|
FRAXEL FACE & NECK
|
Professional
|
Both
|
$1,051.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$420.40 |
| Max. Negotiated Rate |
$788.25 |
| Rate for Payer: Aetna Medicare |
$525.50
|
| Rate for Payer: BCBS Complete |
$420.40
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$788.25
|
| Rate for Payer: UMR Bronson Commercial |
$483.46
|
|
|
FRAXEL FULL FACE
|
Professional
|
Both
|
$630.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna Medicare |
$315.00
|
| Rate for Payer: BCBS Complete |
$252.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.50
|
| Rate for Payer: UMR Bronson Commercial |
$289.80
|
|
|
FRAXEL HANDS
|
Professional
|
Both
|
$368.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$147.20 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Medicare |
$184.00
|
| Rate for Payer: BCBS Complete |
$147.20
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.00
|
| Rate for Payer: UMR Bronson Commercial |
$169.28
|
|
|
FRAXEL LARGE SCAR
|
Professional
|
Both
|
$840.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna Medicare |
$420.00
|
| Rate for Payer: BCBS Complete |
$336.00
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$630.00
|
| Rate for Payer: UMR Bronson Commercial |
$386.40
|
|
|
FRAXEL MEDIUM SCAR
|
Professional
|
Both
|
$315.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Aetna Medicare |
$157.50
|
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: UMR Bronson Commercial |
$144.90
|
|
|
FRAXEL NECK
|
Professional
|
Both
|
$420.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Medicare |
$210.00
|
| Rate for Payer: BCBS Complete |
$168.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.00
|
| Rate for Payer: UMR Bronson Commercial |
$193.20
|
|
|
FRAXEL NECK & CHEST
|
Professional
|
Both
|
$1,261.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$945.75 |
| Rate for Payer: Aetna Medicare |
$630.50
|
| Rate for Payer: BCBS Complete |
$504.40
|
| Rate for Payer: Cash Price |
$1,008.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$945.75
|
| Rate for Payer: UMR Bronson Commercial |
$580.06
|
|
|
FRAXEL PARTIAL TREATMENT - BILATERAL EYES
|
Professional
|
Both
|
$315.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Aetna Medicare |
$157.50
|
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: UMR Bronson Commercial |
$144.90
|
|
|
FRAXEL PARTIAL TREATMENT - PERI-ORAL
|
Professional
|
Both
|
$525.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$393.75 |
| Rate for Payer: Aetna Medicare |
$262.50
|
| Rate for Payer: BCBS Complete |
$210.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$393.75
|
| Rate for Payer: UMR Bronson Commercial |
$241.50
|
|
|
FRAXEL PARTIAL TREATMENT - UPPER LIP
|
Professional
|
Both
|
$263.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
|
|
FRAXEL RESTORE
|
Professional
|
Both
|
$263.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
|
|
FRAXEL SMALL SCAR
|
Professional
|
Both
|
$132.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna Medicare |
$66.00
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.00
|
| Rate for Payer: UMR Bronson Commercial |
$60.72
|
|
|
FRAXEL STRETCH MARKS - ENTIRE ABDOMEN
|
Professional
|
Both
|
$840.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna Medicare |
$420.00
|
| Rate for Payer: BCBS Complete |
$336.00
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$630.00
|
| Rate for Payer: UMR Bronson Commercial |
$386.40
|
|
|
FRAXEL STRETCH MARKS - PERI-UMBILICAL
|
Professional
|
Both
|
$630.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna Medicare |
$315.00
|
| Rate for Payer: BCBS Complete |
$252.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.50
|
| Rate for Payer: UMR Bronson Commercial |
$289.80
|
|
|
FULL TERM NEONATE WITH MAJOR PROBLEMS
|
Facility
|
IP
|
$67,964.48
|
|
|
Service Code
|
MSDRG 793
|
| Min. Negotiated Rate |
$9,268.29 |
| Max. Negotiated Rate |
$67,964.48 |
| Rate for Payer: Aetna Medicare |
$36,880.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44,327.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44,327.56
|
| Rate for Payer: BCBS MAPPO |
$35,462.05
|
| Rate for Payer: BCBS Trust/PPO |
$25,227.47
|
| Rate for Payer: BCN Commercial |
$25,227.47
|
| Rate for Payer: BCN Medicare Advantage |
$35,462.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,462.05
|
| Rate for Payer: Mclaren Medicare |
$35,462.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37,235.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40,781.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$39,008.25
|
| Rate for Payer: Nomi Health Commercial |
$53,787.84
|
| Rate for Payer: PACE Medicare |
$33,688.95
|
| Rate for Payer: PACE SWMI |
$35,462.05
|
| Rate for Payer: PHP Medicare Advantage |
$35,462.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,585.37
|
| Rate for Payer: Priority Health Medicare |
$35,462.05
|
| Rate for Payer: Priority Health Tiered Network |
$9,268.29
|
| Rate for Payer: Railroad Medicare Medicare |
$35,462.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67,964.48
|
| Rate for Payer: UHC Core |
$56,860.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35,462.05
|
| Rate for Payer: UHC Exchange |
$46,436.84
|
| Rate for Payer: VA VA |
$35,462.05
|
|
|
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY
|
Facility
|
IP
|
$36,032.78
|
|
|
Service Code
|
MSDRG 934
|
| Min. Negotiated Rate |
$18,125.58 |
| Max. Negotiated Rate |
$36,032.78 |
| Rate for Payer: Aetna Medicare |
$19,842.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,849.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,849.45
|
| Rate for Payer: BCBS MAPPO |
$19,079.56
|
| Rate for Payer: BCBS Trust/PPO |
$28,587.47
|
| Rate for Payer: BCN Commercial |
$28,587.47
|
| Rate for Payer: BCN Medicare Advantage |
$19,079.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,079.56
|
| Rate for Payer: Mclaren Medicare |
$19,079.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,033.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,941.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,987.52
|
| Rate for Payer: Nomi Health Commercial |
$28,516.74
|
| Rate for Payer: PACE Medicare |
$18,125.58
|
| Rate for Payer: PACE SWMI |
$19,079.56
|
| Rate for Payer: PHP Medicare Advantage |
$19,079.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35,639.60
|
| Rate for Payer: Priority Health Medicare |
$19,079.56
|
| Rate for Payer: Priority Health Tiered Network |
$28,511.68
|
| Rate for Payer: Railroad Medicare Medicare |
$19,079.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36,032.78
|
| Rate for Payer: UHC Core |
$30,145.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,079.56
|
| Rate for Payer: UHC Exchange |
$24,619.45
|
| Rate for Payer: VA VA |
$19,079.56
|
|
|
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC
|
Facility
|
IP
|
$135,607.94
|
|
|
Service Code
|
MSDRG 928
|
| Min. Negotiated Rate |
$57,547.27 |
| Max. Negotiated Rate |
$135,607.94 |
| Rate for Payer: Aetna Medicare |
$62,999.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75,720.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75,720.09
|
| Rate for Payer: BCBS MAPPO |
$60,576.07
|
| Rate for Payer: BCBS Trust/PPO |
$135,607.94
|
| Rate for Payer: BCN Commercial |
$135,607.94
|
| Rate for Payer: BCN Medicare Advantage |
$60,576.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60,576.07
|
| Rate for Payer: Mclaren Medicare |
$60,576.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63,604.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69,662.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$66,633.68
|
| Rate for Payer: Nomi Health Commercial |
$92,527.83
|
| Rate for Payer: PACE Medicare |
$57,547.27
|
| Rate for Payer: PACE SWMI |
$60,576.07
|
| Rate for Payer: PHP Medicare Advantage |
$60,576.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$115,639.27
|
| Rate for Payer: Priority Health Medicare |
$60,576.07
|
| Rate for Payer: Priority Health Tiered Network |
$92,511.40
|
| Rate for Payer: Railroad Medicare Medicare |
$60,576.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116,915.01
|
| Rate for Payer: UHC Core |
$97,814.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$60,576.07
|
| Rate for Payer: UHC Exchange |
$79,882.36
|
| Rate for Payer: VA VA |
$60,576.07
|
|
|
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC
|
Facility
|
IP
|
$63,013.77
|
|
|
Service Code
|
MSDRG 929
|
| Min. Negotiated Rate |
$26,151.14 |
| Max. Negotiated Rate |
$63,013.77 |
| Rate for Payer: Aetna Medicare |
$28,628.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,409.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,409.40
|
| Rate for Payer: BCBS MAPPO |
$27,527.52
|
| Rate for Payer: BCBS Trust/PPO |
$63,013.77
|
| Rate for Payer: BCN Commercial |
$63,013.77
|
| Rate for Payer: BCN Medicare Advantage |
$27,527.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,527.52
|
| Rate for Payer: Mclaren Medicare |
$27,527.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28,903.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,656.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$30,280.27
|
| Rate for Payer: Nomi Health Commercial |
$41,548.32
|
| Rate for Payer: PACE Medicare |
$26,151.14
|
| Rate for Payer: PACE SWMI |
$27,527.52
|
| Rate for Payer: PHP Medicare Advantage |
$27,527.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$51,926.19
|
| Rate for Payer: Priority Health Medicare |
$27,527.52
|
| Rate for Payer: Priority Health Tiered Network |
$41,540.94
|
| Rate for Payer: Railroad Medicare Medicare |
$27,527.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52,499.04
|
| Rate for Payer: UHC Core |
$43,922.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27,527.52
|
| Rate for Payer: UHC Exchange |
$35,870.05
|
| Rate for Payer: VA VA |
$27,527.52
|
|
|
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS, AND/OR FEET; 20 SQ CM OR LESS
|
Facility
|
OP
|
$6,648.46
|
|
|
Service Code
|
CPT 15240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,603.07
|
| Rate for Payer: BCN Commercial |
$3,603.07
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS, EYELIDS, AND/OR LIPS; 20 SQ CM OR LESS
|
Facility
|
OP
|
$6,648.46
|
|
|
Service Code
|
CPT 15260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,725.85
|
| Rate for Payer: BCN Commercial |
$1,725.85
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, SCALP, ARMS, AND/OR LEGS; 20 SQ CM OR LESS
|
Facility
|
OP
|
$6,648.46
|
|
|
Service Code
|
CPT 15220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,725.85
|
| Rate for Payer: BCN Commercial |
$1,725.85
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, SCALP, ARMS, AND/OR LEGS; EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$594.63
|
|
|
Service Code
|
CPT 15221
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$594.63 |
| Max. Negotiated Rate |
$594.63 |
| Rate for Payer: BCBS Trust/PPO |
$594.63
|
| Rate for Payer: BCN Commercial |
$594.63
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$408.16
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
32767
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$179.59 |
| Max. Negotiated Rate |
$367.34 |
| Rate for Payer: Aetna American Axle |
$265.30
|
| Rate for Payer: Aetna American Axle |
$2,758.81
|
| Rate for Payer: Aetna Commercial |
$346.94
|
| Rate for Payer: Aetna Commercial |
$3,607.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,758.81
|
| Rate for Payer: Cash Price |
$326.53
|
| Rate for Payer: Cash Price |
$3,395.46
|
| Rate for Payer: Cofinity Advantage |
$2,971.03
|
| Rate for Payer: Cofinity Advantage |
$285.71
|
| Rate for Payer: Cofinity Commercial |
$3,650.12
|
| Rate for Payer: Cofinity Commercial |
$351.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,395.46
|
| Rate for Payer: Healthscope Commercial |
$367.34
|
| Rate for Payer: Healthscope Commercial |
$3,819.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,971.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,183.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,607.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,183.25
|
| Rate for Payer: PHP Commercial |
$346.94
|
| Rate for Payer: PHP Commercial |
$3,607.68
|
| Rate for Payer: Priority Health SBD |
$2,673.93
|
| Rate for Payer: Priority Health SBD |
$257.14
|
| Rate for Payer: UMR Bronson Commercial |
$179.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,867.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,183.25
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$481.74
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
32767
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$433.57 |
| Rate for Payer: Aetna American Axle |
$313.13
|
| Rate for Payer: Aetna American Axle |
$331.19
|
| Rate for Payer: Aetna American Axle |
$258.24
|
| Rate for Payer: Aetna American Axle |
$517.23
|
| Rate for Payer: Aetna American Axle |
$517.41
|
| Rate for Payer: Aetna American Axle |
$225.86
|
| Rate for Payer: Aetna American Axle |
$468.57
|
| Rate for Payer: Aetna American Axle |
$275.73
|
| Rate for Payer: Aetna American Axle |
$265.30
|
| Rate for Payer: Aetna American Axle |
$526.85
|
| Rate for Payer: Aetna American Axle |
$202.38
|
| Rate for Payer: Aetna American Axle |
$168.86
|
| Rate for Payer: Aetna American Axle |
$2,758.81
|
| Rate for Payer: Aetna Commercial |
$3,607.68
|
| Rate for Payer: Aetna Commercial |
$433.10
|
| Rate for Payer: Aetna Commercial |
$346.94
|
| Rate for Payer: Aetna Commercial |
$337.70
|
| Rate for Payer: Aetna Commercial |
$295.36
|
| Rate for Payer: Aetna Commercial |
$264.65
|
| Rate for Payer: Aetna Commercial |
$676.38
|
| Rate for Payer: Aetna Commercial |
$360.57
|
| Rate for Payer: Aetna Commercial |
$612.74
|
| Rate for Payer: Aetna Commercial |
$220.82
|
| Rate for Payer: Aetna Commercial |
$676.61
|
| Rate for Payer: Aetna Commercial |
$409.48
|
| Rate for Payer: Aetna Commercial |
$688.96
|
| Rate for Payer: Aetna Medicare |
$204.08
|
| Rate for Payer: Aetna Medicare |
$397.87
|
| Rate for Payer: Aetna Medicare |
$240.87
|
| Rate for Payer: Aetna Medicare |
$254.76
|
| Rate for Payer: Aetna Medicare |
$155.68
|
| Rate for Payer: Aetna Medicare |
$2,122.16
|
| Rate for Payer: Aetna Medicare |
$129.90
|
| Rate for Payer: Aetna Medicare |
$405.27
|
| Rate for Payer: Aetna Medicare |
$173.74
|
| Rate for Payer: Aetna Medicare |
$212.10
|
| Rate for Payer: Aetna Medicare |
$398.00
|
| Rate for Payer: Aetna Medicare |
$360.44
|
| Rate for Payer: Aetna Medicare |
$198.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,758.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.41
|
| Rate for Payer: BCBS Complete |
$124.54
|
| Rate for Payer: BCBS Complete |
$103.92
|
| Rate for Payer: BCBS Complete |
$192.70
|
| Rate for Payer: BCBS Complete |
$288.35
|
| Rate for Payer: BCBS Complete |
$1,697.73
|
| Rate for Payer: BCBS Complete |
$318.40
|
| Rate for Payer: BCBS Complete |
$163.26
|
| Rate for Payer: BCBS Complete |
$203.81
|
| Rate for Payer: BCBS Complete |
$138.99
|
| Rate for Payer: BCBS Complete |
$324.22
|
| Rate for Payer: BCBS Complete |
$169.68
|
| Rate for Payer: BCBS Complete |
$158.92
|
| Rate for Payer: BCBS Complete |
$318.30
|
| Rate for Payer: BCBS Trust/PPO |
$18.17
|
| Rate for Payer: BCBS Trust/PPO |
$18.17
|
| Rate for Payer: BCBS Trust/PPO |
$18.17
|
| Rate for Payer: BCBS Trust/PPO |
$18.17
|
| Rate for Payer: BCBS Trust/PPO |
$18.17
|
| Rate for Payer: BCBS Trust/PPO |
$18.17
|
| Rate for Payer: BCBS Trust/PPO |
$18.17
|
| Rate for Payer: BCBS Trust/PPO |
$18.17
|
| Rate for Payer: BCBS Trust/PPO |
$18.17
|
| Rate for Payer: BCBS Trust/PPO |
$18.17
|
| Rate for Payer: BCBS Trust/PPO |
$18.17
|
| Rate for Payer: BCBS Trust/PPO |
$18.17
|
| Rate for Payer: BCBS Trust/PPO |
$18.17
|
| Rate for Payer: BCN Commercial |
$18.17
|
| Rate for Payer: BCN Commercial |
$18.17
|
| Rate for Payer: BCN Commercial |
$18.17
|
| Rate for Payer: BCN Commercial |
$18.17
|
| Rate for Payer: BCN Commercial |
$18.17
|
| Rate for Payer: BCN Commercial |
$18.17
|
| Rate for Payer: BCN Commercial |
$18.17
|
| Rate for Payer: BCN Commercial |
$18.17
|
| Rate for Payer: BCN Commercial |
$18.17
|
| Rate for Payer: BCN Commercial |
$18.17
|
| Rate for Payer: BCN Commercial |
$18.17
|
| Rate for Payer: BCN Commercial |
$18.17
|
| Rate for Payer: BCN Commercial |
$18.17
|
| Rate for Payer: Cash Price |
$207.83
|
| Rate for Payer: Cash Price |
$385.39
|
| Rate for Payer: Cash Price |
$207.83
|
| Rate for Payer: Cash Price |
$277.98
|
| Rate for Payer: Cash Price |
$277.98
|
| Rate for Payer: Cash Price |
$249.08
|
| Rate for Payer: Cash Price |
$249.08
|
| Rate for Payer: Cash Price |
$648.43
|
| Rate for Payer: Cash Price |
$648.43
|
| Rate for Payer: Cash Price |
$636.81
|
| Rate for Payer: Cash Price |
$636.81
|
| Rate for Payer: Cash Price |
$317.83
|
| Rate for Payer: Cash Price |
$317.83
|
| Rate for Payer: Cash Price |
$636.59
|
| Rate for Payer: Cash Price |
$636.59
|
| Rate for Payer: Cash Price |
$326.53
|
| Rate for Payer: Cash Price |
$326.53
|
| Rate for Payer: Cash Price |
$576.70
|
| Rate for Payer: Cash Price |
$339.36
|
| Rate for Payer: Cash Price |
$339.36
|
| Rate for Payer: Cash Price |
$576.70
|
| Rate for Payer: Cash Price |
$3,395.46
|
| Rate for Payer: Cash Price |
$407.62
|
| Rate for Payer: Cash Price |
$3,395.46
|
| Rate for Payer: Cash Price |
$407.62
|
| Rate for Payer: Cash Price |
$385.39
|
| Rate for Payer: Cofinity Advantage |
$567.38
|
| Rate for Payer: Cofinity Advantage |
$504.61
|
| Rate for Payer: Cofinity Advantage |
$557.21
|
| Rate for Payer: Cofinity Advantage |
$557.02
|
| Rate for Payer: Cofinity Advantage |
$296.94
|
| Rate for Payer: Cofinity Advantage |
$243.24
|
| Rate for Payer: Cofinity Advantage |
$278.10
|
| Rate for Payer: Cofinity Advantage |
$356.67
|
| Rate for Payer: Cofinity Advantage |
$285.71
|
| Rate for Payer: Cofinity Advantage |
$217.94
|
| Rate for Payer: Cofinity Advantage |
$337.22
|
| Rate for Payer: Cofinity Advantage |
$181.85
|
| Rate for Payer: Cofinity Advantage |
$2,971.03
|
| Rate for Payer: Cofinity Commercial |
$684.34
|
| Rate for Payer: Cofinity Commercial |
$267.76
|
| Rate for Payer: Cofinity Commercial |
$223.42
|
| Rate for Payer: Cofinity Commercial |
$351.02
|
| Rate for Payer: Cofinity Commercial |
$341.67
|
| Rate for Payer: Cofinity Commercial |
$684.57
|
| Rate for Payer: Cofinity Commercial |
$364.81
|
| Rate for Payer: Cofinity Commercial |
$619.95
|
| Rate for Payer: Cofinity Commercial |
$414.30
|
| Rate for Payer: Cofinity Commercial |
$697.06
|
| Rate for Payer: Cofinity Commercial |
$438.20
|
| Rate for Payer: Cofinity Commercial |
$298.83
|
| Rate for Payer: Cofinity Commercial |
$3,650.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,395.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.98
|
| Rate for Payer: Healthscope Commercial |
$381.78
|
| Rate for Payer: Healthscope Commercial |
$648.78
|
| Rate for Payer: Healthscope Commercial |
$3,819.90
|
| Rate for Payer: Healthscope Commercial |
$367.34
|
| Rate for Payer: Healthscope Commercial |
$458.58
|
| Rate for Payer: Healthscope Commercial |
$233.81
|
| Rate for Payer: Healthscope Commercial |
$716.17
|
| Rate for Payer: Healthscope Commercial |
$280.21
|
| Rate for Payer: Healthscope Commercial |
$729.49
|
| Rate for Payer: Healthscope Commercial |
$312.73
|
| Rate for Payer: Healthscope Commercial |
$433.57
|
| Rate for Payer: Healthscope Commercial |
$716.41
|
| Rate for Payer: Healthscope Commercial |
$357.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$557.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$243.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$557.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$356.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$567.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,971.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$504.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,183.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$540.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$596.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$597.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$607.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$339.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,395.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$648.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$636.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$636.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$277.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$576.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$385.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$326.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$688.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,607.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$612.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$361.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,183.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$607.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$540.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$596.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$597.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.51
|
| Rate for Payer: PHP Commercial |
$676.61
|
| Rate for Payer: PHP Commercial |
$409.48
|
| Rate for Payer: PHP Commercial |
$676.38
|
| Rate for Payer: PHP Commercial |
$337.70
|
| Rate for Payer: PHP Commercial |
$220.82
|
| Rate for Payer: PHP Commercial |
$264.65
|
| Rate for Payer: PHP Commercial |
$433.10
|
| Rate for Payer: PHP Commercial |
$3,607.68
|
| Rate for Payer: PHP Commercial |
$688.96
|
| Rate for Payer: PHP Commercial |
$360.57
|
| Rate for Payer: PHP Commercial |
$295.36
|
| Rate for Payer: PHP Commercial |
$346.94
|
| Rate for Payer: PHP Commercial |
$612.74
|
| Rate for Payer: Priority Health SBD |
$501.32
|
| Rate for Payer: Priority Health SBD |
$218.91
|
| Rate for Payer: Priority Health SBD |
$2,673.93
|
| Rate for Payer: Priority Health SBD |
$267.25
|
| Rate for Payer: Priority Health SBD |
$454.15
|
| Rate for Payer: Priority Health SBD |
$303.50
|
| Rate for Payer: Priority Health SBD |
$257.14
|
| Rate for Payer: Priority Health SBD |
$196.15
|
| Rate for Payer: Priority Health SBD |
$250.29
|
| Rate for Payer: Priority Health SBD |
$163.67
|
| Rate for Payer: Priority Health SBD |
$501.49
|
| Rate for Payer: Priority Health SBD |
$510.64
|
| Rate for Payer: Priority Health SBD |
$321.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UMR Bronson Commercial |
$96.12
|
| Rate for Payer: UMR Bronson Commercial |
$299.90
|
| Rate for Payer: UMR Bronson Commercial |
$151.02
|
| Rate for Payer: UMR Bronson Commercial |
$178.24
|
| Rate for Payer: UMR Bronson Commercial |
$294.42
|
| Rate for Payer: UMR Bronson Commercial |
$128.57
|
| Rate for Payer: UMR Bronson Commercial |
$294.52
|
| Rate for Payer: UMR Bronson Commercial |
$156.95
|
| Rate for Payer: UMR Bronson Commercial |
$147.00
|
| Rate for Payer: UMR Bronson Commercial |
$266.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,570.40
|
| Rate for Payer: UMR Bronson Commercial |
$188.53
|
| Rate for Payer: UMR Bronson Commercial |
$115.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$596.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$597.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,183.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$607.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$540.65
|
|
|
FUROSEMIDE 10 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$25.47
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
163713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna American Axle |
$16.56
|
| Rate for Payer: Aetna American Axle |
$15.31
|
| Rate for Payer: Aetna American Axle |
$18.25
|
| Rate for Payer: Aetna American Axle |
$12.80
|
| Rate for Payer: Aetna Commercial |
$23.86
|
| Rate for Payer: Aetna Commercial |
$21.65
|
| Rate for Payer: Aetna Commercial |
$16.74
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.80
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$22.46
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cofinity Advantage |
$16.48
|
| Rate for Payer: Cofinity Advantage |
$13.78
|
| Rate for Payer: Cofinity Advantage |
$17.83
|
| Rate for Payer: Cofinity Advantage |
$19.65
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$16.93
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Healthscope Commercial |
$25.26
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Healthscope Commercial |
$17.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.77
|
| Rate for Payer: PHP Commercial |
$16.74
|
| Rate for Payer: PHP Commercial |
$21.65
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: PHP Commercial |
$23.86
|
| Rate for Payer: Priority Health SBD |
$17.68
|
| Rate for Payer: Priority Health SBD |
$12.40
|
| Rate for Payer: Priority Health SBD |
$16.05
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: UMR Bronson Commercial |
$10.36
|
| Rate for Payer: UMR Bronson Commercial |
$11.21
|
| Rate for Payer: UMR Bronson Commercial |
$8.66
|
| Rate for Payer: UMR Bronson Commercial |
$12.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.05
|
|
