|
ELECTROLYTE-A INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 00338022104
|
| Hospital Charge Code |
28113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$21.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
ELECTROLYTE-A IV - BOLUS
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 00338022104
|
| Hospital Charge Code |
168933
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$21.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
ELECTROLYTE-A IV - BOLUS
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
NDC 00338022104
|
| Hospital Charge Code |
168933
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna Medicare |
$23.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$17.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
ELECTROLYTE-A IV - DKA
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
NDC 00338022104
|
| Hospital Charge Code |
168932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna Medicare |
$23.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$17.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
ELECTROLYTE-A IV - DKA
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 00338022104
|
| Hospital Charge Code |
168932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$21.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR/TRANSMITTER (EG, CONTACT GROUP[S], INTERLEAVING, AMPLITUDE, PULSE WIDTH, FREQUENCY [HZ], ON/OFF CYCLING, BURST, MAGNET MODE, DOSE LOCKOUT, PATIENT SELECTABLE PARAMETERS, RESPONSIVE NEUROSTIMULATION, DETECTION ALGORITHMS, CLOSED LOOP PARAMETERS, AND PASSIVE PARAMETERS) BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL; WITH COMPLEX SPINAL CORD OR PERIPHERAL NERVE (EG, SACRAL NERVE) NEUROSTIMULATOR PULSE GENERATOR/TRANSMITTER PROGRAMMING BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL
|
Facility
|
OP
|
$282.66
|
|
|
Service Code
|
CPT 95972
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$38.52 |
| Max. Negotiated Rate |
$282.66 |
| Rate for Payer: Aetna Medicare |
$93.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.41
|
| Rate for Payer: BCBS Complete |
$50.61
|
| Rate for Payer: BCBS MAPPO |
$89.93
|
| Rate for Payer: BCBS Trust/PPO |
$115.57
|
| Rate for Payer: BCN Commercial |
$115.57
|
| Rate for Payer: BCN Medicare Advantage |
$89.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.93
|
| Rate for Payer: Mclaren Medicaid |
$48.20
|
| Rate for Payer: Mclaren Medicare |
$89.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.43
|
| Rate for Payer: Meridian Medicaid |
$50.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.42
|
| Rate for Payer: Nomi Health Commercial |
$269.79
|
| Rate for Payer: PACE Medicare |
$85.43
|
| Rate for Payer: PACE SWMI |
$89.93
|
| Rate for Payer: PHP Medicare Advantage |
$89.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.66
|
| Rate for Payer: Priority Health Medicare |
$89.93
|
| Rate for Payer: Priority Health Narrow Network |
$226.13
|
| Rate for Payer: Railroad Medicare Medicare |
$89.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.93
|
| Rate for Payer: UHC Exchange |
$38.52
|
| Rate for Payer: UHC Medicare Advantage |
$89.93
|
| Rate for Payer: UHCCP Medicaid |
$48.20
|
| Rate for Payer: VA VA |
$89.93
|
|
|
ELOSULFASE ALFA 5 MG/5 ML (1 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,667.65
|
|
|
Service Code
|
HCPCS J1322
|
| Hospital Charge Code |
169847
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.54 |
| Max. Negotiated Rate |
$6,000.88 |
| Rate for Payer: Aetna American Axle |
$4,333.97
|
| Rate for Payer: Aetna Commercial |
$5,667.50
|
| Rate for Payer: Aetna Medicare |
$305.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,333.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$367.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$367.40
|
| Rate for Payer: BCBS Complete |
$165.42
|
| Rate for Payer: BCBS MAPPO |
$293.92
|
| Rate for Payer: BCBS Trust/PPO |
$792.49
|
| Rate for Payer: BCN Commercial |
$792.49
|
| Rate for Payer: BCN Medicare Advantage |
$293.92
|
| Rate for Payer: Cash Price |
$5,334.12
|
| Rate for Payer: Cash Price |
$5,334.12
|
| Rate for Payer: Cofinity Commercial |
$5,734.18
|
| Rate for Payer: Cofinity Commercial |
$4,667.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,667.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,334.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$293.92
|
| Rate for Payer: Healthscope Commercial |
$6,000.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,667.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,000.74
|
| Rate for Payer: Mclaren Medicaid |
$157.54
|
| Rate for Payer: Mclaren Medicare |
$293.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$308.62
|
| Rate for Payer: Meridian Medicaid |
$165.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,667.50
|
| Rate for Payer: Nomi Health Commercial |
$881.76
|
| Rate for Payer: PACE Medicare |
$279.22
|
| Rate for Payer: PACE SWMI |
$293.92
|
| Rate for Payer: PHP Commercial |
$5,667.50
|
| Rate for Payer: PHP Medicare Advantage |
$293.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,333.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.90
|
| Rate for Payer: Priority Health Medicare |
$293.92
|
| Rate for Payer: Priority Health Narrow Network |
$676.72
|
| Rate for Payer: Priority Health SBD |
$4,200.62
|
| Rate for Payer: Railroad Medicare Medicare |
$293.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$827.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$293.92
|
| Rate for Payer: UHC Exchange |
$561.71
|
| Rate for Payer: UHC Medicare Advantage |
$293.92
|
| Rate for Payer: UHCCP Medicaid |
$157.54
|
| Rate for Payer: UMR Bronson Commercial |
$2,467.03
|
| Rate for Payer: VA VA |
$293.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,000.74
|
|
|
ELOSULFASE ALFA 5 MG/5 ML (1 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,667.65
|
|
|
Service Code
|
HCPCS J1322
|
| Hospital Charge Code |
169847
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,933.77 |
| Max. Negotiated Rate |
$6,000.88 |
| Rate for Payer: Aetna American Axle |
$4,333.97
|
| Rate for Payer: Aetna Commercial |
$5,667.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,333.97
|
| Rate for Payer: Cash Price |
$5,334.12
|
| Rate for Payer: Cofinity Commercial |
$4,667.36
|
| Rate for Payer: Cofinity Commercial |
$5,734.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,667.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,334.12
|
| Rate for Payer: Healthscope Commercial |
$6,000.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,667.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,000.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,667.50
|
| Rate for Payer: PHP Commercial |
$5,667.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,333.97
|
| Rate for Payer: Priority Health SBD |
$4,200.62
|
| Rate for Payer: UMR Bronson Commercial |
$2,933.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,000.74
|
|
|
ELOTUZUMAB 300 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,916.72
|
|
|
Service Code
|
HCPCS J9176
|
| Hospital Charge Code |
176616
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,603.36 |
| Max. Negotiated Rate |
$5,325.05 |
| Rate for Payer: Aetna American Axle |
$3,845.87
|
| Rate for Payer: Aetna Commercial |
$5,029.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,845.87
|
| Rate for Payer: Cash Price |
$4,733.38
|
| Rate for Payer: Cofinity Commercial |
$4,141.70
|
| Rate for Payer: Cofinity Commercial |
$5,088.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,141.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,733.38
|
| Rate for Payer: Healthscope Commercial |
$5,325.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,141.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,437.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,029.21
|
| Rate for Payer: PHP Commercial |
$5,029.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,845.87
|
| Rate for Payer: Priority Health SBD |
$3,727.53
|
| Rate for Payer: UMR Bronson Commercial |
$2,603.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,437.54
|
|
|
ELOTUZUMAB 300 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,916.72
|
|
|
Service Code
|
HCPCS J9176
|
| Hospital Charge Code |
176616
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$5,325.05 |
| Rate for Payer: Aetna American Axle |
$3,845.87
|
| Rate for Payer: Aetna Commercial |
$5,029.21
|
| Rate for Payer: Aetna Medicare |
$8.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,845.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.65
|
| Rate for Payer: BCBS Complete |
$4.34
|
| Rate for Payer: BCBS MAPPO |
$7.72
|
| Rate for Payer: BCBS Trust/PPO |
$20.80
|
| Rate for Payer: BCN Commercial |
$20.80
|
| Rate for Payer: BCN Medicare Advantage |
$7.72
|
| Rate for Payer: Cash Price |
$4,733.38
|
| Rate for Payer: Cash Price |
$4,733.38
|
| Rate for Payer: Cofinity Commercial |
$5,088.38
|
| Rate for Payer: Cofinity Commercial |
$4,141.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,141.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,733.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.72
|
| Rate for Payer: Healthscope Commercial |
$5,325.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,141.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,437.54
|
| Rate for Payer: Mclaren Medicaid |
$4.14
|
| Rate for Payer: Mclaren Medicare |
$7.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.11
|
| Rate for Payer: Meridian Medicaid |
$4.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,029.21
|
| Rate for Payer: Nomi Health Commercial |
$23.16
|
| Rate for Payer: PACE Medicare |
$7.33
|
| Rate for Payer: PACE SWMI |
$7.72
|
| Rate for Payer: PHP Commercial |
$5,029.21
|
| Rate for Payer: PHP Medicare Advantage |
$7.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,845.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.81
|
| Rate for Payer: Priority Health Medicare |
$7.72
|
| Rate for Payer: Priority Health Narrow Network |
$17.45
|
| Rate for Payer: Priority Health SBD |
$3,727.53
|
| Rate for Payer: Railroad Medicare Medicare |
$7.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.72
|
| Rate for Payer: UHC Exchange |
$14.75
|
| Rate for Payer: UHC Medicare Advantage |
$7.72
|
| Rate for Payer: UHCCP Medicaid |
$4.14
|
| Rate for Payer: UMR Bronson Commercial |
$2,189.19
|
| Rate for Payer: VA VA |
$7.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,437.54
|
|
|
ELOTUZUMAB 400 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$7,888.87
|
|
|
Service Code
|
HCPCS J9176
|
| Hospital Charge Code |
176617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$7,099.98 |
| Rate for Payer: Aetna American Axle |
$5,127.77
|
| Rate for Payer: Aetna Commercial |
$6,705.54
|
| Rate for Payer: Aetna Medicare |
$8.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,127.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.65
|
| Rate for Payer: BCBS Complete |
$4.34
|
| Rate for Payer: BCBS MAPPO |
$7.72
|
| Rate for Payer: BCBS Trust/PPO |
$20.80
|
| Rate for Payer: BCN Commercial |
$20.80
|
| Rate for Payer: BCN Medicare Advantage |
$7.72
|
| Rate for Payer: Cash Price |
$6,311.10
|
| Rate for Payer: Cash Price |
$6,311.10
|
| Rate for Payer: Cofinity Commercial |
$6,784.43
|
| Rate for Payer: Cofinity Commercial |
$5,522.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,522.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,311.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.72
|
| Rate for Payer: Healthscope Commercial |
$7,099.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,522.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,916.65
|
| Rate for Payer: Mclaren Medicaid |
$4.14
|
| Rate for Payer: Mclaren Medicare |
$7.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.11
|
| Rate for Payer: Meridian Medicaid |
$4.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,705.54
|
| Rate for Payer: Nomi Health Commercial |
$23.16
|
| Rate for Payer: PACE Medicare |
$7.33
|
| Rate for Payer: PACE SWMI |
$7.72
|
| Rate for Payer: PHP Commercial |
$6,705.54
|
| Rate for Payer: PHP Medicare Advantage |
$7.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,127.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.81
|
| Rate for Payer: Priority Health Medicare |
$7.72
|
| Rate for Payer: Priority Health Narrow Network |
$17.45
|
| Rate for Payer: Priority Health SBD |
$4,969.99
|
| Rate for Payer: Railroad Medicare Medicare |
$7.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.72
|
| Rate for Payer: UHC Exchange |
$14.75
|
| Rate for Payer: UHC Medicare Advantage |
$7.72
|
| Rate for Payer: UHCCP Medicaid |
$4.14
|
| Rate for Payer: UMR Bronson Commercial |
$2,918.88
|
| Rate for Payer: VA VA |
$7.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,916.65
|
|
|
ELOTUZUMAB 400 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$7,888.87
|
|
|
Service Code
|
HCPCS J9176
|
| Hospital Charge Code |
176617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,471.10 |
| Max. Negotiated Rate |
$7,099.98 |
| Rate for Payer: Aetna American Axle |
$5,127.77
|
| Rate for Payer: Aetna Commercial |
$6,705.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,127.77
|
| Rate for Payer: Cash Price |
$6,311.10
|
| Rate for Payer: Cofinity Commercial |
$5,522.21
|
| Rate for Payer: Cofinity Commercial |
$6,784.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,522.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,311.10
|
| Rate for Payer: Healthscope Commercial |
$7,099.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,522.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,916.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,705.54
|
| Rate for Payer: PHP Commercial |
$6,705.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,127.77
|
| Rate for Payer: Priority Health SBD |
$4,969.99
|
| Rate for Payer: UMR Bronson Commercial |
$3,471.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,916.65
|
|
|
ELRANATAMAB-BCMM 40 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$35,776.82
|
|
|
Service Code
|
HCPCS J1323
|
| Hospital Charge Code |
205012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.22 |
| Max. Negotiated Rate |
$32,199.14 |
| Rate for Payer: UHC Dual Complete DSNP |
$177.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.65
|
| Rate for Payer: UHC Exchange |
$339.51
|
| Rate for Payer: UHC Exchange |
$339.51
|
| Rate for Payer: UHC Medicare Advantage |
$177.65
|
| Rate for Payer: UHC Medicare Advantage |
$177.65
|
| Rate for Payer: UHCCP Medicaid |
$95.22
|
| Rate for Payer: UHCCP Medicaid |
$95.22
|
| Rate for Payer: UMR Bronson Commercial |
$13,237.42
|
| Rate for Payer: UMR Bronson Commercial |
$22,864.64
|
| Rate for Payer: VA VA |
$177.65
|
| Rate for Payer: VA VA |
$177.65
|
| Rate for Payer: Aetna American Axle |
$23,254.93
|
| Rate for Payer: Aetna American Axle |
$40,167.61
|
| Rate for Payer: Aetna Commercial |
$52,526.88
|
| Rate for Payer: Aetna Commercial |
$30,410.30
|
| Rate for Payer: Aetna Medicare |
$184.76
|
| Rate for Payer: Aetna Medicare |
$184.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23,254.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40,167.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.06
|
| Rate for Payer: BCBS Complete |
$99.98
|
| Rate for Payer: BCBS Complete |
$99.98
|
| Rate for Payer: BCBS MAPPO |
$177.65
|
| Rate for Payer: BCBS MAPPO |
$177.65
|
| Rate for Payer: BCBS Trust/PPO |
$482.23
|
| Rate for Payer: BCBS Trust/PPO |
$482.23
|
| Rate for Payer: BCN Commercial |
$482.23
|
| Rate for Payer: BCN Commercial |
$482.23
|
| Rate for Payer: BCN Medicare Advantage |
$177.65
|
| Rate for Payer: BCN Medicare Advantage |
$177.65
|
| Rate for Payer: Cash Price |
$49,437.06
|
| Rate for Payer: Cash Price |
$28,621.46
|
| Rate for Payer: Cash Price |
$49,437.06
|
| Rate for Payer: Cash Price |
$28,621.46
|
| Rate for Payer: Cofinity Commercial |
$43,257.43
|
| Rate for Payer: Cofinity Commercial |
$25,043.77
|
| Rate for Payer: Cofinity Commercial |
$30,768.07
|
| Rate for Payer: Cofinity Commercial |
$53,144.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$25,043.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$43,257.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28,621.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49,437.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.65
|
| Rate for Payer: Healthscope Commercial |
$32,199.14
|
| Rate for Payer: Healthscope Commercial |
$55,616.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43,257.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25,043.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26,832.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46,347.25
|
| Rate for Payer: Mclaren Medicaid |
$95.22
|
| Rate for Payer: Mclaren Medicaid |
$95.22
|
| Rate for Payer: Mclaren Medicare |
$177.65
|
| Rate for Payer: Mclaren Medicare |
$177.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.53
|
| Rate for Payer: Meridian Medicaid |
$99.98
|
| Rate for Payer: Meridian Medicaid |
$99.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30,410.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52,526.88
|
| Rate for Payer: Nomi Health Commercial |
$532.95
|
| Rate for Payer: Nomi Health Commercial |
$532.95
|
| Rate for Payer: PACE Medicare |
$168.77
|
| Rate for Payer: PACE Medicare |
$168.77
|
| Rate for Payer: PACE SWMI |
$177.65
|
| Rate for Payer: PACE SWMI |
$177.65
|
| Rate for Payer: PHP Commercial |
$30,410.30
|
| Rate for Payer: PHP Commercial |
$52,526.88
|
| Rate for Payer: PHP Medicare Advantage |
$177.65
|
| Rate for Payer: PHP Medicare Advantage |
$177.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23,254.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40,167.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$514.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$514.72
|
| Rate for Payer: Priority Health Medicare |
$177.65
|
| Rate for Payer: Priority Health Medicare |
$177.65
|
| Rate for Payer: Priority Health Narrow Network |
$411.78
|
| Rate for Payer: Priority Health Narrow Network |
$411.78
|
| Rate for Payer: Priority Health SBD |
$22,539.40
|
| Rate for Payer: Priority Health SBD |
$38,931.69
|
| Rate for Payer: Railroad Medicare Medicare |
$177.65
|
| Rate for Payer: Railroad Medicare Medicare |
$177.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$500.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$500.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26,832.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46,347.25
|
|
|
ELRANATAMAB-BCMM 40 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$35,776.82
|
|
|
Service Code
|
HCPCS J1323
|
| Hospital Charge Code |
205012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15,741.80 |
| Max. Negotiated Rate |
$32,199.14 |
| Rate for Payer: Aetna American Axle |
$23,254.93
|
| Rate for Payer: Aetna American Axle |
$40,167.61
|
| Rate for Payer: Aetna Commercial |
$30,410.30
|
| Rate for Payer: Aetna Commercial |
$52,526.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23,254.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40,167.61
|
| Rate for Payer: Cash Price |
$28,621.46
|
| Rate for Payer: Cash Price |
$49,437.06
|
| Rate for Payer: Cofinity Commercial |
$53,144.84
|
| Rate for Payer: Cofinity Commercial |
$43,257.43
|
| Rate for Payer: Cofinity Commercial |
$25,043.77
|
| Rate for Payer: Cofinity Commercial |
$30,768.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$25,043.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$43,257.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28,621.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49,437.06
|
| Rate for Payer: Healthscope Commercial |
$32,199.14
|
| Rate for Payer: Healthscope Commercial |
$55,616.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25,043.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43,257.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26,832.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46,347.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52,526.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30,410.30
|
| Rate for Payer: PHP Commercial |
$52,526.88
|
| Rate for Payer: PHP Commercial |
$30,410.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23,254.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40,167.61
|
| Rate for Payer: Priority Health SBD |
$22,539.40
|
| Rate for Payer: Priority Health SBD |
$38,931.69
|
| Rate for Payer: UMR Bronson Commercial |
$15,741.80
|
| Rate for Payer: UMR Bronson Commercial |
$27,190.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26,832.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46,347.25
|
|
|
ELTROMBOPAG OLAMINE 25 MG ORAL POWDER PACKET
|
Facility
|
OP
|
$26,814.05
|
|
|
Service Code
|
NDC 00078069723
|
| Hospital Charge Code |
193346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9,921.20 |
| Max. Negotiated Rate |
$24,132.64 |
| Rate for Payer: Aetna American Axle |
$17,429.13
|
| Rate for Payer: Aetna Commercial |
$22,791.94
|
| Rate for Payer: Aetna Medicare |
$13,407.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,429.13
|
| Rate for Payer: BCBS Complete |
$10,725.62
|
| Rate for Payer: Cash Price |
$21,451.24
|
| Rate for Payer: Cofinity Commercial |
$18,769.84
|
| Rate for Payer: Cofinity Commercial |
$23,060.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,769.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,451.24
|
| Rate for Payer: Healthscope Commercial |
$24,132.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,769.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,110.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,791.94
|
| Rate for Payer: PHP Commercial |
$22,791.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,429.13
|
| Rate for Payer: Priority Health SBD |
$16,892.85
|
| Rate for Payer: UMR Bronson Commercial |
$9,921.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,110.54
|
|
|
ELTROMBOPAG OLAMINE 25 MG ORAL POWDER PACKET
|
Facility
|
OP
|
$893.81
|
|
|
Service Code
|
NDC 00078069719
|
| Hospital Charge Code |
193346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$330.71 |
| Max. Negotiated Rate |
$804.43 |
| Rate for Payer: Aetna American Axle |
$580.98
|
| Rate for Payer: Aetna Commercial |
$759.74
|
| Rate for Payer: Aetna Medicare |
$446.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.98
|
| Rate for Payer: BCBS Complete |
$357.52
|
| Rate for Payer: Cash Price |
$715.05
|
| Rate for Payer: Cofinity Commercial |
$625.67
|
| Rate for Payer: Cofinity Commercial |
$768.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$625.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.05
|
| Rate for Payer: Healthscope Commercial |
$804.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$625.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.74
|
| Rate for Payer: PHP Commercial |
$759.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.98
|
| Rate for Payer: Priority Health SBD |
$563.10
|
| Rate for Payer: UMR Bronson Commercial |
$330.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.36
|
|
|
ELTROMBOPAG OLAMINE 25 MG ORAL POWDER PACKET
|
Facility
|
IP
|
$26,814.05
|
|
|
Service Code
|
NDC 00078069761
|
| Hospital Charge Code |
193346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11,798.18 |
| Max. Negotiated Rate |
$24,132.64 |
| Rate for Payer: Aetna American Axle |
$17,429.13
|
| Rate for Payer: Aetna Commercial |
$22,791.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,429.13
|
| Rate for Payer: Cash Price |
$21,451.24
|
| Rate for Payer: Cofinity Commercial |
$18,769.84
|
| Rate for Payer: Cofinity Commercial |
$23,060.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,769.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,451.24
|
| Rate for Payer: Healthscope Commercial |
$24,132.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,769.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,110.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,791.94
|
| Rate for Payer: PHP Commercial |
$22,791.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,429.13
|
| Rate for Payer: Priority Health SBD |
$16,892.85
|
| Rate for Payer: UMR Bronson Commercial |
$11,798.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,110.54
|
|
|
ELTROMBOPAG OLAMINE 25 MG ORAL POWDER PACKET
|
Facility
|
OP
|
$26,814.05
|
|
|
Service Code
|
NDC 00078069761
|
| Hospital Charge Code |
193346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9,921.20 |
| Max. Negotiated Rate |
$24,132.64 |
| Rate for Payer: Aetna American Axle |
$17,429.13
|
| Rate for Payer: Aetna Commercial |
$22,791.94
|
| Rate for Payer: Aetna Medicare |
$13,407.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,429.13
|
| Rate for Payer: BCBS Complete |
$10,725.62
|
| Rate for Payer: Cash Price |
$21,451.24
|
| Rate for Payer: Cofinity Commercial |
$18,769.84
|
| Rate for Payer: Cofinity Commercial |
$23,060.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,769.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,451.24
|
| Rate for Payer: Healthscope Commercial |
$24,132.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,769.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,110.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,791.94
|
| Rate for Payer: PHP Commercial |
$22,791.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,429.13
|
| Rate for Payer: Priority Health SBD |
$16,892.85
|
| Rate for Payer: UMR Bronson Commercial |
$9,921.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,110.54
|
|
|
ELTROMBOPAG OLAMINE 25 MG ORAL POWDER PACKET
|
Facility
|
IP
|
$26,814.05
|
|
|
Service Code
|
NDC 00078069723
|
| Hospital Charge Code |
193346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11,798.18 |
| Max. Negotiated Rate |
$24,132.64 |
| Rate for Payer: Aetna American Axle |
$17,429.13
|
| Rate for Payer: Aetna Commercial |
$22,791.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,429.13
|
| Rate for Payer: Cash Price |
$21,451.24
|
| Rate for Payer: Cofinity Commercial |
$18,769.84
|
| Rate for Payer: Cofinity Commercial |
$23,060.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,769.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,451.24
|
| Rate for Payer: Healthscope Commercial |
$24,132.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,769.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,110.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,791.94
|
| Rate for Payer: PHP Commercial |
$22,791.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,429.13
|
| Rate for Payer: Priority Health SBD |
$16,892.85
|
| Rate for Payer: UMR Bronson Commercial |
$11,798.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,110.54
|
|
|
ELTROMBOPAG OLAMINE 25 MG ORAL POWDER PACKET
|
Facility
|
IP
|
$893.81
|
|
|
Service Code
|
NDC 00078069719
|
| Hospital Charge Code |
193346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$393.28 |
| Max. Negotiated Rate |
$804.43 |
| Rate for Payer: Aetna American Axle |
$580.98
|
| Rate for Payer: Aetna Commercial |
$759.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.98
|
| Rate for Payer: Cash Price |
$715.05
|
| Rate for Payer: Cofinity Commercial |
$625.67
|
| Rate for Payer: Cofinity Commercial |
$768.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$625.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.05
|
| Rate for Payer: Healthscope Commercial |
$804.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$625.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.74
|
| Rate for Payer: PHP Commercial |
$759.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.98
|
| Rate for Payer: Priority Health SBD |
$563.10
|
| Rate for Payer: UMR Bronson Commercial |
$393.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.36
|
|
|
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; AXILLARY, BRACHIAL, INNOMINATE, SUBCLAVIAN ARTERY, BY ARM INCISION
|
Facility
|
OP
|
$16,646.50
|
|
|
Service Code
|
CPT 34101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$577.13 |
| Max. Negotiated Rate |
$16,646.50 |
| Rate for Payer: Aetna Medicare |
$5,508.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,620.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,620.50
|
| Rate for Payer: BCBS Complete |
$2,980.81
|
| Rate for Payer: BCBS MAPPO |
$5,296.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,665.22
|
| Rate for Payer: BCN Commercial |
$3,665.22
|
| Rate for Payer: BCN Medicare Advantage |
$5,296.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,296.40
|
| Rate for Payer: Mclaren Medicaid |
$2,838.87
|
| Rate for Payer: Mclaren Medicare |
$5,296.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,561.22
|
| Rate for Payer: Meridian Medicaid |
$2,980.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,090.86
|
| Rate for Payer: Nomi Health Commercial |
$11,122.44
|
| Rate for Payer: PACE Medicare |
$5,031.58
|
| Rate for Payer: PACE SWMI |
$5,296.40
|
| Rate for Payer: PHP Medicare Advantage |
$5,296.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,838.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,646.50
|
| Rate for Payer: Priority Health Medicare |
$5,296.40
|
| Rate for Payer: Priority Health Narrow Network |
$13,317.20
|
| Rate for Payer: Railroad Medicare Medicare |
$5,296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$634.84
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,296.40
|
| Rate for Payer: UHC Exchange |
$577.13
|
| Rate for Payer: UHC Medicare Advantage |
$5,296.40
|
| Rate for Payer: UHCCP Medicaid |
$2,838.87
|
| Rate for Payer: VA VA |
$5,296.40
|
|
|
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; FEMOROPOPLITEAL, AORTOILIAC ARTERY, BY LEG INCISION
|
Facility
|
OP
|
$16,646.50
|
|
|
Service Code
|
CPT 34201
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$991.02 |
| Max. Negotiated Rate |
$16,646.50 |
| Rate for Payer: Aetna Medicare |
$5,508.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,620.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,620.50
|
| Rate for Payer: BCBS Complete |
$2,980.81
|
| Rate for Payer: BCBS MAPPO |
$5,296.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,665.22
|
| Rate for Payer: BCN Commercial |
$3,665.22
|
| Rate for Payer: BCN Medicare Advantage |
$5,296.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,296.40
|
| Rate for Payer: Mclaren Medicaid |
$2,838.87
|
| Rate for Payer: Mclaren Medicare |
$5,296.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,561.22
|
| Rate for Payer: Meridian Medicaid |
$2,980.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,090.86
|
| Rate for Payer: Nomi Health Commercial |
$11,122.44
|
| Rate for Payer: PACE Medicare |
$5,031.58
|
| Rate for Payer: PACE SWMI |
$5,296.40
|
| Rate for Payer: PHP Medicare Advantage |
$5,296.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,838.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,646.50
|
| Rate for Payer: Priority Health Medicare |
$5,296.40
|
| Rate for Payer: Priority Health Narrow Network |
$13,317.20
|
| Rate for Payer: Railroad Medicare Medicare |
$5,296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,090.12
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,296.40
|
| Rate for Payer: UHC Exchange |
$991.02
|
| Rate for Payer: UHC Medicare Advantage |
$5,296.40
|
| Rate for Payer: UHCCP Medicaid |
$2,838.87
|
| Rate for Payer: VA VA |
$5,296.40
|
|
|
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; RADIAL OR ULNAR ARTERY, BY ARM INCISION
|
Facility
|
OP
|
$16,646.50
|
|
|
Service Code
|
CPT 34111
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$576.53 |
| Max. Negotiated Rate |
$16,646.50 |
| Rate for Payer: Aetna Medicare |
$5,508.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,620.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,620.50
|
| Rate for Payer: BCBS Complete |
$2,980.81
|
| Rate for Payer: BCBS MAPPO |
$5,296.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,665.22
|
| Rate for Payer: BCN Commercial |
$3,665.22
|
| Rate for Payer: BCN Medicare Advantage |
$5,296.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,296.40
|
| Rate for Payer: Mclaren Medicaid |
$2,838.87
|
| Rate for Payer: Mclaren Medicare |
$5,296.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,561.22
|
| Rate for Payer: Meridian Medicaid |
$2,980.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,090.86
|
| Rate for Payer: Nomi Health Commercial |
$11,122.44
|
| Rate for Payer: PACE Medicare |
$5,031.58
|
| Rate for Payer: PACE SWMI |
$5,296.40
|
| Rate for Payer: PHP Medicare Advantage |
$5,296.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,838.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,646.50
|
| Rate for Payer: Priority Health Medicare |
$5,296.40
|
| Rate for Payer: Priority Health Narrow Network |
$13,317.20
|
| Rate for Payer: Railroad Medicare Medicare |
$5,296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$634.18
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,296.40
|
| Rate for Payer: UHC Exchange |
$576.53
|
| Rate for Payer: UHC Medicare Advantage |
$5,296.40
|
| Rate for Payer: UHCCP Medicaid |
$2,838.87
|
| Rate for Payer: VA VA |
$5,296.40
|
|
|
EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES A MEDICALLY APPROPRIATE HISTORY AND/OR EXAMINATION AND MODERATE LEVEL OF MEDICAL DECISION MAKING
|
Facility
|
OP
|
$1,311.28
|
|
|
Service Code
|
CPT 99284
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$117.56 |
| Max. Negotiated Rate |
$1,311.28 |
| Rate for Payer: Aetna Medicare |
$433.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$521.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$521.51
|
| Rate for Payer: BCBS Complete |
$234.81
|
| Rate for Payer: BCBS MAPPO |
$417.21
|
| Rate for Payer: BCBS Trust/PPO |
$800.66
|
| Rate for Payer: BCN Commercial |
$800.66
|
| Rate for Payer: BCN Medicare Advantage |
$417.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$417.21
|
| Rate for Payer: Mclaren Medicaid |
$223.62
|
| Rate for Payer: Mclaren Medicare |
$417.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$438.07
|
| Rate for Payer: Meridian Medicaid |
$234.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.79
|
| Rate for Payer: Nomi Health Commercial |
$1,251.63
|
| Rate for Payer: PACE Medicare |
$396.35
|
| Rate for Payer: PACE SWMI |
$417.21
|
| Rate for Payer: PHP Medicare Advantage |
$417.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,311.28
|
| Rate for Payer: Priority Health Medicare |
$417.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,049.02
|
| Rate for Payer: Railroad Medicare Medicare |
$417.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$417.21
|
| Rate for Payer: UHC Exchange |
$117.56
|
| Rate for Payer: UHC Medicare Advantage |
$417.21
|
| Rate for Payer: UHCCP Medicaid |
$223.62
|
| Rate for Payer: VA VA |
$417.21
|
|
|
EMOLLIENT TOPICAL CREAM
|
Facility
|
OP
|
$23.29
|
|
|
Service Code
|
NDC 00225052053
|
| Hospital Charge Code |
77778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$20.96 |
| Rate for Payer: Aetna American Axle |
$15.14
|
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna Medicare |
$11.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.14
|
| Rate for Payer: BCBS Complete |
$9.32
|
| Rate for Payer: Cash Price |
$18.63
|
| Rate for Payer: Cofinity Commercial |
$16.30
|
| Rate for Payer: Cofinity Commercial |
$20.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$20.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.80
|
| Rate for Payer: PHP Commercial |
$19.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.14
|
| Rate for Payer: Priority Health SBD |
$14.67
|
| Rate for Payer: UMR Bronson Commercial |
$8.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.47
|
|
