|
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S], [EG, SPINAL OR LATERAL RECESS STENOSIS]), SINGLE VERTEBRAL SEGMENT; LUMBAR
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 63047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,100.53 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$8,446.38
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,210.58
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$1,100.53
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S], [EG, SPINAL OR LATERAL RECESS STENOSIS]), SINGLE VERTEBRAL SEGMENT; THORACIC
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 63046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,224.63 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$8,283.36
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,347.09
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$1,224.63
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
LAMINECTOMY, FACETECTOMY, OR FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S] [EG, SPINAL OR LATERAL RECESS STENOSIS]), DURING POSTERIOR INTERBODY ARTHRODESIS, LUMBAR; EACH ADDITIONAL VERTEBRAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 63053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$224.63 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$620.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.09
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$224.63
|
|
|
LAMINECTOMY, FACETECTOMY, OR FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S] [EG, SPINAL OR LATERAL RECESS STENOSIS]), DURING POSTERIOR INTERBODY ARTHRODESIS, LUMBAR; SINGLE VERTEBRAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$830.11
|
|
|
Service Code
|
CPT 63052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$252.79 |
| Max. Negotiated Rate |
$830.11 |
| Rate for Payer: BCBS Trust/PPO |
$830.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.07
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$252.79
|
|
|
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL, EXTRAMEDULLARY, LUMBAR
|
Facility
|
OP
|
$13,752.00
|
|
|
Service Code
|
CPT 63282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,976.44 |
| Max. Negotiated Rate |
$13,752.00 |
| Rate for Payer: BCBS Trust/PPO |
$6,948.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,174.08
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Exchange |
$1,976.44
|
|
|
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM; INTRADURAL, EXTRAMEDULLARY, THORACIC
|
Facility
|
OP
|
$7,389.46
|
|
|
Service Code
|
CPT 63281
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,879.00 |
| Max. Negotiated Rate |
$7,389.46 |
| Rate for Payer: BCBS Trust/PPO |
$7,389.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,306.63
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$2,096.94
|
|
|
LAMINECTOMY FOR EXCISION OR EVACUATION OF INTRASPINAL LESION OTHER THAN NEOPLASM, EXTRADURAL; LUMBAR
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 63267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,366.74 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$5,747.99
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,503.41
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$1,366.74
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE, EPIDURAL
|
Facility
|
OP
|
$61,212.80
|
|
|
Service Code
|
CPT 63655
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$838.25 |
| 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 |
$21,574.47
|
| 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) |
$922.08
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,444.70
|
| Rate for Payer: UHC Exchange |
$838.25
|
| Rate for Payer: UHC Medicare Advantage |
$20,028.04
|
| Rate for Payer: VA VA |
$19,444.70
|
|
|
LAMINECTOMY WITH REMOVAL OF ABNORMAL FACETS AND/OR PARS INTER-ARTICULARIS WITH DECOMPRESSION OF CAUDA EQUINA AND NERVE ROOTS FOR SPONDYLOLISTHESIS, LUMBAR (GILL TYPE PROCEDURE)
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 63012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,188.94 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$8,920.85
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,307.83
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$1,188.94
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; 1 INTERSPACE, CERVICAL
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 63020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,093.66 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$8,250.22
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,203.03
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$1,093.66
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; 1 INTERSPACE, LUMBAR
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 63030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$911.93 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$7,087.90
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,003.12
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$911.93
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; EACH ADDITIONAL INTERSPACE, CERVICAL OR LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$11,265.36
|
|
|
Service Code
|
CPT 63035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$228.55 |
| Max. Negotiated Rate |
$11,265.36 |
| Rate for Payer: BCBS Trust/PPO |
$11,265.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.40
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$228.55
|
|
|
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC, REEXPLORATION, SINGLE INTERSPACE; EACH ADDITIONAL LUMBAR INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$5,042.00
|
|
|
Service Code
|
CPT 63044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$128.17 |
| Max. Negotiated Rate |
$5,042.00 |
| Rate for Payer: BCBS Trust/PPO |
$128.17
|
| Rate for Payer: UHC Core |
$5,042.00
|
|
|
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC, REEXPLORATION, SINGLE INTERSPACE; LUMBAR
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 63042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,286.52 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$7,952.04
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,415.17
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$1,286.52
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
LAMIVUDINE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,026.00
|
|
|
Service Code
|
NDC 49702-205-48
|
| Hospital Charge Code |
15881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$451.44 |
| Max. Negotiated Rate |
$923.40 |
| Rate for Payer: Aetna American Axle |
$666.90
|
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$666.90
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cofinity Commercial |
$718.20
|
| Rate for Payer: Cofinity Commercial |
$882.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$820.80
|
| Rate for Payer: Healthscope Commercial |
$923.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$718.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$769.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$872.10
|
| Rate for Payer: PHP Commercial |
$872.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$718.20
|
| Rate for Payer: Priority Health SBD |
$646.38
|
| Rate for Payer: UMR Bronson Commercial |
$451.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$769.50
|
|
|
LAMIVUDINE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$706.80
|
|
|
Service Code
|
NDC 57237-274-24
|
| Hospital Charge Code |
15881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$310.99 |
| Max. Negotiated Rate |
$636.12 |
| Rate for Payer: Aetna American Axle |
$459.42
|
| Rate for Payer: Aetna Commercial |
$600.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$459.42
|
| Rate for Payer: Cash Price |
$565.44
|
| Rate for Payer: Cofinity Commercial |
$494.76
|
| Rate for Payer: Cofinity Commercial |
$607.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$565.44
|
| Rate for Payer: Healthscope Commercial |
$636.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$494.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$530.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$600.78
|
| Rate for Payer: PHP Commercial |
$600.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.76
|
| Rate for Payer: Priority Health SBD |
$445.28
|
| Rate for Payer: UMR Bronson Commercial |
$310.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$530.10
|
|
|
LAMIVUDINE 150 MG TABLET
|
Facility
|
IP
|
$774.34
|
|
|
Service Code
|
NDC 60505-3251-6
|
| Hospital Charge Code |
15880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$340.71 |
| Max. Negotiated Rate |
$696.91 |
| Rate for Payer: Aetna American Axle |
$503.32
|
| Rate for Payer: Aetna Commercial |
$658.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.32
|
| Rate for Payer: Cash Price |
$619.47
|
| Rate for Payer: Cofinity Commercial |
$542.04
|
| Rate for Payer: Cofinity Commercial |
$665.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$619.47
|
| Rate for Payer: Healthscope Commercial |
$696.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$580.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$658.19
|
| Rate for Payer: PHP Commercial |
$658.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.04
|
| Rate for Payer: Priority Health SBD |
$487.83
|
| Rate for Payer: UMR Bronson Commercial |
$340.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$580.76
|
|
|
LAMIVUDINE 150 MG TABLET
|
Facility
|
IP
|
$497.17
|
|
|
Service Code
|
NDC 0904-6583-04
|
| Hospital Charge Code |
15880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$218.75 |
| Max. Negotiated Rate |
$447.45 |
| Rate for Payer: Aetna American Axle |
$323.16
|
| Rate for Payer: Aetna Commercial |
$422.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.16
|
| Rate for Payer: Cash Price |
$397.74
|
| Rate for Payer: Cofinity Commercial |
$348.02
|
| Rate for Payer: Cofinity Commercial |
$427.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.74
|
| Rate for Payer: Healthscope Commercial |
$447.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$372.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$422.59
|
| Rate for Payer: PHP Commercial |
$422.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.02
|
| Rate for Payer: Priority Health SBD |
$313.22
|
| Rate for Payer: UMR Bronson Commercial |
$218.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$372.88
|
|
|
LAMIVUDINE 150 MG TABLET
|
Facility
|
IP
|
$1,182.82
|
|
|
Service Code
|
NDC 68180-602-07
|
| Hospital Charge Code |
15880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$520.44 |
| Max. Negotiated Rate |
$1,064.54 |
| Rate for Payer: Aetna American Axle |
$768.83
|
| Rate for Payer: Aetna Commercial |
$1,005.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$768.83
|
| Rate for Payer: Cash Price |
$946.26
|
| Rate for Payer: Cofinity Commercial |
$1,017.23
|
| Rate for Payer: Cofinity Commercial |
$827.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$946.26
|
| Rate for Payer: Healthscope Commercial |
$1,064.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$827.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$887.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,005.40
|
| Rate for Payer: PHP Commercial |
$1,005.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$827.97
|
| Rate for Payer: Priority Health SBD |
$745.18
|
| Rate for Payer: UMR Bronson Commercial |
$520.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$887.12
|
|
|
LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET
|
Facility
|
IP
|
$240.48
|
|
|
Service Code
|
NDC 31722-506-60
|
| Hospital Charge Code |
21810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.81 |
| Max. Negotiated Rate |
$216.43 |
| Rate for Payer: Aetna American Axle |
$156.31
|
| Rate for Payer: Aetna Commercial |
$204.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.31
|
| Rate for Payer: Cash Price |
$192.38
|
| Rate for Payer: Cofinity Commercial |
$168.34
|
| Rate for Payer: Cofinity Commercial |
$206.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.38
|
| Rate for Payer: Healthscope Commercial |
$216.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.41
|
| Rate for Payer: PHP Commercial |
$204.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.34
|
| Rate for Payer: Priority Health SBD |
$151.50
|
| Rate for Payer: UMR Bronson Commercial |
$105.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.36
|
|
|
LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET
|
Facility
|
IP
|
$3,251.86
|
|
|
Service Code
|
NDC 49702-202-18
|
| Hospital Charge Code |
21810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,430.82 |
| Max. Negotiated Rate |
$2,926.67 |
| Rate for Payer: Aetna American Axle |
$2,113.71
|
| Rate for Payer: Aetna Commercial |
$2,764.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,113.71
|
| Rate for Payer: Cash Price |
$2,601.49
|
| Rate for Payer: Cofinity Commercial |
$2,276.30
|
| Rate for Payer: Cofinity Commercial |
$2,796.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,601.49
|
| Rate for Payer: Healthscope Commercial |
$2,926.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,276.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,438.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,764.08
|
| Rate for Payer: PHP Commercial |
$2,764.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,276.30
|
| Rate for Payer: Priority Health SBD |
$2,048.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,430.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,438.90
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$152.75
|
|
|
Service Code
|
NDC 51672-4131-1
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.21 |
| Max. Negotiated Rate |
$137.48 |
| Rate for Payer: Aetna American Axle |
$99.29
|
| Rate for Payer: Aetna Commercial |
$129.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.29
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Commercial |
$106.92
|
| Rate for Payer: Cofinity Commercial |
$131.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$137.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.84
|
| Rate for Payer: PHP Commercial |
$129.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.92
|
| Rate for Payer: Priority Health SBD |
$96.23
|
| Rate for Payer: UMR Bronson Commercial |
$67.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.56
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$387.75
|
|
|
Service Code
|
NDC 68084-319-01
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.61 |
| Max. Negotiated Rate |
$348.98 |
| Rate for Payer: Aetna American Axle |
$252.04
|
| Rate for Payer: Aetna Commercial |
$329.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.04
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$271.42
|
| Rate for Payer: Cofinity Commercial |
$333.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$348.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$329.59
|
| Rate for Payer: PHP Commercial |
$329.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.42
|
| Rate for Payer: Priority Health SBD |
$244.28
|
| Rate for Payer: UMR Bronson Commercial |
$170.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.81
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$207.10
|
|
|
Service Code
|
NDC 68382-008-01
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.12 |
| Max. Negotiated Rate |
$186.39 |
| Rate for Payer: Aetna American Axle |
$134.62
|
| Rate for Payer: Aetna Commercial |
$176.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.62
|
| Rate for Payer: Cash Price |
$165.68
|
| Rate for Payer: Cofinity Commercial |
$144.97
|
| Rate for Payer: Cofinity Commercial |
$178.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.68
|
| Rate for Payer: Healthscope Commercial |
$186.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.04
|
| Rate for Payer: PHP Commercial |
$176.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.97
|
| Rate for Payer: Priority Health SBD |
$130.47
|
| Rate for Payer: UMR Bronson Commercial |
$91.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.32
|
|
|
LAMOTRIGINE 100 MG TABLET
|
Facility
|
IP
|
$387.75
|
|
|
Service Code
|
NDC 68084-319-11
|
| Hospital Charge Code |
13982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.61 |
| Max. Negotiated Rate |
$348.98 |
| Rate for Payer: Aetna American Axle |
$252.04
|
| Rate for Payer: Aetna Commercial |
$329.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.04
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$271.42
|
| Rate for Payer: Cofinity Commercial |
$333.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$348.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$329.59
|
| Rate for Payer: PHP Commercial |
$329.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.42
|
| Rate for Payer: Priority Health SBD |
$244.28
|
| Rate for Payer: UMR Bronson Commercial |
$170.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.81
|
|
