|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH FIRST METATARSAL AND MEDIAL CUNEIFORM JOINT ARTHRODESIS, ANY METHOD
|
Facility
|
OP
|
$39,622.51
|
|
|
Service Code
|
CPT 28297
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$579.37 |
| Max. Negotiated Rate |
$39,622.51 |
| Rate for Payer: Aetna Medicare |
$13,110.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,758.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,758.31
|
| Rate for Payer: BCBS Complete |
$7,095.02
|
| Rate for Payer: BCBS MAPPO |
$12,606.65
|
| Rate for Payer: BCBS Trust/PPO |
$6,587.82
|
| Rate for Payer: BCN Commercial |
$6,587.82
|
| Rate for Payer: BCN Medicare Advantage |
$12,606.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,606.65
|
| Rate for Payer: Mclaren Medicaid |
$6,757.16
|
| Rate for Payer: Mclaren Medicare |
$12,606.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,236.98
|
| Rate for Payer: Meridian Medicaid |
$7,095.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,497.65
|
| Rate for Payer: Nomi Health Commercial |
$26,473.96
|
| Rate for Payer: PACE Medicare |
$11,976.32
|
| Rate for Payer: PACE SWMI |
$12,606.65
|
| Rate for Payer: PHP Medicare Advantage |
$12,606.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,757.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39,622.51
|
| Rate for Payer: Priority Health Medicare |
$12,606.65
|
| Rate for Payer: Priority Health Narrow Network |
$31,698.01
|
| Rate for Payer: Railroad Medicare Medicare |
$12,606.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$637.31
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,606.65
|
| Rate for Payer: UHC Exchange |
$579.37
|
| Rate for Payer: UHC Medicare Advantage |
$12,606.65
|
| Rate for Payer: UHCCP Medicaid |
$6,757.16
|
| Rate for Payer: VA VA |
$12,606.65
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH PROXIMAL METATARSAL OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$579.33 |
| 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 |
$2,986.19
|
| Rate for Payer: BCN Commercial |
$2,986.19
|
| 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) |
$637.26
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$579.33
|
| 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 PROXIMAL PHALANX OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 28298
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$489.43 |
| 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 |
$4,225.56
|
| Rate for Payer: BCN Commercial |
$4,225.56
|
| 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) |
$538.37
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$489.43
|
| 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
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH RESECTION OF PROXIMAL PHALANX BASE, WHEN PERFORMED, ANY METHOD
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$467.13 |
| 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 |
$3,676.71
|
| Rate for Payer: BCN Commercial |
$3,676.71
|
| 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) |
$513.84
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$467.13
|
| 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, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL PHALANGECTOMY)
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$371.35 |
| 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 |
$3,245.82
|
| Rate for Payer: BCN Commercial |
$3,245.82
|
| 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) |
$408.48
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$371.35
|
| 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 OF LAGOPHTHALMOS, WITH IMPLANTATION OF UPPER EYELID LID LOAD (EG, GOLD WEIGHT)
|
Facility
|
OP
|
$7,184.18
|
|
|
Service Code
|
CPT 67912
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$455.80 |
| 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 |
$1,644.51
|
| Rate for Payer: BCN Commercial |
$1,644.51
|
| 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) |
$501.38
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,285.79
|
| Rate for Payer: UHC Exchange |
$455.80
|
| 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
|
|
|
CORTICOTROPIN 80 UNIT/ML INJECTION GEL
|
Facility
|
OP
|
$10,111.44
|
|
|
Service Code
|
HCPCS J0801
|
| Hospital Charge Code |
9685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10,111.44 |
| Max. Negotiated Rate |
$10,111.44 |
| Rate for Payer: BCBS Trust/PPO |
$10,111.44
|
| Rate for Payer: BCN Commercial |
$10,111.44
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$272.62
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.95 |
| Max. Negotiated Rate |
$245.36 |
| Rate for Payer: Aetna American Axle |
$177.20
|
| Rate for Payer: Aetna American Axle |
$85.68
|
| Rate for Payer: Aetna American Axle |
$53.80
|
| Rate for Payer: Aetna Commercial |
$112.05
|
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna Commercial |
$231.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.68
|
| 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 |
$71.18
|
| Rate for Payer: Cofinity Commercial |
$234.45
|
| Rate for Payer: Cofinity Commercial |
$113.37
|
| Rate for Payer: Cofinity Commercial |
$92.27
|
| Rate for Payer: Cofinity Commercial |
$190.83
|
| Rate for Payer: Cofinity Commercial |
$57.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Healthscope Commercial |
$118.64
|
| Rate for Payer: Healthscope Commercial |
$74.49
|
| Rate for Payer: Healthscope Commercial |
$245.36
|
| 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 |
$62.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.86
|
| 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 |
$112.05
|
| 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 |
$85.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.20
|
| Rate for Payer: Priority Health SBD |
$83.05
|
| Rate for Payer: Priority Health SBD |
$171.75
|
| Rate for Payer: Priority Health SBD |
$52.15
|
| Rate for Payer: UMR Bronson Commercial |
$58.00
|
| Rate for Payer: UMR Bronson Commercial |
$119.95
|
| Rate for Payer: UMR Bronson Commercial |
$36.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.08
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$82.77
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.62 |
| Max. Negotiated Rate |
$77.41 |
| Rate for Payer: Aetna American Axle |
$53.80
|
| Rate for Payer: Aetna American Axle |
$189.21
|
| Rate for Payer: Aetna American Axle |
$85.68
|
| Rate for Payer: Aetna American Axle |
$177.20
|
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna Commercial |
$231.73
|
| Rate for Payer: Aetna Commercial |
$112.05
|
| Rate for Payer: Aetna Commercial |
$247.43
|
| Rate for Payer: Aetna Medicare |
$145.54
|
| Rate for Payer: Aetna Medicare |
$136.31
|
| Rate for Payer: Aetna Medicare |
$65.91
|
| Rate for Payer: Aetna Medicare |
$41.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.20
|
| Rate for Payer: BCBS Complete |
$116.44
|
| Rate for Payer: BCBS Complete |
$52.73
|
| Rate for Payer: BCBS Complete |
$33.11
|
| Rate for Payer: BCBS Complete |
$109.05
|
| Rate for Payer: BCBS Trust/PPO |
$77.41
|
| Rate for Payer: BCBS Trust/PPO |
$77.41
|
| Rate for Payer: BCBS Trust/PPO |
$77.41
|
| Rate for Payer: BCBS Trust/PPO |
$77.41
|
| Rate for Payer: BCN Commercial |
$77.41
|
| Rate for Payer: BCN Commercial |
$77.41
|
| Rate for Payer: BCN Commercial |
$77.41
|
| Rate for Payer: BCN Commercial |
$77.41
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Cofinity Commercial |
$234.45
|
| Rate for Payer: Cofinity Commercial |
$113.37
|
| Rate for Payer: Cofinity Commercial |
$92.27
|
| Rate for Payer: Cofinity Commercial |
$190.83
|
| Rate for Payer: Cofinity Commercial |
$203.76
|
| Rate for Payer: Cofinity Commercial |
$250.34
|
| Rate for Payer: Cofinity Commercial |
$57.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.10
|
| 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 |
$105.46
|
| Rate for Payer: Healthscope Commercial |
$118.64
|
| Rate for Payer: Healthscope Commercial |
$74.49
|
| Rate for Payer: Healthscope Commercial |
$261.98
|
| Rate for Payer: Healthscope Commercial |
$245.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.76
|
| 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 |
$62.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.05
|
| Rate for Payer: PHP Commercial |
$70.35
|
| Rate for Payer: PHP Commercial |
$231.73
|
| Rate for Payer: PHP Commercial |
$112.05
|
| Rate for Payer: PHP Commercial |
$247.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.21
|
| Rate for Payer: Priority Health SBD |
$83.05
|
| Rate for Payer: Priority Health SBD |
$183.39
|
| Rate for Payer: Priority Health SBD |
$171.75
|
| Rate for Payer: Priority Health SBD |
$52.15
|
| Rate for Payer: UMR Bronson Commercial |
$48.77
|
| Rate for Payer: UMR Bronson Commercial |
$107.70
|
| Rate for Payer: UMR Bronson Commercial |
$30.62
|
| Rate for Payer: UMR Bronson Commercial |
$100.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.08
|
|
|
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 |
$124.72 |
| Max. Negotiated Rate |
$356.10 |
| 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: BCBS Trust/PPO |
$356.10
|
| Rate for Payer: BCN Commercial |
$356.10
|
| Rate for Payer: Cash Price |
$302.94
|
| 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 HMO/PPO/Tiered Network |
$155.90
|
| Rate for Payer: Priority Health Narrow Network |
$124.72
|
| Rate for Payer: Priority Health SBD |
$238.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.92
|
| Rate for Payer: UHC Exchange |
$132.92
|
| 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
|
OP
|
$251.49
|
|
|
Service Code
|
HCPCS 91319
|
| Hospital Charge Code |
208366
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.22 |
| 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 |
$125.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.47
|
| Rate for Payer: BCBS Complete |
$100.60
|
| Rate for Payer: BCBS Trust/PPO |
$200.49
|
| Rate for Payer: BCN Commercial |
$200.49
|
| Rate for Payer: Cash Price |
$201.19
|
| 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 HMO/PPO/Tiered Network |
$87.78
|
| Rate for Payer: Priority Health Narrow Network |
$70.22
|
| Rate for Payer: Priority Health SBD |
$158.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.84
|
| Rate for Payer: UHC Exchange |
$74.84
|
| Rate for Payer: UMR Bronson Commercial |
$93.05
|
| 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
|
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 (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: Healthscope Commercial |
$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: 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 |
$52.44 |
| 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 |
$281.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.20
|
| Rate for Payer: BCBS Complete |
$225.36
|
| Rate for Payer: BCBS Trust/PPO |
$149.73
|
| Rate for Payer: BCN Commercial |
$149.73
|
| Rate for Payer: Cash Price |
$450.71
|
| 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 HMO/PPO/Tiered Network |
$65.55
|
| Rate for Payer: Priority Health Narrow Network |
$52.44
|
| Rate for Payer: Priority Health SBD |
$354.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.89
|
| Rate for Payer: UHC Exchange |
$55.89
|
| 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
|
|
|
CRANIOPLASTY FOR SKULL DEFECT; LARGER THAN 5 CM DIAMETER
|
Facility
|
OP
|
$4,216.23
|
|
|
Service Code
|
CPT 62141
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,139.29 |
| Max. Negotiated Rate |
$4,216.23 |
| Rate for Payer: BCBS Trust/PPO |
$4,216.23
|
| Rate for Payer: BCN Commercial |
$4,216.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,253.22
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$1,139.29
|
|
|
CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); NONAUTOGENOUS GRAFT (EG, BIOLOGICAL COLLAGEN, THERMOPLASTIC GRAFT)
|
Facility
|
OP
|
$16,646.50
|
|
|
Service Code
|
CPT 36830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$644.61 |
| Max. Negotiated Rate |
$16,646.50 |
| Rate for Payer: Aetna Medicare |
$5,508.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,620.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,620.50
|
| Rate for Payer: BCBS Complete |
$2,980.81
|
| Rate for Payer: BCBS MAPPO |
$5,296.40
|
| Rate for Payer: BCBS Trust/PPO |
$6,761.09
|
| Rate for Payer: BCN Commercial |
$6,761.09
|
| Rate for Payer: BCN Medicare Advantage |
$5,296.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,296.40
|
| Rate for Payer: Mclaren Medicaid |
$2,838.87
|
| Rate for Payer: Mclaren Medicare |
$5,296.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,561.22
|
| Rate for Payer: Meridian Medicaid |
$2,980.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,090.86
|
| Rate for Payer: Nomi Health Commercial |
$11,122.44
|
| Rate for Payer: PACE Medicare |
$5,031.58
|
| Rate for Payer: PACE SWMI |
$5,296.40
|
| Rate for Payer: PHP Medicare Advantage |
$5,296.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,838.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,646.50
|
| Rate for Payer: Priority Health Medicare |
$5,296.40
|
| Rate for Payer: Priority Health Narrow Network |
$13,317.20
|
| Rate for Payer: Railroad Medicare Medicare |
$5,296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$709.07
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,296.40
|
| Rate for Payer: UHC Exchange |
$644.61
|
| Rate for Payer: UHC Medicare Advantage |
$5,296.40
|
| Rate for Payer: UHCCP Medicaid |
$2,838.87
|
| Rate for Payer: VA VA |
$5,296.40
|
|
|
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 |
$5,739.88 |
| 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 |
$4,464.36
|
| Rate for Payer: Cofinity Commercial |
$5,484.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,464.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,102.12
|
| Rate for Payer: Healthscope Commercial |
$5,739.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,464.36
|
| 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
|
|
|
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 |
$68.97 |
| Max. Negotiated Rate |
$5,739.88 |
| Rate for Payer: Aetna American Axle |
$4,145.47
|
| Rate for Payer: Aetna Commercial |
$5,421.00
|
| Rate for Payer: Aetna Medicare |
$133.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,145.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.85
|
| Rate for Payer: BCBS Complete |
$72.42
|
| Rate for Payer: BCBS MAPPO |
$128.68
|
| Rate for Payer: BCBS Trust/PPO |
$346.94
|
| Rate for Payer: BCN Commercial |
$346.94
|
| Rate for Payer: BCN Medicare Advantage |
$128.68
|
| 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 |
$4,464.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,464.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,102.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.68
|
| Rate for Payer: Healthscope Commercial |
$5,739.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,464.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,783.24
|
| Rate for Payer: Mclaren Medicaid |
$68.97
|
| Rate for Payer: Mclaren Medicare |
$128.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.11
|
| Rate for Payer: Meridian Medicaid |
$72.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,421.00
|
| Rate for Payer: Nomi Health Commercial |
$386.04
|
| Rate for Payer: PACE Medicare |
$122.25
|
| Rate for Payer: PACE SWMI |
$128.68
|
| Rate for Payer: PHP Commercial |
$5,421.00
|
| Rate for Payer: PHP Medicare Advantage |
$128.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,145.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.93
|
| Rate for Payer: Priority Health Medicare |
$128.68
|
| Rate for Payer: Priority Health Narrow Network |
$295.94
|
| Rate for Payer: Priority Health SBD |
$4,017.92
|
| Rate for Payer: Railroad Medicare Medicare |
$128.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$362.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.68
|
| Rate for Payer: UHC Exchange |
$245.92
|
| Rate for Payer: UHC Medicare Advantage |
$128.68
|
| Rate for Payer: UHCCP Medicaid |
$68.97
|
| Rate for Payer: UMR Bronson Commercial |
$2,359.73
|
| Rate for Payer: VA VA |
$128.68
|
| 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 |
$88.76
|
| 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
|
$8,445.02
|
|
|
Service Code
|
CPT 46940
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$139.82 |
| Max. Negotiated Rate |
$8,445.02 |
| Rate for Payer: Aetna Medicare |
$2,794.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,358.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,358.68
|
| Rate for Payer: BCBS Complete |
$1,512.21
|
| Rate for Payer: BCBS MAPPO |
$2,686.94
|
| Rate for Payer: BCBS Trust/PPO |
$180.93
|
| Rate for Payer: BCN Commercial |
$180.93
|
| Rate for Payer: BCN Medicare Advantage |
$2,686.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,686.94
|
| Rate for Payer: Mclaren Medicaid |
$1,440.20
|
| Rate for Payer: Mclaren Medicare |
$2,686.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,821.29
|
| Rate for Payer: Meridian Medicaid |
$1,512.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,089.98
|
| Rate for Payer: Nomi Health Commercial |
$5,642.57
|
| Rate for Payer: PACE Medicare |
$2,552.59
|
| Rate for Payer: PACE SWMI |
$2,686.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,686.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,440.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,445.02
|
| Rate for Payer: Priority Health Medicare |
$2,686.94
|
| Rate for Payer: Priority Health Narrow Network |
$6,756.02
|
| Rate for Payer: Railroad Medicare Medicare |
$2,686.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.80
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,686.94
|
| Rate for Payer: UHC Exchange |
$139.82
|
| Rate for Payer: UHC Medicare Advantage |
$2,686.94
|
| Rate for Payer: UHCCP Medicaid |
$1,440.20
|
| Rate for Payer: VA VA |
$2,686.94
|
|
|
CURETTAGE, POSTPARTUM
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 59160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$185.96 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,889.77
|
| Rate for Payer: BCN Commercial |
$2,889.77
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.56
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$185.96
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$17.43
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$15.69 |
| Rate for Payer: Aetna American Axle |
$11.33
|
| Rate for Payer: Aetna American Axle |
$11.74
|
| Rate for Payer: Aetna American Axle |
$11.40
|
| Rate for Payer: Aetna American Axle |
$8.77
|
| Rate for Payer: Aetna American Axle |
$14.18
|
| Rate for Payer: Aetna Commercial |
$14.82
|
| Rate for Payer: Aetna Commercial |
$11.47
|
| Rate for Payer: Aetna Commercial |
$18.55
|
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Aetna Medicare |
$8.77
|
| Rate for Payer: Aetna Medicare |
$9.03
|
| Rate for Payer: Aetna Medicare |
$8.72
|
| Rate for Payer: Aetna Medicare |
$6.74
|
| Rate for Payer: Aetna Medicare |
$10.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.40
|
| Rate for Payer: BCBS Complete |
$6.97
|
| Rate for Payer: BCBS Complete |
$5.40
|
| Rate for Payer: BCBS Complete |
$7.22
|
| Rate for Payer: BCBS Complete |
$8.73
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: BCBS Trust/PPO |
$3.10
|
| Rate for Payer: BCBS Trust/PPO |
$3.10
|
| Rate for Payer: BCBS Trust/PPO |
$3.10
|
| Rate for Payer: BCBS Trust/PPO |
$3.10
|
| Rate for Payer: BCBS Trust/PPO |
$3.10
|
| Rate for Payer: BCN Commercial |
$3.10
|
| Rate for Payer: BCN Commercial |
$3.10
|
| Rate for Payer: BCN Commercial |
$3.10
|
| Rate for Payer: BCN Commercial |
$3.10
|
| Rate for Payer: BCN Commercial |
$3.10
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$12.20
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$11.60
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Cofinity Commercial |
$15.27
|
| Rate for Payer: Cofinity Commercial |
$15.53
|
| Rate for Payer: Cofinity Commercial |
$12.64
|
| Rate for Payer: Cofinity Commercial |
$14.99
|
| Rate for Payer: Cofinity Commercial |
$9.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$16.25
|
| Rate for Payer: Healthscope Commercial |
$12.14
|
| Rate for Payer: Healthscope Commercial |
$15.69
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Healthscope Commercial |
$19.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.47
|
| Rate for Payer: PHP Commercial |
$18.55
|
| Rate for Payer: PHP Commercial |
$15.35
|
| Rate for Payer: PHP Commercial |
$14.82
|
| Rate for Payer: PHP Commercial |
$11.47
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.33
|
| Rate for Payer: Priority Health SBD |
$10.98
|
| Rate for Payer: Priority Health SBD |
$13.75
|
| Rate for Payer: Priority Health SBD |
$11.38
|
| Rate for Payer: Priority Health SBD |
$8.50
|
| Rate for Payer: Priority Health SBD |
$11.05
|
| Rate for Payer: UMR Bronson Commercial |
$4.99
|
| Rate for Payer: UMR Bronson Commercial |
$6.49
|
| Rate for Payer: UMR Bronson Commercial |
$6.45
|
| Rate for Payer: UMR Bronson Commercial |
$6.68
|
| Rate for Payer: UMR Bronson Commercial |
$8.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
