| Rate for Payer: PACE Medicare |
$2,161.53
|
| Rate for Payer: PACE SWMI |
$2,275.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,275.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,219.56
|
| Rate for Payer: Priority Health Medicare |
$2,275.29
|
| Rate for Payer: Railroad Medicare Medicare |
$2,275.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,404.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,275.29
|
| Rate for Payer: UHC Exchange |
$4,348.31
|
| Rate for Payer: UHC Medicare Advantage |
$2,275.29
|
| Rate for Payer: UHCCP Medicaid |
$1,219.56
|
| Rate for Payer: VA VA |
$2,275.29
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$272.62
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.87 |
| Max. Negotiated Rate |
$245.36 |
| Rate for Payer: Aetna American Axle |
$177.20
|
| Rate for Payer: Aetna American Axle |
$53.80
|
| Rate for Payer: Aetna American Axle |
$85.68
|
| Rate for Payer: Aetna American Axle |
$189.21
|
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna Commercial |
$231.73
|
| Rate for Payer: Aetna Commercial |
$247.43
|
| Rate for Payer: Aetna Commercial |
$112.05
|
| Rate for Payer: Aetna Medicare |
$145.54
|
| Rate for Payer: Aetna Medicare |
$65.91
|
| Rate for Payer: Aetna Medicare |
$41.38
|
| Rate for Payer: Aetna Medicare |
$136.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.68
|
| Rate for Payer: BCBS Complete |
$52.73
|
| Rate for Payer: BCBS Complete |
$33.11
|
| Rate for Payer: BCBS Complete |
$116.44
|
| Rate for Payer: BCBS Complete |
$109.05
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Commercial |
$234.45
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Cofinity Commercial |
$113.37
|
| Rate for Payer: Cofinity Commercial |
$250.34
|
| Rate for Payer: Cofinity Commercial |
$203.76
|
| Rate for Payer: Cofinity Commercial |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$92.27
|
| Rate for Payer: Cofinity Commercial |
$190.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.10
|
| Rate for Payer: Healthscope Commercial |
$261.98
|
| Rate for Payer: Healthscope Commercial |
$118.64
|
| Rate for Payer: Healthscope Commercial |
$245.36
|
| Rate for Payer: Healthscope Commercial |
$74.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.43
|
| Rate for Payer: PHP Commercial |
$247.43
|
| Rate for Payer: PHP Commercial |
$231.73
|
| Rate for Payer: PHP Commercial |
$70.35
|
| Rate for Payer: PHP Commercial |
$112.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.68
|
| Rate for Payer: Priority Health SBD |
$183.39
|
| Rate for Payer: Priority Health SBD |
$52.15
|
| Rate for Payer: Priority Health SBD |
$171.75
|
| Rate for Payer: Priority Health SBD |
$83.05
|
| Rate for Payer: UMR Bronson Commercial |
$107.70
|
| Rate for Payer: UMR Bronson Commercial |
$100.87
|
| Rate for Payer: UMR Bronson Commercial |
$30.62
|
| Rate for Payer: UMR Bronson Commercial |
$48.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.47
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$131.82
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna American Axle |
$85.68
|
| Rate for Payer: Aetna American Axle |
$177.20
|
| Rate for Payer: Aetna American Axle |
$53.80
|
| Rate for Payer: Aetna Commercial |
$231.73
|
| Rate for Payer: Aetna Commercial |
$112.05
|
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.20
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cofinity Commercial |
$92.27
|
| Rate for Payer: Cofinity Commercial |
$234.45
|
| Rate for Payer: Cofinity Commercial |
$190.83
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Cofinity Commercial |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$113.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.10
|
| Rate for Payer: Healthscope Commercial |
$245.36
|
| Rate for Payer: Healthscope Commercial |
$118.64
|
| Rate for Payer: Healthscope Commercial |
$74.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.73
|
| Rate for Payer: PHP Commercial |
$70.35
|
| Rate for Payer: PHP Commercial |
$231.73
|
| Rate for Payer: PHP Commercial |
$112.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.68
|
| Rate for Payer: Priority Health SBD |
$52.15
|
| Rate for Payer: Priority Health SBD |
$171.75
|
| Rate for Payer: Priority Health SBD |
$83.05
|
| Rate for Payer: UMR Bronson Commercial |
$58.00
|
| Rate for Payer: UMR Bronson Commercial |
$36.42
|
| Rate for Payer: UMR Bronson Commercial |
$119.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.47
|
|
|
COVID VACC 2024-2025 (12 YRS UP) (PFIZER)(PF) 30 MCG/0.3 ML IM SYRINGE
|
Facility
|
IP
|
$378.67
|
|
|
Service Code
|
HCPCS 91320
|
| Hospital Charge Code |
208412
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.61 |
| Max. Negotiated Rate |
$340.80 |
| Rate for Payer: Aetna American Axle |
$246.14
|
| Rate for Payer: Aetna Commercial |
$321.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.14
|
| Rate for Payer: Cash Price |
$302.94
|
| Rate for Payer: Cofinity Commercial |
$265.07
|
| Rate for Payer: Cofinity Commercial |
$325.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$265.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.94
|
| Rate for Payer: Healthscope Commercial |
$340.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.87
|
| Rate for Payer: PHP Commercial |
$321.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.14
|
| Rate for Payer: Priority Health SBD |
$238.56
|
| Rate for Payer: UMR Bronson Commercial |
$166.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.00
|
|
|
COVID VACC 2024-2025 (12 YRS UP) (PFIZER)(PF) 30 MCG/0.3 ML IM SYRINGE
|
Facility
|
OP
|
$378.67
|
|
|
Service Code
|
HCPCS 91320
|
| Hospital Charge Code |
208412
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.11 |
| Max. Negotiated Rate |
$340.80 |
| Rate for Payer: Aetna American Axle |
$246.14
|
| Rate for Payer: Aetna Commercial |
$321.87
|
| Rate for Payer: Aetna Medicare |
$189.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.14
|
| Rate for Payer: BCBS Complete |
$151.47
|
| Rate for Payer: Cash Price |
$302.94
|
| Rate for Payer: Cofinity Commercial |
$265.07
|
| Rate for Payer: Cofinity Commercial |
$325.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$265.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.94
|
| Rate for Payer: Healthscope Commercial |
$340.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.87
|
| Rate for Payer: PHP Commercial |
$321.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.14
|
| Rate for Payer: Priority Health SBD |
$238.56
|
| Rate for Payer: UMR Bronson Commercial |
$140.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.00
|
|
|
COVID VACC 2024-25 (5-11 YRS)(PFIZER)(PF) 10 MCG/0.3 ML IM SUSP (EUA)
|
Facility
|
IP
|
$251.49
|
|
|
Service Code
|
HCPCS 91319
|
| Hospital Charge Code |
208366
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.66 |
| Max. Negotiated Rate |
$226.34 |
| Rate for Payer: Aetna American Axle |
$163.47
|
| Rate for Payer: Aetna Commercial |
$213.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.47
|
| Rate for Payer: Cash Price |
$201.19
|
| Rate for Payer: Cofinity Commercial |
$176.04
|
| Rate for Payer: Cofinity Commercial |
$216.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.19
|
| Rate for Payer: Healthscope Commercial |
$226.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.77
|
| Rate for Payer: PHP Commercial |
$213.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.47
|
| Rate for Payer: Priority Health SBD |
$158.44
|
| Rate for Payer: UMR Bronson Commercial |
$110.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.62
|
|
|
COVID VACC 2024-25 (5-11 YRS)(PFIZER)(PF) 10 MCG/0.3 ML IM SUSP (EUA)
|
Facility
|
OP
|
$251.49
|
|
|
Service Code
|
HCPCS 91319
|
| Hospital Charge Code |
208366
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.05 |
| Max. Negotiated Rate |
$226.34 |
| Rate for Payer: Aetna American Axle |
$163.47
|
| Rate for Payer: Aetna Commercial |
$213.77
|
| Rate for Payer: Aetna Medicare |
$125.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.47
|
| Rate for Payer: BCBS Complete |
$100.60
|
| Rate for Payer: Cash Price |
$201.19
|
| Rate for Payer: Cofinity Commercial |
$176.04
|
| Rate for Payer: Cofinity Commercial |
$216.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.19
|
| Rate for Payer: Healthscope Commercial |
$226.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.77
|
| Rate for Payer: PHP Commercial |
$213.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.47
|
| Rate for Payer: Priority Health SBD |
$158.44
|
| Rate for Payer: UMR Bronson Commercial |
$93.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.62
|
|
|
COVID VACC 2024-25 (6MOS-4YRS)(PFIZER)(PF) 3 MCG/0.3 ML IM SUSP (EUA)
|
Facility
|
IP
|
$563.39
|
|
|
Service Code
|
HCPCS 91318
|
| Hospital Charge Code |
208367
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$247.89 |
| Max. Negotiated Rate |
$507.05 |
| Rate for Payer: Aetna American Axle |
$366.20
|
| Rate for Payer: Aetna Commercial |
$478.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.20
|
| Rate for Payer: Cash Price |
$450.71
|
| Rate for Payer: Cofinity Commercial |
$394.37
|
| Rate for Payer: Cofinity Commercial |
$484.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$394.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.71
|
| Rate for Payer: Healthscope Commercial |
$507.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$394.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$422.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.88
|
| Rate for Payer: PHP Commercial |
$478.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$366.20
|
| Rate for Payer: Priority Health SBD |
$354.94
|
| Rate for Payer: UMR Bronson Commercial |
$247.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$422.54
|
|
|
COVID VACC 2024-25 (6MOS-4YRS)(PFIZER)(PF) 3 MCG/0.3 ML IM SUSP (EUA)
|
Facility
|
OP
|
$563.39
|
|
|
Service Code
|
HCPCS 91318
|
| Hospital Charge Code |
208367
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$208.45 |
| Max. Negotiated Rate |
$507.05 |
| Rate for Payer: Aetna American Axle |
$366.20
|
| Rate for Payer: Aetna Commercial |
$478.88
|
| Rate for Payer: Aetna Medicare |
$281.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.20
|
| Rate for Payer: BCBS Complete |
$225.36
|
| Rate for Payer: Cash Price |
$450.71
|
| Rate for Payer: Cofinity Commercial |
$394.37
|
| Rate for Payer: Cofinity Commercial |
$484.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$394.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.71
|
| Rate for Payer: Healthscope Commercial |
$507.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$394.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$422.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.88
|
| Rate for Payer: PHP Commercial |
$478.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$366.20
|
| Rate for Payer: Priority Health SBD |
$354.94
|
| Rate for Payer: UMR Bronson Commercial |
$208.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$422.54
|
|
|
CPT 0255T
|
Professional
|
Both
|
$455.00
|
|
|
Service Code
|
HCPCS 0255T
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$295.75 |
| Rate for Payer: Aetna Medicare |
$227.50
|
| Rate for Payer: BCBS Complete |
$182.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.75
|
| Rate for Payer: UMR Bronson Commercial |
$209.30
|
|
|
CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); NONAUTOGENOUS GRAFT (EG, BIOLOGICAL COLLAGEN, THERMOPLASTIC GRAFT)
|
Facility
|
OP
|
$14,840.35
|
|
|
Service Code
|
CPT 36830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,825.83 |
| Max. Negotiated Rate |
$14,840.35 |
| Rate for Payer: Aetna Medicare |
$5,482.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,590.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,590.09
|
| Rate for Payer: BCBS Complete |
$2,967.12
|
| Rate for Payer: BCBS MAPPO |
$5,272.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,272.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,272.07
|
| Rate for Payer: Mclaren Medicaid |
$2,825.83
|
| Rate for Payer: Mclaren Medicare |
$5,272.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,535.67
|
| Rate for Payer: Meridian Medicaid |
$2,967.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,062.88
|
| Rate for Payer: PACE Medicare |
$5,008.47
|
| Rate for Payer: PACE SWMI |
$5,272.07
|
| Rate for Payer: PHP Medicare Advantage |
$5,272.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,825.83
|
| Rate for Payer: Priority Health Medicare |
$5,272.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5,272.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,840.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,272.07
|
| Rate for Payer: UHC Exchange |
$10,075.45
|
| Rate for Payer: UHC Medicare Advantage |
$5,272.07
|
| Rate for Payer: UHCCP Medicaid |
$2,825.83
|
| Rate for Payer: VA VA |
$5,272.07
|
|
|
CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,377.65
|
|
|
Service Code
|
HCPCS J0791
|
| Hospital Charge Code |
192134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$5,739.89 |
| Rate for Payer: Aetna American Axle |
$4,145.47
|
| Rate for Payer: Aetna Commercial |
$5,421.00
|
| Rate for Payer: Aetna Medicare |
$134.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,145.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$161.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$161.85
|
| Rate for Payer: BCBS Complete |
$72.87
|
| Rate for Payer: BCBS MAPPO |
$129.48
|
| Rate for Payer: BCN Medicare Advantage |
$129.48
|
| Rate for Payer: Cash Price |
$5,102.12
|
| Rate for Payer: Cash Price |
$5,102.12
|
| Rate for Payer: Cofinity Commercial |
$5,484.78
|
| Rate for Payer: Cofinity Commercial |
$4,464.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,464.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,102.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.48
|
| Rate for Payer: Healthscope Commercial |
$5,739.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,464.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,783.24
|
| Rate for Payer: Mclaren Medicaid |
$69.40
|
| Rate for Payer: Mclaren Medicare |
$129.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.95
|
| Rate for Payer: Meridian Medicaid |
$72.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,421.00
|
| Rate for Payer: PACE Medicare |
$123.01
|
| Rate for Payer: PACE SWMI |
$129.48
|
| Rate for Payer: PHP Commercial |
$5,421.00
|
| Rate for Payer: PHP Medicare Advantage |
$129.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,145.47
|
| Rate for Payer: Priority Health Medicare |
$129.48
|
| Rate for Payer: Priority Health SBD |
$4,017.92
|
| Rate for Payer: Railroad Medicare Medicare |
$129.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$364.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.48
|
| Rate for Payer: UHC Exchange |
$247.45
|
| Rate for Payer: UHC Medicare Advantage |
$129.48
|
| Rate for Payer: UHCCP Medicaid |
$69.40
|
| Rate for Payer: UMR Bronson Commercial |
$2,359.73
|
| Rate for Payer: VA VA |
$129.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,783.24
|
|
|
CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,377.65
|
|
|
Service Code
|
HCPCS J0791
|
| Hospital Charge Code |
192134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,806.17 |
| Max. Negotiated Rate |
$5,739.89 |
| Rate for Payer: Aetna American Axle |
$4,145.47
|
| Rate for Payer: Aetna Commercial |
$5,421.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,145.47
|
| Rate for Payer: Cash Price |
$5,102.12
|
| Rate for Payer: Cofinity Commercial |
$4,464.35
|
| Rate for Payer: Cofinity Commercial |
$5,484.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,464.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,102.12
|
| Rate for Payer: Healthscope Commercial |
$5,739.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,464.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,783.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,421.00
|
| Rate for Payer: PHP Commercial |
$5,421.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,145.47
|
| Rate for Payer: Priority Health SBD |
$4,017.92
|
| Rate for Payer: UMR Bronson Commercial |
$2,806.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,783.24
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$177.53
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
108145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.11 |
| Max. Negotiated Rate |
$159.78 |
| Rate for Payer: Aetna American Axle |
$115.39
|
| Rate for Payer: Aetna Commercial |
$150.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.39
|
| Rate for Payer: Cash Price |
$142.02
|
| Rate for Payer: Cofinity Commercial |
$124.27
|
| Rate for Payer: Cofinity Commercial |
$152.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.02
|
| Rate for Payer: Healthscope Commercial |
$159.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.90
|
| Rate for Payer: PHP Commercial |
$150.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.39
|
| Rate for Payer: Priority Health SBD |
$111.84
|
| Rate for Payer: UMR Bronson Commercial |
$78.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.15
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$177.53
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
108145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.69 |
| Max. Negotiated Rate |
$159.78 |
| Rate for Payer: Aetna American Axle |
$115.39
|
| Rate for Payer: Aetna Commercial |
$150.90
|
| Rate for Payer: Aetna Medicare |
$88.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.39
|
| Rate for Payer: BCBS Complete |
$71.01
|
| Rate for Payer: Cash Price |
$142.02
|
| Rate for Payer: Cofinity Commercial |
$124.27
|
| Rate for Payer: Cofinity Commercial |
$152.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.02
|
| Rate for Payer: Healthscope Commercial |
$159.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.90
|
| Rate for Payer: PHP Commercial |
$150.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.39
|
| Rate for Payer: Priority Health SBD |
$111.84
|
| Rate for Payer: UMR Bronson Commercial |
$65.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.15
|
|
|
CURETTAGE OR CAUTERY OF ANAL FISSURE, INCLUDING DILATION OF ANAL SPHINCTER (SEPARATE PROCEDURE); INITIAL
|
Facility
|
OP
|
$7,528.73
|
|
|
Service Code
|
CPT 46940
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,433.59 |
| Max. Negotiated Rate |
$7,528.73 |
| Rate for Payer: Aetna Medicare |
$2,781.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,343.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,343.25
|
| Rate for Payer: BCBS Complete |
$1,505.26
|
| Rate for Payer: BCBS MAPPO |
$2,674.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,674.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,674.60
|
| Rate for Payer: Mclaren Medicaid |
$1,433.59
|
| Rate for Payer: Mclaren Medicare |
$2,674.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,808.33
|
| Rate for Payer: Meridian Medicaid |
$1,505.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,075.79
|
| Rate for Payer: PACE Medicare |
$2,540.87
|
| Rate for Payer: PACE SWMI |
$2,674.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,674.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,433.59
|
| Rate for Payer: Priority Health Medicare |
$2,674.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,674.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,528.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,674.60
|
| Rate for Payer: UHC Exchange |
$5,111.43
|
| Rate for Payer: UHC Medicare Advantage |
$2,674.60
|
| Rate for Payer: UHCCP Medicaid |
$1,433.59
|
| Rate for Payer: VA VA |
$2,674.60
|
|
