|
DARUNAVIR 800 MG TABLET
|
Facility
|
OP
|
$7,785.54
|
|
|
Service Code
|
NDC 59676056630
|
| Hospital Charge Code |
163784
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,880.65 |
| Max. Negotiated Rate |
$7,006.99 |
| Rate for Payer: Aetna American Axle |
$5,060.60
|
| Rate for Payer: Aetna Commercial |
$6,617.71
|
| Rate for Payer: Aetna Medicare |
$3,892.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,060.60
|
| Rate for Payer: BCBS Complete |
$3,114.22
|
| Rate for Payer: Cash Price |
$6,228.43
|
| Rate for Payer: Cofinity Commercial |
$5,449.88
|
| Rate for Payer: Cofinity Commercial |
$6,695.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,449.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,228.43
|
| Rate for Payer: Healthscope Commercial |
$7,006.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,449.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,839.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,617.71
|
| Rate for Payer: PHP Commercial |
$6,617.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,060.60
|
| Rate for Payer: Priority Health SBD |
$4,904.89
|
| Rate for Payer: UMR Bronson Commercial |
$2,880.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,839.15
|
|
|
DAUNORUBICIN 44 MG AND CYTARABINE 100 MG IN LIPOSOME IV SOLUTION
|
Facility
|
IP
|
$46,942.95
|
|
|
Service Code
|
HCPCS J9153
|
| Hospital Charge Code |
184345
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20,654.90 |
| Max. Negotiated Rate |
$42,248.65 |
| Rate for Payer: Aetna American Axle |
$30,512.92
|
| Rate for Payer: Aetna Commercial |
$39,901.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,512.92
|
| Rate for Payer: Cash Price |
$37,554.36
|
| Rate for Payer: Cofinity Commercial |
$32,860.07
|
| Rate for Payer: Cofinity Commercial |
$40,370.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$32,860.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37,554.36
|
| Rate for Payer: Healthscope Commercial |
$42,248.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32,860.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35,207.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39,901.51
|
| Rate for Payer: PHP Commercial |
$39,901.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30,512.92
|
| Rate for Payer: Priority Health SBD |
$29,574.06
|
| Rate for Payer: UMR Bronson Commercial |
$20,654.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35,207.21
|
|
|
DAUNORUBICIN 44 MG AND CYTARABINE 100 MG IN LIPOSOME IV SOLUTION
|
Facility
|
OP
|
$46,942.95
|
|
|
Service Code
|
HCPCS J9153
|
| Hospital Charge Code |
184345
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.26 |
| Max. Negotiated Rate |
$42,248.65 |
| Rate for Payer: Aetna American Axle |
$30,512.92
|
| Rate for Payer: Aetna Commercial |
$39,901.51
|
| Rate for Payer: Aetna Medicare |
$266.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,512.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$320.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$320.11
|
| Rate for Payer: BCBS Complete |
$144.13
|
| Rate for Payer: BCBS MAPPO |
$256.09
|
| Rate for Payer: BCN Medicare Advantage |
$256.09
|
| Rate for Payer: Cash Price |
$37,554.36
|
| Rate for Payer: Cash Price |
$37,554.36
|
| Rate for Payer: Cofinity Commercial |
$40,370.94
|
| Rate for Payer: Cofinity Commercial |
$32,860.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$32,860.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37,554.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$256.09
|
| Rate for Payer: Healthscope Commercial |
$42,248.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32,860.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35,207.21
|
| Rate for Payer: Mclaren Medicaid |
$137.26
|
| Rate for Payer: Mclaren Medicare |
$256.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$268.89
|
| Rate for Payer: Meridian Medicaid |
$144.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$294.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39,901.51
|
| Rate for Payer: PACE Medicare |
$243.29
|
| Rate for Payer: PACE SWMI |
$256.09
|
| Rate for Payer: PHP Commercial |
$39,901.51
|
| Rate for Payer: PHP Medicare Advantage |
$256.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30,512.92
|
| Rate for Payer: Priority Health Medicare |
$256.09
|
| Rate for Payer: Priority Health SBD |
$29,574.06
|
| Rate for Payer: Railroad Medicare Medicare |
$256.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$720.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$256.09
|
| Rate for Payer: UHC Exchange |
$489.41
|
| Rate for Payer: UHC Medicare Advantage |
$256.09
|
| Rate for Payer: UHCCP Medicaid |
$137.26
|
| Rate for Payer: UMR Bronson Commercial |
$17,368.89
|
| Rate for Payer: VA VA |
$256.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35,207.21
|
|
|
DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$510.66
|
|
|
Service Code
|
HCPCS J9150
|
| Hospital Charge Code |
22661
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$459.59 |
| Rate for Payer: Aetna American Axle |
$331.93
|
| Rate for Payer: Aetna American Axle |
$208.44
|
| Rate for Payer: Aetna American Axle |
$750.07
|
| Rate for Payer: Aetna American Axle |
$734.71
|
| Rate for Payer: Aetna Commercial |
$272.57
|
| Rate for Payer: Aetna Commercial |
$980.87
|
| Rate for Payer: Aetna Commercial |
$434.06
|
| Rate for Payer: Aetna Commercial |
$960.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.71
|
| Rate for Payer: Cash Price |
$408.53
|
| Rate for Payer: Cash Price |
$256.54
|
| Rate for Payer: Cash Price |
$923.17
|
| Rate for Payer: Cash Price |
$904.26
|
| Rate for Payer: Cofinity Commercial |
$357.46
|
| Rate for Payer: Cofinity Commercial |
$972.08
|
| Rate for Payer: Cofinity Commercial |
$791.22
|
| Rate for Payer: Cofinity Commercial |
$807.77
|
| Rate for Payer: Cofinity Commercial |
$992.41
|
| Rate for Payer: Cofinity Commercial |
$224.47
|
| Rate for Payer: Cofinity Commercial |
$275.78
|
| Rate for Payer: Cofinity Commercial |
$439.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$807.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$791.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$904.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$923.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.54
|
| Rate for Payer: Healthscope Commercial |
$459.59
|
| Rate for Payer: Healthscope Commercial |
$1,017.29
|
| Rate for Payer: Healthscope Commercial |
$288.60
|
| Rate for Payer: Healthscope Commercial |
$1,038.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$807.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$791.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$865.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$847.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$960.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$980.87
|
| Rate for Payer: PHP Commercial |
$960.77
|
| Rate for Payer: PHP Commercial |
$980.87
|
| Rate for Payer: PHP Commercial |
$272.57
|
| Rate for Payer: PHP Commercial |
$434.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$734.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.07
|
| Rate for Payer: Priority Health SBD |
$726.99
|
| Rate for Payer: Priority Health SBD |
$321.72
|
| Rate for Payer: Priority Health SBD |
$202.02
|
| Rate for Payer: Priority Health SBD |
$712.10
|
| Rate for Payer: UMR Bronson Commercial |
$141.09
|
| Rate for Payer: UMR Bronson Commercial |
$497.34
|
| Rate for Payer: UMR Bronson Commercial |
$507.74
|
| Rate for Payer: UMR Bronson Commercial |
$224.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$865.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$847.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.00
|
|
|
DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,130.32
|
|
|
Service Code
|
HCPCS J9150
|
| Hospital Charge Code |
22661
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$1,017.29 |
| Rate for Payer: Aetna American Axle |
$734.71
|
| Rate for Payer: Aetna American Axle |
$750.07
|
| Rate for Payer: Aetna American Axle |
$331.93
|
| Rate for Payer: Aetna American Axle |
$208.44
|
| Rate for Payer: Aetna Commercial |
$434.06
|
| Rate for Payer: Aetna Commercial |
$960.77
|
| Rate for Payer: Aetna Commercial |
$980.87
|
| Rate for Payer: Aetna Commercial |
$272.57
|
| Rate for Payer: Aetna Medicare |
$22.57
|
| Rate for Payer: Aetna Medicare |
$22.57
|
| Rate for Payer: Aetna Medicare |
$22.57
|
| Rate for Payer: Aetna Medicare |
$22.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.12
|
| Rate for Payer: BCBS Complete |
$12.21
|
| Rate for Payer: BCBS Complete |
$12.21
|
| Rate for Payer: BCBS Complete |
$12.21
|
| Rate for Payer: BCBS Complete |
$12.21
|
| Rate for Payer: BCBS MAPPO |
$21.70
|
| Rate for Payer: BCBS MAPPO |
$21.70
|
| Rate for Payer: BCBS MAPPO |
$21.70
|
| Rate for Payer: BCBS MAPPO |
$21.70
|
| Rate for Payer: BCN Medicare Advantage |
$21.70
|
| Rate for Payer: BCN Medicare Advantage |
$21.70
|
| Rate for Payer: BCN Medicare Advantage |
$21.70
|
| Rate for Payer: BCN Medicare Advantage |
$21.70
|
| Rate for Payer: Cash Price |
$256.54
|
| Rate for Payer: Cash Price |
$408.53
|
| Rate for Payer: Cash Price |
$256.54
|
| Rate for Payer: Cash Price |
$923.17
|
| Rate for Payer: Cash Price |
$904.26
|
| Rate for Payer: Cash Price |
$923.17
|
| Rate for Payer: Cash Price |
$408.53
|
| Rate for Payer: Cash Price |
$904.26
|
| Rate for Payer: Cofinity Commercial |
$992.41
|
| Rate for Payer: Cofinity Commercial |
$791.22
|
| Rate for Payer: Cofinity Commercial |
$972.08
|
| Rate for Payer: Cofinity Commercial |
$807.77
|
| Rate for Payer: Cofinity Commercial |
$439.17
|
| Rate for Payer: Cofinity Commercial |
$357.46
|
| Rate for Payer: Cofinity Commercial |
$224.47
|
| Rate for Payer: Cofinity Commercial |
$275.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$791.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$807.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$904.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$923.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.70
|
| Rate for Payer: Healthscope Commercial |
$1,017.29
|
| Rate for Payer: Healthscope Commercial |
$1,038.56
|
| Rate for Payer: Healthscope Commercial |
$459.59
|
| Rate for Payer: Healthscope Commercial |
$288.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$807.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$791.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$865.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$847.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.50
|
| Rate for Payer: Mclaren Medicaid |
$11.63
|
| Rate for Payer: Mclaren Medicaid |
$11.63
|
| Rate for Payer: Mclaren Medicaid |
$11.63
|
| Rate for Payer: Mclaren Medicaid |
$11.63
|
| Rate for Payer: Mclaren Medicare |
$21.70
|
| Rate for Payer: Mclaren Medicare |
$21.70
|
| Rate for Payer: Mclaren Medicare |
$21.70
|
| Rate for Payer: Mclaren Medicare |
$21.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.79
|
| Rate for Payer: Meridian Medicaid |
$12.21
|
| Rate for Payer: Meridian Medicaid |
$12.21
|
| Rate for Payer: Meridian Medicaid |
$12.21
|
| Rate for Payer: Meridian Medicaid |
$12.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$960.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$980.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.57
|
| Rate for Payer: PACE Medicare |
$20.61
|
| Rate for Payer: PACE Medicare |
$20.61
|
| Rate for Payer: PACE Medicare |
$20.61
|
| Rate for Payer: PACE Medicare |
$20.61
|
| Rate for Payer: PACE SWMI |
$21.70
|
| Rate for Payer: PACE SWMI |
$21.70
|
| Rate for Payer: PACE SWMI |
$21.70
|
| Rate for Payer: PACE SWMI |
$21.70
|
| Rate for Payer: PHP Commercial |
$272.57
|
| Rate for Payer: PHP Commercial |
$960.77
|
| Rate for Payer: PHP Commercial |
$980.87
|
| Rate for Payer: PHP Commercial |
$434.06
|
| Rate for Payer: PHP Medicare Advantage |
$21.70
|
| Rate for Payer: PHP Medicare Advantage |
$21.70
|
| Rate for Payer: PHP Medicare Advantage |
$21.70
|
| Rate for Payer: PHP Medicare Advantage |
$21.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$734.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.07
|
| Rate for Payer: Priority Health Medicare |
$21.70
|
| Rate for Payer: Priority Health Medicare |
$21.70
|
| Rate for Payer: Priority Health Medicare |
$21.70
|
| Rate for Payer: Priority Health Medicare |
$21.70
|
| Rate for Payer: Priority Health SBD |
$726.99
|
| Rate for Payer: Priority Health SBD |
$202.02
|
| Rate for Payer: Priority Health SBD |
$712.10
|
| Rate for Payer: Priority Health SBD |
$321.72
|
| Rate for Payer: Railroad Medicare Medicare |
$21.70
|
| Rate for Payer: Railroad Medicare Medicare |
$21.70
|
| Rate for Payer: Railroad Medicare Medicare |
$21.70
|
| Rate for Payer: Railroad Medicare Medicare |
$21.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.70
|
| Rate for Payer: UHC Exchange |
$41.47
|
| Rate for Payer: UHC Exchange |
$41.47
|
| Rate for Payer: UHC Exchange |
$41.47
|
| Rate for Payer: UHC Exchange |
$41.47
|
| Rate for Payer: UHC Medicare Advantage |
$21.70
|
| Rate for Payer: UHC Medicare Advantage |
$21.70
|
| Rate for Payer: UHC Medicare Advantage |
$21.70
|
| Rate for Payer: UHC Medicare Advantage |
$21.70
|
| Rate for Payer: UHCCP Medicaid |
$11.63
|
| Rate for Payer: UHCCP Medicaid |
$11.63
|
| Rate for Payer: UHCCP Medicaid |
$11.63
|
| Rate for Payer: UHCCP Medicaid |
$11.63
|
| Rate for Payer: UMR Bronson Commercial |
$118.65
|
| Rate for Payer: UMR Bronson Commercial |
$426.97
|
| Rate for Payer: UMR Bronson Commercial |
$418.22
|
| Rate for Payer: UMR Bronson Commercial |
$188.94
|
| Rate for Payer: VA VA |
$21.70
|
| Rate for Payer: VA VA |
$21.70
|
| Rate for Payer: VA VA |
$21.70
|
| Rate for Payer: VA VA |
$21.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$847.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$865.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.00
|
|
|
DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$4,448.08
|
|
|
Service Code
|
CPT 11044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$3,019.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
DEBRIDEMENT (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), OPEN WOUND, (EG, FIBRIN, DEVITALIZED EPIDERMIS AND/OR DERMIS, EXUDATE, DEBRIS, BIOFILM), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, USE OF A WHIRLPOOL, WHEN PERFORMED AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION, TOTAL WOUND(S) SURFACE AREA; FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$545.50
|
|
|
Service Code
|
CPT 97597
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
DEBRIDEMENT (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), OPEN WOUND, (EG, FIBRIN, DEVITALIZED EPIDERMIS AND/OR DERMIS, EXUDATE, DEBRIS, BIOFILM), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, USE OF A WHIRLPOOL, WHEN PERFORMED AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION, TOTAL WOUND(S) SURFACE AREA; FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$545.50
|
|
|
Service Code
|
CPT 97597
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN AND SUBCUTANEOUS TISSUES
|
Facility
|
OP
|
$1,931.58
|
|
|
Service Code
|
CPT 11010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,311.40
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: VA VA |
$686.20
|
|
|
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN AND SUBCUTANEOUS TISSUES
|
Facility
|
OP
|
$1,931.58
|
|
|
Service Code
|
CPT 11010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,311.40
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: VA VA |
$686.20
|
|
|
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN, SUBCUTANEOUS TISSUE, MUSCLE FASCIA, AND MUSCLE
|
Facility
|
OP
|
$1,931.58
|
|
|
Service Code
|
CPT 11011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,311.40
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: VA VA |
$686.20
|
|
|
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN, SUBCUTANEOUS TISSUE, MUSCLE FASCIA, MUSCLE, AND BONE
|
Facility
|
OP
|
$7,857.23
|
|
|
Service Code
|
CPT 11012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$5,334.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN, SUBCUTANEOUS TISSUE, MUSCLE FASCIA, MUSCLE, AND BONE
|
Facility
|
OP
|
$7,857.23
|
|
|
Service Code
|
CPT 11012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$5,334.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
DEBRIDEMENT, MASTOIDECTOMY CAVITY, COMPLEX (EG, WITH ANESTHESIA OR MORE THAN ROUTINE CLEANING)
|
Facility
|
OP
|
$1,398.05
|
|
|
Service Code
|
CPT 69222
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$266.21 |
| Max. Negotiated Rate |
$1,398.05 |
| Rate for Payer: Aetna Medicare |
$516.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$620.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$620.83
|
| Rate for Payer: BCBS Complete |
$279.52
|
| Rate for Payer: BCBS MAPPO |
$496.66
|
| Rate for Payer: BCN Medicare Advantage |
$496.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$496.66
|
| Rate for Payer: Mclaren Medicaid |
$266.21
|
| Rate for Payer: Mclaren Medicare |
$496.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$521.49
|
| Rate for Payer: Meridian Medicaid |
$279.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$571.16
|
| Rate for Payer: PACE Medicare |
$471.83
|
| Rate for Payer: PACE SWMI |
$496.66
|
| Rate for Payer: PHP Medicare Advantage |
$496.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.21
|
| Rate for Payer: Priority Health Medicare |
$496.66
|
| Rate for Payer: Railroad Medicare Medicare |
$496.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,398.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$496.66
|
| Rate for Payer: UHC Exchange |
$949.17
|
| Rate for Payer: UHC Medicare Advantage |
$496.66
|
| Rate for Payer: UHCCP Medicaid |
$266.21
|
| Rate for Payer: VA VA |
$496.66
|
|
|
DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,680.50
|
|
|
Service Code
|
CPT 11043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$319.99 |
| Max. Negotiated Rate |
$1,680.50 |
| Rate for Payer: Aetna Medicare |
$620.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Exchange |
$1,140.93
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$319.99
|
| Rate for Payer: VA VA |
$597.00
|
|
|
DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE
|
Facility
|
OP
|
$1,680.50
|
|
|
Service Code
|
CPT 11000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$319.99 |
| Max. Negotiated Rate |
$1,680.50 |
| Rate for Payer: Aetna Medicare |
$620.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Exchange |
$1,140.93
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$319.99
|
| Rate for Payer: VA VA |
$597.00
|
|
|
DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); 1 TO 5
|
Facility
|
OP
|
$163.07
|
|
|
Service Code
|
CPT 11720
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$163.07 |
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$110.71
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$31.05
|
| Rate for Payer: VA VA |
$57.93
|
|
|
DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,096.83
|
|
|
Service Code
|
CPT 11042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$744.66
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,096.83
|
|
|
Service Code
|
CPT 11042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$744.66
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
DECITABINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$993.92
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
76364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$367.75 |
| Max. Negotiated Rate |
$894.53 |
| Rate for Payer: Aetna American Axle |
$646.05
|
| Rate for Payer: Aetna American Axle |
$326.60
|
| Rate for Payer: Aetna American Axle |
$337.01
|
| Rate for Payer: Aetna American Axle |
$360.27
|
| Rate for Payer: Aetna American Axle |
$278.83
|
| Rate for Payer: Aetna American Axle |
$325.16
|
| Rate for Payer: Aetna American Axle |
$171.29
|
| Rate for Payer: Aetna American Axle |
$562.41
|
| Rate for Payer: Aetna American Axle |
$241.65
|
| Rate for Payer: Aetna American Axle |
$256.51
|
| Rate for Payer: Aetna American Axle |
$559.16
|
| Rate for Payer: Aetna American Axle |
$4,316.46
|
| Rate for Payer: Aetna American Axle |
$301.83
|
| Rate for Payer: Aetna Commercial |
$425.20
|
| Rate for Payer: Aetna Commercial |
$844.83
|
| Rate for Payer: Aetna Commercial |
$440.70
|
| Rate for Payer: Aetna Commercial |
$224.00
|
| Rate for Payer: Aetna Commercial |
$427.09
|
| Rate for Payer: Aetna Commercial |
$316.00
|
| Rate for Payer: Aetna Commercial |
$735.46
|
| Rate for Payer: Aetna Commercial |
$471.12
|
| Rate for Payer: Aetna Commercial |
$364.62
|
| Rate for Payer: Aetna Commercial |
$394.70
|
| Rate for Payer: Aetna Commercial |
$5,644.60
|
| Rate for Payer: Aetna Commercial |
$335.44
|
| Rate for Payer: Aetna Commercial |
$731.21
|
| Rate for Payer: Aetna Medicare |
$131.76
|
| Rate for Payer: Aetna Medicare |
$251.23
|
| Rate for Payer: Aetna Medicare |
$185.88
|
| Rate for Payer: Aetna Medicare |
$197.31
|
| Rate for Payer: Aetna Medicare |
$3,320.36
|
| Rate for Payer: Aetna Medicare |
$496.96
|
| Rate for Payer: Aetna Medicare |
$214.49
|
| Rate for Payer: Aetna Medicare |
$250.12
|
| Rate for Payer: Aetna Medicare |
$259.24
|
| Rate for Payer: Aetna Medicare |
$432.62
|
| Rate for Payer: Aetna Medicare |
$277.13
|
| Rate for Payer: Aetna Medicare |
$430.12
|
| Rate for Payer: Aetna Medicare |
$232.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,316.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.01
|
| Rate for Payer: BCBS Complete |
$185.74
|
| Rate for Payer: BCBS Complete |
$2,656.28
|
| Rate for Payer: BCBS Complete |
$397.57
|
| Rate for Payer: BCBS Complete |
$207.39
|
| Rate for Payer: BCBS Complete |
$200.98
|
| Rate for Payer: BCBS Complete |
$171.59
|
| Rate for Payer: BCBS Complete |
$200.10
|
| Rate for Payer: BCBS Complete |
$346.10
|
| Rate for Payer: BCBS Complete |
$344.10
|
| Rate for Payer: BCBS Complete |
$105.41
|
| Rate for Payer: BCBS Complete |
$157.85
|
| Rate for Payer: BCBS Complete |
$148.71
|
| Rate for Payer: BCBS Complete |
$221.70
|
| Rate for Payer: Cash Price |
$414.78
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cash Price |
$5,312.57
|
| Rate for Payer: Cash Price |
$371.48
|
| Rate for Payer: Cash Price |
$443.41
|
| Rate for Payer: Cash Price |
$343.18
|
| Rate for Payer: Cash Price |
$297.42
|
| Rate for Payer: Cash Price |
$210.82
|
| Rate for Payer: Cash Price |
$315.70
|
| Rate for Payer: Cash Price |
$401.97
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cash Price |
$795.14
|
| Rate for Payer: Cash Price |
$692.20
|
| Rate for Payer: Cofinity Commercial |
$368.91
|
| Rate for Payer: Cofinity Commercial |
$432.12
|
| Rate for Payer: Cofinity Commercial |
$605.67
|
| Rate for Payer: Cofinity Commercial |
$350.17
|
| Rate for Payer: Cofinity Commercial |
$430.21
|
| Rate for Payer: Cofinity Commercial |
$739.82
|
| Rate for Payer: Cofinity Commercial |
$5,711.01
|
| Rate for Payer: Cofinity Commercial |
$4,648.50
|
| Rate for Payer: Cofinity Commercial |
$445.88
|
| Rate for Payer: Cofinity Commercial |
$260.24
|
| Rate for Payer: Cofinity Commercial |
$226.64
|
| Rate for Payer: Cofinity Commercial |
$300.28
|
| Rate for Payer: Cofinity Commercial |
$276.24
|
| Rate for Payer: Cofinity Commercial |
$339.38
|
| Rate for Payer: Cofinity Commercial |
$184.47
|
| Rate for Payer: Cofinity Commercial |
$362.93
|
| Rate for Payer: Cofinity Commercial |
$325.05
|
| Rate for Payer: Cofinity Commercial |
$399.34
|
| Rate for Payer: Cofinity Commercial |
$319.72
|
| Rate for Payer: Cofinity Commercial |
$476.66
|
| Rate for Payer: Cofinity Commercial |
$387.98
|
| Rate for Payer: Cofinity Commercial |
$351.72
|
| Rate for Payer: Cofinity Commercial |
$854.77
|
| Rate for Payer: Cofinity Commercial |
$695.74
|
| Rate for Payer: Cofinity Commercial |
$744.12
|
| Rate for Payer: Cofinity Commercial |
$602.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$351.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$362.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$605.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$325.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$387.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$276.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,648.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$602.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$350.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$695.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,312.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$692.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.14
|
| Rate for Payer: Healthscope Commercial |
$466.62
|
| Rate for Payer: Healthscope Commercial |
$452.21
|
| Rate for Payer: Healthscope Commercial |
$355.17
|
| Rate for Payer: Healthscope Commercial |
$778.73
|
| Rate for Payer: Healthscope Commercial |
$894.53
|
| Rate for Payer: Healthscope Commercial |
$774.23
|
| Rate for Payer: Healthscope Commercial |
$386.07
|
| Rate for Payer: Healthscope Commercial |
$498.83
|
| Rate for Payer: Healthscope Commercial |
$417.92
|
| Rate for Payer: Healthscope Commercial |
$334.59
|
| Rate for Payer: Healthscope Commercial |
$5,976.64
|
| Rate for Payer: Healthscope Commercial |
$450.22
|
| Rate for Payer: Healthscope Commercial |
$237.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$605.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$350.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$362.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$695.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,648.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$602.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$387.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$351.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$415.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$745.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,980.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$388.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$376.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$731.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$844.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,644.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.44
|
| Rate for Payer: PHP Commercial |
$394.70
|
| Rate for Payer: PHP Commercial |
$440.70
|
| Rate for Payer: PHP Commercial |
$224.00
|
| Rate for Payer: PHP Commercial |
$5,644.60
|
| Rate for Payer: PHP Commercial |
$425.20
|
| Rate for Payer: PHP Commercial |
$735.46
|
| Rate for Payer: PHP Commercial |
$316.00
|
| Rate for Payer: PHP Commercial |
$731.21
|
| Rate for Payer: PHP Commercial |
$335.44
|
| Rate for Payer: PHP Commercial |
$364.62
|
| Rate for Payer: PHP Commercial |
$471.12
|
| Rate for Payer: PHP Commercial |
$427.09
|
| Rate for Payer: PHP Commercial |
$844.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,316.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$559.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.41
|
| Rate for Payer: Priority Health SBD |
$292.54
|
| Rate for Payer: Priority Health SBD |
$166.02
|
| Rate for Payer: Priority Health SBD |
$234.22
|
| Rate for Payer: Priority Health SBD |
$326.64
|
| Rate for Payer: Priority Health SBD |
$315.15
|
| Rate for Payer: Priority Health SBD |
$626.17
|
| Rate for Payer: Priority Health SBD |
$248.62
|
| Rate for Payer: Priority Health SBD |
$541.96
|
| Rate for Payer: Priority Health SBD |
$4,183.65
|
| Rate for Payer: Priority Health SBD |
$316.55
|
| Rate for Payer: Priority Health SBD |
$545.11
|
| Rate for Payer: Priority Health SBD |
$270.25
|
| Rate for Payer: Priority Health SBD |
$349.18
|
| Rate for Payer: UMR Bronson Commercial |
$146.01
|
| Rate for Payer: UMR Bronson Commercial |
$171.81
|
| Rate for Payer: UMR Bronson Commercial |
$367.75
|
| Rate for Payer: UMR Bronson Commercial |
$2,457.06
|
| Rate for Payer: UMR Bronson Commercial |
$158.72
|
| Rate for Payer: UMR Bronson Commercial |
$191.83
|
| Rate for Payer: UMR Bronson Commercial |
$137.55
|
| Rate for Payer: UMR Bronson Commercial |
$185.91
|
| Rate for Payer: UMR Bronson Commercial |
$320.14
|
| Rate for Payer: UMR Bronson Commercial |
$97.51
|
| Rate for Payer: UMR Bronson Commercial |
$185.09
|
| Rate for Payer: UMR Bronson Commercial |
$205.08
|
| Rate for Payer: UMR Bronson Commercial |
$318.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$376.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,980.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$415.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$745.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.85
|
|
|
DECITABINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$901.88
|
|
|
Service Code
|
HCPCS J0893
|
| Hospital Charge Code |
76364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$333.70 |
| Max. Negotiated Rate |
$811.69 |
| Rate for Payer: Aetna American Axle |
$586.22
|
| Rate for Payer: Aetna Commercial |
$766.60
|
| Rate for Payer: Aetna Medicare |
$450.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.22
|
| Rate for Payer: BCBS Complete |
$360.75
|
| Rate for Payer: Cash Price |
$721.50
|
| Rate for Payer: Cofinity Commercial |
$631.32
|
| Rate for Payer: Cofinity Commercial |
$775.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$631.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.50
|
| Rate for Payer: Healthscope Commercial |
$811.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$631.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$676.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$766.60
|
| Rate for Payer: PHP Commercial |
$766.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.22
|
| Rate for Payer: Priority Health SBD |
$568.18
|
| Rate for Payer: UMR Bronson Commercial |
$333.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$676.41
|
|
|
DECITABINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$865.25
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
76364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$380.71 |
| Max. Negotiated Rate |
$778.73 |
| Rate for Payer: Aetna American Axle |
$562.41
|
| Rate for Payer: Aetna American Axle |
$171.29
|
| Rate for Payer: Aetna American Axle |
$241.65
|
| Rate for Payer: Aetna American Axle |
$256.51
|
| Rate for Payer: Aetna American Axle |
$301.83
|
| Rate for Payer: Aetna American Axle |
$325.16
|
| Rate for Payer: Aetna American Axle |
$337.01
|
| Rate for Payer: Aetna American Axle |
$278.83
|
| Rate for Payer: Aetna American Axle |
$360.27
|
| Rate for Payer: Aetna American Axle |
$4,316.46
|
| Rate for Payer: Aetna Commercial |
$471.12
|
| Rate for Payer: Aetna Commercial |
$316.00
|
| Rate for Payer: Aetna Commercial |
$364.62
|
| Rate for Payer: Aetna Commercial |
$735.46
|
| Rate for Payer: Aetna Commercial |
$224.00
|
| Rate for Payer: Aetna Commercial |
$335.44
|
| Rate for Payer: Aetna Commercial |
$394.70
|
| Rate for Payer: Aetna Commercial |
$440.70
|
| Rate for Payer: Aetna Commercial |
$5,644.60
|
| Rate for Payer: Aetna Commercial |
$425.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,316.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.16
|
| Rate for Payer: Cash Price |
$297.42
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cash Price |
$692.20
|
| Rate for Payer: Cash Price |
$371.48
|
| Rate for Payer: Cash Price |
$443.41
|
| Rate for Payer: Cash Price |
$5,312.57
|
| Rate for Payer: Cash Price |
$414.78
|
| Rate for Payer: Cash Price |
$315.70
|
| Rate for Payer: Cash Price |
$343.18
|
| Rate for Payer: Cash Price |
$210.82
|
| Rate for Payer: Cofinity Commercial |
$387.98
|
| Rate for Payer: Cofinity Commercial |
$339.38
|
| Rate for Payer: Cofinity Commercial |
$399.34
|
| Rate for Payer: Cofinity Commercial |
$276.24
|
| Rate for Payer: Cofinity Commercial |
$319.72
|
| Rate for Payer: Cofinity Commercial |
$300.28
|
| Rate for Payer: Cofinity Commercial |
$445.88
|
| Rate for Payer: Cofinity Commercial |
$362.93
|
| Rate for Payer: Cofinity Commercial |
$368.91
|
| Rate for Payer: Cofinity Commercial |
$5,711.01
|
| Rate for Payer: Cofinity Commercial |
$260.24
|
| Rate for Payer: Cofinity Commercial |
$430.21
|
| Rate for Payer: Cofinity Commercial |
$350.17
|
| Rate for Payer: Cofinity Commercial |
$184.47
|
| Rate for Payer: Cofinity Commercial |
$4,648.50
|
| Rate for Payer: Cofinity Commercial |
$744.12
|
| Rate for Payer: Cofinity Commercial |
$605.67
|
| Rate for Payer: Cofinity Commercial |
$226.64
|
| Rate for Payer: Cofinity Commercial |
$325.05
|
| Rate for Payer: Cofinity Commercial |
$476.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,648.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$387.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$362.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$325.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$350.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$605.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$276.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,312.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$692.20
|
| Rate for Payer: Healthscope Commercial |
$466.62
|
| Rate for Payer: Healthscope Commercial |
$417.92
|
| Rate for Payer: Healthscope Commercial |
$778.73
|
| Rate for Payer: Healthscope Commercial |
$237.18
|
| Rate for Payer: Healthscope Commercial |
$355.17
|
| Rate for Payer: Healthscope Commercial |
$334.59
|
| Rate for Payer: Healthscope Commercial |
$450.22
|
| Rate for Payer: Healthscope Commercial |
$386.07
|
| Rate for Payer: Healthscope Commercial |
$5,976.64
|
| Rate for Payer: Healthscope Commercial |
$498.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$350.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$362.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$605.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,648.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$387.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$388.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,980.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$415.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,644.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.46
|
| Rate for Payer: PHP Commercial |
$5,644.60
|
| Rate for Payer: PHP Commercial |
$471.12
|
| Rate for Payer: PHP Commercial |
$394.70
|
| Rate for Payer: PHP Commercial |
$316.00
|
| Rate for Payer: PHP Commercial |
$440.70
|
| Rate for Payer: PHP Commercial |
$364.62
|
| Rate for Payer: PHP Commercial |
$425.20
|
| Rate for Payer: PHP Commercial |
$735.46
|
| Rate for Payer: PHP Commercial |
$224.00
|
| Rate for Payer: PHP Commercial |
$335.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,316.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.83
|
| Rate for Payer: Priority Health SBD |
$292.54
|
| Rate for Payer: Priority Health SBD |
$270.25
|
| Rate for Payer: Priority Health SBD |
$248.62
|
| Rate for Payer: Priority Health SBD |
$545.11
|
| Rate for Payer: Priority Health SBD |
$4,183.65
|
| Rate for Payer: Priority Health SBD |
$234.22
|
| Rate for Payer: Priority Health SBD |
$349.18
|
| Rate for Payer: Priority Health SBD |
$326.64
|
| Rate for Payer: Priority Health SBD |
$315.15
|
| Rate for Payer: Priority Health SBD |
$166.02
|
| Rate for Payer: UMR Bronson Commercial |
$204.31
|
| Rate for Payer: UMR Bronson Commercial |
$163.58
|
| Rate for Payer: UMR Bronson Commercial |
$243.87
|
| Rate for Payer: UMR Bronson Commercial |
$115.95
|
| Rate for Payer: UMR Bronson Commercial |
$380.71
|
| Rate for Payer: UMR Bronson Commercial |
$173.64
|
| Rate for Payer: UMR Bronson Commercial |
$2,921.91
|
| Rate for Payer: UMR Bronson Commercial |
$220.11
|
| Rate for Payer: UMR Bronson Commercial |
$188.75
|
| Rate for Payer: UMR Bronson Commercial |
$228.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$415.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,980.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.18
|
|
|
DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL COMPARTMENTS ONLY
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 27600
|
|
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
|
|
|
DEFERASIROX 250 MG DISPERSIBLE TABLET
|
Facility
|
OP
|
$1,307.81
|
|
|
Service Code
|
NDC 43598085630
|
| Hospital Charge Code |
43416
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$483.89 |
| Max. Negotiated Rate |
$1,177.03 |
| Rate for Payer: Aetna American Axle |
$850.08
|
| Rate for Payer: Aetna Commercial |
$1,111.64
|
| Rate for Payer: Aetna Medicare |
$653.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$850.08
|
| Rate for Payer: BCBS Complete |
$523.12
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cofinity Commercial |
$1,124.72
|
| Rate for Payer: Cofinity Commercial |
$915.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$915.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.25
|
| Rate for Payer: Healthscope Commercial |
$1,177.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$915.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.64
|
| Rate for Payer: PHP Commercial |
$1,111.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.08
|
| Rate for Payer: Priority Health SBD |
$823.92
|
| Rate for Payer: UMR Bronson Commercial |
$483.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.86
|
|
|
DEFERASIROX 250 MG DISPERSIBLE TABLET
|
Facility
|
IP
|
$1,307.81
|
|
|
Service Code
|
NDC 43598085630
|
| Hospital Charge Code |
43416
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$575.44 |
| Max. Negotiated Rate |
$1,177.03 |
| Rate for Payer: Aetna American Axle |
$850.08
|
| Rate for Payer: Aetna Commercial |
$1,111.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$850.08
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cofinity Commercial |
$1,124.72
|
| Rate for Payer: Cofinity Commercial |
$915.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$915.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.25
|
| Rate for Payer: Healthscope Commercial |
$1,177.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$915.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.64
|
| Rate for Payer: PHP Commercial |
$1,111.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.08
|
| Rate for Payer: Priority Health SBD |
$823.92
|
| Rate for Payer: UMR Bronson Commercial |
$575.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.86
|
|
