|
ANTI-INHIBITOR COAGULANT COMPLEX 700 UNIT-1,300 UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$5.54
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
191213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: Aetna American Axle |
$3.60
|
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$4.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.60
|
| Rate for Payer: Priority Health SBD |
$3.49
|
| Rate for Payer: UMR Bronson Commercial |
$2.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
|
ANTI-INHIBITOR COAGULANT COMPLX 1,750 UNIT-3,250 UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$5.54
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
116307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: Aetna American Axle |
$3.60
|
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna Medicare |
$2.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.95
|
| Rate for Payer: BCBS Complete |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$2.36
|
| Rate for Payer: BCBS Trust/PPO |
$6.35
|
| Rate for Payer: BCN Commercial |
$6.35
|
| Rate for Payer: BCN Medicare Advantage |
$2.36
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.36
|
| Rate for Payer: Healthscope Commercial |
$4.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.16
|
| Rate for Payer: Mclaren Medicaid |
$1.26
|
| Rate for Payer: Mclaren Medicare |
$2.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.48
|
| Rate for Payer: Meridian Medicaid |
$1.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: Nomi Health Commercial |
$7.08
|
| Rate for Payer: PACE Medicare |
$2.24
|
| Rate for Payer: PACE SWMI |
$2.36
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: PHP Medicare Advantage |
$2.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.75
|
| Rate for Payer: Priority Health Medicare |
$2.36
|
| Rate for Payer: Priority Health Narrow Network |
$5.40
|
| Rate for Payer: Priority Health SBD |
$3.49
|
| Rate for Payer: Railroad Medicare Medicare |
$2.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.36
|
| Rate for Payer: UHC Exchange |
$4.51
|
| Rate for Payer: UHC Medicare Advantage |
$2.36
|
| Rate for Payer: UHCCP Medicaid |
$1.26
|
| Rate for Payer: UMR Bronson Commercial |
$2.05
|
| Rate for Payer: VA VA |
$2.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
|
ANTI-INHIBITOR COAGULANT COMPLX 1,750 UNIT-3,250 UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$5.54
|
|
|
Service Code
|
HCPCS J7198
|
| Hospital Charge Code |
116307
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: Aetna American Axle |
$3.60
|
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$4.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.60
|
| Rate for Payer: Priority Health SBD |
$3.49
|
| Rate for Payer: UMR Bronson Commercial |
$2.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
|
ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$10.72
|
|
|
Service Code
|
HCPCS J7197
|
| Hospital Charge Code |
9116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna American Axle |
$6.97
|
| Rate for Payer: Aetna Commercial |
$9.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.97
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cofinity Commercial |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$9.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.58
|
| Rate for Payer: Healthscope Commercial |
$9.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.11
|
| Rate for Payer: PHP Commercial |
$9.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.97
|
| Rate for Payer: Priority Health SBD |
$6.75
|
| Rate for Payer: UMR Bronson Commercial |
$4.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.04
|
|
|
ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$10.72
|
|
|
Service Code
|
HCPCS J7197
|
| Hospital Charge Code |
9116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Aetna American Axle |
$6.97
|
| Rate for Payer: Aetna Commercial |
$9.11
|
| Rate for Payer: Aetna Medicare |
$4.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.95
|
| Rate for Payer: BCBS Complete |
$2.23
|
| Rate for Payer: BCBS MAPPO |
$3.96
|
| Rate for Payer: BCBS Trust/PPO |
$10.37
|
| Rate for Payer: BCN Commercial |
$10.37
|
| Rate for Payer: BCN Medicare Advantage |
$3.96
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cofinity Commercial |
$9.22
|
| Rate for Payer: Cofinity Commercial |
$7.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.96
|
| Rate for Payer: Healthscope Commercial |
$9.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.04
|
| Rate for Payer: Mclaren Medicaid |
$2.12
|
| Rate for Payer: Mclaren Medicare |
$3.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.16
|
| Rate for Payer: Meridian Medicaid |
$2.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.11
|
| Rate for Payer: Nomi Health Commercial |
$11.88
|
| Rate for Payer: PACE Medicare |
$3.76
|
| Rate for Payer: PACE SWMI |
$3.96
|
| Rate for Payer: PHP Commercial |
$9.11
|
| Rate for Payer: PHP Medicare Advantage |
$3.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.09
|
| Rate for Payer: Priority Health Medicare |
$3.96
|
| Rate for Payer: Priority Health Narrow Network |
$8.87
|
| Rate for Payer: Priority Health SBD |
$6.75
|
| Rate for Payer: Railroad Medicare Medicare |
$3.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.96
|
| Rate for Payer: UHC Exchange |
$7.57
|
| Rate for Payer: UHC Medicare Advantage |
$3.96
|
| Rate for Payer: UHCCP Medicaid |
$2.12
|
| Rate for Payer: UMR Bronson Commercial |
$3.97
|
| Rate for Payer: VA VA |
$3.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.04
|
|
|
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$4,142.04
|
|
|
Service Code
|
HCPCS J7511
|
| Hospital Charge Code |
24585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$509.34 |
| Max. Negotiated Rate |
$3,727.84 |
| Rate for Payer: Aetna American Axle |
$2,692.33
|
| Rate for Payer: Aetna Commercial |
$3,520.73
|
| Rate for Payer: Aetna Medicare |
$988.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,692.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,187.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,187.82
|
| Rate for Payer: BCBS Complete |
$534.81
|
| Rate for Payer: BCBS MAPPO |
$950.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,579.68
|
| Rate for Payer: BCN Commercial |
$2,579.68
|
| Rate for Payer: BCN Medicare Advantage |
$950.26
|
| Rate for Payer: Cash Price |
$3,313.63
|
| Rate for Payer: Cash Price |
$3,313.63
|
| Rate for Payer: Cofinity Commercial |
$3,562.15
|
| Rate for Payer: Cofinity Commercial |
$2,899.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,899.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,313.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$950.26
|
| Rate for Payer: Healthscope Commercial |
$3,727.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,899.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,106.53
|
| Rate for Payer: Mclaren Medicaid |
$509.34
|
| Rate for Payer: Mclaren Medicare |
$950.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$997.77
|
| Rate for Payer: Meridian Medicaid |
$534.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,092.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,520.73
|
| Rate for Payer: Nomi Health Commercial |
$2,850.78
|
| Rate for Payer: PACE Medicare |
$902.75
|
| Rate for Payer: PACE SWMI |
$950.26
|
| Rate for Payer: PHP Commercial |
$3,520.73
|
| Rate for Payer: PHP Medicare Advantage |
$950.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$509.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,692.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,753.51
|
| Rate for Payer: Priority Health Medicare |
$950.26
|
| Rate for Payer: Priority Health Narrow Network |
$2,202.81
|
| Rate for Payer: Priority Health SBD |
$2,609.49
|
| Rate for Payer: Railroad Medicare Medicare |
$950.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,674.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$950.26
|
| Rate for Payer: UHC Exchange |
$1,816.04
|
| Rate for Payer: UHC Medicare Advantage |
$950.26
|
| Rate for Payer: UHCCP Medicaid |
$509.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,532.55
|
| Rate for Payer: VA VA |
$950.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,106.53
|
|
|
ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$4,142.04
|
|
|
Service Code
|
HCPCS J7511
|
| Hospital Charge Code |
24585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,822.50 |
| Max. Negotiated Rate |
$3,727.84 |
| Rate for Payer: Cofinity Commercial |
$2,899.43
|
| Rate for Payer: Cofinity Commercial |
$3,562.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,899.43
|
| Rate for Payer: Aetna American Axle |
$2,692.33
|
| Rate for Payer: Aetna Commercial |
$3,520.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,692.33
|
| Rate for Payer: Cash Price |
$3,313.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,313.63
|
| Rate for Payer: Healthscope Commercial |
$3,727.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,899.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,106.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,520.73
|
| Rate for Payer: PHP Commercial |
$3,520.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,692.33
|
| Rate for Payer: Priority Health SBD |
$2,609.49
|
| Rate for Payer: UMR Bronson Commercial |
$1,822.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,106.53
|
|
|
ANTI-THYMO IMMUNE GLOBULIN (ATGAM) 5 MCG/0.1 ML TEST DOSE
|
Facility
|
OP
|
$22.54
|
|
|
Service Code
|
HCPCS J7504
|
| Hospital Charge Code |
169802
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$13,067.19 |
| Rate for Payer: Aetna American Axle |
$14.65
|
| Rate for Payer: Aetna Commercial |
$19.16
|
| Rate for Payer: Aetna Medicare |
$4,529.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,444.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,444.66
|
| Rate for Payer: BCBS Complete |
$2,451.40
|
| Rate for Payer: BCBS MAPPO |
$4,355.73
|
| Rate for Payer: BCBS Trust/PPO |
$11,744.49
|
| Rate for Payer: BCN Commercial |
$11,744.49
|
| Rate for Payer: BCN Medicare Advantage |
$4,355.73
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cofinity Commercial |
$19.38
|
| Rate for Payer: Cofinity Commercial |
$15.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,355.73
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.90
|
| Rate for Payer: Mclaren Medicaid |
$2,334.67
|
| Rate for Payer: Mclaren Medicare |
$4,355.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,573.52
|
| Rate for Payer: Meridian Medicaid |
$2,451.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,009.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.16
|
| Rate for Payer: Nomi Health Commercial |
$13,067.19
|
| Rate for Payer: PACE Medicare |
$4,137.94
|
| Rate for Payer: PACE SWMI |
$4,355.73
|
| Rate for Payer: PHP Commercial |
$19.16
|
| Rate for Payer: PHP Medicare Advantage |
$4,355.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,334.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,421.27
|
| Rate for Payer: Priority Health Medicare |
$4,355.73
|
| Rate for Payer: Priority Health Narrow Network |
$9,137.02
|
| Rate for Payer: Priority Health SBD |
$14.20
|
| Rate for Payer: Railroad Medicare Medicare |
$4,355.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,260.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,355.73
|
| Rate for Payer: UHC Exchange |
$8,324.24
|
| Rate for Payer: UHC Medicare Advantage |
$4,355.73
|
| Rate for Payer: UHCCP Medicaid |
$2,334.67
|
| Rate for Payer: UMR Bronson Commercial |
$8.34
|
| Rate for Payer: VA VA |
$4,355.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.90
|
|
|
ANTI-THYMO IMMUNE GLOBULIN (ATGAM) 5 MCG/0.1 ML TEST DOSE
|
Facility
|
IP
|
$22.54
|
|
|
Service Code
|
HCPCS J7504
|
| Hospital Charge Code |
169802
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$20.29 |
| Rate for Payer: Aetna American Axle |
$14.65
|
| Rate for Payer: Aetna Commercial |
$19.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.65
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cofinity Commercial |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$19.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.03
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.16
|
| Rate for Payer: PHP Commercial |
$19.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.65
|
| Rate for Payer: Priority Health SBD |
$14.20
|
| Rate for Payer: UMR Bronson Commercial |
$9.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.90
|
|
|
ANTIVENIN CROTALIDAE (EQUINE) SOLUTION FOR INJECTION
|
Facility
|
IP
|
$3,775.65
|
|
|
Service Code
|
HCPCS J0841
|
| Hospital Charge Code |
188592
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,661.29 |
| Max. Negotiated Rate |
$3,398.08 |
| Rate for Payer: Aetna American Axle |
$2,454.17
|
| Rate for Payer: Aetna Commercial |
$3,209.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,454.17
|
| Rate for Payer: Cash Price |
$3,020.52
|
| Rate for Payer: Cofinity Commercial |
$2,642.96
|
| Rate for Payer: Cofinity Commercial |
$3,247.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,642.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,020.52
|
| Rate for Payer: Healthscope Commercial |
$3,398.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,642.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,831.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,209.30
|
| Rate for Payer: PHP Commercial |
$3,209.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,454.17
|
| Rate for Payer: Priority Health SBD |
$2,378.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,661.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,831.74
|
|
|
ANTIVENIN CROTALIDAE (EQUINE) SOLUTION FOR INJECTION
|
Facility
|
OP
|
$3,775.65
|
|
|
Service Code
|
HCPCS J0841
|
| Hospital Charge Code |
188592
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$550.56 |
| Max. Negotiated Rate |
$3,398.08 |
| Rate for Payer: Aetna American Axle |
$2,454.17
|
| Rate for Payer: Aetna Commercial |
$3,209.30
|
| Rate for Payer: Aetna Medicare |
$1,068.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,454.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,283.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,283.96
|
| Rate for Payer: BCBS Complete |
$578.09
|
| Rate for Payer: BCBS MAPPO |
$1,027.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,804.47
|
| Rate for Payer: BCN Commercial |
$2,804.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,027.17
|
| Rate for Payer: Cash Price |
$3,020.52
|
| Rate for Payer: Cash Price |
$3,020.52
|
| Rate for Payer: Cofinity Commercial |
$3,247.06
|
| Rate for Payer: Cofinity Commercial |
$2,642.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,642.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,020.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,027.17
|
| Rate for Payer: Healthscope Commercial |
$3,398.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,642.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,831.74
|
| Rate for Payer: Mclaren Medicaid |
$550.56
|
| Rate for Payer: Mclaren Medicare |
$1,027.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,078.53
|
| Rate for Payer: Meridian Medicaid |
$578.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,181.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,209.30
|
| Rate for Payer: Nomi Health Commercial |
$3,081.51
|
| Rate for Payer: PACE Medicare |
$975.81
|
| Rate for Payer: PACE SWMI |
$1,027.17
|
| Rate for Payer: PHP Commercial |
$3,209.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,027.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$550.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,454.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,993.46
|
| Rate for Payer: Priority Health Medicare |
$1,027.17
|
| Rate for Payer: Priority Health Narrow Network |
$2,394.77
|
| Rate for Payer: Priority Health SBD |
$2,378.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1,027.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,891.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,027.17
|
| Rate for Payer: UHC Exchange |
$1,963.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,027.17
|
| Rate for Payer: UHCCP Medicaid |
$550.56
|
| Rate for Payer: UMR Bronson Commercial |
$1,396.99
|
| Rate for Payer: VA VA |
$1,027.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,831.74
|
|
|
ANTIVENIN LATRODECTUS MACTANS 6,000 UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$123.31
|
|
|
Service Code
|
NDC 00006542402
|
| Hospital Charge Code |
24188
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.26 |
| Max. Negotiated Rate |
$110.98 |
| Rate for Payer: Aetna American Axle |
$80.15
|
| Rate for Payer: Aetna Commercial |
$104.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.15
|
| Rate for Payer: Cash Price |
$98.65
|
| Rate for Payer: Cofinity Commercial |
$106.05
|
| Rate for Payer: Cofinity Commercial |
$86.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.65
|
| Rate for Payer: Healthscope Commercial |
$110.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.81
|
| Rate for Payer: PHP Commercial |
$104.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.15
|
| Rate for Payer: Priority Health SBD |
$77.69
|
| Rate for Payer: UMR Bronson Commercial |
$54.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.48
|
|
|
ANTIVENIN LATRODECTUS MACTANS 6,000 UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$123.31
|
|
|
Service Code
|
NDC 00006542402
|
| Hospital Charge Code |
24188
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.62 |
| Max. Negotiated Rate |
$110.98 |
| Rate for Payer: Aetna American Axle |
$80.15
|
| Rate for Payer: Aetna Commercial |
$104.81
|
| Rate for Payer: Aetna Medicare |
$61.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.15
|
| Rate for Payer: BCBS Complete |
$49.32
|
| Rate for Payer: Cash Price |
$98.65
|
| Rate for Payer: Cofinity Commercial |
$106.05
|
| Rate for Payer: Cofinity Commercial |
$86.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.65
|
| Rate for Payer: Healthscope Commercial |
$110.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.81
|
| Rate for Payer: PHP Commercial |
$104.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.15
|
| Rate for Payer: Priority Health SBD |
$77.69
|
| Rate for Payer: UMR Bronson Commercial |
$45.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.48
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
|
OP
|
$421.35
|
|
|
Service Code
|
NDC 00003089321
|
| Hospital Charge Code |
163984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.90 |
| Max. Negotiated Rate |
$379.22 |
| Rate for Payer: Aetna American Axle |
$273.88
|
| Rate for Payer: Aetna Commercial |
$358.15
|
| Rate for Payer: Aetna Medicare |
$210.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.88
|
| Rate for Payer: BCBS Complete |
$168.54
|
| Rate for Payer: Cash Price |
$337.08
|
| Rate for Payer: Cofinity Commercial |
$294.94
|
| Rate for Payer: Cofinity Commercial |
$362.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.08
|
| Rate for Payer: Healthscope Commercial |
$379.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.15
|
| Rate for Payer: PHP Commercial |
$358.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.88
|
| Rate for Payer: Priority Health SBD |
$265.45
|
| Rate for Payer: UMR Bronson Commercial |
$155.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.01
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
|
OP
|
$702.24
|
|
|
Service Code
|
NDC 00003089331
|
| Hospital Charge Code |
163984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.83 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna American Axle |
$456.46
|
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna Medicare |
$351.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: BCBS Complete |
$280.90
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$491.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$491.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.46
|
| Rate for Payer: Priority Health SBD |
$442.41
|
| Rate for Payer: UMR Bronson Commercial |
$259.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.68
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
|
IP
|
$421.35
|
|
|
Service Code
|
NDC 00003089321
|
| Hospital Charge Code |
163984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.39 |
| Max. Negotiated Rate |
$379.22 |
| Rate for Payer: Aetna American Axle |
$273.88
|
| Rate for Payer: Aetna Commercial |
$358.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.88
|
| Rate for Payer: Cash Price |
$337.08
|
| Rate for Payer: Cofinity Commercial |
$294.94
|
| Rate for Payer: Cofinity Commercial |
$362.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.08
|
| Rate for Payer: Healthscope Commercial |
$379.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.15
|
| Rate for Payer: PHP Commercial |
$358.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.88
|
| Rate for Payer: Priority Health SBD |
$265.45
|
| Rate for Payer: UMR Bronson Commercial |
$185.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.01
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
|
IP
|
$702.24
|
|
|
Service Code
|
NDC 00003089331
|
| Hospital Charge Code |
163984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$308.99 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna American Axle |
$456.46
|
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$491.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$491.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.46
|
| Rate for Payer: Priority Health SBD |
$442.41
|
| Rate for Payer: UMR Bronson Commercial |
$308.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.68
|
|
|
APIXABAN 5 MG TABLET
|
Facility
|
IP
|
$702.24
|
|
|
Service Code
|
NDC 00003089431
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$308.99 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna American Axle |
$456.46
|
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$491.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$491.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.46
|
| Rate for Payer: Priority Health SBD |
$442.41
|
| Rate for Payer: UMR Bronson Commercial |
$308.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.68
|
|
|
APIXABAN 5 MG TABLET
|
Facility
|
OP
|
$702.24
|
|
|
Service Code
|
NDC 00003089431
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.83 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna American Axle |
$456.46
|
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna Medicare |
$351.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: BCBS Complete |
$280.90
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$491.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$491.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.46
|
| Rate for Payer: Priority Health SBD |
$442.41
|
| Rate for Payer: UMR Bronson Commercial |
$259.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.68
|
|
|
APIXABAN 5 MG TABLET
|
Facility
|
OP
|
$421.35
|
|
|
Service Code
|
NDC 00003089421
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.90 |
| Max. Negotiated Rate |
$379.22 |
| Rate for Payer: Aetna American Axle |
$273.88
|
| Rate for Payer: Aetna Commercial |
$358.15
|
| Rate for Payer: Aetna Medicare |
$210.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.88
|
| Rate for Payer: BCBS Complete |
$168.54
|
| Rate for Payer: Cash Price |
$337.08
|
| Rate for Payer: Cofinity Commercial |
$294.94
|
| Rate for Payer: Cofinity Commercial |
$362.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.08
|
| Rate for Payer: Healthscope Commercial |
$379.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.15
|
| Rate for Payer: PHP Commercial |
$358.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.88
|
| Rate for Payer: Priority Health SBD |
$265.45
|
| Rate for Payer: UMR Bronson Commercial |
$155.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.01
|
|
|
APIXABAN 5 MG TABLET
|
Facility
|
IP
|
$421.35
|
|
|
Service Code
|
NDC 00003089421
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.39 |
| Max. Negotiated Rate |
$379.22 |
| Rate for Payer: Aetna American Axle |
$273.88
|
| Rate for Payer: Aetna Commercial |
$358.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.88
|
| Rate for Payer: Cash Price |
$337.08
|
| Rate for Payer: Cofinity Commercial |
$294.94
|
| Rate for Payer: Cofinity Commercial |
$362.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.08
|
| Rate for Payer: Healthscope Commercial |
$379.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.15
|
| Rate for Payer: PHP Commercial |
$358.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.88
|
| Rate for Payer: Priority Health SBD |
$265.45
|
| Rate for Payer: UMR Bronson Commercial |
$185.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.01
|
|
|
APPENDECTOMY; WHEN DONE FOR INDICATED PURPOSE AT TIME OF OTHER MAJOR PROCEDURE (NOT AS SEPARATE PROCEDURE) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 44955
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$81.35 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$308.28
|
| Rate for Payer: BCN Commercial |
$308.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.48
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$81.35
|
|
|
APPLICATION OF A MULTIPLANE (PINS OR WIRES IN MORE THAN 1 PLANE), UNILATERAL, EXTERNAL FIXATION SYSTEM (EG, ILIZAROV, MONTICELLI TYPE)
|
Facility
|
OP
|
$39,622.51
|
|
|
Service Code
|
CPT 20692
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.03 |
| Max. Negotiated Rate |
$39,622.51 |
| Rate for Payer: Aetna Medicare |
$13,110.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,758.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,758.31
|
| Rate for Payer: BCBS Complete |
$7,095.02
|
| Rate for Payer: BCBS MAPPO |
$12,606.65
|
| Rate for Payer: BCBS Trust/PPO |
$10,032.17
|
| Rate for Payer: BCN Commercial |
$10,032.17
|
| Rate for Payer: BCN Medicare Advantage |
$12,606.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,606.65
|
| Rate for Payer: Mclaren Medicaid |
$6,757.16
|
| Rate for Payer: Mclaren Medicare |
$12,606.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,236.98
|
| Rate for Payer: Meridian Medicaid |
$7,095.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,497.65
|
| Rate for Payer: Nomi Health Commercial |
$26,473.96
|
| Rate for Payer: PACE Medicare |
$11,976.32
|
| Rate for Payer: PACE SWMI |
$12,606.65
|
| Rate for Payer: PHP Medicare Advantage |
$12,606.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,757.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39,622.51
|
| Rate for Payer: Priority Health Medicare |
$12,606.65
|
| Rate for Payer: Priority Health Narrow Network |
$31,698.01
|
| Rate for Payer: Railroad Medicare Medicare |
$12,606.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,197.93
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,606.65
|
| Rate for Payer: UHC Exchange |
$1,089.03
|
| Rate for Payer: UHC Medicare Advantage |
$12,606.65
|
| Rate for Payer: UHCCP Medicaid |
$6,757.16
|
| Rate for Payer: VA VA |
$12,606.65
|
|
|
APPLICATION OF A UNIPLANE (PINS OR WIRES IN 1 PLANE), UNILATERAL, EXTERNAL FIXATION SYSTEM
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 20690
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$578.48 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,126.82
|
| Rate for Payer: BCN Commercial |
$4,126.82
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$636.33
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$578.48
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 29105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.99 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$160.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$193.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$193.25
|
| Rate for Payer: BCBS Complete |
$87.01
|
| Rate for Payer: BCBS MAPPO |
$154.60
|
| Rate for Payer: BCBS Trust/PPO |
$123.88
|
| Rate for Payer: BCN Commercial |
$123.88
|
| Rate for Payer: BCN Medicare Advantage |
$154.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.60
|
| Rate for Payer: Mclaren Medicaid |
$82.87
|
| Rate for Payer: Mclaren Medicare |
$154.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.33
|
| Rate for Payer: Meridian Medicaid |
$87.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.79
|
| Rate for Payer: Nomi Health Commercial |
$324.66
|
| Rate for Payer: PACE Medicare |
$146.87
|
| Rate for Payer: PACE SWMI |
$154.60
|
| Rate for Payer: PHP Medicare Advantage |
$154.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$485.91
|
| Rate for Payer: Priority Health Medicare |
$154.60
|
| Rate for Payer: Priority Health Narrow Network |
$388.73
|
| Rate for Payer: Railroad Medicare Medicare |
$154.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.09
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.60
|
| Rate for Payer: UHC Exchange |
$40.99
|
| Rate for Payer: UHC Medicare Advantage |
$154.60
|
| Rate for Payer: UHCCP Medicaid |
$82.87
|
| Rate for Payer: VA VA |
$154.60
|
|
