|
INSERTION OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER, INCLUDING PLACEMENT OF PUMP, RESERVOIR, AND CUFF
|
Facility
|
OP
|
$56,445.28
|
|
|
Service Code
|
CPT 53445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$741.98 |
| Max. Negotiated Rate |
$56,445.28 |
| Rate for Payer: Aetna Medicare |
$18,647.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,412.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,412.82
|
| Rate for Payer: BCBS Complete |
$10,299.14
|
| Rate for Payer: BCBS MAPPO |
$17,930.26
|
| Rate for Payer: BCBS Trust/PPO |
$16,103.99
|
| Rate for Payer: BCN Medicare Advantage |
$17,930.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,930.26
|
| Rate for Payer: Mclaren Medicaid |
$9,807.85
|
| Rate for Payer: Mclaren Medicare |
$17,930.26
|
| Rate for Payer: Meridian Medicaid |
$10,299.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,826.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,619.80
|
| Rate for Payer: PACE Medicare |
$17,033.75
|
| Rate for Payer: PACE SWMI |
$17,930.26
|
| Rate for Payer: PHP Medicare Advantage |
$17,930.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,807.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56,445.28
|
| Rate for Payer: Priority Health Medicare |
$17,930.26
|
| Rate for Payer: Priority Health Narrow Network |
$45,156.22
|
| Rate for Payer: Railroad Medicare Medicare |
$17,930.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$816.18
|
| Rate for Payer: UHC Core |
$18,337.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,930.26
|
| Rate for Payer: UHC Exchange |
$741.98
|
| Rate for Payer: UHC Medicare Advantage |
$18,468.17
|
| Rate for Payer: VA VA |
$17,930.26
|
|
|
INSERTION OF INTERBODY BIOMECHANICAL DEVICE(S) (EG, SYNTHETIC CAGE, MESH) WITH INTEGRAL ANTERIOR INSTRUMENTATION FOR DEVICE ANCHORING (EG, SCREWS, FLANGES), WHEN PERFORMED, TO INTERVERTEBRAL DISC SPACE IN CONJUNCTION WITH INTERBODY ARTHRODESIS, EACH INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$920.37
|
|
|
Service Code
|
CPT 22853
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$252.13 |
| Max. Negotiated Rate |
$920.37 |
| Rate for Payer: BCBS Trust/PPO |
$920.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.34
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$252.13
|
|
|
INSERTION OF INTRAUTERINE DEVICE (IUD)
|
Facility
|
OP
|
$722.81
|
|
|
Service Code
|
CPT 58300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$49.12 |
| Max. Negotiated Rate |
$722.81 |
| Rate for Payer: BCBS Trust/PPO |
$722.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.35
|
| Rate for Payer: Priority Health Narrow Network |
$117.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.03
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$49.12
|
|
|
INSERTION OF INTRAVASCULAR VENA CAVA FILTER, ENDOVASCULAR APPROACH INCLUDING VASCULAR ACCESS, VESSEL SELECTION, AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, INTRAPROCEDURAL ROADMAPPING, AND IMAGING GUIDANCE (ULTRASOUND AND FLUOROSCOPY), WHEN PERFORMED
|
Facility
|
OP
|
$15,377.24
|
|
|
Service Code
|
CPT 37191
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$210.22 |
| Max. Negotiated Rate |
$15,377.24 |
| Rate for Payer: Aetna Medicare |
$5,080.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,105.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,105.86
|
| Rate for Payer: BCBS Complete |
$2,805.77
|
| Rate for Payer: BCBS MAPPO |
$4,884.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,925.98
|
| Rate for Payer: BCN Medicare Advantage |
$4,884.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,884.69
|
| Rate for Payer: Mclaren Medicaid |
$2,671.93
|
| Rate for Payer: Mclaren Medicare |
$4,884.69
|
| Rate for Payer: Meridian Medicaid |
$2,805.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,128.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,617.39
|
| Rate for Payer: PACE Medicare |
$4,640.46
|
| Rate for Payer: PACE SWMI |
$4,884.69
|
| Rate for Payer: PHP Medicare Advantage |
$4,884.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,671.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,377.24
|
| Rate for Payer: Priority Health Medicare |
$4,884.69
|
| Rate for Payer: Priority Health Narrow Network |
$12,301.79
|
| Rate for Payer: Railroad Medicare Medicare |
$4,884.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.24
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,884.69
|
| Rate for Payer: UHC Exchange |
$210.22
|
| Rate for Payer: UHC Medicare Advantage |
$5,031.23
|
| Rate for Payer: VA VA |
$4,884.69
|
|
|
INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$8,919.33
|
|
|
Service Code
|
CPT 36556
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$81.53 |
| Max. Negotiated Rate |
$8,919.33 |
| Rate for Payer: Aetna Medicare |
$2,946.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$3,185.71
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,919.33
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$7,135.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.68
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,833.29
|
| Rate for Payer: UHC Exchange |
$81.53
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
INSERTION OF PENILE PROSTHESIS; NON-INFLATABLE (SEMI-RIGID)
|
Facility
|
OP
|
$35,920.42
|
|
|
Service Code
|
CPT 54400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$522.60 |
| Max. Negotiated Rate |
$35,920.42 |
| Rate for Payer: Aetna Medicare |
$11,866.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,262.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,262.99
|
| Rate for Payer: BCBS Complete |
$6,554.13
|
| Rate for Payer: BCBS MAPPO |
$11,410.39
|
| Rate for Payer: BCBS Trust/PPO |
$10,034.66
|
| Rate for Payer: BCN Medicare Advantage |
$11,410.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,410.39
|
| Rate for Payer: Mclaren Medicaid |
$6,241.48
|
| Rate for Payer: Mclaren Medicare |
$11,410.39
|
| Rate for Payer: Meridian Medicaid |
$6,554.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,980.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,121.95
|
| Rate for Payer: PACE Medicare |
$10,839.87
|
| Rate for Payer: PACE SWMI |
$11,410.39
|
| Rate for Payer: PHP Medicare Advantage |
$11,410.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,241.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35,920.42
|
| Rate for Payer: Priority Health Medicare |
$11,410.39
|
| Rate for Payer: Priority Health Narrow Network |
$28,736.34
|
| Rate for Payer: Railroad Medicare Medicare |
$11,410.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$574.86
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,410.39
|
| Rate for Payer: UHC Exchange |
$522.60
|
| Rate for Payer: UHC Medicare Advantage |
$11,752.70
|
| Rate for Payer: VA VA |
$11,410.39
|
|
|
INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$8,919.33
|
|
|
Service Code
|
CPT 36571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$304.19 |
| Max. Negotiated Rate |
$8,919.33 |
| Rate for Payer: Aetna Medicare |
$2,946.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,814.56
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,919.33
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$7,135.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$334.61
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,833.29
|
| Rate for Payer: UHC Exchange |
$304.19
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC), WITHOUT SUBCUTANEOUS PORT OR PUMP, WITHOUT IMAGING GUIDANCE; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$4,481.48
|
|
|
Service Code
|
CPT 36569
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$91.36 |
| Max. Negotiated Rate |
$4,481.48 |
| Rate for Payer: Aetna Medicare |
$1,480.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,779.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,779.46
|
| Rate for Payer: BCBS Complete |
$817.70
|
| Rate for Payer: BCBS MAPPO |
$1,423.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,062.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,423.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,423.57
|
| Rate for Payer: Mclaren Medicaid |
$778.69
|
| Rate for Payer: Mclaren Medicare |
$1,423.57
|
| Rate for Payer: Meridian Medicaid |
$817.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,494.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,637.11
|
| Rate for Payer: PACE Medicare |
$1,352.39
|
| Rate for Payer: PACE SWMI |
$1,423.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,423.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$778.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,481.48
|
| Rate for Payer: Priority Health Medicare |
$1,423.57
|
| Rate for Payer: Priority Health Narrow Network |
$3,585.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,423.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.50
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,423.57
|
| Rate for Payer: UHC Exchange |
$91.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,466.28
|
| Rate for Payer: VA VA |
$1,423.57
|
|
|
INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; SIMPLE (EG, FOLEY)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 51702
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$118.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.94
|
| Rate for Payer: BCBS Complete |
$65.22
|
| Rate for Payer: BCBS MAPPO |
$113.55
|
| Rate for Payer: BCBS Trust/PPO |
$242.13
|
| Rate for Payer: BCN Medicare Advantage |
$113.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.55
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Mclaren Medicare |
$113.55
|
| Rate for Payer: Meridian Medicaid |
$65.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.58
|
| Rate for Payer: PACE Medicare |
$107.87
|
| Rate for Payer: PACE SWMI |
$113.55
|
| Rate for Payer: PHP Medicare Advantage |
$113.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.43
|
| Rate for Payer: Priority Health Medicare |
$113.55
|
| Rate for Payer: Priority Health Narrow Network |
$285.94
|
| Rate for Payer: Railroad Medicare Medicare |
$113.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.02
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.55
|
| Rate for Payer: UHC Exchange |
$24.56
|
| Rate for Payer: UHC Medicare Advantage |
$116.96
|
| Rate for Payer: VA VA |
$113.55
|
|
|
INSERTION OF TESTICULAR PROSTHESIS (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$14,479.04
|
|
|
Service Code
|
CPT 54660
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$353.96 |
| Max. Negotiated Rate |
$14,479.04 |
| Rate for Payer: Aetna Medicare |
$4,783.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,749.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,749.21
|
| Rate for Payer: BCBS Complete |
$2,641.88
|
| Rate for Payer: BCBS MAPPO |
$4,599.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,584.37
|
| Rate for Payer: BCN Medicare Advantage |
$4,599.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,599.37
|
| Rate for Payer: Mclaren Medicaid |
$2,515.86
|
| Rate for Payer: Mclaren Medicare |
$4,599.37
|
| Rate for Payer: Meridian Medicaid |
$2,641.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,829.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,289.28
|
| Rate for Payer: PACE Medicare |
$4,369.40
|
| Rate for Payer: PACE SWMI |
$4,599.37
|
| Rate for Payer: PHP Medicare Advantage |
$4,599.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,515.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,479.04
|
| Rate for Payer: Priority Health Medicare |
$4,599.37
|
| Rate for Payer: Priority Health Narrow Network |
$11,583.23
|
| Rate for Payer: Railroad Medicare Medicare |
$4,599.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.36
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,599.37
|
| Rate for Payer: UHC Exchange |
$353.96
|
| Rate for Payer: UHC Medicare Advantage |
$4,737.35
|
| Rate for Payer: VA VA |
$4,599.37
|
|
|
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$8,919.33
|
|
|
Service Code
|
CPT 36561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$321.22 |
| Max. Negotiated Rate |
$8,919.33 |
| Rate for Payer: Aetna Medicare |
$2,946.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,441.65
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,919.33
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$7,135.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.34
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,833.29
|
| Rate for Payer: UHC Exchange |
$321.22
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; YOUNGER THAN 5 YEARS OF AGE
|
Facility
|
OP
|
$8,919.33
|
|
|
Service Code
|
CPT 36560
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$375.58 |
| Max. Negotiated Rate |
$8,919.33 |
| Rate for Payer: Aetna Medicare |
$2,946.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,894.36
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,919.33
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$7,135.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$413.14
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,833.29
|
| Rate for Payer: UHC Exchange |
$375.58
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$8,919.33
|
|
|
Service Code
|
CPT 36558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$249.84 |
| Max. Negotiated Rate |
$8,919.33 |
| Rate for Payer: Aetna Medicare |
$2,946.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,105.82
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,919.33
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$7,135.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.82
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,833.29
|
| Rate for Payer: UHC Exchange |
$249.84
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
INSERTION OF TUNNELED INTRAPERITONEAL CATHETER FOR DIALYSIS, OPEN
|
Facility
|
OP
|
$9,680.93
|
|
|
Service Code
|
CPT 49421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$220.37 |
| Max. Negotiated Rate |
$9,680.93 |
| Rate for Payer: Aetna Medicare |
$3,198.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,844.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,844.02
|
| Rate for Payer: BCBS Complete |
$1,766.41
|
| Rate for Payer: BCBS MAPPO |
$3,075.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,519.12
|
| Rate for Payer: BCN Medicare Advantage |
$3,075.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,075.22
|
| Rate for Payer: Mclaren Medicaid |
$1,682.15
|
| Rate for Payer: Mclaren Medicare |
$3,075.22
|
| Rate for Payer: Meridian Medicaid |
$1,766.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,228.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,536.50
|
| Rate for Payer: PACE Medicare |
$2,921.46
|
| Rate for Payer: PACE SWMI |
$3,075.22
|
| Rate for Payer: PHP Medicare Advantage |
$3,075.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,682.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,680.93
|
| Rate for Payer: Priority Health Medicare |
$3,075.22
|
| Rate for Payer: Priority Health Narrow Network |
$7,744.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,075.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.41
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,075.22
|
| Rate for Payer: UHC Exchange |
$220.37
|
| Rate for Payer: UHC Medicare Advantage |
$3,167.48
|
| Rate for Payer: VA VA |
$3,075.22
|
|
|
INSERTION OR REPLACEMENT OF BREAST IMPLANT ON SEPARATE DAY FROM MASTECTOMY
|
Facility
|
OP
|
$26,377.89
|
|
|
Service Code
|
CPT 19342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$750.82 |
| Max. Negotiated Rate |
$26,377.89 |
| Rate for Payer: Aetna Medicare |
$8,714.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,473.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,473.91
|
| Rate for Payer: BCBS Complete |
$4,812.97
|
| Rate for Payer: BCBS MAPPO |
$8,379.13
|
| Rate for Payer: BCBS Trust/PPO |
$6,766.78
|
| Rate for Payer: BCN Medicare Advantage |
$8,379.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,379.13
|
| Rate for Payer: Mclaren Medicaid |
$4,583.38
|
| Rate for Payer: Mclaren Medicare |
$8,379.13
|
| Rate for Payer: Meridian Medicaid |
$4,812.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,798.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,636.00
|
| Rate for Payer: PACE Medicare |
$7,960.17
|
| Rate for Payer: PACE SWMI |
$8,379.13
|
| Rate for Payer: PHP Medicare Advantage |
$8,379.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,583.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,377.89
|
| Rate for Payer: Priority Health Medicare |
$8,379.13
|
| Rate for Payer: Priority Health Narrow Network |
$21,102.31
|
| Rate for Payer: Railroad Medicare Medicare |
$8,379.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$825.90
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,379.13
|
| Rate for Payer: UHC Exchange |
$750.82
|
| Rate for Payer: UHC Medicare Advantage |
$8,630.50
|
| Rate for Payer: VA VA |
$8,379.13
|
|
|
INSERTION OR REPLACEMENT OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR INDUCTIVE COUPLING; WITH CONNECTION TO 2 OR MORE ELECTRODE ARRAYS
|
Facility
|
OP
|
$86,891.22
|
|
|
Service Code
|
CPT 61886
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$885.08 |
| Max. Negotiated Rate |
$86,891.22 |
| Rate for Payer: Aetna Medicare |
$28,705.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,502.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,502.05
|
| Rate for Payer: BCBS Complete |
$15,854.38
|
| Rate for Payer: BCBS MAPPO |
$27,601.64
|
| Rate for Payer: BCBS Trust/PPO |
$28,922.51
|
| Rate for Payer: BCN Medicare Advantage |
$27,601.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,601.64
|
| Rate for Payer: Mclaren Medicaid |
$15,098.10
|
| Rate for Payer: Mclaren Medicare |
$27,601.64
|
| Rate for Payer: Meridian Medicaid |
$15,854.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28,981.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,741.89
|
| Rate for Payer: PACE Medicare |
$26,221.56
|
| Rate for Payer: PACE SWMI |
$27,601.64
|
| Rate for Payer: PHP Medicare Advantage |
$27,601.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,098.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86,891.22
|
| Rate for Payer: Priority Health Medicare |
$27,601.64
|
| Rate for Payer: Priority Health Narrow Network |
$69,512.98
|
| Rate for Payer: Railroad Medicare Medicare |
$27,601.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$973.59
|
| Rate for Payer: UHC Core |
$52,490.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$27,601.64
|
| Rate for Payer: UHC Exchange |
$885.08
|
| Rate for Payer: UHC Medicare Advantage |
$28,429.69
|
| Rate for Payer: VA VA |
$27,601.64
|
|
|
INSERTION OR REPLACEMENT OF PERIPHERAL, SACRAL, OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, REQUIRING POCKET CREATION AND CONNECTION BETWEEN ELECTRODE ARRAY AND PULSE GENERATOR OR RECEIVER
|
Facility
|
OP
|
$61,212.80
|
|
|
Service Code
|
CPT 64590
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$289.13 |
| Max. Negotiated Rate |
$61,212.80 |
| Rate for Payer: Aetna Medicare |
$20,222.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,305.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,305.88
|
| Rate for Payer: BCBS Complete |
$11,169.04
|
| Rate for Payer: BCBS MAPPO |
$19,444.70
|
| Rate for Payer: BCBS Trust/PPO |
$24,357.70
|
| Rate for Payer: BCN Medicare Advantage |
$19,444.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,444.70
|
| Rate for Payer: Mclaren Medicaid |
$10,636.25
|
| Rate for Payer: Mclaren Medicare |
$19,444.70
|
| Rate for Payer: Meridian Medicaid |
$11,169.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,416.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,361.40
|
| Rate for Payer: PACE Medicare |
$18,472.46
|
| Rate for Payer: PACE SWMI |
$19,444.70
|
| Rate for Payer: PHP Medicare Advantage |
$19,444.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,636.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61,212.80
|
| Rate for Payer: Priority Health Medicare |
$19,444.70
|
| Rate for Payer: Priority Health Narrow Network |
$48,970.24
|
| Rate for Payer: Railroad Medicare Medicare |
$19,444.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.04
|
| Rate for Payer: UHC Core |
$30,600.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,444.70
|
| Rate for Payer: UHC Exchange |
$289.13
|
| Rate for Payer: UHC Medicare Advantage |
$20,028.04
|
| Rate for Payer: VA VA |
$19,444.70
|
|
|
INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, REQUIRING POCKET CREATION AND CONNECTION BETWEEN ELECTRODE ARRAY AND PULSE GENERATOR OR RECEIVER
|
Facility
|
OP
|
$86,891.22
|
|
|
Service Code
|
CPT 63685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$336.61 |
| Max. Negotiated Rate |
$86,891.22 |
| Rate for Payer: Aetna Medicare |
$28,705.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,502.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,502.05
|
| Rate for Payer: BCBS Complete |
$15,854.38
|
| Rate for Payer: BCBS MAPPO |
$27,601.64
|
| Rate for Payer: BCBS Trust/PPO |
$31,984.94
|
| Rate for Payer: BCN Medicare Advantage |
$27,601.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,601.64
|
| Rate for Payer: Mclaren Medicaid |
$15,098.10
|
| Rate for Payer: Mclaren Medicare |
$27,601.64
|
| Rate for Payer: Meridian Medicaid |
$15,854.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28,981.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,741.89
|
| Rate for Payer: PACE Medicare |
$26,221.56
|
| Rate for Payer: PACE SWMI |
$27,601.64
|
| Rate for Payer: PHP Medicare Advantage |
$27,601.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,098.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86,891.22
|
| Rate for Payer: Priority Health Medicare |
$27,601.64
|
| Rate for Payer: Priority Health Narrow Network |
$69,512.98
|
| Rate for Payer: Railroad Medicare Medicare |
$27,601.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.27
|
| Rate for Payer: UHC Core |
$30,600.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$27,601.64
|
| Rate for Payer: UHC Exchange |
$336.61
|
| Rate for Payer: UHC Medicare Advantage |
$28,429.69
|
| Rate for Payer: VA VA |
$27,601.64
|
|
|
INSULIN 1 UNIT/ ML INFUSION 100 ML (IV PREMIX)
|
Facility
|
IP
|
$77.40
|
|
|
Service Code
|
NDC 9900-0018-34
|
| Hospital Charge Code |
300906
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$69.66 |
| Rate for Payer: Aetna American Axle |
$50.31
|
| Rate for Payer: Aetna Commercial |
$65.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.31
|
| Rate for Payer: Cash Price |
$61.92
|
| Rate for Payer: Cofinity Commercial |
$54.18
|
| Rate for Payer: Cofinity Commercial |
$66.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.92
|
| Rate for Payer: Healthscope Commercial |
$69.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.79
|
| Rate for Payer: PHP Commercial |
$65.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.18
|
| Rate for Payer: Priority Health SBD |
$48.76
|
| Rate for Payer: UMR Bronson Commercial |
$34.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.05
|
|
|
INSULIN 5 UNIT/5 ML IV PUSH 5 ML
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
NDC 9900-0011-38
|
| Hospital Charge Code |
300205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna American Axle |
$13.00
|
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health SBD |
$12.60
|
| Rate for Payer: UMR Bronson Commercial |
$8.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
INSULIN ASPART 100 UNIT/ML CUSTOM SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$248.94
|
|
|
Service Code
|
NDC 0169-7501-11
|
| Hospital Charge Code |
180447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.53 |
| Max. Negotiated Rate |
$224.05 |
| Rate for Payer: Aetna American Axle |
$161.81
|
| Rate for Payer: Aetna Commercial |
$211.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.81
|
| Rate for Payer: Cash Price |
$199.15
|
| Rate for Payer: Cofinity Commercial |
$174.26
|
| Rate for Payer: Cofinity Commercial |
$214.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.15
|
| Rate for Payer: Healthscope Commercial |
$224.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.60
|
| Rate for Payer: PHP Commercial |
$211.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.26
|
| Rate for Payer: Priority Health SBD |
$156.83
|
| Rate for Payer: UMR Bronson Commercial |
$109.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.70
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 0169-6339-10
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna American Axle |
$75.17
|
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Commercial |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.29
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.95
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UMR Bronson Commercial |
$50.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.73
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 0169-6339-10
|
| Hospital Charge Code |
301084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna American Axle |
$75.17
|
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Commercial |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.29
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.95
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UMR Bronson Commercial |
$50.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.73
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 0169-6339-10
|
| Hospital Charge Code |
300796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna American Axle |
$75.17
|
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Commercial |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.29
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.95
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UMR Bronson Commercial |
$50.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.73
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) LOW DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 0169-6339-10
|
| Hospital Charge Code |
301082
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna American Axle |
$75.17
|
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Commercial |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.29
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.95
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UMR Bronson Commercial |
$50.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.73
|
|
