|
ARMODAFINIL 150 MG TABLET
|
Facility
|
IP
|
$3,763.13
|
|
|
Service Code
|
NDC 63459-215-30
|
| Hospital Charge Code |
96966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,655.78 |
| Max. Negotiated Rate |
$3,386.82 |
| Rate for Payer: Aetna American Axle |
$2,446.03
|
| Rate for Payer: Aetna Commercial |
$3,198.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,446.03
|
| Rate for Payer: Cash Price |
$3,010.50
|
| Rate for Payer: Cofinity Commercial |
$2,634.19
|
| Rate for Payer: Cofinity Commercial |
$3,236.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,010.50
|
| Rate for Payer: Healthscope Commercial |
$3,386.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,634.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,822.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,198.66
|
| Rate for Payer: PHP Commercial |
$3,198.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,634.19
|
| Rate for Payer: Priority Health SBD |
$2,370.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,655.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,822.35
|
|
|
ARMODAFINIL 50 MG TABLET
|
Facility
|
IP
|
$76.67
|
|
|
Service Code
|
NDC 69339-177-03
|
| Hospital Charge Code |
96965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna American Axle |
$49.84
|
| Rate for Payer: Aetna Commercial |
$65.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.84
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cofinity Commercial |
$53.67
|
| Rate for Payer: Cofinity Commercial |
$65.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.34
|
| Rate for Payer: Healthscope Commercial |
$69.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.17
|
| Rate for Payer: PHP Commercial |
$65.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.67
|
| Rate for Payer: Priority Health SBD |
$48.30
|
| Rate for Payer: UMR Bronson Commercial |
$33.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.50
|
|
|
ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYSIODESIS); COMBINED DISTAL FEMUR, PROXIMAL TIBIA AND FIBULA
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 27479
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$910.62 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,402.41
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,001.68
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$910.62
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYSIODESIS); DISTAL FEMUR
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 27475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$662.09 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,319.56
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$728.30
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$662.09
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYSIODESIS); TIBIA AND FIBULA, PROXIMAL
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 27477
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$730.52 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,171.38
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$803.57
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$730.52
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
ARREST, EPIPHYSEAL (EPIPHYSIODESIS), OPEN; DISTAL FIBULA
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 27732
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.45 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$502.10
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$456.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
ARREST, EPIPHYSEAL (EPIPHYSIODESIS), OPEN; DISTAL TIBIA AND FIBULA
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 27734
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$656.85 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$722.54
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$656.85
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
ARREST, HEMIEPIPHYSEAL, DISTAL FEMUR OR PROXIMAL TIBIA OR FIBULA (EG, GENU VARUS OR VALGUS)
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 27485
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$669.95 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,171.38
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$736.94
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$669.95
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$179.60
|
|
|
Service Code
|
HCPCS J9017
|
| Hospital Charge Code |
29071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$161.64 |
| Rate for Payer: Aetna American Axle |
$116.74
|
| Rate for Payer: Aetna American Axle |
$81.78
|
| Rate for Payer: Aetna American Axle |
$115.68
|
| Rate for Payer: Aetna Commercial |
$151.27
|
| Rate for Payer: Aetna Commercial |
$152.66
|
| Rate for Payer: Aetna Commercial |
$106.94
|
| Rate for Payer: Aetna Medicare |
$16.41
|
| Rate for Payer: Aetna Medicare |
$16.41
|
| Rate for Payer: Aetna Medicare |
$16.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.73
|
| Rate for Payer: BCBS Complete |
$9.07
|
| Rate for Payer: BCBS Complete |
$9.07
|
| Rate for Payer: BCBS Complete |
$9.07
|
| Rate for Payer: BCBS MAPPO |
$15.78
|
| Rate for Payer: BCBS MAPPO |
$15.78
|
| Rate for Payer: BCBS MAPPO |
$15.78
|
| Rate for Payer: BCBS Trust/PPO |
$51.00
|
| Rate for Payer: BCBS Trust/PPO |
$51.00
|
| Rate for Payer: BCBS Trust/PPO |
$51.00
|
| Rate for Payer: BCN Medicare Advantage |
$15.78
|
| Rate for Payer: BCN Medicare Advantage |
$15.78
|
| Rate for Payer: BCN Medicare Advantage |
$15.78
|
| Rate for Payer: Cash Price |
$142.38
|
| Rate for Payer: Cash Price |
$142.38
|
| Rate for Payer: Cash Price |
$143.68
|
| Rate for Payer: Cash Price |
$143.68
|
| Rate for Payer: Cash Price |
$100.65
|
| Rate for Payer: Cash Price |
$100.65
|
| Rate for Payer: Cofinity Commercial |
$154.46
|
| Rate for Payer: Cofinity Commercial |
$108.20
|
| Rate for Payer: Cofinity Commercial |
$88.07
|
| Rate for Payer: Cofinity Commercial |
$124.58
|
| Rate for Payer: Cofinity Commercial |
$153.05
|
| Rate for Payer: Cofinity Commercial |
$125.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$113.23
|
| Rate for Payer: Healthscope Commercial |
$160.17
|
| Rate for Payer: Healthscope Commercial |
$161.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.48
|
| Rate for Payer: Mclaren Medicaid |
$8.63
|
| Rate for Payer: Mclaren Medicaid |
$8.63
|
| Rate for Payer: Mclaren Medicaid |
$8.63
|
| Rate for Payer: Mclaren Medicare |
$15.78
|
| Rate for Payer: Mclaren Medicare |
$15.78
|
| Rate for Payer: Mclaren Medicare |
$15.78
|
| Rate for Payer: Meridian Medicaid |
$9.07
|
| Rate for Payer: Meridian Medicaid |
$9.07
|
| Rate for Payer: Meridian Medicaid |
$9.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$152.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.94
|
| Rate for Payer: PACE Medicare |
$14.99
|
| Rate for Payer: PACE Medicare |
$14.99
|
| Rate for Payer: PACE Medicare |
$14.99
|
| Rate for Payer: PACE SWMI |
$15.78
|
| Rate for Payer: PACE SWMI |
$15.78
|
| Rate for Payer: PACE SWMI |
$15.78
|
| Rate for Payer: PHP Commercial |
$152.66
|
| Rate for Payer: PHP Commercial |
$106.94
|
| Rate for Payer: PHP Commercial |
$151.27
|
| Rate for Payer: PHP Medicare Advantage |
$15.78
|
| Rate for Payer: PHP Medicare Advantage |
$15.78
|
| Rate for Payer: PHP Medicare Advantage |
$15.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.33
|
| Rate for Payer: Priority Health Medicare |
$15.78
|
| Rate for Payer: Priority Health Medicare |
$15.78
|
| Rate for Payer: Priority Health Medicare |
$15.78
|
| Rate for Payer: Priority Health Narrow Network |
$43.46
|
| Rate for Payer: Priority Health Narrow Network |
$43.46
|
| Rate for Payer: Priority Health Narrow Network |
$43.46
|
| Rate for Payer: Priority Health SBD |
$112.12
|
| Rate for Payer: Priority Health SBD |
$113.15
|
| Rate for Payer: Priority Health SBD |
$79.26
|
| Rate for Payer: Railroad Medicare Medicare |
$15.78
|
| Rate for Payer: Railroad Medicare Medicare |
$15.78
|
| Rate for Payer: Railroad Medicare Medicare |
$15.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.78
|
| Rate for Payer: UHC Medicare Advantage |
$16.26
|
| Rate for Payer: UHC Medicare Advantage |
$16.26
|
| Rate for Payer: UHC Medicare Advantage |
$16.26
|
| Rate for Payer: UMR Bronson Commercial |
$66.45
|
| Rate for Payer: UMR Bronson Commercial |
$65.85
|
| Rate for Payer: UMR Bronson Commercial |
$46.55
|
| Rate for Payer: VA VA |
$15.78
|
| Rate for Payer: VA VA |
$15.78
|
| Rate for Payer: VA VA |
$15.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.70
|
|
|
ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$179.60
|
|
|
Service Code
|
HCPCS J9017
|
| Hospital Charge Code |
29071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.02 |
| Max. Negotiated Rate |
$161.64 |
| Rate for Payer: Aetna American Axle |
$116.74
|
| Rate for Payer: Aetna Commercial |
$152.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.74
|
| Rate for Payer: Cash Price |
$143.68
|
| Rate for Payer: Cofinity Commercial |
$125.72
|
| Rate for Payer: Cofinity Commercial |
$154.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.68
|
| Rate for Payer: Healthscope Commercial |
$161.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$152.66
|
| Rate for Payer: PHP Commercial |
$152.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.72
|
| Rate for Payer: Priority Health SBD |
$113.15
|
| Rate for Payer: UMR Bronson Commercial |
$79.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.70
|
|
|
ARTEMETHER-LUMEFANTRINE 20 MG-120 MG TABLET
|
Facility
|
IP
|
$463.81
|
|
|
Service Code
|
NDC 0078-0568-45
|
| Hospital Charge Code |
96948
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.08 |
| Max. Negotiated Rate |
$417.43 |
| Rate for Payer: Aetna American Axle |
$301.48
|
| Rate for Payer: Aetna Commercial |
$394.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.48
|
| Rate for Payer: Cash Price |
$371.05
|
| Rate for Payer: Cofinity Commercial |
$324.67
|
| Rate for Payer: Cofinity Commercial |
$398.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.05
|
| Rate for Payer: Healthscope Commercial |
$417.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$394.24
|
| Rate for Payer: PHP Commercial |
$394.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.67
|
| Rate for Payer: Priority Health SBD |
$292.20
|
| Rate for Payer: UMR Bronson Commercial |
$204.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.86
|
|
|
ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION (SEPARATE PROCEDURE); PERCUTANEOUS
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 36620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$42.57 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$515.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.83
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$42.57
|
|
|
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM BASILIC VEIN TRANSPOSITION
|
Facility
|
OP
|
$15,377.24
|
|
|
Service Code
|
CPT 36819
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$702.36 |
| Max. Negotiated Rate |
$15,377.24 |
| Rate for Payer: Aetna Medicare |
$5,080.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,105.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,105.86
|
| Rate for Payer: BCBS Complete |
$2,805.77
|
| Rate for Payer: BCBS MAPPO |
$4,884.69
|
| Rate for Payer: BCBS Trust/PPO |
$5,492.09
|
| Rate for Payer: BCN Medicare Advantage |
$4,884.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,884.69
|
| Rate for Payer: Mclaren Medicaid |
$2,671.93
|
| Rate for Payer: Mclaren Medicare |
$4,884.69
|
| Rate for Payer: Meridian Medicaid |
$2,805.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,128.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,617.39
|
| Rate for Payer: PACE Medicare |
$4,640.46
|
| Rate for Payer: PACE SWMI |
$4,884.69
|
| Rate for Payer: PHP Medicare Advantage |
$4,884.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,671.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,377.24
|
| Rate for Payer: Priority Health Medicare |
$4,884.69
|
| Rate for Payer: Priority Health Narrow Network |
$12,301.79
|
| Rate for Payer: Railroad Medicare Medicare |
$4,884.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$772.60
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,884.69
|
| Rate for Payer: UHC Exchange |
$702.36
|
| Rate for Payer: UHC Medicare Advantage |
$5,031.23
|
| Rate for Payer: VA VA |
$4,884.69
|
|
|
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM CEPHALIC VEIN TRANSPOSITION
|
Facility
|
OP
|
$15,377.24
|
|
|
Service Code
|
CPT 36818
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$663.40 |
| Max. Negotiated Rate |
$15,377.24 |
| Rate for Payer: Aetna Medicare |
$5,080.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,105.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,105.86
|
| Rate for Payer: BCBS Complete |
$2,805.77
|
| Rate for Payer: BCBS MAPPO |
$4,884.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,149.17
|
| Rate for Payer: BCN Medicare Advantage |
$4,884.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,884.69
|
| Rate for Payer: Mclaren Medicaid |
$2,671.93
|
| Rate for Payer: Mclaren Medicare |
$4,884.69
|
| Rate for Payer: Meridian Medicaid |
$2,805.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,128.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,617.39
|
| Rate for Payer: PACE Medicare |
$4,640.46
|
| Rate for Payer: PACE SWMI |
$4,884.69
|
| Rate for Payer: PHP Medicare Advantage |
$4,884.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,671.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,377.24
|
| Rate for Payer: Priority Health Medicare |
$4,884.69
|
| Rate for Payer: Priority Health Narrow Network |
$12,301.79
|
| Rate for Payer: Railroad Medicare Medicare |
$4,884.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.74
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,884.69
|
| Rate for Payer: UHC Exchange |
$663.40
|
| Rate for Payer: UHC Medicare Advantage |
$5,031.23
|
| Rate for Payer: VA VA |
$4,884.69
|
|
|
ARTERIOVENOUS ANASTOMOSIS, OPEN; DIRECT, ANY SITE (EG, CIMINO TYPE) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$8,919.33
|
|
|
Service Code
|
CPT 36821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$634.91 |
| Max. Negotiated Rate |
$8,919.33 |
| Rate for Payer: Aetna Medicare |
$2,946.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$4,286.48
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,919.33
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$7,135.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.40
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,833.29
|
| Rate for Payer: UHC Exchange |
$634.91
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JOINT OR BURSA (EG, TEMPOROMANDIBULAR, ACROMIOCLAVICULAR, WRIST, ELBOW OR ANKLE, OLECRANON BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$828.79
|
|
|
Service Code
|
CPT 20605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$828.79 |
| Rate for Payer: Aetna Medicare |
$273.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$290.76
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.79
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$663.03
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.62
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.27
|
| Rate for Payer: UHC Exchange |
$36.02
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JOINT OR BURSA (EG, TEMPOROMANDIBULAR, ACROMIOCLAVICULAR, WRIST, ELBOW OR ANKLE, OLECRANON BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$828.79
|
|
|
Service Code
|
CPT 20605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$828.79 |
| Rate for Payer: Aetna Medicare |
$273.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$290.76
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.79
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$663.03
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.62
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.27
|
| Rate for Payer: UHC Exchange |
$36.02
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$828.79
|
|
|
Service Code
|
CPT 20610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$828.79 |
| Rate for Payer: Aetna Medicare |
$273.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$290.76
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.79
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$663.03
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.98
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.27
|
| Rate for Payer: UHC Exchange |
$44.53
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$828.79
|
|
|
Service Code
|
CPT 20610
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$828.79 |
| Rate for Payer: Aetna Medicare |
$273.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$290.76
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.79
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$663.03
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.98
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.27
|
| Rate for Payer: UHC Exchange |
$44.53
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA (EG, FINGERS, TOES); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$828.79
|
|
|
Service Code
|
CPT 20600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$828.79 |
| Rate for Payer: Aetna Medicare |
$273.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$290.76
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.79
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$663.03
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.54
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.27
|
| Rate for Payer: UHC Exchange |
$35.04
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA (EG, FINGERS, TOES); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$828.79
|
|
|
Service Code
|
CPT 20600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$828.79 |
| Rate for Payer: Aetna Medicare |
$273.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$290.76
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.79
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$663.03
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.54
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.27
|
| Rate for Payer: UHC Exchange |
$35.04
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
ARTHRODESIS, ANKLE, OPEN
|
Facility
|
OP
|
$36,827.89
|
|
|
Service Code
|
CPT 27870
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$36,827.89 |
| Rate for Payer: Aetna Medicare |
$12,166.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,623.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,623.31
|
| Rate for Payer: BCBS Complete |
$6,719.70
|
| Rate for Payer: BCBS MAPPO |
$11,698.65
|
| Rate for Payer: BCBS Trust/PPO |
$8,199.18
|
| Rate for Payer: BCN Medicare Advantage |
$11,698.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,698.65
|
| Rate for Payer: Mclaren Medicaid |
$6,399.16
|
| Rate for Payer: Mclaren Medicare |
$11,698.65
|
| Rate for Payer: Meridian Medicaid |
$6,719.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,283.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,453.45
|
| Rate for Payer: PACE Medicare |
$11,113.72
|
| Rate for Payer: PACE SWMI |
$11,698.65
|
| Rate for Payer: PHP Medicare Advantage |
$11,698.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,399.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,827.89
|
| Rate for Payer: Priority Health Medicare |
$11,698.65
|
| Rate for Payer: Priority Health Narrow Network |
$29,462.31
|
| Rate for Payer: Railroad Medicare Medicare |
$11,698.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.05
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,698.65
|
| Rate for Payer: UHC Exchange |
$996.41
|
| Rate for Payer: UHC Medicare Advantage |
$12,049.61
|
| Rate for Payer: VA VA |
$11,698.65
|
|
|
ARTHRODESIS, ANTERIOR INTERBODY, INCLUDING DISC SPACE PREPARATION, DISCECTOMY, OSTEOPHYTECTOMY AND DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOTS; CERVICAL BELOW C2
|
Facility
|
OP
|
$36,827.89
|
|
|
Service Code
|
CPT 22551
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.33 |
| Max. Negotiated Rate |
$36,827.89 |
| Rate for Payer: Aetna Medicare |
$12,166.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,623.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,623.31
|
| Rate for Payer: BCBS Complete |
$6,719.70
|
| Rate for Payer: BCBS MAPPO |
$11,698.65
|
| Rate for Payer: BCBS Trust/PPO |
$28,097.16
|
| Rate for Payer: BCN Medicare Advantage |
$11,698.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,698.65
|
| Rate for Payer: Mclaren Medicaid |
$6,399.16
|
| Rate for Payer: Mclaren Medicare |
$11,698.65
|
| Rate for Payer: Meridian Medicaid |
$6,719.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,283.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,453.45
|
| Rate for Payer: PACE Medicare |
$11,113.72
|
| Rate for Payer: PACE SWMI |
$11,698.65
|
| Rate for Payer: PHP Medicare Advantage |
$11,698.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,399.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,827.89
|
| Rate for Payer: Priority Health Medicare |
$11,698.65
|
| Rate for Payer: Priority Health Narrow Network |
$29,462.31
|
| Rate for Payer: Railroad Medicare Medicare |
$11,698.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,854.96
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,698.65
|
| Rate for Payer: UHC Exchange |
$1,686.33
|
| Rate for Payer: UHC Medicare Advantage |
$12,049.61
|
| Rate for Payer: VA VA |
$11,698.65
|
|
|
ARTHRODESIS, ANTERIOR INTERBODY, INCLUDING DISC SPACE PREPARATION, DISCECTOMY, OSTEOPHYTECTOMY AND DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOTS; CERVICAL BELOW C2, EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$32,738.53
|
|
|
Service Code
|
CPT 22552
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$388.02 |
| Max. Negotiated Rate |
$32,738.53 |
| Rate for Payer: BCBS Trust/PPO |
$32,738.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.82
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Exchange |
$388.02
|
|
|
ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); LUMBAR
|
Facility
|
OP
|
$23,807.51
|
|
|
Service Code
|
CPT 22558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,507.87 |
| Max. Negotiated Rate |
$23,807.51 |
| Rate for Payer: BCBS Trust/PPO |
$23,807.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,658.66
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Exchange |
$1,507.87
|
|
